Outcomes following single, caudally based bilateral versus unilateral frontonasal sinusotomy for treatment of equine paranasal sinus disease

Abstract

Background: Bilateral sinus disease is relatively uncommon in horses, accounting for 3%-4.5% of horses with sinonasal disease, but may require bilateral paranasal surgery for complete resolution. Complications and recurrence following bilateral sinusotomy have not been reported or compared to those following unilateral procedures.Objective: To describe clinical features and outcomes in horses undergoing standing single, caudally based bilateral frontonasal sinusotomy compared to unilateral frontonasal surgery.Methods: Records of horses (n = 37) undergoing surgical treatment for sinus disease (five bilateral, 32 unilateral) were retrospectively reviewed (2010-2017) for signalment, presenting complaint, duration of signs preoperatively, diagnostic imaging, treatments administered, duration hospitalization, complications, and owner satisfaction with the procedure. Mann-Whitney testing was used to compare age, duration of hospitalization, and follow-up time in horses undergoing unilateral or bilateral procedures. Fisher's exact testing was used to determine if sex predilection was present for unilateral or bilateral disease. Survival time and time to recurrence were compared by Kaplan-Meier survival curves and log-rank curve comparison testing. Significance was assessed at p < 0.05. Results:Length of signs prior to admission did not differ between horses with unilateral and bilateral disease (p = 0.09), but there was a tendency for horses with bilateral disease to have clinical signs for longer. Age (p = 0.19) and hospitalization duration (p = 0.53) did not differ between horses undergoing unilateral versus bilateral procedures. Recurrence or failure to resolve signs was reported in 11/32 (34%) of unilateral and 0/5 bilateral cases (p = 0.07). Conclusions:The bilateral single, caudally based sinusotomy approach may be considered to effectively treat bilateral paranasal sinus disease without concern for increasedThis is an open access article under the terms of the Creative Commons Attribution-NonCommercial-NoDerivs License, which permits use and distribution in any medium, provided the original work is properly cited, the use is non-commercial and no modifications or adaptations are made.

Antimicrobial use as an adjunctive treatment in dental‐related sinusitis in horses: A systematic review

“…In two studies (Kološ et al, 2017(Kološ et al, , 2020, tetracyclines (doxycycline or oxytetracycline) were combined with metronidazole (20 mg/kg PO, BID) and given for 9-10 days. In one study (Pezzanite et al, 2021), gentamicin Antimicrobials were used in all studies included in this review.…”

“…Given the small number of FDA-approved antimicrobials for horses and scarcity of clear therapeutic indications, off-label use of human drugs is common in equine clinical practice (FDA, 2008;Wilson & Magdesian, 2021). For example, treatment with metronidazole and cephalothin has been reported in three studies (Kološ et al, 2017(Kološ et al, , 2020Pezzanite et al, 2021). The definition of off-label use includes the status of approval of a specific drug by the FDA or other relevant authority and the approved indications for product use (dose, dosing interval, route of administration and duration of treatment) (FDA, 2008).…”

“…Sulfadiazine-trimethoprim (TMS), used in three studies (Dixon et al, 2015(Dixon et al, , 2021Pezzanite et al, 2021), is bioavailable in the mucosa of the paranasal sinuses of horses when given at a dose of 30 mg/kg PO BID (Bienert-Zeit et al, 2015). However, this antimicrobial is not effective against strict anaerobes (Ensink et al, 2005;Hardefeldt et al, 2019;Khan et al, 2013) and may not be an appropriate indication for DRS treatment or prevention of bacteraemia following dental extraction (Kern et al, 2016).…”

“…First-line treatment with procaine benzylpenicillin and neomycin (10 and 5 mg/kg respectively IM, SID for 3-5 days) followed by oral administration of sulphadiazine-trimethoprim (30 mg/kg, SID/ BID for 3-14 days) was reported in two studies (Dixon et al, 2015(Dixon et al, , 2021. First-line therapy with sulphadiazine-trimethoprim was also described (Pezzanite et al, 2021). In one study (Dixon et al, 2021), continuation of oral treatment with sulphadiazine-trimethoprim for 3-5 days after hospital discharge was recommended.…”

Blood Transfusion in Equids—A Practical Approach and Review

“…Certain surgeries are associated with an increased risk of both intra- and postoperative hemorrhage. As mentioned above, these include surgeries involving the head and paranasal sinuses, reproductive tract and spleen, as well as the foot, and various foreign-body and tumor removal surgeries [ 21 , 22 , 23 , 24 , 25 , 26 ]. Intraoperative hemorrhage is deemed to be a surgical complication if it is unexpected and/or severe enough to warrant blood transfusion [ 27 ].…”