Transnasal, Endoscopically Guided Skull-Based Surgery by Pharyngotomy for Mass Removal from the Sphenopalatine Sinus in a Horse.
Authors: Radcliffe Rolfe M, Messiaen Yasmine, Irby Nita L, Divers Thomas J, Dewey Curtis W, Mitchell Katharyn J, Schnabel Lauren V, Bezuidenhout Abraham J, Scrivani Peter V, Ducharme Norm G
Journal: Veterinary surgery : VS
Summary
# Editorial Summary A seven-year-old Warmblood gelding that developed acute blindness three weeks after blunt head trauma was found on CT imaging to have a large mass filling the sphenopalatine sinus, extending dorsally towards the optic canals. Rather than utilising the standard transnasal rostral approach, the surgical team accessed the mass via a transnasal, endoscopically guided ventral pharyngotomy—effectively creating a window through the soft palate to reach the caudal extent of the affected sinus. Histopathological examination suggested a chondroma, and whilst surgical removal was successful and the horse's condition remained stable throughout the 6.5-year follow-up period, vision was not restored, likely due to irreversible optic nerve damage from chronic mass effect. This case demonstrates a viable alternative surgical approach for sphenopalatine sinus pathology, particularly where lesions extend caudally beyond the range of conventional rostral techniques, though practitioners should note that earlier intervention may be crucial for preserving function in cases where neural structures are at risk. Future refinement using smaller-diameter instrumentation and CT-guided navigation may further expand access and improve outcomes in similar presentations.
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Practical Takeaways
- •Transnasal endoscopic pharyngotomy offers a viable surgical approach for accessing sphenopalatine sinus lesions extending caudally, potentially improving outcomes over traditional approaches
- •Acute blindness following head trauma in horses warrants CT imaging to evaluate for masses within the sphenopalatine sinus compressing optic structures
- •Specialized endoscopic bone instruments and CT image guidance during the procedure may further improve surgical access and mass removal in this location
Key Findings
- •Transnasal endoscopically-guided ventral pharyngotomy approach successfully accessed and allowed removal of a large sphenopalatine sinus mass in a horse
- •The mass extended dorsally to the dorsal cortex of the sphenoid bone near the optic canals, causing acute blindness 3 weeks post-trauma
- •Histopathology suggested chondroma; horse recovered well surgically though vision was not regained at 6.5-year follow-up but disease did not progress