Laser vaporization of the dorsal turbinate as an alternative method of accessing and evaluating the paranasal sinuses.

The research article presents an alternative method of accessing and evaluating the paranasal sinuses, in which researchers created an opening (stoma) through the dorsal turbinate in horses using laser vaporization. The main aim is to provide a less invasive alternative to traditional sinusotomy techniques with reduced complications.

Methodology

• The experiment was performed on both cadaveric equine heads (2 in number) and fully grown, healthy horses (5 in number).
• The researchers first tested the feasibility of the method on the cadaver heads. Using a custom-built, laser introducer rod (LIR), a diode laser fiber with a contact probe was inserted into the nasal passage.
• A videoendoscope was then passed through to identify the exact position for stoma creation – typically on the caudal, medial aspect of the turbinate which overlies the dorsal conchal sinus (DCS).
• After identifying the exact position, the researchers created an opening (stoma) facilitating endoscope passage. They also performed sinoscopy to identify the structures within the conchofrontal sinus (CFS) and caudal maxillary sinus (CMS), and assess the quality of the approach.
• This method was then repeated on the live horses, which were kept standing and mildly sedated. The results were recorded, including time taken, amount of laser energy used, and any complications observed.
• The stoma size and any long-term effects of the procedure were evaluated after five weeks or more post-operation.

Findings

• The researchers successfully created the stoma through the turbinate in both the cadaver samples and in four of the five live horses. These stomas persisted for over five weeks.
• However, in one instance, the location of the stoma prevented sinoscopy from being successfully carried out, indicating that the positioning of the stoma is crucial for the procedure to be feasible.

Conclusions

• The research concluded that laser vaporization of the dorsal turbinate through the nasal passage can create a persistent stoma, providing a consistent portal to the paranasal sinuses for at least five weeks.
• The study indicates that this standing endoscopic sinusotomy method, performed within the nasal cavity through the DCS, presents a less invasive alternative to traditional sinusotomy techniques. Its benefits include fewer potential complications and a more aesthetically pleasing result.