Laser Vaporization of the Dorsal Turbinate as an Alternative Method of Accessing and Evaluating the Paranasal Sinuses

Abstract

To report a technique for stoma creation into the conchofrontal sinus (CFS) through the dorsal turbinate and to evaluate stoma as a site for sinoscopy. Prospective experimental study. Cadaveric equine heads (n=2) and normal adult horses (5). Technique feasibility was established on 2 cadaver heads. A diode laser fiber with a contact probe was passed into the nasal passage through a custom built, laser introducer rod (LIR). A videoendoscope was passed ventral to the LIR. A site on the caudal, medial aspect of the turbinate overlying the dorsal conchal sinus (DCS) was identified. A stoma to facilitate endoscope passage was created through the turbinate and sinoscopy performed to identify structures within the CFS and caudal maxillary sinus (CMS) and to evaluate the quality of the approach. The procedure was then performed in standing, sedated horses. Time required, laser energy used and complications were recorded. Endoscopy was performed ≥5 weeks postoperatively to assess stoma size and long-term effects of the procedure. A stoma was successfully created through the turbinate in both cadaveric skulls and in 4 horses; the stoma persisted for ≥5 weeks. The location of the stoma in 1 horse precluded sinoscopy. Laser vaporization of the dorsal turbinate through the nasal passage creates a stoma that lasts for at least 5 weeks providing a portal to the paranasal sinuses. Based on experience in 1 horse stoma location is critical to ensure adequate endoscope manipulation and sinoscopy. Standing endoscopic sinusotomy within the nasal cavity through the DCS is an alternative to more invasive sinusotomy techniques with fewer potential complications and a cosmetic result.