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Review article - Peer-reviewed, 2022

Equine Suture Exostosis: A Review of Cases from a Multicenter Retrospective Study

Verwilghen, Denis; Easley, Jack; Zwick, Timo; Uhlhorn, Maggy; Grulke, Sigrid; Simhofer, Hubert; Townsend, Neil; Liyou, Oliver; Bodeus, Fabrice; Zani, Davide Danilo; Vlaminck, Lieven; Pearce, Chris; Staszyk, Carsten; Bienert-Zeit, Astrid;


Simple summary Suture exostosis is a condition affecting the horse's head. The connections between the bone plates that form the horse's face have been shown to react to insult. Horses will then develop a swelling along the face that may be painful. Little is known about this condition and the present research project aimed to investigate horses presented to equine clinics with symptoms of the disorder. It was revealed that the condition can form following trauma, underlying sinus disease, following a surgery or without any apparent cause. Various treatment options to resolve the condition have been reported and the outcomes of those are described in the paper. Most consistently the proper diagnosis and identification and removal of potential bone sequestra are crucial for a timely resolution. Suture exostosis is an intriguing and not uncommon pathology that has to be included in the differential diagnosis for horses with swelling of the head. Although several singular case reports have been published, no large case series is available. The aim of this study is to report a multicentric retrospective collection of suture exostosis cases. Data concerning horses with suture exostosis in the facial region were collected retrospectively. Information regarding breed, age, gender, history, imaging findings, initiated treatment, response to treatment and follow up was recorded. One hundred and five cases of various breeds were reported. Analysis revealed the cases could be grouped into four entities: 45 developed following sino-nasal surgery, 23 following trauma, seven with underlying sinus pathology and 25 idiopathic. Treatment consisted of sequestra removal, plate fixation, antimicrobial and anti-inflammatory drugs or no treatment. Whereas initial localized pain fades within few days or weeks, resolution or reduction of the swelling was obtained in most cases after 3 months to 1.5 years. The etiopathogenesis of suture exostosis seems to consist of different entities. Identification of an underlying cause, particularly the presence of a bone sequester and infection is important to speed up resolution and before concluding an idiopathic case. When performing sinusotomies, it is important to provide as little trauma as possible to the surgical site in order to prevent suture exostosis as a complication.


horse; bone sutures; facial; sequestra; infection; maxillofacial; dentistry

Published in

Veterinary Sciences

2022, volume: 9, number: 7, article number: 365
Publisher: MDPI

Authors' information

Verwilghen, Denis
University of Sydney
Verwilghen, Denis
University of Melbourne
Easley, Jack
Easley Equine Dent
Zwick, Timo
Equine Clinic Gessertshausen
Swedish University of Agricultural Sciences, University Animal Hospital
Grulke, Sigrid
University of Liege
Simhofer, Hubert
Equine Vets
Townsend, Neil
Three Counties Equine Hospital
Liyou, Oliver
Equine Veterinary Dental Services
Bodeus, Fabrice
Centre Vétérinaire des Templiers
Zani, Davide Danilo
University of Milan
Vlaminck, Lieven
Ghent University
Pearce, Chris
Equine Dental Clinic
Staszyk, Carsten
Justus Liebig University Giessen
Bienert-Zeit, Astrid
University of Veterinary Medicine Hannover, Foundation

UKÄ Subject classification

Clinical Science

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