Abstract
Bilateral paranasal sinus diseases are rarely reported in horses. Treatment using a bilateral frontonasal bone flap on a standing, regular-sized adult horse has not been described previously. A 13-year-old Thoroughbred gelding was evaluated for bilateral mucopurulent nasal discharge. Radiographic, endoscopic and computed tomographic examinations revealed bilateral sinus pathological changes consistent with an ethmoid haematoma involving the maxillary and frontal sinuses. A bilateral frontonasal bone flap was created under standing sedation and local anaesthesia. A tracheotomy was performed initially to ensure a patent airway during the procedure. Additional analgesia had to be given to transect the dorsal part of the nasal septum while elevating the flap. The sinus masses were removed and communications with the nasal cavities created uneventfully. Small sequestra were removed transendoscopically from the left caudal maxillary sinus 4 weeks after the initial procedure. The horse made a complete recovery with an excellent cosmetic outcome. Histopathology revealed the mass to be a sinus cyst. We concluded that a bilateral sinus bone flap can be used in adult regular-sized horses to access the left and right paranasal sinuses simultaneously. Regional nerve blocks should be performed in order to increase analgesia. A temporary tracheotomy prevents any airway obstruction during the procedure. The post-operative cosmesis is excellent.Keywordsfrontonasal bone flap; sinus cyst; computed tomography; standing surgery; horse.
Highlights
Bilateral paranasal sinus diseases are rarely reported in horses
We described the successful surgical management of a bilateral sinus cyst using a large bilateral frontonasal bone flap on a standing adult Thoroughbred gelding
The frontonasal bone flap was previously reported as being the ideal approach to the paranasal sinuses because it allows access to the conchofrontal sinus, the caudal maxillary sinus and the ventral conchal and rostral maxillary sinuses after perforation of the maxillary septal bulla (Easley & Freeman 2013a)
Summary
In previous studies reporting on large numbers of horses with sinonasal diseases, only 3.0% – 4.5% of cases had bilateral sinus involvement (Dixon et al 2011; Tremaine & Dixon 2010). These cases may require bilateral sinus surgery in order to treat the primary affection. Even if the trend in treating sinonasal disorders in horses is to be as conservative and as minimally invasive as possible (Barakzai & Dixon 2014; Dixon et al 2012b; Easley & Freeman 2013a), sometimes osteoclastic flaps remain essential to get sufficient access to the lesion. To our knowledge, such a procedure has not been reported on a fully grown regular-sized horse
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