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.