Trans‐endoscopic diode laser fenestration of equine conchae via contralateral nostril approach

Kološ, Filip; Bodeček, Š.; Žert, Zdeněk

doi:10.1111/vsu.12680

Cited by 12 publications

(25 citation statements)

References 26 publications

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“…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.…”

Section: Introductionmentioning

confidence: 99%

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

Jehle

Biermann²,

Haltmayer³

2022

Veterinary Sciences

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This retrospective case series aims to highlight the advantages and disadvantages of different treatment options for sinus disease in horses, with a special focus on surgical approaches. The medical records of 25 horses with sinusitis which presented to the equine hospital, Vetmeduni Vienna, between August 2020 and January 2022 were analysed. In 11 cases, conservative treatment by the transnasal endoscopic lavage of the affected sinuses through the sinonasal channel or through a developed, pre-existing sinonasal fistula was performed. In the remaining 14 cases, openings into the sinus for subsequent lavage were surgically created either via classical trephination/bone flaps (8) or by transnasal endoscopically guided minimally invasive approaches (8). In some cases (2), a combination of classical extra-nasal and minimally invasive transnasal approaches was required. The minimally invasive techniques used were comprised of laser surgery (3), electrosurgery (3) and balloon sinoplasty (2). The sinusitis and underlying diseases were successfully treated in all of the horses until hospital discharge. Long-term follow-up could be obtained only from a small number of patients due to the temporal proximity (the study began two years ago) to their initial discharge from the hospital, but they showed the continuous resolution of clinical signs in all cases in which follow up data were available. The results of this case series indicate that if surgical intervention is required, minimally invasive techniques appear to be a promising and potentially cheaper alternative to classical extra-nasal approaches for the treatment of sinus disease in selected cases. In the future, the use of these techniques should be considered more commonly with the broader availability of improved endoscopes and instruments. Additionally, by using small-diameter endoscopes, the need for any surgical intervention might be significantly reduced in many cases.

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Section: Introductionmentioning

confidence: 99%

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

Jehle

Biermann²,

Haltmayer³

2022

Veterinary Sciences

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“…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.…”

Section: Discussionmentioning

confidence: 99%

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

et al. 2021

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Idiopathic sino-nasal obstruction resulting in retention of large amounts of liquid in the paranasal sinus compartments was diagnosed in seven young (2. 2 ± 0.7 years) miniature-breed horses based on clinical, endoscopic, radiographic, and CT scan examinations. The most prevalent clinical signs included decreased or no airflow from the nostril(s) (7/7) and nasal discharge (6/7). The problem presented bilaterally in six of seven cases. An alternative sino-nasal communication was created through bone flap osteotomy surgery and perforation of the ventromedial floor of the dorsal conchae in all cases, followed by fixation of silicone irrigation tubes/Foley catheters in six of seven cases to keep the newly created ostium patent. This resulted in long-term resolution of the problem with good cosmetic appearance in all animals following a median period of 19 months. Premature loss of fixed tubes was reported in three cases.

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“…In this study, electrosurgical instruments were effectively used to create large sinonasal communications in horses. Transendoscopic conchal fenestration techniques with laser surgery have been described . Electrosurgical equipment was favored in this study because of the ease of instrument handling, lower cost, and difficulty of sectioning bone with surgical lasers.…”

Section: Discussionmentioning

confidence: 99%

“…Sinonasal drainage can also be affected by congenital deformations, dental diseases, traumatic insults, space‐occupying lesions (eg, sinus cysts, progressive ethmoidal hematoma, and neoplastic disease), and combinations of these conditions . Minimally invasive or transnasal surgical techniques recently developed to improve sinus drainage include balloon catheterization of the nasomaxillary opening and laser vaporization of the ventral and dorsal conchal sinuses . Fenestration of the dorsal conchal sinus limits access and drainage to the caudal sinus compartments consisting of the caudal maxillary (CMS), conchofrontal (CFS), middle conchal (MCS; ethmoidal), and sphenopalatine (SPS) sinuses.…”

Section: Introductionmentioning

confidence: 99%

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

et al. 2019

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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.

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Trans‐endoscopic diode laser fenestration of equine conchae via contralateral nostril approach

Abstract: The endoscopic approach reported here provides good visualization during the trans-endoscopic laser fenestration of the conchae. The fenestrations may allow a trans-nasal sinoscopic examination and treatment in selected cases of sinusitis in horses.

Cited by 12 publications

References 26 publications

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

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

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

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

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