Authors: Perez Jairo A, Hutton Anne E, Cudd Sarah K, Brown James A
Journal: Veterinary surgery : VS
Summary
# Editorial Summary Accessing the sphenopalatine sinus (SPS) in horses presents significant clinical challenges, particularly when pathology requires direct visualisation and tissue sampling. Perez and colleagues developed and tested a novel standing trans-nasal endoscopic approach using CO2 laser fenestration through the rostral palatine bone to reach the SPS, first validating anatomical landmarks in cadavers before applying the technique to a clinical case of unilateral epistaxis. The cadaver work identified the optimal fenestration site within the nasopharynx, midway between the vomer and dorsal conchal wall, confirming that CO2 laser ablation could effectively penetrate both mucosa and bone whilst maintaining adequate endoscopic visualisation. In the clinical case, the procedure successfully provided direct access to obtain biopsies of a soft tissue mass (ultimately diagnosed as undifferentiated carcinoma) using long-handled forceps introduced via the ipsilateral middle meatus, though the two-stage standing approach was necessary to manage mucosal bleeding. For practitioners managing horses with suspected SPS pathology, this technique offers a minimally invasive alternative to traditional surgical approaches, enabling tissue diagnosis whilst avoiding general anaesthesia—particularly valuable given that many SPS lesions prove neoplastic or otherwise serious, where early identification informs prognosis and treatment decisions.
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Practical Takeaways
- •This novel standing endoscopic technique offers a minimally invasive alternative to traditional approaches for diagnosing and accessing sphenopalatine sinus pathology without general anesthesia
- •Practitioners should consider epistaxis with radiographic evidence of sphenopalatine sinus masses as a potential indication for this diagnostic procedure to obtain tissue samples for definitive diagnosis
- •The two-stage procedure design accommodates intraoperative hemorrhage management while maintaining standing sedation, making it a practical option for field or clinic-based cases
Key Findings
- •Standing trans-nasal endoscopic CO2 laser fenestration successfully accessed the sphenopalatine sinus through the rostral palatine bone in the nasopharynx
- •The procedure allowed direct endoscopic visualization and biopsy of a soft tissue mass identified as undifferentiated carcinoma
- •Fenestration site identified as midway between vomer and dorsal conchal wall provided optimal access to the palatine portion of the sphenopalatine sinus
- •Two-step procedure under standing sedation was necessary due to mucosal bleeding obscuring visualization during initial fenestration