Summary Intrasinus neoplasia remains a rare but difficult condition to diagnose and treat in the horse, comprising approximately 8–19% of sinonasal disorders. There are, however, only a few case series upon which to base an approach to diagnosis and management (Cotchin 1967, 1977; Madewell et al. 1976; Stunzi and Hauser 1976; Sundberg et al. 1977; Priester and McKay 1980; Boulton 1985; Hilbert et al. 1988; Dixon and Head 1999; Head and Dixon 1999; Tremaine and Dixon 2001a,b). Squamous cell carcinoma (SCC) is the most common neoplasm observed in the equine paranasal sinuses. Evidence from other species would indicate that early recognition of SCC is crucial to the success of treatment and the ideal treatment remains complete excision with margins. Sinus involvement generally precludes this and we must often settle for surgical debulking, with or without adjunctive radio‐ or chemotherapy. In horses, as in other species, early recognition is difficult because clinical signs are nonspecific. Treatment is, therefore, often not attempted due to the extensive nature of lesions at presentation and the limited surgical access. The accompanying article by Kowalczyk et al. (2011) showed how 3‐dimensional (3D) imaging can identify the hallmark changes associated with aggressive neoplasia in the equine sinuses (Kowalczyk et al. 2011). The value of computed tomography (CT) and magnetic resonance imaging (MRI) lies in noninvasive early diagnosis as well as lesion monitoring post intervention. Where CT can be performed with the horse in the standing position, avoidance of general anaesthesia offers further value, especially as standing surgical techniques now allow thorough, minimally invasive evaluation and biopsy of the equine sinuses. In combination, standing CT and minimally invasive sinus surgery allow accurate and early diagnosis and monitoring of disease progression, opening the door for advances in surgical and adjunctive treatments for this complex condition.
Summary Progressive haematomata (PH) are a rare cause of equine paranasal sinusitis and are thought to result from recurrent haemorrhage within the respiratory submucosa of the ethmoidal labyrinth. Clinical signs of PH are variable but mostly attributable to rupture of the mass with haemorrhage, occlusion of nasomaxillary drainage and secondary infection. Almost all affected horses have unilateral or bilateral, intermittent, serosanguinous nasal discharge. Radiographic examination is useful in identifying large PH, but small masses can be overlooked because of superimposition. Computed tomography (CT) has the benefit of producing cross‐sectional images of the sinuses, overcoming the limitations of radiography. The cases in this report suffered from bilateral PH not associated with the ethmoidal labyrinth. They highlight the benefit of CT in the diagnosis, surgical planning and evaluation of the architecture of the sinuses. Preoperative treatment with formalin to desiccate the mass prior to removal can be performed more safely when guided by CT.
Summary Primary fungal sinusitis was identified in 5 horses displaying signs of headshaking. All 5 horses had fungal plaques adhered to the infraorbital canal (IOC). Headshaking signs were exhibited by 3 horses prior to treatment and 2 horses after treatment. Standing computed tomography (CT) identified erosion of the IOC in the 2 cases in which it was performed. Fungal culture and PCR identified 3 species of fungi, Rhizomucor pusillus, Scedosporium apiospermum and Aspergillus nidulans which have not previously been described as a cause of sinusitis in horses. Surgical debridement followed by topical antifungal therapy was used in all 5 horses. Recurrence of the fungal plaques in 4 horses necessitated further treatment. The headshaking signs and nasal discharge resolved in 3 horses allowing a return to their previous use. Two horses developed persistent headshaking signs despite multiple treatments. Primary fungal sinusitis should be considered as a cause of headshaking signs in horses, due to a suspected trigeminal neuropathy. Computed tomography is valuable in identifying erosion of the IOC which is not identified with conventional radiography. Three out of the 5 cases were treated successfully but permanent resolution of the fungal infection is difficult to achieve once the bone overlying the infraorbital nerve has been eroded.
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