Surgical enlargement of the nasomaxillary aperture and transnasal conchotomy of the ventral conchal sinus: Two surgical techniques to improve sinus drainage in horses

Abstract

Objective To evaluate 2 surgical techniques for establishing and/or improving paranasal sinus drainage in cadaver heads and horses with sinusitis and evaluate the feasibility of postoperative transnasal sinus endoscopy. Study design Ex vivo study (equine cadaver heads) and case series. Sample population Nine adult equine cadaver heads and 8 horses with recurrent sinusitis. Methods For the ex vivo study, the following procedures were performed on 9 cadaver heads: preoperative and postoperative computed tomography (heads 1–6), endoscopy‐guided transnasal conchotomy of the ventral conchal sinus (TCVCS) and surgical enlargement of the nasomaxillary aperture (SENMAP) on opposite sides (heads 1–3), combined TCVCS and SENMAP on both sides (heads 4–9), evaluation of sinus drainage before and after surgery (heads 7–9), and postoperative transnasal endoscopy (heads 4–9). For the case series, 8 horses with secondary sinusitis were treated in standing position with SENMAP and/or TCVCS and postoperative transnasal endoscopy. Results Sinonasal communications were successfully created in all cadavers and affected live horses. Transnasal endoscopy of all sinuses except the middle conchal sinus was possible in heads 4–9 and in all clinical cases. Sinus drainage was improved (P = .028) by combining techniques. Blood loss in live horses ranged from 0.5–5.5 L (1.95 ± 1.5) per horse. Sinusitis resolved in all affected horses during follow‐up of 3.2–25.5 months (13.5 ± 8.5). Conclusion Transnasal conchotomy of the ventral conchal sinus and SENMAP consistently created large sinonasal communications, facilitating sinus endoscopy and improving sinus drainage. Clinical significance Transnasal conchotomy of the ventral conchal sinus and SENMAP are viable options to treat horses with sinusitis and anatomical obstructions of the sinonasal communications.

Trephination versus Minimally Invasive Transnasal Approaches for the Diagnosis and Treatment of Sinus Disease in Horses

“…It is important to keep in mind that, in cases of secondary sinusitis, the treatment of the underlying cause is mandatory for long-term resolution of clinical sings [ 3 ]. Classical extra-nasal surgical techniques, including maxillary and frontal trephinations and bone flaps, have successfully been used to gain access to the sinus system and treat sinusitis [ 3 , 7 , 8 , 9 , 10 , 11 , 12 , 13 ] with or without sinuscopy via the externally created openings [ 3 , 8 , 10 , 14 , 15 , 16 , 17 ]. However, with improvements in the quality and size of endoscopes and instruments, transnasal endoscopically guided techniques have also been successfully used in the last 20 years [ 4 , 12 , 18 , 19 , 20 , 21 , 22 , 23 ].…”

“…Classical extra-nasal surgical techniques, including maxillary and frontal trephinations and bone flaps, have successfully been used to gain access to the sinus system and treat sinusitis [ 3 , 7 , 8 , 9 , 10 , 11 , 12 , 13 ] with or without sinuscopy via the externally created openings [ 3 , 8 , 10 , 14 , 15 , 16 , 17 ]. However, with improvements in the quality and size of endoscopes and instruments, transnasal endoscopically guided techniques have also been successfully used in the last 20 years [ 4 , 12 , 18 , 19 , 20 , 21 , 22 , 23 ]. These minimally invasive transnasal techniques can be divided into three groups.…”

Diagnosis and Surgical Treatment of Idiopathic Primary Sino-Nasal Obstruction in Miniature Horse Breeds: Long-Term Follow-Up of Seven Cases

“…The treatment performed included surgical sinus access through a large fronto-nasal bone flap osteotomy and perforating the conchal wall for re-establishment of more permanent drainage to the nose proved to be successful for all cases without recurrence of fluid accumulation. However, a more minimally invasive approach, such as transendoscopic laser fenestration ( 20 , 21 ) or endoscopy-guided transnasal conchotomy ( 22 , 23 ), might be more sufficient to restore sino-nasal drainage in these cases. However, the obstructed nasal passages precluded such an approach.…”

Intraoperative depression of the bulla of the maxillary septum as a method of improving sinus drainage without epistaxis in horses

“…Even if the surgical procedure has been relatively blood-free, this procedure creates immediate and significant haemorrhage. To overcome this problem but maintain good post-operative drainage from infected sinuses, or to facilitate post-operative management, the balloon sinoplasty procedure was developed (Bell et al 2009); and more recently Bach et al (2019) reported on using a combination of electrocautery and sharp surgery to perform a transnasal conchotomy and surgical enlargement of the nasomaxillary aperture (SENMAP). Following these procedures, the packing can be passed through the widened nasomaxillary aperture into the middle and ventral meati and down the nostril.…”

“…2009); and more recently Bach et al . (2019) reported on using a combination of electrocautery and sharp surgery to perform a transnasal conchotomy and surgical enlargement of the nasomaxillary aperture (SENMAP). Following these procedures, the packing can be passed through the widened nasomaxillary aperture into the middle and ventral meati and down the nostril.…”