Comparison of sinoscopic techniques for examining the rostral maxillary and ventral conchal sinuses of horses.
Authors: Perkins Justin D, Bennett Cees, Windley Zoë, Schumacher Jim
Journal: Veterinary surgery : VS
Summary
# Sinoscopic examination of the rostral maxillary and ventral conchal sinuses: finding the best approach Effective endoscopic visualisation of the equine rostral maxillary sinus (RMS) and ventral conchal sinus (VCS) is clinically essential for diagnosing and treating conditions such as sinusitis and neoplasia, yet the optimal surgical approach has remained unclear. Using 40 cadaveric equine heads, Perkins and colleagues systematically compared six different trephination techniques, assessing how reliably each provided visualisation of both the rostral and caudal aspects of these interconnected structures. Whilst conventional RMS trephinations achieved only 28–40% success rates for complete examination, approaches incorporating fenestration of the ventral conchal bulla proved far superior: the combined conchofrontal and caudal maxillary sinus approach with VCB fenestration succeeded in 68% and 88% of cases respectively. Critically, direct RMS trephination offered poor VCS visualisation and risked iatrogenic damage to maxillary cheek tooth reserve crowns, making it unsuitable as a primary approach. For practitioners managing sinus disease, this evidence supports shifting toward fenestration-based techniques—particularly the combined approach—to achieve thorough endoscopic examination whilst minimising the risk of secondary dental complications.
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Practical Takeaways
- •When planning sinoscopy for rostral maxillary or ventral conchal sinus examination, use conchofrontal trephination with ventral conchal bulla fenestration as your primary approach to maximize visualization while protecting tooth structures
- •Avoid simple rostral trephination into the maxillary sinus alone, as it fails to visualize ventral conchal structures and risks iatrogenic damage to maxillary cheek tooth reserves
- •If complete visualization of both rostral and caudal sinus aspects is required, combine conchofrontal and caudal maxillary sinus trephination with ventral conchal fenestration for best results (88% success)
Key Findings
- •Combined conchofrontal and caudal maxillary sinus trephination with ventral conchal bulla fenestration achieved 68% success for rostral structures and 88% for caudal structures
- •Direct rostral maxillary sinus trephination provided poor access to ventral conchal sinus (0% success for rostral aspects) and risked maxillary cheek tooth reserve crown damage
- •Light-indicated rostral maxillary sinus approach achieved only 8% success for rostral structures despite endoscopic transillumination guidance
- •Conchofrontal trephination with ventral conchal bulla fenestration (60% rostral, 73% caudal success) represents a more practical alternative to combined approach