Surgeons correct wry nose in two foals using a new approach

At left, the foal before surgical correction, and right, after.
At left, the foal before surgical correction, and right, after. Images: Sapper, Sánchez-Andrade, et al.

The successful correction of wry nose in two foals using a new surgical technique has been described in a case report in the journal Equine Veterinary Education.

Wry nose in foals leads to breathing difficulties and weaning problems, as well as reduced performance.

Cassandra Sapper and her colleagues at the University of Zurich described a new gingival approach to correct the problem.

One of the foals was a Swiss warmblood filly and the other a Friesian colt.

They described cutting the incisive and maxillary bones. A 3.5mm locking compression plate with screws was inserted in the incisive and maxillary bones and in several teeth to stabilise the gap.

The front part of the nasal septum was resected in both cases, and bone cutting and plate fixation were employed to correct the nasal bone deviation.

A 2.4-mm UniLOCK plate was used in one foal and a 2.7-mm locking compression plate in the other.

CT scans of foal one before surgical correction.
Left: Presurgical dorsoventral volume-rendered CT view of the above foal showing deviation of the upper jaw to the left and brachygnathia superior. Centre: Dorsoventral radiographic view before correction. Right: Presurgical CT scan of the nasal septum showing the deviation and obstruction of the nasal passages before the deviated rostral part of the septum. Images: Sapper, Sánchez-Andrade, et al.

The study team reported that respiratory difficulties and facial malformation were markedly reduced in both foals.

While an underbite and deviation could not be completely eliminated, the overall outcome was good. There was a significant reduction in the deviation and associated clinical signs in both foals.

The surgical technique resulted in good bone healing and satisfactory cosmetic results in both foals.

Dorsoventral radiographic view of Foal 1 after surgical correction showing the implants in the nasal and incisive bones.
Dorsoventral radiographic view of Foal 1 after surgical correction showing the implants in the nasal and incisive bones. Image: Sapper, Sánchez-Andrade, et al.

At the time of writing, the filly was 4.5 years old and was being used for therapeutic riding.

Almost two years after surgery, the colt had not yet been in training but had a mild constant respiratory noise and a persistent underbite, although this did not affect food intake.

The colt was subjected to euthanasia because of subchondral cystic lesions in a stifle joint that had been ongoing since early in life. The owners had been satisfied with the cosmetic result of the facial surgery, the authors reported.

The case report team said their technique was largely equivalent to a previously described gingival method, but their new approach does not involve cutting the skin and muscles on the side of the head, which means less soft-tissue trauma. Muscles, blood vessels and nerves were preserved, and nerve damage and bleeding were minimised.

It has been suggested that corrective surgery in foals with wry nose should be done at two to three months of age to allow sufficient growth of the jaw to accommodate the implants.

However, the foals in the case report were 3 and 7.5 weeks old at the time of surgery, which was thought to be an advantage because of faster healing of the bone cut sites.

Indeed, implant fixation in the bones was not a problem, and x-ray follow-up confirmed rapid healing of the bone cuts.

The results suggest that corrective surgery of wry nose can be accomplished in younger foals.

The findings, they said, suggest their method is a viable option to correct wry nose in foals.

“The surgical technique had a satisfactory cosmetic outcome but did not lead to complete resolution of the respiratory problems.”

They continued: “We feel that the described complications can be minimised through modification of the surgical technique.”

Gingival approach to correct wry nose using locking compression plates in two foals
C.B. Sapper, J. Suárez Sánchez-Andrade, F. Theiss, A. Fürst.
Equine Veterinary Education, 20 September 2021,

The study, published under a Creative Commons License, can be read here

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