Trephination of the equine rostral maxillary sinus: efficacy and safety of two trephine sites.
Authors: Barakzai Safia Z, Kane-Smyth Justine, Lowles Joanna, Townsend Neil
Journal: Veterinary surgery : VS
Summary
# Editorial Summary: Rostral Maxillary Sinus Trephination — Site Selection and Age Considerations Maxillary sinus disease requires reliable surgical access, yet anatomical variation between individual horses can complicate trephination. Barakzai and colleagues examined two potential trephine portals in 40 cadaveric skulls using radiography and direct sinusotomy to evaluate their accuracy and safety, with particular attention to risk of iatrogenic tooth trauma. The rostral site proved significantly more dependable, entering the rostral maxillary sinus in 98% of skulls compared with only 68% for the caudal approach; whilst direct contact with cheek tooth crowns was relatively uncommon at both sites, younger horses (≤5 years) showed substantially elevated risk at both locations, with a significant negative correlation between age and the likelihood of tooth contact. Given that maxillary sinus trephination remains a common procedure for addressing sinusitis, cysts and other pathology, these findings suggest practitioners should favour the rostral portal as standard technique but must exercise particular caution with animals under five years of age, ideally utilising pre-operative radiographic planning to confirm sinus location and tooth anatomy before instrumentation. This age-related anatomical variation likely reflects ongoing maxillary bone remodelling and dental eruption in younger horses, factors that should inform clinical decision-making and informed consent discussions with owners.
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Practical Takeaways
- •Use the rostral RMS trephine portal as the preferred anatomical site—it reliably enters the sinus in 98% of cases versus only 68% for the caudal approach
- •In horses ≤5 years old, radiographic guidance is essential before trephination to avoid damaging erupting or functional cheek teeth, as younger horses carry significantly higher risk
- •Even with the preferred rostral site, expect a 18% chance of overlying a cheek tooth; combine anatomical landmarks with imaging in young horses
Key Findings
- •Rostral RMS trephine site was within the sinus in 98% of skulls versus 68% for caudal site
- •Rostral site overlay a cheek tooth in 18% of skulls compared to 10% for caudal site
- •Horses ≤5 years old showed significantly higher risk of trephine site overlying a tooth at both rostral (P=.02) and caudal (P=.03) sites
- •Radiographic appearance of maxillary septum correlated with anatomic location in 12 of 14 dissected skulls (86%)