Trans-endoscopic diode laser fenestration of equine conchae via contralateral nostril approach.
Authors: Kološ Filip, Bodeček Štěpán, Žert Zdeněk
Journal: Veterinary surgery : VS
Summary
Chronic and recurrent sinusitis in horses presents a significant diagnostic and therapeutic challenge, particularly when traditional approaches fail to provide adequate drainage or visualisation of affected paranasal compartments. This cadaveric and clinical study examined a novel technique using trans-endoscopic diode laser fenestration of the conchae via a contralateral nostril approach, performed in seven cadaveric heads and eight live patients (seven horses, one donkey) with diagnosed sinusitis. Fenestrations were created in dorsal conchae (eight total: six cadaveric, two clinical) and ventral conchae (ten total: five cadaveric, five clinical), achieving good visualisation quality in six of eight patients despite bleeding complications in two cases; all patients demonstrated drainage through the fenestrations, and subsequent trans-nasal sinoscopy was possible in six of eight clinical cases, with stoma patency maintained for a mean of 14 days post-operatively and clinical improvement observed in six of eight patients. The technique offers a minimally invasive alternative for direct sinoscopic examination and therapeutic intervention in selected sinusitis cases, though visualisation can be compromised by haemorrhage and larger sinus masses may limit treatment options even after successful fenestration. For practitioners managing equine sinusitis, this approach warrants consideration as part of the surgical toolkit, particularly where conventional trephination has been ineffective or where enhanced visualisation of contralateral or dorsal sinus compartments is needed.
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Practical Takeaways
- •This trans-nasal endoscopic laser technique offers a minimally invasive alternative to traditional trephination for treating equine sinusitis, with good drainage and clinical outcomes in most cases
- •The procedure allows direct visualization and access to sinus contents for treatment of masses or infected material, improving on blind flushing techniques
- •Expect about 75% success rate for full sinoscopic examination; some cases with large masses may limit access, and bleeding can compromise visualization intraoperatively
Key Findings
- •Contralateral trans-nasal endoscopic laser fenestration of conchae was technically feasible in 8 equine patients (7 horses, 1 donkey) with sinusitis
- •Fenestrations provided adequate visualization and allowed trans-nasal sinoscopy in 6/8 patients for direct examination and treatment
- •Clinical signs improved in 6/8 patients with mean stoma persistence of 14 days postoperatively
- •Drainage through fenestrations was achieved in all patients, though visualization was compromised by bleeding in 2 cases