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TDK conference 2022

Medical treatment of oro-sinal and oro-nasal fistulas with a biological membrane in horses
Mag Eszter Vivien - year 5
University of Veterinary Medicine Budapest, Department and Clinic of Equine Medicine
Supervisor: Dr. Pál Tuska


Treatment of oro-sinal, oro-cutaneous and oro-nasal fistulas in horses is usually very difficult and expensive. The purpose of our study is to present a new method that compensates for the structural and functional deficiencies of the cells and tissues in the alveolus by using the body's own regenerative capacity. According to our hypothesis, the biological membrane made from the horse's own blood, rich in platelets and white blood cells, stimulates the connective tissue healing of the fistula passage that has stalled in healing, thus making the patient symptom-free, shortening the healing time and reducing the costs of the follow-up treatment.

From the patient material of the ÁTE Department of Equine Medicine and Clinic, we applied biological membranes to 10 horses. In cases diagnosed with oro-sinal or oro-nasal fistula, the epithelium covering the inner part of the fistula was removed along the entire length of it, and then the affected part was rinsed from the oral cavity. In justified cases, feed parts that entered the sinus system were removed during trepanation of the paranasal sinuses. After that, we took an impression sample of the affected area with a 2-component dental silicone paste, with particular attention to the non-healing alveolus and the teeth in the mesial and distal direction from it. On the basis of which an implant covering the alveolus was made with the help of a three-dimensional printer, made in the dental laboratory. A biological membrane, rich in platelets and white blood cells, was placed in the cavity of the affected alveolus and fistula. In order to protect the membrane from contamination from the oral cavity, a dental silicone sealant and the previously individually manufactured alveolar ridge covering implant were used to cover the alveolus.

Three out of ten cases are symptom-free, but the result is not yet final, because we treated them less than six weeks ago, so healing is still in progress. In three of the ten cases, the fistula had already existed for a long time (> 6 months) when we started the treatment. In these horses, the fistula passage, although it showed a continuous shrinking tendency, did not close completely. In one case, neither the date of tooth extraction nor the time of fistula formation was known, nor was follow-up of healing possible. Fistulas were recent (<8 weeks) in three cases, in which all horses became asymptomatic and the fistula was completely closed.

Our clinical results confirm that, in the case of newly formed fistulas, symptom-freeness and complete recovery in 2-5 months can be achieved with the method we describe. Complete symptom relief can also be expected when chronic fistulas are treated. In all cases, the biological membrane helped the granulation tissue sprout in the alveolus. Based on our clinical experience, an additional advantage of using the implant is that it prevents the teeth from moving towards each other, thus preventing the development of further diastemas.

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