400
EQUINE VETERINARY EDUCATION
Equine vet. Educ. (2020) 32 (8) 400 doi: 10.1111/eve.13068_1
Case Report
Trans-nasal endoscopic treatment of equine sinus disease in 14 clinical cases F. Kolo
s* , S. Bode cek, M. Vyvial, S. Krisov Keywords: horse; sinusitis; endoscopy; concha; fenestration
Summary Trans-nasal endoscopic sinus treatment was used in four horses diagnosedwith primary sinusitis and 10 horses with dental sinusitis. Pre-existing (n = 5) or surgically created (n = 9) sinonasal fistulae were used as portals for trans-nasal endoscopic exploration, debridement and lavage of the inflamed sinus cavities. Necrotic
and purulent material adjacent to the pre-existing sinonasal fistulae (Fig 1) was debrided under endoscopic control to make
them patent for the endoscope. Surgical endoscopic sinonasal fistulation (Fig 2) was performed using either a trans-endoscopic diode laser fibre (four cases) or an electrocautery instrument under endoscopic control (five cases). All procedures were performed on standing sedated horses with the use of local anaesthesia. In six cases, the ventral concha was fenestrated in order to enter the ventral conchal and rostral maxillary sinus. In
Fig 1: A pre-existing sinonasal fistula with an adjacent sequester of the conchal bone (Case number 5). DC, dorsal concha; MC, middle concha; NS, nasal septum.
two cases, the dorsal concha was fenestrated to access the caudal group of the paranasal sinuses. One case required fenestration of the ventral conchal bulla due to its empyema. Post-operative bleeding was controlled with a nasal cavity tamponade for 24 h. Endoscopic lavage of the inflamed sinuses (via the working channel of the endoscope or using a separate rigid lavage catheter) was performed every 2–3days. Medical treatment consisted of antibiotic and anti-inflammatory drugs. In cases of dental sinusitis, the underlying dental pathology was addressed. Median hospitalisation time was 10 days (range 5– 25 days) and the median number of endoscopic procedures (including the initial procedure) was 4 (range 3–7). Cases were followed up by telephone consultations with the owners. Median follow-up timewas 9.5 months (range 4–22 months). A complete resolution of clinical signs was reported in 7/10 cases of dental sinusitis (five with surgically created and two with pre-existing sinonasal fistulae); a clinical improvement (occasional nonpurulent nasal discharge) was reported in two cases with pre-existing sinonasal fistulae. Complete resolution of clinical signs was observed in 3/4 cases of primary sinusitis (all had surgically created fistulae). Two cases (one primary and one dental sinusitis) showed recurrence of the purulent nasal discharge. Recurrence of the primary sinusitis was caused by inspissated purulent exudate in the ventral conchal sinus, which was not noticed during the initial treatment of the caudal sinus group empyema. In the second case, recurrence was caused by inaccessible dental fragments in the rostralmaxillary sinus with severely hyperplastic mucosal lining. Both cases underwent trephination of the affected sinuses and made a full recovery after removal of the remaining pathological sinus content.
Key points
• Trans-nasal endoscopic paranasal sinus treatment using sinonasal fistulae can be successfully used in selected cases of primary and dental sinusitis.
• Effective surgical endoscopic sinonasal fistulation requires correct assessment of location, extent and character of the inflammatory process and adequate space in the nasal cavities.
Fig 2: Surgically created (trans-endoscopic diode laser fibre) sinonasal fistula in the dorsal concha with inspissated purulent exudate protruding through the fenestration; DC, dorsal concha; VC, ventral concha; NS, nasal septum.
• Effect of the trans-nasal endoscopic treatment is limited in cases of sinus disease with masses growing inside the sinus cavity; in cases showing severe chronic mucosal hyperplasia inside the sinus and in cases with severely distorted anatomy of nasal and paranasal cavities – presence of these factors makes sinusotomy preferable over the trans-nasal endoscopic approach.
a and M. Mrckov a a
Equine Clinic, University of Veterinary and Pharmaceutical Sciences, Brno, Czech Republic *Corresponding author email:
kolosf@vfu.cz
© 2019 EVJ Ltd
Page 1 |
Page 2 |
Page 3 |
Page 4 |
Page 5 |
Page 6 |
Page 7 |
Page 8 |
Page 9 |
Page 10 |
Page 11 |
Page 12 |
Page 13 |
Page 14 |
Page 15 |
Page 16 |
Page 17 |
Page 18 |
Page 19 |
Page 20 |
Page 21 |
Page 22 |
Page 23 |
Page 24 |
Page 25 |
Page 26 |
Page 27 |
Page 28 |
Page 29 |
Page 30 |
Page 31 |
Page 32 |
Page 33 |
Page 34 |
Page 35 |
Page 36 |
Page 37 |
Page 38 |
Page 39 |
Page 40 |
Page 41 |
Page 42 |
Page 43 |
Page 44 |
Page 45 |
Page 46 |
Page 47 |
Page 48 |
Page 49 |
Page 50 |
Page 51 |
Page 52 |
Page 53 |
Page 54 |
Page 55 |
Page 56 |
Page 57 |
Page 58 |
Page 59 |
Page 60 |
Page 61 |
Page 62 |
Page 63 |
Page 64 |
Page 65 |
Page 66 |
Page 67 |
Page 68 |
Page 69 |
Page 70 |
Page 71 |
Page 72 |
Page 73 |
Page 74 |
Page 75 |
Page 76 |
Page 77 |
Page 78 |
Page 79 |
Page 80 |
Page 81 |
Page 82 |
Page 83 |
Page 84 |
Page 85 |
Page 86 |
Page 87 |
Page 88 |
Page 89 |
Page 90 |
Page 91 |
Page 92
