Student Case Presentation
Look inside the teat – Management of milk outflow disturbances
| Date/Time: |
9/12/2024 01
|
| Presenter: |
Selina Boone |
| Veterinary School: |
TN |
Abstract:
A 3-year-old, Holstein cow was evaluated for milk outflow disturbances of 5-6 days duration without improvement. Upon presentation, her physical examination was within normal limits apart from the udder. The left front quarter and teat were mildly distended and no milk could be manually expressed. Palpation of the teat revealed the presence of a small mass at the proximal end of the streak canal. A hyperechoic structure was present on ultrasound overriding the proximal opening of the streak canal. Patient underwent theloscopy to restore milk outflow.
The patient was placed in right lateral recumbency on a tilt table under mild sedation and a ring block of the teat performed with lidocaine. With a rigid scope inserted in the wall of the teat pointing distally, the fibrotic proliferative tissue was excised and the quarter fully drained. A silicon teat insert was placed in the streak canal at the end of surgery.
Post-operative care consisted of passive milking of the quarter with a teat cannula once daily, anti-inflammatory, and antimicrobial medications. A new silicone teat insert was carefully placed after each milking in the left front teat. Passive milking was recommended for 12 days before resuming mechanical milking. Strict recommendation was given to not hand milk the left front quarter. Long-term follow up indicated return to normal milk ejection from the teat, and absence of scaring on the teat allowing the patient to pursue show career.
Peer or self-inflicted blunt trauma to the distal end of the teat or excessive milking duration, vacuum settings can lead to trauma of the rosette of Furstenberg. Traditional blind surgeries can be associated with additional scaring of the streak canal. Minimally invasive surgery allows precise identification and removal of intraluminal masses impinging milk outflow. Strict post-operative management is key for the successful outcome of these cases.
