Equis ISSN 2398-2977

Paranasal sinus: bone flap technique

Contributor(s): Stephen Adams, Paddy Dixon, Graham Munroe

Introduction

  • The paransal sinuses in the horse are commonly affected by a variety of disease processes, some of which require exploration or surgical treatment.
  • Bone flap techniques in the frontal and maxillary sinuses have been developed to allow maximum access to all parts of the paranasal sinuses for diagnosis and treatment of intrasinus disorders with superior cosmetic results.
  • Two main approaches:
    • Frontonasal flap: access to conchofrontal and caudal maxillary sinuses with additional steps for entry into rostral maxillary and ventral conchal sinuses.
    • Maxillary sinus flap: most suitable for lesions of the rostral and caudal maxillary sinuses (especially in older horses) but by breaking down the bony plates beneath the infra-orbital canal/ventroconchal sinus and between the rostral and caudal maxillary sinuses access can be gained to other parts.

Uses

  • Exploration of paranasal sinuses.
  • Removal of tumors   Respiratory: neoplasia  , masses, diseased cheek teeth, abnormal and infected mucosa.
  • Establish drainage into nasal cavity.

Advantages

  • Greater access to all parts of the paranasal sinuses for visualization and surgical manipulation.
  • Flexible positioning and size.
  • Good cosmetic results.
  • Frontonasal flap approach is superior to maxillary approach because of greater access, ease of generation and minimal hemorrhage.
  • Can be performed in horses that are docile and not head shy with sedation   Anesthesia: standing chemical restraint  and local anaesthesia   Anesthesia: local - overview  .

Disadvantages

Requirements

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Preparation

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Procedure

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Aftercare

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Outcomes

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Prognosis

  • Healing of bone flaps is usually excellent despite extensive sinus infection.

Further Reading

Publications

Refereed papers

  • Recent references from PubMed and VetMedResource.
  • Perkins J & Barakzai S (2005) The equine paranasal sinuses - Part 4. UK Vet 10 (5), 5-8.
  • Schumacher J et al (2000) Paranasal sinus surgery through a frontonasal flap in sedated, standing horses. Vet Surg 29 (2), 173-177 PubMed.
  • Schumacher J & Crossland L E (1994) Removal of inspissated purulent exudate from the ventral conchal sinus of three standing horses. JAVMA 205, 1312-1314 PubMed.
  • Freeman D E et al (1990) A large frontonasal bone flap for sinus surgery in the horse. Vet Surg 19, 122-130 PubMed.


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