Surgical enlargement of the nasomaxillary aperture and transnasal conchotomy of the ventral conchal sinus: Two surgical techniques to improve sinus drainage in horses.
Authors: Bach Fabienne Sabine, Böhler Alexandra, Schieder Katrin, Handschuh Stephan, Simhofer Hubert
Journal: Veterinary surgery : VS
Summary
# Editorial Summary: Surgical Techniques for Equine Sinusitis Two minimally invasive surgical approaches—transnasal conchotomy of the ventral conchal sinus (TCVCS) and surgical enlargement of the nasomaxillary aperture (SENMAP)—offer effective alternatives for managing recurrent equine sinusitis, particularly in cases complicated by anatomical obstruction. Researchers validated these techniques using nine cadaver heads with computed tomography and endoscopic evaluation, then applied them clinically to eight standing horses with secondary sinusitis, assessing drainage improvement and surgical feasibility. Combined application of both procedures significantly enhanced sinus drainage (P = .028) and enabled postoperative transnasal endoscopy of the maxillary, ventral, and dorsal conchal sinuses, whilst all eight treated horses achieved complete sinusitis resolution over follow-up periods averaging 13.5 months despite moderate intraoperative blood loss (mean 1.95 L per horse). For practitioners managing horses with treatment-resistant sinusitis or anatomical drainage impairment, these standing-position techniques provide reliable options to create large sinonasal communications that facilitate both therapeutic access and improved physiological drainage, potentially reducing the need for more invasive procedures.
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Practical Takeaways
- •For horses with recurrent sinusitis and anatomical obstructions, combining transnasal conchotomy with nasomaxillary aperture enlargement provides superior drainage improvement over either technique alone
- •These standing surgical procedures consistently resolve secondary sinusitis with acceptable blood loss (mean 1.95 L per horse) and enable postoperative endoscopic monitoring
- •Combining techniques improves surgical success and allows better visualization for postoperative assessment and treatment of refractory cases
Key Findings
- •Sinonasal communications were successfully created in all 8 clinical cases using SENMAP and/or TCVCS techniques
- •Combined TCVCS and SENMAP significantly improved sinus drainage compared to single techniques (P = 0.028)
- •Sinusitis resolved in all affected horses during follow-up of 3.2–25.5 months (mean 13.5 ± 8.5 months)
- •Postoperative transnasal endoscopy was feasible in all clinical cases, enabling visualization of most sinuses except the middle conchal sinus