Transnasal endoscopic treatment of equine sinus disease in 14 clinical cases

Transnasal endoscopic sinus treatment was used in four horses diagnosed with primary sinusitis and 10 horses with dental sinusitis. Pre-existing (n = 5) or surgically created (n = 9) sinonasal fistulae were used as portals for transnasal endoscopic exploration, debridement and lavage of the inflamed sinus cavities. Endoscopic sinonasal fistulation was performed using either trans-endoscopic diode laser fibre (four cases) or an electrocautery instrument under endoscopic control (five cases). All procedures were performed on standing sedated horses with the use of local anaesthesia. In six cases, the ventral concha was fenestrated in order to gain a portal into the ventral conchal and rostral maxillary sinus. In two cases the dorsal concha was fenestrated to access the caudal group of the paranasal sinuses. One case required fenestration of the ventral conchal bulla due to its empyema. Post-operative bleeding was controlled with a nasal cavity tamponade for 24 h. Endoscopic lavage and debridement of the inflamed sinuses were performed every 2-3 days. Medical treatment consisted of antibiotic and anti-inflammatory drugs. In the cases of dental sinusitis, the underlying dental pathology was addressed. Median hospitalisation time was 10 days (range 5-25 days) and the median number of endoscopic procedures (including the initial procedure) was 4 (range 3-7). Cases were followed-up by telephone consultations with their owners. Intervals between discharge and last follow-up ranged from 4 to 22 months (median 9.5 months). Complete recovery was reported in 10 cases, clinical improvement (occasional nonpurulent discharge) in two cases. Two cases were readmitted due to recurrence of the purulent nasal discharge; both subsequently underwent trephination of the affected sinuses and made a full recovery after removal of the remaining pathological sinus content.