Equine paranasal sinus disease: a long-term study of 200 cases (1997-2009): treatments and long-term results of treatments.
Authors: Dixon P M, Parkin T D, Collins N, Hawkes C, Townsend N, Tremaine W H, Fisher G, Ealey R, Barakzai S Z
Journal: Equine veterinary journal
Summary
# Editorial Summary: Equine Paranasal Sinus Disease—Long-term Outcomes in 200 Cases Over a 13-year period, Dixon and colleagues retrospectively analysed treatment outcomes across nine distinct types of sinus pathology in 200 horses, comparing evolving surgical and endoscopic approaches to establish evidence-based management strategies for this frequently troublesome condition. The cohort encompassed primary sinusitis (both acute and chronic presentations), dental-related disease, cysts, trauma, oromaxillary fistulae, neoplasia, mycosis, and ethmoid haematoma, with treatments shifting progressively towards more conservative techniques including sinoscopic lavage and standing sinusotomy via a maxillary approach. Following a median of a single treatment, 91% of horses achieved complete resolution and a further 7% showed partial improvement across all disease types except neoplasia (which achieved cure in only 22% of cases), with particular success noted in sinus cyst removal and improved outcomes in chronic primary sinusitis managed by removal of inspissated material via existing sinonasal fistulae or sinusotomy rather than aggressive sinostomy. The data demonstrate that standing maxillary sinusotomy in mature horses, combined with conservative debridement strategies and careful dental management (attempting oral extraction before repulsion), delivers excellent long-term prognosis and warrants adoption as first-line surgical intervention in general equine practice. These findings challenge the necessity for more invasive historical approaches and provide a rational framework for treatment selection based on sinus pathology type and individual patient factors.
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Practical Takeaways
- •Conservative surgical approaches using sinoscopy and small maxillary sinusotomy should be first-line treatment for most sinus disease in mature horses, avoiding more invasive procedures
- •For dental-related sinus disease, attempt oral extraction of infected teeth before repulsion—even failed attempts improve outcomes of subsequent repulsion procedures
- •Prognosis varies dramatically by disease type: expect excellent results for cysts and infectious/traumatic disease, but neoplastic cases require different management strategy and have poor prognosis
Key Findings
- •91% of horses with equine sinus disease (excluding neoplasia) achieved full cure following a median of one treatment
- •Conservative sinoscopic lavage and standing sinusotomy with maxillary approach were effective for chronic primary sinusitis and avoided need for sinonasal fistulation
- •Sinus cysts showed excellent prognosis with removal, while neoplastic cases had poor outcome (only 22% cured)
- •Attempted oral extraction of infected cheek teeth, even if unsuccessful, facilitated subsequent dental repulsion with few postoperative complications