ISSN 2398-2977      

Paranasal sinus: bone flap technique

pequis

Introduction

  • The paranasal 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. Most suitable for younger horses where risk of trauma to dental structures is high through a maxillary approach.
    • 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 (paranasal sinus cyst, ethmoid hematoma), 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.
  • The sinuses may be packed with hemostatic gauze if hemorrhage is excessive.
  • Frontonasal flap approach is superior to maxillary approach because of greater access, ease of generation and minimal hemorrhage.
  • Can be performed standing in horses that are docile and not head shy with sedation Anesthesia: standing chemical restraint and local anesthesia 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.
  • Depends on underlying disease process.

Further Reading

Publications

Refereed papers

  • Recent references from PubMed and VetMedResource.
  • Barakzai S Z & Dixon P M (2014) Standing equine sinus surgery. Vet Clin North Am Equine Pract 30 (1), 45-62 PubMed.
  • Dixon P M & O'Leary J M (2012) A review of equine paranasal sinusitis: medical and surgical treatments. Equine Vet Ed 24 (3), 143-158 WileyOnline.
  • Dixon P M, Parkin T D, Collins N et al (2012) Equine paranasal sinus disease: a long-term study of 200 cases (1997–2009): treatments and long-term results of treatments. Equine Vet J 44 (3), 272-276 PubMed.
  • Tatarniuk D M, Bell C & Carmalt J L (2010) A description of the relationship between the nasomaxillary aperture and the paranasal sinus system of horses. Vet J 186 (2), 216-220 PubMed.

Other sources of information

  • Beard W (2014) Frontonasal and Maxillary Sinusotomy Performed Under General Anesthesia. In: Advances in Equine Upper Respiratory Surgery. Ed: Hawkins J. Wiley. pp 177-183 WileyOnline.
  • Nickels F A (2012) Chapter 43 - Nasal Passages and Paranasal Sinuses. In: Equine Surgery. 4th edn. Eds: Auer J A & Stick J A. Equine Surgery (Fourth Edition). W B Saunders. pp 557-568.
  • Tremaine W H & Freeman D E (2007) Disorders of the Paranasal Sinuses. In: Equine respiratory medicine and surgery. Saunders Elsevier, USA. pp 403-404.

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