Temporohyoid osteoarthropathy (THO) is a progressive bilateral disease of unknown aetiology that most commonly affects adult horses. Irrespective of aetiology, THO frequently results in pain or fracture of the petrous temporal bone during normal movement of the tongue and larynx. In an effort to decrease pain and reduce the likelihood of petrous temporal bone fracture, partial stylohyoidectomy and ceratohyoidectomy have been developed. Serious complications have been reported following stylohyoidectomy and therefore the current recommendation is to perform unilateral ceratohyoidectomy. Benefits of ceratohyoidectomy include a lower risk of vascular and nerve damage and a reduced risk of clinical signs recurrence when compared with stylohyoidectomy. This report describes a case of THO in which clinical signs recurred approximately 2 years after unilateral ceratohyoidectomy was performed. Due to this complication, resection of the contralateral ceratohyoid bone was performed, which resulted in complete resolution of clinical signs. Although the clinical signs are frequently unilateral, the disease is most commonly a progressive bilateral condition and some horses may not have complete resolution of clinical signs when unilateral ceratohyoidectomy is performed. Therefore, if clinical signs persist after unilateral ceratohyoidectomy, a therapeutic consideration should include bilateral ceratohyoidectomy. This report suggests a favourable short-term prognosis for a horse treated with bilateral ceratohyoidectomy.