Paranasal sinus surgery through a frontonasal flap in sedated, standing horses

Objective-To report experience with paranasal sinus surgery through a frontonasal flap in sedated, standing horses. Study Design-Treatment of 10 horses with naturally occurring paranasal sinus disease through a frontonasal bone flap created with the horses standing. Animals-Ten adult horses. Methods-After restraint and sedation, local anesthetic was injected subcutaneously along the proposed incision line over the conchofrontal sinus and was instilled into the sinuses through a small hole created in the frontal bone. A 3- sided, rectangular, cutaneous incision that extended through the periosteum was created over the frontal and nasal bones. The incision was extended into the conchofrontal sinus using a bone saw, and the base of the flap, on the midline of the face, was fractured. The sinuses were explored, and the horse was treated for the disease encountered. The flap was repositioned; subcutaneous tissue and skin were sutured separately. Results-The horses had few signs of discomfort during creation of the bone flap and during disease treatment. Diseases encountered included inspissated exudate in the ventral conchal sinus (five horses), feed and exudate throughout the sinuses (one horse), occlusion of the nasomaxillary aperature (one horse), polyp (one horse), osteoma (one horse), and progressive ethmoidal hematoma (one horse). Conclusion-In selected cases, surgery of the paranasal sinuses can be performed safely on sedated and standing horses through a frontonasal bone flap. Clinical Relevance-Performing surgery through a frontonasal bone flap with the horst standing and sedated, rather than anesthetized, eliminates risks and expense of general anesthesia. (C) Copyright 2000 by The American College of Veterinary Surgeons.