Sinoscopic treatment of rostral maxillary and ventral conchal sinusitis in 60 horses.
Authors: Perkins Justin D, Windley Zoë, Dixon Padraic M, Smith Matthew, Barakzai Safia Z
Journal: Veterinary surgery : VS
Summary
# Editorial Summary: Sinoscopic Treatment of Rostral Maxillary and Ventral Conchal Sinusitis Rostral maxillary sinus (RMS) and ventral conchal sinus (VCS) disease in horses often requires invasive surgical approaches, but endoscopic techniques offer a potentially less damaging alternative. Perkins and colleagues evaluated sinoscopy via a conchofrontal sinus portal with ventral conchal bulla fenestration in 60 horses with suspected paranasal sinus disease, combining endoscopic visualisation with supplementary imaging (CT, radiography, scintigraphy) and upper airway examination where indicated. The conchofrontal approach successfully permitted visualisation of the RMS and VCS in 53 horses (88%), with haemorrhage from the fenestration limiting examination in 12 cases (21%); notably, sinoscopy proved diagnostically useful in 82% of horses with primary sinusitis and enabled visualisation of all cases of neoplasia, sinus cysts, and progressive ethmoidal haematomas, though dental sinusitis typically required additional diagnostic modalities for confirmation. Endoscopic-guided treatment combined with sinus lavage successfully resolved many cases of sinus cysts and primary sinusitis, thereby avoiding osteoplastic sinus surgery and its inherent complications. For practitioners managing horses with suspected RMS or VCS disease, this technique represents a valuable minimally invasive option that merits consideration before committing to traditional surgical approaches, though the potential for significant haemorrhage during fenestration warrants careful case selection and haemostasis management.
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Practical Takeaways
- •Sinoscopy via conchofrontal approach with ventral conchal bulla fenestration is a minimally invasive alternative to osteoplastic sinus surgery for diagnosing and treating many sinus conditions, avoiding associated surgical risks
- •This technique works reliably for visualizing cysts and primary sinusitis lesions and allows endoscopic-guided treatment combined with sinus lavage, but expect occasional hemorrhage complications and plan for additional diagnostics in suspected dental cases
- •Success rate of 88% visualization makes this approach a practical first-line diagnostic tool for paranasal sinus disease, potentially reducing need for more invasive surgical interventions
Key Findings
- •Conchofrontal sinus approach with ventral conchal bulla fenestration provided adequate visualization of rostral maxillary and ventral conchal sinuses in 88% of 60 horses (53/60)
- •Sinoscopy was diagnostically useful in 82% of horses with primary sinusitis
- •Endoscopic visualization was successful in all horses with neoplasia, sinus cysts, and progressive ethmoidal hematomas
- •Hemorrhage from ventral conchal bulla fenestration prevented examination in 21% of cases (12/60), while other diagnostic modalities were typically required to confirm dental sinusitis