Endoscopic therapy of progressive ethmoidal haematomas in horses via sinus maxillary trepanation - casereports

Abstract

During the period from 1999 to 2003 two patients with a progressive ethmoical haematoma were treated minimalinvasive via trepanation at the Clinic for Horses of the School of Veterinary Medicine, Hannover. The diagnosis was made by clinical examination, endoscopy of nasal passages as well as radiography of the head in lateral and ventrodorsol directions and CT-examination. After successful endoscopic treatment of the intranasal haematomas, done by electrosurgery with a wiresnare, by neodym-YAG-laser photoablation and/or by injection of 4% formaldehyde solution, the horses showed relapsing nasal hemorrhage after 3 (case 2) and 24 (case 1) months. Cause of bleeding was a secretion out of the nasomaxillary aperture. In both horses additionally a second CT-examination was performed and a expansion of the progressive haematomas into a caudoventral cave of the maxillary sinus below the orbita could be recognized. The trepanation was done on the standing sedated horse, followed by an endoscopic treatment of the visible haematoma (electrosurgery, injection of 4% formaldehyde solution). The aftercare consisted in antiphlogistics and antibiotics for 5 days and irrigation of the maxillary sinus for four weeks. Follow up neither epistaxis nor any endoscopic signs of progressive haematoma relapse was seen in both horses 12 months after trepanation.