Discussion

Pascoe, R.J.
Aims: To describe a minimally invasive transbuccal approach to
extraction of 5 maxillary cheek teeth in 4 horses where clinical
crown fracture prevented standing oral extraction. Methods: Five
maxillary teeth with pre-existing coronal fracture or oral extraction
failure were selected. A 5 mm skin incision was made in the cheek
3-5 cm beneath the tooth avoiding vital structures. A trocar
advanced through the buccal tissues provided direct instrument
access. Elevators were used to loosen the tooth. A 4 mm hole was
drilled into the tooth under radiographic guidance. A thread was
cut and a weighted pin screwed into the drill-hole. The tooth was
manipulated and then tapped ventrally into the mouth. The
alveolus was curetted and plugged using dental impression wax.
The skin incision was closed using simple interrupted sutures.
Results: All horses recovered uneventfully from surgery. Three
teeth (60%) were removed under standing sedation. Due to
temperament, one horse (20%) received general anaesthesia.
One horse (20%) exhibited abnormal tooth anatomy preventing
pin retention so repulsion was undertaken. All cases returned to
work within 3-6 weeks. Follow-up at 5-7 months found all horses
working at original levels. No visible scars from the trocar site were
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reported. The repulsion case had slight scarring associated with
trephination. Conclusions: In this short case series, the technique
success rate was 80% with 60% being undertaken without
general anaesthesia. No complications arose from application of
the technique. Improved preoperative imaging using computed
tomography would have shown MTE was inappropriate in the
case needing repulsion. Practical significance: This technique
shows favourable complication rates comparable to oral
extraction. Avoidance of surgical techniques with higher
complication rates and general anaesthetic risks is desirable.
Acknowledgements: Referring veterinary surgeons and staff at
Bell Equine for their assistance.