Fenestration of the maxillary septal bulla using different surgical approaches and endoscopy systems in horses: An ex vivo study.
Authors: de Lima A E, Mendes R P, Piñeros D D V, Alibrando B B, de Zoppa A L V, da Silva L C L C, de Freitas S H, Corrêa R R
Journal: Journal of equine veterinary science
Summary
# Editorial Summary: Maxillary Septal Bulla Fenestration in Equine Sinoscopy Equine sinusitis management often requires surgical fenestration of the maxillary septal bulla to improve drainage and facilitate treatment, yet optimal techniques for this procedure remain unclear. De Lima and colleagues used six chemically preserved cadaveric heads to systematically evaluate two surgical portal approaches (frontal and caudal maxillary) combined with 0° and 30° rigid endoscopes, assessing both visualisation quality and instrument accessibility for fenestration. All specimens achieved satisfactory sinus cavity exploration; however, portal selection critically determined procedural success, with the caudal maxillary portal proving problematic as a viewing portal due to infraorbital canal interference in 50% of cases, and frontal portals creating significant obstruction when used for instrumentation (83.33% complete prevention or 16.66% partial interference with bulla fenestration). The authors' recommendation—using frontal portals exclusively for visualisation whilst accessing the maxillary septal bulla through caudal maxillary instrument portals—provides a clear surgical protocol that should improve consistency and success rates when managing horses with recurrent sinusitis or bulla-related pathology. Lens angle selection appeared less critical than portal positioning, suggesting that portal placement strategy warrants greater emphasis in clinical training and case planning than endoscope specifications.
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Practical Takeaways
- •When performing endoscopic fenestration of the maxillary septal bulla, use frontal portals for visualization and caudal maxillary portals for instrument passage to maximize procedural success
- •Avoid using caudal maxillary portals as primary viewing portals as anatomical constraints from the infraorbital canal will limit visualization in approximately half of cases
- •Frontal portals should not be used as instrument portals due to consistent interference from the frontomaxillary opening that compromises fenestration technique
Key Findings
- •Frontal portals used as viewing portals with caudal maxillary portals as instrument portals achieved successful fenestration of the maxillary septal bulla in all specimens
- •Caudal maxillary portals as viewing portals resulted in limited endoscope maneuverability due to infraorbital canal interference in 50% of antimeres
- •Frontal portals used as instrument portals caused frontomaxillary opening interference that either prevented (16.66%) or interfered with (83.33%) appropriate bulla fenestration
- •Both 0° and 30° endoscope lens angles successfully visualized sinus cavities and structures of interest across all specimens