Veterinary Surgery

37:142148, 2008

Surgical Correction of Wry Nose in Four Horses

JIM SCHUMACHER, DVM, MS, Diplomate ACVS, MRCVS, PALLE BRINK, DVM, Diplomate ECVS, JACK EASLEY, DVM, MS, Diplomate
ABVP, and PATRICK POLLOCK, BVMS, CertES (Soft Tissue), Diplomate ECVS

ObjectiveTo describe surgical techniques used for correction of congenital nasal deviation (wry
nose) in horses (wry nose) and to report outcome.
Study DesignRetrospective study.
AnimalsHorses (n 4), 517 months old with wry nose.
MethodsNasal deviation was corrected by transecting the premaxillae/maxillae and nasal bones
at their site of maximum curvature and realigning and stabilizing the bones in a more normal
alignment using internal xation. The nasal septum was removed during the same anesthetic period.
ResultsFor each horse, physical appearance was improved and respiratory stridor eliminated.
ConclusionsWry nose can be corrected by transecting the premaxillae/maxillae and nasal bones
and stabilizing the transected bones in a more normal alignment; the nasal septum can be removed
concurrently.
Clinical RelevanceSurgical correction of wry nose may provide a good functional and cosmetic
outcome.
r Copyright 2008 by The American College of Veterinary Surgeons

mandibular incisors, and the tongue may protrude. An

affected foal may have difculty nursing,4 and its nasal
septum may be so severely deviated that the foal has
respiratory stridor even when resting. Nasal obstruction
caused by deviation of the nasal septum is usually most
severe on the convex side of the deformity.
Mildly affected foals need no treatment for survival,
but severely affected foals may require immediate, intensive management. Slight nasal deviation may straighten
with growth,5 but horses with moderate or severe deviation require surgical treatment to resolve respiratory
obstruction and to improve incisor occlusion and cosmetic appearance.
One report of surgical correction of wry nose described a 2-stage procedure, with the stages being
performed 3 months apart.3 During the 1st stage, the
maxillae/premaxillae were transected at their point of

INTRODUCTION

RY NOSE (campylorrhinus lateralis) is a congenital shortening and deviation of the maxillae, premaxillae, nasal bones, vomer, and nasal septum.14
Although wry nose reportedly occurs in many equine
breeds, incidence is seemingly highest in Arabian horses,
causing speculation that the malformation may be genetic1; however, to our knowledge, inheritance of this
abnormality has not been reported. Inability of the uterus, particularly that of a primiparous mare, to distend to
accommodate the fetus as it grows has been speculated as
one cause of this abnormality.5
Nasal deviation may be mild to severe (up to 901) and
may be accompanied by abnormal arching of the nasal
bones and hard palate, and by cleft palate. All or some of
the premaxillary incisors may fail to occlude with the

From the Department of Large Animal Clinical Sciences, University of Tennessee, Knoxville, TN; the Helsingborg Equine Hospital,
Helsingborg, Sweden; Equine Veterinary Practice, Shelbyville, KY; and the Department of Large Animal Sciences, Royal Veterinary and
Agricultural University, Copenhagen, Denmark.
Work was performed at the Helsingborg Equine Hospital, Helsingborg, Sweden; the Department of Large Animal Sciences, Royal
Veterinary and Agricultural University, Copenhagen, Denmark; and the Department of Large Animal Clinical Sciences, University of
Tennessee, TN, USA.
Address reprint requests to Jim Schumacher, DVM, MS, Diplomate ACVS, MRCVS, Department of Large Animal Clinical Sciences,
University of Tennessee, Knoxville, TN 37996. E-mail: jschumac@utk.edu.
Submitted May 2007; Accepted September 2007
r Copyright 2008 by The American College of Veterinary Surgeons
0161-3499/08
doi:10.1111/j.1532-950X.2007.00362.x

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maximum curvature, realigned, and stabilized using pins

and an autogenous rib graft. During the 2nd stage, the
nasal bones were transected and stabilized in correct
alignment with wire suture, and the deformed portion of
the nasal septum was excised.
We describe similar surgical techniques, performed
during a single anesthetic period, used to correct congenital deviation of the nose of 4 horses (517 months
old) and report outcome.
MATERIALS AND METHODS
Presurgical Treatment
Within an hour before surgery, horses were administered
antibiotics and either unixin meglumine (1.1 mg/kg intravenously [IV]) or phenylbutazone (2.2 mg/kg IV). For each
horse, several liters of blood were collected from a suitable
donor horse for potential blood transfusion during surgery.
While standing and sedated, each horse had a temporary
tracheostomy at the junction of the proximal and middle
thirds of the neck.

Anesthesia
A cuffed endotracheal tube was inserted into the tracheostomy, either immediately before or after the horse was anesthetized. Horses were sedated with xylazine (1.1 mg/kg IV)
and anesthetized with a mixture of ketamine (2.2 mg/kg IV)
and diazepam (0.06 mg/kg IV), and anesthesia maintained
with isourane in oxygen. Two horses were administered an
infusion of ketamine (3 mg/kg/h) and 2% lidocaine (4 mg/kg/
h). Two horses had a bilateral infraorbital nerve block with
2% mepivacaine before or after anesthetic induction. During
surgery, each horse was administered lactated Ringers solution IV, and 2 horses were also administered a plasma expander IV.

143

and the skin edges stapled. A protective Stent bandage, composed of gauze swabs, was sutured over the site.
To straighten the premaxillae/maxillae, the horse was positioned in dorsal recumbency, and its mouth was maintained
in an opened position using either a Guenther oral speculum
(Alberts, Old Chatham, NY) inserted between the incisors or a
Bayer mouth wedge (Jorgenson Laboratories, Loveland, CO)
inserted between the cheek teeth of 1 side. The gingiva dorsal
to the incisors was exposed by xing the upper lip to the
bridge of the nose with towel clamps, and the rostral portion
of the oral cavity was cleansed using povidone-iodine soap
and rinsed with water. A 3-cm-long, longitudinal mucosal incision centered at the point of greatest curvature was created
in each interalveolar space over the ventral aspect of each
premaxilla/maxilla (Fig 1). The incision extended through the
periosteum, which was elevated from the medial and lateral
surfaces of the bone, using a periosteal elevator.
The premaxillae/maxillae and palatine processes of the
premaxillae were transected though the incisions using an oscillating saw (Fig 2). After removing the Guenther speculum
or the Bayer wedge, the rostral portion of the upper jaw was
rotated toward the sagittal plane of the head until the premaxillary and mandibular incisors were correctly aligned. A
piece of bone, 13 cm long, that corresponded in length to the
gap created on the concave side of the jaw when the maxillae/
premaxillae were straightened was cut from the harvested section of rib using an oscillating saw. This bone segment was
inserted tightly into the gap using a mallet and a dental punch.
The transected segment of the upper jaw was stabilized
with 2, trocar-point Steinmann pins (6 mm diameter), using a
high-speed, pneumatic drill (Maxidriver, 3M Corporation;
Figs 3 and 4). Each pin was inserted between a central and
intermediate incisor and driven through the medullary cavity
of the transected segment of the premaxilla into the medullary

Surgical Procedure
Before straightening the maxillae/premaxillae, a section of
rib to be grafted at the site of maxillary/premaxillary osteotomy was harvested with the horse positioned in left or right
lateral recumbency, or in dorsal recumbency. After preparing
the thorax for aseptic surgery, a 10-cm-long incision was created over the right 7th (1 horse) or left 11th (3 horses) rib,
beginning at the costochondral junction and extending dorsally, through the skin, subcutaneous tissues, and periosteum,
along the longitudinal axis of the rib. After reecting the periosteum, a 24-cm-long section of rib was transected using
obstetrical wire (3 horses) or an oscillating saw (Maxidriver,
3M Corporation, Minneapolis, MN; 1 horse). The rib segment
was stored in gauze sponges soaked in physiological saline
(0.9% NaCl) solution until needed. Bupivacaine was injected
around the surgical site in 1 horse, after rib resection to desensitize the local intercostal nerve. The incision was closed in
layers with either 2-0 polyglactin 910 or 2-0 polydioxanone

Fig 1. The ventral aspect of each premaxilla/maxilla was

exposed through a 3-cm-long, longitudinal mucosal incision
centered at the point of greatest curvature at the interalveolar
space.

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SURGICAL CORRECTION OF WRY NOSE IN HORSES

Fig 2. Anatomic anomaly of the maxillae/premaxillae and

nasal bones and osteotomy sites. (A) Rostral to caudal view.
(B) Lateral view.

cavity of the ipsilateral maxillary bone. The pin inserted on the

concave side of the jaw also penetrated the medullary cavity of
the rib graft. Pins were cut ush with the gingiva using a hack
saw or a bolt cutter, and the pins were driven below the gingiva using a mallet and a punch. The sites of gingival penetration of the pins were left unsutured to heal by second
intention. The gingival incisions at the interalveolar space
were closed with absorbable suture (0 polyglactin 910 or 2-0
polydioxanone) in a cruciate pattern.
The horse was repositioned in lateral recumbency, with the
concave side of the deviation uppermost, and the dorsal aspect
of its head was tilted 451 with a sand bag. After preparing the
bridge of the nose for aseptic surgery, a 610-cm-long, longitudinal, curved, cutaneous incision, centered over the site of
maximum deviation of the nasal bones, was made between the
2 deviated nasal bones. The nasal bones were exposed using a
self-retaining retractor, and the periosteum over each nasal
bone was incised longitudinally and reected. The nasal bones
were transected perpendicular to their long axis at the point of
maximum curvature by using an oscillating saw being careful
not to penetrate the underlying parietal cartilage. The gap
created on the concave side of the deviation when the bones
were rotated into proper alignment was eliminated in horse 1
by inserting a wedge-shaped segment of one of the cortices of
the harvested section of rib into the gap. The gap in the nasal
bones of the other 3 horses was eliminated by performing a
wedge osteotomy at the convex side of the nasal bones at the
site of transection by using an oscillating saw (Fig 3).
For horse 1, the transected segments of the nasal bones and
the wedge of rib inserted into the gap on the concave side of
the nasal bones were xed to the parent nasal bones with 1mm-diameter Kirschner wires by using a high-speed drill. The
Kirschner wires were inserted, caudal to rostral, between the
internal and external laminae of the thin, transected end of
each nasal bone so that each emerged through the dorsal surface of the bone and skin at the level of the external nares. The
wires were then inserted retrograde, through the rib graft on
one side, between the internal and external laminae of the
parent nasal bones (Fig 4). The nasal bone on the side that
received the bone graft was stabilized with 2 wires, one 4.5 cm

Fig 3. Rostral view. Dashed lines show placement of Steinmann pins. Stippled pattern shows gap in nasal bones and premaxillae/maxillae created by transection and repositioning of
the bones. The gap created when the transected nasal bones
were aligned along the longitudinal axis of the head was eliminated by performing a wedge osteotomy at the convex side of
the nasal bones at the site of transection.

long and the other 6 cm long, and the other nasal bone was
stabilized with one 14-cm-long wire. The exposed ends of the
wires were cut ush with skin.
For horse 2, the left nasal bone was xed to its parent bone
with one 1-mm-diameter Kirschner wire, and the right nasal
bone was xed to its parent bone using a 6-hole, 2.7 mm dynamic compression plate. For horses 3 and 4, the transected
end of each nasal bone was xed to its parent bone using a 6hole, 9-hole, or 11-hole 2.7 mm reconstruction plate (Fig 5).
The plates were xed with 8 mm long, 2.7 mm cortical screws.
The subcutaneous tissue was sutured with absorbable suture (2-0 polyglactin 910 or 2-0 polydioxanone) in a simple
continuous pattern, and the skin edges stapled. A protective
Stent bandage, composed of gauze swabs, was sutured over
the surgical site.
The nasal septum was removed with the horse in lateral
recumbency with the dorsal aspect of its head elevated 451
with a sand bag. The mouth was held open with a Bayer
mouth wedge or a Guenther oral speculum. The caudal aspect

SCHUMACHER ET AL

145

The septum was removed using a technique similar to that

described by Tulleners and Raker6 (horses 2, 3) or a modication of that technique described by Doyle and Freeman7
(horses 1, 4). Two to 3 cm of the rostral aspect of the septum
was retained to provide support for the soft tissues at the
rostral aspect of the nose. After packing the nasal chamber
tightly with rolled gauze, the nostrils were sutured closed to
retain the packing. The subcutaneous tissue of the incision was
closed in a simple interrupted pattern using 2-0 polygalactin
910 or polydioxanone suture, and the skin edges apposed with
staples. The endotracheal tube was removed, either before or
after the horse recovered from anesthesia, and replaced with a
tracheostomy tube.
Fig 4. (A) Rostral view. Dashed lines denote path of Steinmann pins. Thin lines in the nasal bones denote Kirschner wires.
(B) Lateral view. Kirschner wires in nasal bones (denoted by
thin lines) and Steinmann pins in the premaxillae and maxillae.
Kirschner wires were inserted, caudal to cranial, through the
transected end of each nasal bone of horse 1, so that each pin
emerged through the dorsal surface of the bone and skin at the
level of the external nares. The wires were then inserted retrograde into the parent nasal bones.

of the nasal bones was exposed through a semi-circular

or straight cutaneous incision that extended through the
periosteum. The incision was centered where the nasal bones
began to diverge, just rostral to the conchofrontal sinuses. The
skin and periosteum were reected, and a circular section of
the nasal bones was removed through the center of the incision by using either a 3/8 in. (16 mm) or a 5/8 in. (25 mm) Galt
trephine. Parietal cartilage of the septum exposed by the trephine hole was excised with a scalpel to expose the right and
left nasal cavities.

Fig 5. The transected end of each nasal bone of horses 3 and

4 was xed to its parent nasal bone using a dynamic compression plate or a reconstruction plate.

Clinical Cases
Horse 1. A 321 kg, 9-month-old, Swedish Warmblood
lly admitted for correction of wry nose present since birth.
The lly was the 3rd of 5 foals produced by the dam; no other
sibling had wry nose. The lly had no difculty nursing, had
mild respiratory stridor at rest but developed severe respiratory stridor during exercise. The premaxillae, maxillae, and
nasal bones were deviated to the left at the level of the interalveolar space and the nasal bones were abnormally arched.
The right corner premaxillary incisor was in occlusion with the
left corner mandibular incisor, and the incisor bite was slanted
ventrally from left to right so that the right premaxillary incisors were positioned ventral to the left premaxillary incisors.
Airow from the right nasal cavity was less than from the left
side, which was narrowed by the alar fold and alar cartilage,
both depressed into the airway. On skull radiographs, there
was curvature of the premaxillae and maxillae in the center of
the interalveolar space, causing the rostral aspect of the upper
jaw to deviate
501 to the left. The nasal bones were similarly deviated.
Horse 2. A 410 kg, 17-month-old, Thoroughbred lly admitted for correction of wry nose and associated respiratory
stridor present since birth. The lly was the 4th of 5 foals
produced by its dam; no other sibling had wry nose. On skull
radiography, performed shortly after birth, the premaxillae/
maxillae and nasal bones were deviated
351 to the right.
Despite the severe deviation, the lly had no difculty nursing.
At 3 months of age, a xed acrylic platform with a metal
incline plane was applied to its lower dental arcade, and retention wires were placed between the maxillary cheek teeth
and premaxillary incisors on the convex side of the deviation.
The deviation improved only
101, and the acrylic device
and retention wires were removed after 3 months when improvement appeared to have ceased.
On admission, the premaxillae/maxillae, nasal bones, and
nasal septum were deviated moderately to the right at the level
of the interalveolar space, and the nasal bones were abnormally arched. The left intermediate and corner premaxillary
incisors were in occlusion with the right intermediate and
corner mandibular incisors, and the incisor bite was slanted
ventrally from right to left so that the left premaxillary incisors
were positioned ventral to the right maxillary incisors. Airow
from the left nasal cavity was less than from the right side. On

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SURGICAL CORRECTION OF WRY NOSE IN HORSES

skull radiographs, there was curvature of the premaxillae and

maxillae at the center of the interalveolar space that caused the
rostral aspect of the upper jaw to deviate
251 to the right.
The nasal bones were similarly deviated to the right and
slightly ventrally.
Horse 3. A 5-month-old, 216 kg, Warmblood, cross-bred
colt admitted for correction of wry nose and associated respiratory stridor present since birth. The colt was the 6th foal of
its dam, and no other siblings had wry nose. At birth, excoriation of the convex side of the horses upper jaw was observed, indicating that the deformity might have been caused
by malpositioning in utero. Despite the deformity, no difculty nursing was observed.
On admission, the nose was abnormally arched and deviated severely to the left at the level of the interalveolar space.
The premaxillary incisors were positioned at the left commissure of the lips and were completely out of occlusion with the
mandibular incisors. On skull radiographs, there was curvature of the premaxillae and maxillae in the center of the
interalveolar space, causing the rostral aspect of the upper jaw
to deviate
801 to the left, and the nasal bones were similarly
deviated.
Horse 4. An 8-month-old, 310 kg Friesian colt admitted
for the correction of wry nose and associated respiratory
stridor, present since birth. The dam had delivered other normal foals, but the number was unknown. Despite severe deviation, the foal had no difculty nursing and maintained
good body condition.
On admission, the maxillae/premaxillae, nasal bones, and
nasal septum were deviated severely to the right. Airow from
the right nasal cavity was markedly reduced, and the left nasal
cavity was so reduced at its opening that a nger could not be
inserted into it. The premaxillary incisors were completely out
of occlusion with the mandibular incisors. On skull radiographs, the premaxillae/maxillae were deviated 601 to the
right, at the center of the interalveolar space. The nasal bones
were abnormally arched and deviated slightly more than the
premaxillae/maxillae.

Postoperative Care
The nasal packing was removed the day after surgery, and
the tracheostomy tube was maintained in the trachea for 12
days after the packing was removed. Horses were administered antimicrobial drugs for 514 days. For analgesia, horse 1
was administered butorphanol (0.02 mg/kg intramuscularly
[IM] once daily) and methadone (0.1 mg/kg IM once daily) for
3 days and ketoprofen (2 mg/kg IV twice daily) for 5 days,
then meloxicam (0.6 mg/kg IV once daily) for 14 days. Horse 2
was administered phenylbutazone (4.4 mg/kg IV twice daily
for 2 days and then 2.2 mg/kg IV twice daily for 3 days). Horse
3 was administered phenylbutazone (2.2 mg/kg IV twice daily
for 3 days and then 2.2 mg/kg orally once daily for 5 days).
After recovering from anesthesia, horse 4 was administered
methadone (0.06 mg/kg IV) and butorphanol (0.02 mg/kg IV)
and a continuous rate infusion (CRI) of methadone,
butorphanol, and detomidine. The CRI was formulated by
adding methadone (180 mg), butorphanol (60 mg), and

detomidine (13 mg) to 240 mL 0.9% saline solution, which

was administered at 2 mL/h for 4 days. Horse 4 was also administered unixin meglumine (1.1 mg/kg IV once daily for
5 days).

RESULTS
Total anesthesia time was 3.54.5 hours (mean and
median, 4 hours). Blood transfusions were not required.
Horses were bright and alert after recovering from anesthesia, none had signs of severe pain, all had a normal
appetite, and all ate within 6 hours.
Several days after surgery, airow through the right
external naris of horse 1 was considerably less than
through the left naris, so 9 days after surgery, 2 cm of the
remaining rostral portion of the nasal septum was excised
using a scalpel. The horse was sedated with detomidine
(0.02 mg/kg IV) and butorphanol (0.02 mg/kg IV) but
was not administered of regional or local anesthesia. The
day after surgery, horse 3 had radiographic evidence of
migration of 1 pin used to stabilize the jaw into the nasal
chamber. Horses were discharged from the hospital 313
days (mean, 9 days) after surgery.
Outcome
Horse 1. At 10 weeks after surgery, the owner removed 1 Steinmann pin when its rostral end protruded
through the gingival mucosa into the lip. The other pin
was removed 1 week later with the horse sedated, and the
3 small Kirschner wires used to stabilize the nasal bones
were left in situ. At 14 weeks, the nose appeared to be
deviated slightly to its left (the direction of the original
deviation) and, when viewed from the front, mildly rotated counterclockwise. All premaxillary incisors contacted the mandibular gingiva just caudal to the mandibular
incisors. On skull radiographs, the rib grafts could not be
distinguished from surrounding bone. When exercised,
the horse had abnormal respiratory noise that seemed to
emanate from the nostrils, especially the left nostril (i.e.,
the concave side of the deviation). The abnormal noise
was alleviated when the alar folds were temporarily retracted with sutures and was permanently alleviated by
excising both alar folds, with the horse anesthetized, 712
months after surgery.
At 18 months, the horse received a gold medal (highest
award for 2-year-old horses based on a complex grading
system for conformation and posture) from the Swedish
Association of Warmbloods. Although the horses nose
was still abnormally arched, the judges commented that
the former deviation was only barely noticeable. At 29
months, the horse had no apparent respiratory impairment, was competing successfully in dressage, and was
also in training for jumping. The horse was intended to

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SCHUMACHER ET AL

be used primarily for high-level dressage, and the owner

stated that the horse was performing beyond her expectation.
Horse 2. Pins were removed from the premaxillae at
6 weeks, with the horse sedated. Healing of the osteotomy
sites was not examined radiographically. At 1 year, there
was no respiratory impairment, but abnormal respiratory
noise occurred during low-intensity exercise while the
horse was in training for at racing. The noise seemingly
localized to the region of the external nares ceased during
high-intensity exercise. At 18 months, the soft tissue over
the plate used to stabilize the right nasal bone became
swollen and developed 2 draining tracts. Swelling and
drainage resolved after the plate was removed with the
horse sedated. Occlusion of the incisors was normal, and
although the horses nose was still abnormally arched, the
facial appearance was acceptable to the owner. At 22
months, the horse had trained and raced to the owners
expectation and without apparent respiratory impairment.
Horse 3. One Steinmann pin was lost spontaneously
from the upper jaw at 4 weeks and the remaining pin,
which protruded into the nasal chamber, was removed at
6 weeks with the horse sedated. Protrusion of the pin into
the nasal chamber had not caused any complication. At
6 weeks, the incisors were aligned properly, but the
premaxillary incisors were located caudal to the mandibular incisors, and none were in occlusion. Airow from
the right nostril (i.e., the convex side of the deviation) was
slightly less than from the left nostril, and the right alar
cartilage of the nose was slightly depressed into the external naris. On radiographs, the osteotomy sites were
nearly healed, and the rib graft could not be distinguished
from surrounding bone. Although the horses nose was
excessively convex in prole, the owner considered the
horses cosmetic appearance greatly improved (Fig 6). At
11 months, the horse made no abnormal noise at rest or
during exercise, and its stamina, when it exercised at
pasture, seemed equivalent to other horses of similar age
with which it exercised.
Horse 4. Four weeks after surgery, a loud snoring
noise developed and was accompanied by a foul-smelling
nasal discharge. The discharge and abnormal respiratory
noise resolved after a small, necrotic portion of the dorsocaudal edge of the nasal septum, identied during nasal
endoscopy was removed using a sponge forceps with the
horse sedated. The right pin was noted to be protruding
through the mucosa above the incisor teeth and was removed.
At 5 months, a discharging tract was observed on the
left side of the upper lip. The tract appeared to be associated with the remaining pin, which was loose and
protruded from the premaxillae into the lip. Removal of
the pin, performed with the horse sedated, resolved the

Fig 6. (A) Horse 3 before surgery. (B) Horse 3 soon after

surgery.

draining tract. At 10 months, the owner considered the

horses cosmetic appearance to be good, even though its
nose was abnormally convex in prole. The incisor teeth
were aligned normally and in occlusion, and when used
for pleasure riding, the horse had good stamina and made
no abnormal respiratory noise.

DISCUSSION
We found that the technique we used to correct wry
nose in these 4 horses resulted in a cosmetic appearance
and respiratory capacity that owners considered good. At
last follow-up, 1029 months after surgery, horses 1, 2,
and 4 were being used for the athletic endeavors for
which they were intended (i.e., dressage and jumping
[horse 1] racing [horse 2], and pleasure riding [horse 4]).
Horse 3 had not been introduced to training at 11 months
after surgery but exercised at pasture without obvious
impairment of stamina and without making an abnormal
respiratory noise.
Our techniques were similar to those described by
Valdez et al, but we corrected the deformity during a
single anesthetic period. Whereas they removed only the
deviated, rostral portion of the nasal septum, we removed
all but the dorsocaudal aspect of the nasal septum. Correction during 1 anesthetic period decreased convalescent
time and expense. Because we removed nearly all of the
nasal septum, the caudal cut edge of the remaining rostral
aspect of the septum resided caudal to the nasal conchae,
within the nasopharynx. When only the rostral, deformed
portion of the nasal septum is removed, the airways can

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SURGICAL CORRECTION OF WRY NOSE IN HORSES

become obstructed if the caudal cut edge of the septum

thickens because this edge lies between the conchae.
Excising the nasal septum has been reported to result
in nasal bone collapse and seems most likely to occur in
horses o1 year old.6 Although 3 of our horses were o1
year old, none had nasal collapse. Horse 1 had abnormal
respiratory noise caused by collapse of the alar fold after
wry nose correction. Collapse may have occurred from
loss of support to the soft tissue structures of the nose
when several centimeters of remaining rostral portion of
the septum was resected. We believe that nasal bone collapse was prevented by anchoring each transected nasal
bone segment to its parent bone with either Kirschner
wires, or plates and screws. The Kirschner wires used to
stabilize the transected nasal bones of horse 1 and one
nasal bone in horse 2 were effective but were difcult to
implant because the thickness of the nasal bones was not
much more than the diameter of the pins, making pin
insertion between the internal and external laminae of the
bones, without penetrating the nasal or facial surface of
the bone, difcult. Because of this difculty, one of the
transected nasal bones of horse 2 and both transected
nasal bones of the other 3 horses were stabilized with
plates and screws.
Fixing the premaxillary incisors to the mandibular incisors with wire, in addition to stabilizing the upper jaw
with pins, has been recommended to increase stability at
the sites of premaxillary/maxillary osteotomy.8 Using this
method of stabilization, the horse must be fed through a
stomach tube until the wires are removed after the
osteotomies have partially healed. We found that additional stability provided by wiring the premaxillary incisors to the mandibular incisors is not necessary for
healing and that horses can be returned to their normal
diet as soon as they recover from anesthesia.
Distraction osteogenesis was reported to be effective in
correcting wry nose of a 13-month-old horse.2 Using this
technique, the premaxillae/maxillae were partially transected at their point of maximum curvature and a unilateral, distraction, external skeletal xator on the
concave side of the deformity was used to periodically
distract pins inserted rostral and caudal to the osteotomy.
Deviation of the premaxillae/maxillae, nasal bones, and
nasal septum of this horse was resolved after 55 days,
even though a distraction device was applied only to the
premaxillae/maxillae.2 The horse had no respiratory impairment, even though its nasal septum had not been

removed. A disadvantage of using distraction osteogenesis for correction of wry nose is that the horse must be
hospitalized for a prolonged time so that the external
xator can be frequently adjusted to maintain a distractive force. Danger of injury to the dam may prohibit use
of the device in a nursing foal.
Two of our horses were administered potent analgesic
drugs after surgery because of anticipated postoperative
pain, but may have been unnecessary because horses
2 and 3 that were only administered non-steroidal antiinammatory drugs after surgery were not apparently in
discomfort.
Using the techniques we report, the cosmetic appearance of horses with wry nose can be improved, and a
nasal passage adequate in size to permit affected horses to
be used for athletic purposes can be achieved. Collapse of
the alar folds and ventral aspect of the nasal diverticula
resulting in abnormal respiratory noise or partial obstruction of the nasal passage may occur after surgery.
Resection of the alar folds may be necessary to resolve
the abnormal respiratory noise and partial obstruction of
the nasal passage.

REFERENCES
1. Baker GJ: Abnormalities of development and eruption, in
Baker FJ, Easley JR (eds): Equine Dentistry (ed 1). Philadelphia, PA, Saunders, 1999, pp 4959
2. Puchol JL, Herran R, Durall L, et al: Use of distraction
osteogenesis for the correction of deviated nasal septum
and premaxilla in a horse. J Am Vet Med Assoc 224:1147
1150, 2004
3. Valdez H, McMullan WC, Hobson HP, et al: Surgical correction of deviated nasal septum and premaxilla in a colt. J
Am Vet Med Assoc 173:10011004, 1978
4. McKellar GM, Collins AP: The surgical correction of a deviated anterior maxilla in a horse. Aust Vet J 70:112114,
1993
5. Vandeplassche M, Simoens P, Bouters R, et al: Aetiology and
pathogenesis of congenital torticollis and head scoliosis in
the equine foetus. Equine Vet J 16:419424, 1984
6. Tulleners EP, Raker CW: Nasal septum resection in the
horse. Vet Surg 12:4147, 1983
7. Doyle AJ, Freeman DE: Extensive nasal septum resection in
horses using a 3-wire method. Vet Surg 34:167173, 2005
8. Auer JA: Craniomaxillofacial disorders, in Auer JA, Stick JA
(eds): Textbook of Equine Surgery (ed 3). Philadelphia,
PA, Saunders, 2006, pp 13411362