Oral Extraction and Nasal Retrieval of a Fragmented Maxillary Fourth Premolar Tooth in a Horse Using Endoscopic Guidance: A Case Report

This case report presents the removal of the left maxillary fourth premolar tooth (208) which had a chronic complicated crown root fracture in a 9-year-old Warmblood mare. Following a 14-month history of malodorous nasal discharge, clinical and radiographic examination allowed the diagnosis of a comminuted crown root fracture of 208 and oronasal fistula. Some root fragments inaccessible for oral extraction were subsequently removed using a transnasal approach through the existing oronasal fistulous tract using bronchoesophageal forceps under endoscopic guidance. The oronasal fistula was surgically debrided and the alveolus was occluded with polyvinyl siloxane to avoid postoperative food contamination. This minimally invasive approach prevented the need for more extensive external approaches, reducing the risk of complications. This case highlights the value of careful surgical planning and demonstrates the feasibility of minimally invasive techniques for complex equine dental extractions in particular cases.