Laser vaporization of the dorsal turbinate as an alternative method of accessing and evaluating the paranasal sinuses.
Authors: Morello Samantha L, Parente Eric J
Journal: Veterinary surgery : VS
Summary
# Editorial Summary: Laser-Assisted Dorsal Turbinate Sinusotomy Paranasal sinus disease in horses often requires invasive surgical approaches; this 2010 study explored whether a less traumatic alternative could be achieved by using diode laser vaporisation to create a stoma (opening) through the dorsal turbinate as an access portal for diagnostic sinoscopy. Researchers developed and tested a custom laser introducer rod technique in two cadaveric heads before performing the procedure in five standing, sedated horses, recording operative time, energy requirements, and complications whilst monitoring stoma patency endoscopically at five weeks or beyond. Four of the five horses had successful stoma creation that persisted for at least five weeks, permitting direct visualisation of the conchofrontal and caudal maxillary sinuses, although placement proved critical—one horse's stoma location prevented adequate endoscope manipulation. As a minimally invasive alternative to traditional sinusotomy (which requires trephination through the frontal bone or cheek), this technique offers reduced surgical morbidity, improved cosmetics, and the ability to perform diagnostic and therapeutic procedures in standing animals, though practitioners should be aware that precise anatomical positioning is essential for successful sinoscopic evaluation and that longer-term stoma behaviour beyond five weeks remains undocumented.
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Practical Takeaways
- •This technique offers a less invasive alternative to traditional sinusotomy for diagnostic and therapeutic access to the paranasal sinuses in standing horses
- •The stoma remains patent for at least 5 weeks, allowing for repeated access or delayed therapeutic procedures if needed
- •Precise stoma placement on the caudal, medial aspect of the dorsal turbinate is essential for successful visualization and endoscopic manipulation
Key Findings
- •Laser vaporization of the dorsal turbinate successfully created a stoma in 4 of 5 standing horses and 2 cadaveric heads
- •The created stoma persisted for at least 5 weeks postoperatively
- •Standing endoscopic access to the conchofrontal and caudal maxillary sinuses was achieved with minimal invasiveness
- •Stoma location was critical to ensure adequate endoscope manipulation and visualization