Wry Not, a 2023 Standardbred filly, made headlines last year after a surgical team at New Bolton Center at The University of Pennsylvania, in Kennett Square successfully repaired her severe wry nose. Kyla Ortved, DVM, PhD, Dipl. ACVS, ACVSMR, associate professor of large animal surgery and Jose Garcia-Lopez, VMD, Dipl. ACVS, ACVSMR, associate professor of large animal surgery collaborated on what they both describe as the worst case of wry nose they have seen. They used advanced diagnostics and surgical techniques to straighten out this filly’s nose.

What is Wry Nose in Horses?

Veterinarians believe wry nose is a congenital condition, meaning it is present at birth and arises during the developmental stages of the fetus. It can affect a foal’s overall health and performance. Affected animals have a deviation of the nasal septum, which gives the nose an asymmetrical appearance. While wry nose is relatively rare, it requires prompt attention from horse owners, breeders, and veterinarians to ensure the foal gets the necessary treatment.

Causes of Wry Nose in Foals

There is a wide spectrum of severity of this condition, explains Ortved. Several factors contribute to the occurrence of wry nose, and while the exact cause is not always clear, genetics, nutritional imbalances, and environmental factors are commonly associated with it.

Genetics: Genetic predisposition plays a significant role in the development of wry nose. If one or both of the foal’s parents have a history of wry nose or skeletal abnormalities, there is an increased likelihood of the foal inheriting the condition. Responsible breeding practices, such as avoiding crossing horses with a known history of wry nose, can help reduce the foal’s risk.

Nutritional Imbalances: Deficiencies in essential nutrients in the mare’s diet such as vitamins and minerals, particularly during early gestation, can impact a foal’s skeletal structure formation and might contribute to the development of wry nose. Adequate prenatal nutrition is crucial for the overall health of the foal.

Environmental Factors: The mare’s environment during pregnancy can influence her foal’s development. Exposure to certain toxins, infectious agents, or stress might contribute to the occurrence of wry nose. Ensuring a healthy and stress-free environment for pregnant mares can help minimize the risk.

Identifying Wry Nose in Foals

Owners must recognize a wry nose in foals to allow early intervention and proper management. Most owners will identify the abnormal skeletal structure immediately but more mild cases may require a more detailed examination, says Garcia-Lopez. Common signs include:

Asymmetry: The most apparent sign of wry nose is asymmetry of the foal’s nose. Again, the degree of deviation can range from mild to severe.

Difficulty Breathing: Foals with wry nose might have trouble breathing due to their altered nasal structure. This can lead to respiratory issues and impact foals’ overall health.

Difficulty Nursing: Foals with wry nose might struggle with nursing because the deformity can affect their ability to latch onto the teat. This can result in reduced milk intake and potential nutritional deficiencies. It’s particularly important that foals nurse in the immediate postpartum period, when they must ingest colostrum. Although a foal might be able to nurse, an incorrect latch or swallow can lead to aspiration pneumonia, says Garcia-Lopez.

Failure to Thrive: In severe cases foals with wry nose might grow and develop poorly. The physical challenges associated with the condition and the foal’s nursing issues can lead to failure to thrive.

Managing and Treating Wry Nose

While wry nose cannot be entirely corrected, several management strategies can help improve the foal’s quality of life and minimize potential complications.

A veterinarian should examine foals within the first 24 hours because, again, diagnosing wry nose early is essential for effective treatment and minimizing secondary disease. “These cases are usually noticed right after foaling; if somehow it goes unnoticed, the big issue is inability to nurse or aspiration pneumonia,” says Garcia-Lopez.

Affected foals that cannot nurse appropriately need nutritional support and colostrum supplementation. The foal’s veterinarian will check their IgG levels and administer plasma to be sure they receive proper immunity transfer. Some foals might need to be fed via nasogastric tube until repair.

“In mild cases, foals can generally nurse and breathe without too much issue so (it) can be managed conservatively,” says Ortved. In the mildest cases veterinarians might recommend using nasal splints to help support the foal’s nasal structure and promote more symmetrical growth. They will typically apply splints during the early stages of the foal’s life and adjust them periodically as the foal grows.

In severe cases where conservative measures are insufficient, veterinarians might consider surgical intervention to correct the deviation of the nasal septum and create a more normal nasal structure. Surgery is often reserved for extreme cases and requires a significant commitment from both the veterinarian and owner. “Foals are unable to nurse, so (they) either require surgery or euthanasia,” says Ortved.

Owners should schedule regular veterinary checkups to monitor the foal’s progress and adjust management strategies as needed. Close observation allows for timely intervention in case of complications or changes in the foal’s condition.

Long-Term Prognosis for Wry Nose Foals

The foal’s prognosis for life and performance depends on the severity of the wry nose. In mild cases foals can adapt to their unique abnormality and live a full and healthy life, but more severely affected foals will not survive (without intervention) because of restricted airflow and the inability to nurse. Managing abnormal dental occlusions—how the tooth surfaces meet and their ability to chew—with a regular schedule of veterinary care is vital to these horses’ quality of life and wellness going forward.

The athletic prognosis for foals with wry nose often depends on the severity of the condition and the owner’s discipline of choice. “It depends on which athletic activity we are looking at; as a racehorse the prognosis is guarded; in nonracehorses the prognosis is better,” says Garcia-Lopez. Racehorses typically need a nasal septum resection, he adds, to allow the airflow necessary for the sport.

Take-Home Message

Wry nose in foals is a challenging condition to handle; it takes careful management and attention from horse owners, breeders, and veterinarians to ensure affected animals thrive. Advancements in veterinary care and a proactive care approach can significantly improve the quality of life for affected foals. Ongoing research and collaboration within the equine community will continue to contribute to veterinarians’ understanding of wry nose and aid in the development of more effective management strategies.

As for Wry Not, Ortved reports that while she and her colleagues will continue follow-up corrections, the filly is doing well so far: “The foal will never be normal but hopefully will be able to lead a relatively happy and healthy life.”