Case Report Rapport de cas

Management and long-term outcome of partial glossectomy in 2 horses

Hayley M. Lang, Luca Panizzi, Travis T. Smyth, Andrea E. Plaxton, Katharina L. Lohmann,
Spencer M. Barber

Abstract — Records were reviewed for 2 horses with partial glossectomy, 1 traumatic and 1 elective. According
to long-term follow-up by telephone, both horses had recovered well, experiencing only temporary difficulty while
eating, and went on to be ridden successfully using mouth bits. Partial glossectomy, therefore, had a favorable
prognosis in 2 performance horses.

Résumé — Gestion et résultat à long terme de la glossectomie partielle chez 2 chevaux. Les dossiers ont été
examinés pour 2 chevaux ayant subi une glossectomie partielle, 1 étant une glossectomie traumatique et 1 étant
une glossectomie non urgente. Selon le suivi à long terme par téléphone, les deux chevaux se sont bien rétablis,
ont éprouvé seulement une difficulté temporaire à manger et ont ensuite pu être montés avec succès en utilisant
des mors. Par conséquent, une glossectomie partielle a présenté un pronostic favorable chez 2 chevaux de
performance.
(Traduit par Isabelle Vallières)
Can Vet J 2014;55:263–267

T he tongue serves as an organ of food prehension, mastica-

tion, grooming, deglutition, taste, and vocalization, and is
suspected to play a role in upper airway stability (1–4). Some
under bridle after having a major portion of the apex of the
tongue removed.

reported abnormalities of the tongue in the horse include trau-
matic injuries (1,5–10), glossitis (10,11), neoplasia (12–14),
and tongue paralysis (15–20). Lacerations to the tongue of
horses are common (6), usually involve the free portion of the
tongue, and the majority are transverse in orientation (6,7).
These lacerations can result from foreign objects, self-inflicted
bites, or inappropriate use of bits (1,5–9). Clinical signs include
oral hemorrhage, ptyalism, inappetence, anorexia, dysphagia,
halitosis, pyrexia, and tongue protrusion from the mouth (7).
Tongue injuries can be managed with primary closure, second
intention healing or glossectomy depending on the severity,
duration, and location of the injury (1,5–9).
This paper reports the use of partial glossectomy as a treat-
ment for tongue paralysis, and reports the long-term outcome,
especially with regards to performance when ridden with a bit,
following traumatic and elective glossectomy. The authors are
unaware of any other reports on the performance of horses
Department of Large Animal Clinical Sciences, Western College
of Veterinary Medicine, University of Saskatchewan, Saskatoon.
Address all correspondence to Dr. Hayley M. Lang; e-mail:
hml56@cornell.edu
Dr. Lang’s current address is Equine and Farm Animal Hospital,
College of Veterinary Medicine, Cornell University, 930 Campus
Road, Ithaca, New York 14853-6401, USA.
Use of this article is limited to a single copy for personal study.
Anyone interested in obtaining reprints should contact the
CVMA office (hbroughton@cvma-acmv.org) for additional
copies or permission to use this material elsewhere.
Case descriptions
Case 1
A 15-year-old, 526-kg, Quarter horse gelding, used for plea-
sure riding, was admitted with a history of complete traumatic
amputation of the rostral portion of the tongue (12 cm). The
owner noticed the horse was inappetent, had excess salivation,
blood around the mouth and on the front legs, and the portion
of the tongue was found. Oral examination revealed complete,
transverse laceration of the tongue with loss of the rostral 1/3
of the tongue just rostral to the frenulum (i.e., tongue apex).
The horse was administered ceftiofur and phenylbutazone and
referred to the hospital due to not being able to eat and drink
properly.
On admission, the gelding was tachycardic and mildly dehy-
drated. He was given Lactated Ringers solution (Hospira,
Montreal, Quebec), 65 mL/kg body weight (BW) per day, IV,
and continued on ceftiofur (Excenel; Pfizer Canada, Kirkland,
Quebec), 1 g IV, q24h, for 4 d, phenylbutazone (Bute,
Phenylbutazone 20%; Rafter Products, Calgary, Alberta), 2.2 to
4.4 mg/kg BW, IV, q24h for 2 d, and a tetanus toxoid vaccine
(Tetanus Toxoid, Wyeth Animal Health, Guelph, Ontario), IM.
During the 7-day hospitalization period, soaked pelleted
rations, soaked beet pulp, and grass hay were offered. For 2 d he
was unable to masticate and swallow effectively, and only small
amounts of feed were ingested. By day 3 he started to chew and
swallow but dropped the majority of his feed. Mashes were at
first more difficult to keep in his mouth, but required less chew-
ing. On day 4 a nasogastric tube was passed and 8 L of senior
pellet slurry was administered. On day 5, on oral examination
the tongue appeared to be healing well by second intention. He

CVJ / VOL 55 / MARCH 2014 263

R A P P O R T D E CA S
Figure 1. Case 2, protrusion of the tongue from the left
interdental space on presentation.
continued to improve in his ability to eat and was discharged on
day 7 with instructions to continue special feeding.
A phone interview was conducted with both the owner and
trainer of the gelding 2.5 y following the injury. For 6 mo he
was fed free choice grass hay and a large mash of senior feed,
soaked beet pulp once daily, with powdered salt and minerals
added because of his inability to lick salt/mineral blocks. Then
he had free choice pasture grazing in the summer and free choice
hay in the winter.
Weight loss was noticed initially, but he progressively regained
his original weight. The owner feels maintaining a healthy
weight is now more difficult, the horse eats more slowly, his
lips and facial muscles are more developed and dynamic in
movement, and he has developed the ability to protrude a small
amount of the remaining portion of his tongue.
Riding with a halter resumed 5 months following the injury,
and at 1 year a professional trainer started him in a hackamore
and then transferred him to a bit with a wide, medium height
port and loose shanks, designed to utilize the bars and roof of
the horse’s mouth rather than the tongue. The trainer reported
that the horse could move the bit with its tongue, so the stump
of the tongue was able to get under or contact the bit’s mouth-
piece. The horse was very responsive to a slow soft pressure
on the reins, but compared to normal horses, he overreacted
to more sudden firm pressure on the bit. The owner feels the
horse has no abnormal behaviors in response to the bit, but
because he is no longer able to lick saliva from his lips he wipes
264
Figure 2. Case 2, intra-operative view of the tongue showing
the amputated portion and the sutured stump. Rostral to the
marker line represents the portion of tongue that had protruded.
his muzzle on his front legs during work, rest, and eating. The
horse has returned to a slightly higher level of work than prior
to the injury.
Case 2
A 7-month old, weaned, 220-kg, Quarter horse filly was pre-
sented with a history of tongue protrusion from the left side
of her mouth since birth (Figure 1). There was no evidence of
trauma at birth (parturition not observed), the dam’s previous
foals and ancestors were all normal, and all horses on the farm
had been healthy during the pregnancy. As a foal the horse
seemed to have some difficulty nursing; however, she appeared
to develop normally. After weaning she was fed hay and grain,
and had no difficulty eating. Just prior to presentation she had
sustained a mild laceration to the tongue, likely due to biting it.
On examination, the filly was in good body condition and
normal except that 6 cm of her tongue protruded at an angle
from the left side of her mouth through the interdental space
(Figure 1). The dorsal aspect of the protruding portion of the
tongue had callous formation where it lay against the left premo-
lars. It remained protruded, but could be retracted completely
into the mouth during eating and when it was pulled. Tongue
tone felt mildly to moderately decreased and the left side of the
tongue appeared slightly atrophied.
No abnormalities were seen on radiographic examination
of the head and hyoid area. On resting videoendoscopy of the
upper airway there was a small amount of white material within
the left guttural pouch which was collected for culture and
sensitivity. Actinobacillus species, that was sensitive to all the
antibiotics tested, was grown. A specific diagnosis was not made.
A congenital generalized decreased muscle tone to the tongue,
and atrophy of the left side of the tongue were suspected.
Surgical removal of the protruding portion of the tongue
was recommended to protect the tongue from trauma on exter-
nal objects or from freezing during the winter. The American
Quarter Horse Association (AQHA) was contacted and granted
permission for surgical treatment without affecting the horse’s
registration or performance record.
CVJ / VOL 55 / MARCH 2014

Figure 3. Case 2, appearance of the tongue 2 hours after
partial glossectomy.
Before surgery, the filly was given sodium penicillin
(Penicillin G Sodium; Novopharm, Scarborough, Ontario),
22 000 IU/kg BW, IV, q6h, and phenylbutazone (Rafter
Products), 2.2 to 4.4 mg/kg BW, IV, q24h, and the portion
of the tongue protruding was marked with a blue marker and
staples once the horse was anesthetized. She was anesthetized
and positioned in right lateral recumbency. A local block with
2% lidocaine hydrochloride was performed at the base of the
tongue, and a tourniquet was placed just cranial to the frenu-
lum to control hemorrhage. The site selected for amputation
was 7 cm caudal to the tip of the tongue, 3.5 cm rostral to
the lingual frenulum, located 1.5 cm caudal to the protruding
portion of tongue, and running transversely across the tongue.
To allow optimal closure, the tongue tissue was incised at an
angle such that a wedge of musculature was removed, leaving
dorsal and ventral flaps that could be easily apposed without
tension (5,6). The tissue flaps were reduced with 3 horizontal
and 1 vertical mattress sutures using 1 polydioxanone (PDS II,
Ethicon Canada, Markham, Ontario). Triangular wedges of tis-
sue were removed on either side of the tongue to prevent “dog
ear” formation at the ends of the opposed flaps. The edges of the
flaps were apposed with 2 separate pieces of 0 PDS in a simple
continuous suture pattern (Figure 2).
Immediately following recovery from anesthesia there was no
tongue protruding from the filly’s mouth (Figure 3). The filly
had some difficulty initially eating a mash of bran and senior
pellets, but later that day was able to eat hay without any dif-
CVJ / VOL 55 / MARCH 2014
ficulty. She was discharged with instructions for administration
of phenylbutazone (1 g PO, q24h for 3 days).
Two weeks after surgery the filly was eating well and sutures
were still in place. A telephone interview was conducted 3.5 y
following surgery once the filly was in full work. The owner
reported that the filly did not have trouble eating, had normal
CA S E R E P O R T
eating behavior, maintained a good body condition, and as a
yearling was a champion halter horse. She was started under
saddle at about 32 mo of age (2 y post surgery) using a snaffle
bit with a jointed mouthpiece. The owner did not notice any
abnormality with her accepting the bit, and for the past 18 mo
she has been ridden 1.5 hours 5 times a week, in training as a
working cow horse, without any abnormalities seen. The owner
reports that about 2 cm of tongue are located under the bit’s
mouthpiece.
Discussion
Traumatic glossectomy or glossectomy as a treatment for severely
traumatized tongues (devitalized or with minimal attachment
to the parent portion of tongue) in horses has been previously
described (1,5–9). Based on a classification system for human
glossectomies, and adopted for injuries in dogs (2), both glos-
sectomies in this report are classified as “partial glossectomies,”
which are defined as loss or amputation of part or all of the free
tongue rostral to the frenulum. Elective glossectomy has not
been described as a treatment for glossitis, neoplasia, or tongue
paralysis in the horse (10–20), but has been used for such con-
ditions in dogs (2). Partial glossectomy should be considered as
a viable treatment option in horses, especially with conditions
refractory to medical management. To the authors’ knowledge
this is the first report of a partial glossectomy in the horse as a
surgical treatment for persistent tongue paralysis or protrusion.
Potential causes of tongue protrusion or paralysis in the horse
include abnormal behavior (21), congenital abnormality (15),
botulism (16,19,20), abnormalities of or injury to the hypoglos-
sal nerve or its origin (3,4,17,18,20,22), and equine protozoal
myeloencephalitis (15). The muscles of the tongue, styloglossus,
hyoglossus, and genioglossus, all receive their motor innerva-
tion from the hypoglossal nerve [cranial nerve XII (CN XII)]
(3,4,18,22), which has a nucleus in the medulla of the hind
brain (3,18). These muscles all play some role in retraction of
the tongue but are also important for depression and protru-
sion of the tongue (3,4). The genioglossus muscle, which is
important in tongue protrusion, is innervated by contralateral
cortical fibers, whereas the other tongue muscles have bilateral
cortical innervation (22). The clinical significance is that a
unilateral cortical lesion may cause contralateral genioglossus
muscle weakness and deviation of the protruded tongue away
from the side of the lesion, whereas a CN XII injury causes
ipsilateral genioglossus muscle weakness with the protruded
tongue deviating to the side of the injured nerve (22). Because
of different muscle actions and innervation, localization of brain
or nerve injury can be very difficult.
The presence of tongue protrusion in case 2 since birth rules
out a behavioral problem. A congenital problem with the tongue
musculature or hypoglossal nerve or its cortical center, or an
injury while foaling is possible but no other abnormalities were
265
 identified on clinical examination or radiographs, and the ampu-
tated portion was not sent for histological examination. The
hypoglossal nerve passes close to the guttural pouch; however,
the empyema seen at 7 mo of age was minimal and not likely
present at birth. Equine protozoal myeloencephalits (EPM) can
have transplacental transmission (15); however, this filly was
R A P P O R T D E CA S
born and raised in western Canada where Sarcocystis neurona
infection has not been previously reported. Neospora hughesi
has been reported to cause EPM in a horse that had not been
outside of western Canada (23). Although the horse in case 2
was not tested for EPM, the likelihood of it being the cause of
the tongue abnormality is very low considering the geographic
location and the lack of other clinical signs later on in life. The
cause of the tongue protrusion remains unknown; however, we
suspect some abnormality in hypoglossal nerve innervation.
Complications following a partial glossectomy are possible
but not usually significant. Although contamination is inevi-
table, infection is rare (2,5). Excessive swelling of the tongue
and suture dehiscence are possible and their chances of occur-
ring can be decreased with the use of antibiotics, non-steroidal
anti-inflammatory drugs, oral antiseptic rinses, obliterating
dead space with the use of tension relieving sutures, and feeding
mashes after surgery (6,7). Tongue wounds heal well by second
intention healing (5–7); however, primary closure and antibiotic
therapy will likely hasten healing and improve functionality
and cosmetics (1,5–8). Acid-base disturbances from excessive
loss of saliva have been reported (1,2), but were not observed
in these cases.
Most horses are able to eat and drink effectively following
a partial glossectomy (1,5–8). They may initially have some
difficulty, but quickly adapt as observed with both cases in this
report. Dogs with more extensive glossectomies, subtotal or
total, quickly learn how to eat (2). A study in humans revealed
that the volume of food swallowed per second was significantly
correlated to the area of tongue removed, and that degluti-
tion remained within the normal range if less than 1/6 of the
entire tongue was removed (23). The authors could not find
any reports of the normal length of the horse’s tongue, which
would likely vary depending on age, size, and breed. However,
the horses in our study lost most of the apex (12 and 7 cm), the
free portion of the tongue rostral to the frenulum; therefore, the
authors believe that this is greater than 1/6 of the entire length
of these horses’ tongues. The 2 horses both initially ingested
their food more slowly; therefore, allowing access to food for a
longer period of time is necessary in the initial post-operative
period. As observed with our 2 cases, mashes or grain are more
easily dropped initially; however, they are important in initial
post-operative management as these foods are less abrasive,
require less chewing, are likely easier to swallow, and have a
more predictable nutritional value than hay. Hay may be well-
tolerated but must be of high quality as more work is required
during mastication. The horse in Case 2 adapted quickly and
now maintains a healthy body condition on a typical diet. The
horse in Case 1 had more difficulty eating immediately after
surgery and subsequently had visible chewing abnormalities
and difficulty retaining an ideal body condition on a normal
horse ration. This may be related to the traumatic nature of
266
the injury that pulled off the rostral portion of the tongue, and
the possibility that some neurological damage occurred to the
remaining tongue. This horse, in contrast to the horse in case 2,
had a normal tongue prior to injury and therefore was not pre-
conditioned to altered tongue function.
Tongue amputation to the level of the frenulum is well-
tolerated with regard to eating (5,9), but there is no information
regarding a horse’s athletic performance and acceptance of a bit.
Both horses in our study went on to excellent performance with
use of mouth bits. The trainer of the horse in case 1 used a bit
with a wide, high port and loose shanks that would theoretically
put less pressure on the tongue and utilize the bars and palate
of the mouth more. The horse in Case 2 was untrained prior to
glossectomy but subjectively responded normally to training,
initially with a jointed ring bit snaffle which was followed by a
D-ring snaffle bit. All bits put some pressure on the tongue (21)
so a bit-less bridle, hackamore, or bosal may be an easy solution
after a glossectomy; however, some disciplines require a horse
to compete with a bit. Our report demonstrates that horses can
perform well with a bit after a partial glossectomy but under-
standing the mechanics of bits, bridles, and accessories may be
helpful to owners and veterinarians. Generally, horses are started
with a snaffle bit (ringed bit with no shanks) that has a jointed
mouthpiece and eventually are advanced into bits with a solid
mouth piece, port (elevated portion of the mouthpiece), and
shanks. These devices can exert pressure on a number of areas
including: bars (mandibular interdental space), lips, tongue,
hard palate, chin, nose, and poll (21), with the tongue and pal-
ate being the most sensitive (21). The tongue normally protects
the bars from pressure as it sits higher, partially covers the bars,
and absorbs some of the force (25,26). Snaffle bits have rings
for attachment of the reins rather than a shank, and a pull puts
pressure on the tongue, bars, and lip corners (21). A straight
mouthpiece exerts more pressure on the tongue compared to a
jointed mouthpiece, which bends over the tongue and places
more pressure on the bars and lips (21). The diameter of the
mouthpiece also plays a role in severity with narrow being more
severe (21). Ported bits have less contact with the tongue but put
pressure on the hard palate (21), and are generally reserved for
horses more advanced in training. Shank bits give a mechanical
advantage so that less force on the reins is required to exert a
given pressure in the mouth (21).
Following a partial glossectomy the bit may be problematic
if its mouthpiece irritates the tongue stump or gets under the
tip of the tongue. However, if the bit’s mouthpiece is located
rostral to the stump more pressure from the bit’s mouthpiece
will be placed on the bars and lips. In both our cases the horses
performed well with bits. The horse in Case 1 had some prob-
lems initially adjusting to the bit despite already being trained.
This might be related to the stump being located caudal to
the mouthpiece; however, since the horse was capable of mov-
ing the bit around it must have been able to get it under the
mouthpiece due to the wide port. The horse in Case 2 accepted
a bit normally, possibly because the tongue was long enough to
extend under the mouthpiece. For an untrained horse started
after a partial glossectomy, a snaffle bit with a jointed and larger
diameter mouthpiece may be best to minimize pressure on the
CVJ / VOL 55 / MARCH 2014
tongue and bars. For a trained horse after partial glossectomy,
a bit with a wide low port with mobile shanks is likely optimal.
This report verifies both that horses can eat well after a partial
glossectomy with removal of the tongue just rostral to the frenu-
lum, and that they can return to a high level of performance
while ridden with a bit. Partial glossectomy should be considered
as a treatment option for any condition in which partial amputa-
tion of the tongue could be beneficial to the horse. CVJ
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