Intrasinus bolstering of traumatic maxillary sinus fractures by using Foley catheter balloons in two foals.
Authors: Gardner Alison K, Santschi Elizabeth M, Mudge Margaret C, Belknap James K, Metzler Anne G
Journal: Veterinary surgery : VS
Summary
# Editorial Summary: Intrasinus Bolstering of Traumatic Maxillary Sinus Fractures Using Foley Catheter Balloons Severe comminuted fractures of the equine maxillary sinus and orbit present considerable surgical challenges, particularly when fragments are extensively denuded of periosteum and remain unstable despite suture fixation. Gardner and colleagues describe a novel supportive technique in which inflated Foley catheter balloons were placed intrasinus to bolster fracture fragments in two weanling foals following kick injuries, with the catheters maintained for 4 weeks post-operatively whilst exiting through a frontal sinus trephine. Both animals underwent preoperative computed tomography and dacrocystorhinography to assess comminution severity and nasolacrimal duct integrity, followed by surgical debridement of small fragments, suturing of larger pieces with polydioxanone, and nasolacrimal canaliculosinusotomy reconstruction. One foal prematurely dislodged the catheters and stenting at 11 days; however, both achieved complete fracture healing without surgical site infection, sinusitis, or sequestration, and progressed to high-level performance with good cosmesis and bilateral nasal airflow. This technique offers farriers and equine surgeons a practical, cost-effective method to maintain fracture stability during the critical healing window when dealing with unstable comminuted sinus fractures—particularly valuable in cases where traditional rigid fixation may prove difficult or where additional support is needed alongside suture repair.
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Practical Takeaways
- •Foley catheter balloons offer a cost-effective, readily available option for supporting unstable comminuted sinus fractures during healing when conventional fixation alone cannot maintain fragment position
- •Combined nasolacrimal canaliculosinusotomy and stenting should accompany sinus fracture repair when duct disruption is present to prevent epiphora
- •Plan for 4 weeks of catheter maintenance post-operatively, though premature dislodgement did not prevent good outcomes in this small case series
Key Findings
- •Foley catheter balloons successfully bolstered comminuted maxillary sinus fractures when placed intrasinus after suture repair
- •Both foals achieved good fracture healing, acceptable cosmesis, and bilateral nasal airflow without sinusitis or sequestration
- •Nasolacrimal stenting combined with catheter support resolved epiphora in both cases
- •Both foals returned to high-level performance despite one premature catheter dislodgement at 11 days post-op