A bilateral sinus cyst treated via a bilateral frontonasal bone flap in a standing horse.

The research article discusses the successful treatment of a rare case of bilateral paranasal sinus disease in a horse, using a novel method of creating a bilateral frontonasal bone flap under sedation and local anesthesia.

Background and Purpose of Study

• The purpose of the study was to explore a novel approach to treating a rare equine health issue – bilateral paranasal sinus disease. This ailment is not often reported in horses, but evidence of it was found in a 13-year-old Thoroughbred gelding, which was presenting with a bilateral mucopurulent nasal discharge.

Methodology

• The case was diagnosed using a combination of radiographic, endoscopic, and computed tomographic examinations. These revealed pathological changes bilaterally in the sinuses, suggestive of an ethmoid hematoma involving the maxillary and frontal sinuses.
• In order to treat this, the researchers performed a bilateral frontonasal bone flap – a process not previously reported in a standing, full-sized adult horse. A tracheotomy was also performed initially to ensure the horse had a clear airway throughout the procedure.
• During the process of elevating the flap, additional analgesia was administered to the horse as the dorsal section of the nasal septum was transected.
• The sinus masses were then successfully removed, and communications with the nasal cavities were created.

Results and Findings

• The procedure was successful, with only small sequestra needing to be removed from the left caudal maxillary sinus 4 weeks after the initial procedure.
• The horse recovered fully, with an excellent cosmetic outcome. Histopathological examination revealed that the mass removed was a sinus cyst. This confirmed the initial diagnosis.

Conclusions and Recommendations

• The researchers concluded that a bilateral sinus bone flap can be successfully used to access both the right and left paranasal sinuses simultaneously in adult, regular-sized horses.
• Regional nerve blocks are recommended to increase analgesia during the procedure.
• To ensure the horse’s airway remains open during the procedure, the researchers recommended a temporary tracheotomy.
• The post-operative cosmetic result was excellent according to the researchers, adding another positive aspect to the bilateral frontonasal bone flap procedure.