Surgical Management of Unilateral Maxillary Molar Teeth Impaction in a Horse

Impaction of equine permanent cheek teeth is most commonly reported in the mandible, whereas maxillary involvement is rare. This report describes an uncommon presentation of congenital impaction of 3 successive maxillary molar teeth in a 4-year-old mare. Computed tomography revealed complex spatial relationships between the impacted teeth, the sinus floor and adjacent structures, which were not fully appreciated on conventional radiography and were essential for surgical planning. Surgical extraction via a maxillary sinus bone flap permitted controlled sectioning and subsequent removal of all affected teeth. Histopathology of sinus floor bone samples demonstrated reactive osteosclerosis consistent with chronic pressure and/or sinus inflammation. Postoperative complications included development of an oromaxillary communication and secondary sinusitis following loss of the polysiloxane putty, which was managed with staged debridement and sinoscopic lavage. At long-term follow-up, satisfactory functional outcome and oral comfort were achieved despite loss of multiple maxillary cheek teeth.