Sinoscopic Treatment of Rostral Maxillary and Ventral Conchal Sinusitis in 60 Horses

Justin D Perkins,Matthew Smith,Safia Z Barakzai,Padraic M Dixon,Zoë Windley

doi:10.1111/j.1532-950x.2009.00556.x

Abstract

To evaluate the use of sinoscopy for detection and treatment of ventral conchal sinus (VCS) and/or rostral maxillary sinus (RMS) disease in horses. Case series Horses (n=60) with suspected paranasal sinus disease. Horses were evaluated by sinoscopy through a conchofrontal sinus (CFS) portal with ventral conchal bulla (VCB) fenestration. Other endoscopic sinus approaches and adjunctive diagnostic tests; oral examination, computed tomography, radiography, scintigraphy and endoscopic examination of the upper portion of the respiratory tract were used in some horses. The CFS approach permitted adequate observation of the RMS and VCS in 53 horses (88%). Hemorrhage caused by VCB fenestration prevented examination of the RMS and/or VCS in 12 horses (21%). Observation of lesions was possible in all horses diagnosed with neoplasia, sinus cysts, and progressive ethmoidal hematomas. Endoscopy of the paranasal sinuses was useful diagnostically in 82% of horses with primary sinusitis. Other diagnostic modalities were usually required to confirm a diagnosis of dental sinusitis. Trephination into the CFS with VCB fenestration is a minimally invasive technique that provides consistent access to the RMS and VCS. It facilitates diagnosis of many sinus disorders and endoscopically guided treatment of many horses with sinus cysts and primary sinusitis, in combination with sinus lavage. Many diseases affecting the RMS and VCS can be diagnosed and resolved endoscopically using a CFS approach with VCB fenestration, thus avoiding the need for osteoplastic sinus surgery and its associated risks and complications.

Highlights

SINOSCOPY IS a minimally invasive technique that can be used to examine, diagnose, and treat diseases of the paranasal sinuses in conscious horses.[1,2,3,4,5] Sinoscopy is of greatest diagnostic value in horses with primary sinusitis, but contributes to the diagnosis of other sinus disorders including dental sinusitis, sinus cysts and progressive ethmoidal hematoma (PEH).[4]
Sinoscopy through a conchofrontal sinus (CFS) portal enabled examination of the rostral maxillary sinus (RMS) and ventral conchal sinus (VCS) in most horses affected with paranasal sinus disease
Creating a portal into the caudal aspect of the RMS has been recommended to examine the VCS and RMS,[2,3] but sinoscopy performed through this portal provides poor visibility of the VCS,[6] and can result in iatrogenic damage to the alveolar bone overlying the apices of the cheek teeth.[6,9]

Summary

Introduction

SINOSCOPY IS a minimally invasive technique that can be used to examine, diagnose, and treat diseases of the paranasal sinuses in conscious horses.[1,2,3,4,5] Sinoscopy is of greatest diagnostic value in horses with primary sinusitis, but contributes to the diagnosis of other sinus disorders including dental sinusitis, sinus cysts and progressive ethmoidal hematoma (PEH).[4]. In a sinoscopic study of 40 cadaveric, normal equine heads a portal into the conchofrontal sinus (CFS), coupled with fenestration of the ventral conchal bulla (VCB), provided the most consistent endoscopic access of any single-portal approach to evaluate the rostral maxillary. EQUINE PARANASAL SINOSCOPY sinus (RMS) and the ventral conchal sinus (VCS).[6] We report the diagnostic information obtained from sinoscopic examination of 60 horses with paranasal sinus disease using a CFS portal with fenestration of the VCB and describe complications and limitations of sinoscopy

Methods

Results

Conclusion