Dental surgery helps retired draft horse King breathe easy again

People dread going to the dentist, but hate getting sinus infections even more. It’s much the same for horses.

“Most of us can appreciate how miserable a sinus infection can be, based on our personal experiences with colds, thus, I find the treatment of dental and sinus diseases so satisfying because it results in an immediate and significant improvement in the comfort of the affected horse,” said Elsa Ludwig, clinical assistant professor of equine surgery at the Marion duPont Scott Equine Medical Center.

Such was the case with King, a 15-year-old Belgian gelding who serves as a “Resident Ambassador” for Gentle Giants Draft Horse Rescue in Mount Airy, Maryland.

King visited the Equine Medical Center in August 2025 after a nasty, and rather odorous, left nasal discharge was noticed, prompting radiographic evaluation of his skull. Radiographs revealed an infection around the roots of one of his left molars, which was tracking into his left sinus. 

A decision was made to perform a computed tomography (CT) scan for a more thorough evaluation, so King was referred to the Equine Medical Center. 

The Marion duPont Scott Equine Medical Center in Leesburg, Virginia, is one of three animal healthcare facilities and teaching hospitals of the Virginia-Maryland College of Veterinary Medicine, which is based at Virginia Tech in Blacksburg, Virginia.

For several years in his previous life, King was a breeding stallion. He arrived at the rescue in 2019 with his longtime partner, Ada, by his side. The pair were deeply bonded and are now thoroughly enjoying their well-earned retirement together.

“Anytime Gentle Giants rolls into the Equine Medical Center, we are greeted with compassionate and knowledgeable staff who take exceptional care of our beloved horses,” said Lorin Grey, director of growth at Gentle Giants Horse Rescue. “King has been in great hands with Dr. Ludwig, and it brings us peace and comfort knowing our big guy is finally feeling better and back to his lively and lovable self.”

As a Resident Ambassador, King represents Gentle Giants Horse Rescue at on- and off-site promotional events. He gently greets the public and educates visitors about the rescue’s mission to save draft horses from slaughter, abuse, and neglect. King has performed in breed demonstrations at the Horse World Expos and is always a crowd favorite at county fairs.

Elsa Ludwig evaluated King and based on clinical findings and CT scan results, identified a fractured tooth with an associated tract extending from King’s oral cavity into his sinuses. Ludwig recommended King undergo extraction of the affected tooth and sinusotomy to facilitate cleaning out the sinus infection and enable drainage.

A sinusotomy is a surgical procedure typically performed with the horse standing. It provides access to the sinus cavity to facilitate the treatment of chronic infection, cysts, or tumors. In King’s case, this procedure allowed Ludwig to access the tooth root infection that was causing the buildup and collection of feed material in his sinuses.

With King under standing sedation, Ludwig, assisted by intern veterinarian Antonio Beck Jr., removed the fragments of the fractured tooth, and the resulting cavity was flushed, dried, and packed with a dental impression material plug. King’s mouth was then carefully rinsed to remove any lingering debris. Ludwig and Beck then turned their attention to King’s sinuses.

When the sinusotomy was completed, an endoscope was passed through the opening into the left sinus, which revealed a scattered accumulation of purulent material. A sample of this material was collected for bacterial culture and sensitivity. 

The Equine Medical Center’s in-house laboratory processed the sample by growing the bacteria to identify the specific organism causing King’s infection and to determine which antibiotics would be most effective in treating it.

The front portion of King’s largest paranasal sinus, which is associated with the roots of the upper cheek teeth, was found to be completely filled with hay and grain, and there was contamination of this feed material throughout the rest of the left side of King’s sinuses. The feed material was removed, and the sinuses were flushed with a sterile saline solution. Medical-grade Manuka honey was administered to the left-sided sinuses for antimicrobial purposes.

King’s surgical site was temporarily closed with staples to allow for continued access for future lavage, and a head bandage was applied before he was taken back to his stall.

During hospitalization, King was given antibiotics and received regular sinus lavages, which resulted in a gradual decrease in the amount of purulent material and accumulated feed within his sinuses and the associated fistula or infection tract.

After six days of hospitalization, King’s dental plug was removed, the area was gently debrided, and a new dental plug was fitted. King was ready to return home for continued care.

King recently visited the Equine Medical Center for a recheck appointment. Endoscopic evaluation of the site of the fractured tooth showed that the area was significantly healed. The dental plug was removed, and the area flushed, revealing healthy granulation tissue with a small fistula or tract in the center; a huge improvement since his hospitalization.

Although there was no obvious sign of nasal discharge, an endoscope was passed into King’s sinuses to check the healing progress. A thorough lavage with sterile saline was performed, and some debris was retrieved, which was suspected to be residual rather than an active infection.

Regular dental care should be an integral part of a horse’s general health program and should reflect the individual needs of each unique horse to ensure their long-term health and comfort. Identifying dental issues and treating them appropriately prevents serious health problems.

Ludwig has a special interest in soft tissue surgery and, in particular, the treatment of dental and sinus issues. 

“Our ability to quickly diagnose these diseases with a combination of radiographs, CT scans, and endoscopy allows for targeted and specific surgical treatments, resulting in enhanced disease resolution and a faster recovery for our patients,” Ludwig said.

There are a multitude of different dental and sinus diseases that can affect horses, and Ludwig is happy to treat them all at the Equine Medical Center.