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Standing trans-nasal endoscopic guided CO2 laser fenestration of the palatine bone to access the sphenopalatine sinus in a horse.
Abstract: To describe a novel standing trans-nasal endoscopic guided CO2 laser fenestration approach to access the sphenopalatine sinus (SPS) in the horse. Methods: Case report. Methods: Cadaver study and client-owned 20-year-old Warmblood gelding. Methods: The rostral palatine bone within the nasopharynx was investigated as a possible site for fenestration to access the SPS in cadavers. The ability to fenestrate the SPS was tested in cadavers using a flexible endoscope and CO2 laser fiber inserted via biopsy channel. The fenestration procedure was then performed in a clinical case presented for unilateral epistaxis where a soft tissue attenuating mass in the right SPS was identified with standing computed tomography (CT). Results: The cadaver study demonstrated the appropriate site within the nasopharynx midway between the vomer and dorsal conchal wall. The CO2 laser successfully ablated the mucosa and palatine bone to enable endoscopic access to the palatine portion of the SPS. The endoscopic procedure was performed as a two-step process via standing sedation due to mucosal bleeding obscuring visualization. Access to the SPS through fenestration allowed biopsy under direct endoscopic visualization with long-handled bronchoesophageal forceps inserted via the ipsilateral middle meatus. The mass within SPS was determined to be an undifferentiated carcinoma. Further treatment was declined and the horse euthanized 6 months following the procedure due to acute onset of neurologic symptoms. Conclusions: Endoscopically guided fenestration of the rostral palatine bone within the nasopharynx using CO2 laser in the standing horse provided good access and visualization of the palatine portion of the SPS.
© 2021 The American College of Veterinary Surgeons.
Publication Date: 2021-04-29 PubMed ID: 33914353DOI: 10.1111/vsu.13647Google Scholar: Lookup The Equine Research Bank provides access to a large database of publicly available scientific literature. Inclusion in the Research Bank does not imply endorsement of study methods or findings by Mad Barn.
- Case Reports
- Journal Article
Summary
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The research article focuses on a new method to access the sphenopalatine sinus (SPS) in a horse using a standing trans-nasal endoscopic guided CO2 laser. This approach was tested in a cadaver study and also applied in a real-world case which involved a 20-year-old Warmblood gelding.
Research Methodology
- The study involved two main parts – a theoretical component wherein the researchers first explored the feasibility of this new approach in cadavers, and a practical aspect where the procedure was performed in a clinical case.
- Initially, the rostral palatine bone within the nasopharynx was examined as a possible area for fenestration to reach the SPS in dead specimens. The effectiveness of this location to fenestrate the SPS was then verified in cadavers through a flexible endoscope and CO2 laser fiber, inserted via biopsy channel.
- Following this, the fenestration method was performed on an actual horse presented with unilateral epistaxis (nosebleed) and a soft tissue mass in the right SPS was identified using standing computed tomography (CT).
Results
- The cadaver study confirmed the location within the horse’s nasopharynx, both midway between the vomer (a part of the nasal septum) and dorsal conchal wall, as suitable sites for the fenestration approach.
- The CO2 laser successfully ablated (removed) the mucosa and palatine bone, thus allowing endoscopic inspection of the palatine portion of the SPS. However, due to mucosal bleeding obscuring the visuals, the procedure was carried out as a two-step process under standing sedation.
- The fenestration provided enough access for a biopsy with a long-handled bronchoesophageal forceps that was inserted via the ipsilateral middle meatus (the opening to the sinus).
- The mass within the SPS was later identified to be an undifferentiated carcinoma (cancer). The treatment was declined and the horse was euthanized six months later due to the emergence of acute neurologic symptoms.
Conclusion
- The CO2 laser-guided fenestration of the rostral palatine bone within the nasopharynx in a standing horse allowed sufficient access and visualization of the palatine portion of the SPS. The research showed potential for the use of CO2 lasers in invasive veterinary procedures.
Cite This Article
APA
Perez JA, Hutton AE, Cudd SK, Brown JA.
(2021).
Standing trans-nasal endoscopic guided CO2 laser fenestration of the palatine bone to access the sphenopalatine sinus in a horse.
Vet Surg, 50(6), 1350-1358.
https://doi.org/10.1111/vsu.13647 Publication
Researcher Affiliations
- Department of Large Animal Clinical Sciences, Marion duPont Scott Equine Medical Center, Virginia-Maryland Regional College of Veterinary Medicine, Leesburg, Virginia, USA.
- Department of Large Animal Clinical Sciences, Marion duPont Scott Equine Medical Center, Virginia-Maryland Regional College of Veterinary Medicine, Leesburg, Virginia, USA.
- Department of Large Animal Clinical Sciences, Marion duPont Scott Equine Medical Center, Virginia-Maryland Regional College of Veterinary Medicine, Leesburg, Virginia, USA.
- The Joint Pathology Center, Silver Spring, Maryland, USA.
- Department of Large Animal Clinical Sciences, Marion duPont Scott Equine Medical Center, Virginia-Maryland Regional College of Veterinary Medicine, Leesburg, Virginia, USA.
MeSH Terms
- Animals
- Carbon Dioxide
- Endoscopy / veterinary
- Horses / surgery
- Lasers
- Male
- Palate, Hard / surgery
- Paranasal Sinuses / surgery
References
This article includes 15 references
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Citations
This article has been cited 1 times.- Jehle MC, Biermann NM, Haltmayer E. Trephination versus Minimally Invasive Transnasal Approaches for the Diagnosis and Treatment of Sinus Disease in Horses. Vet Sci 2022 Jul 1;9(7).
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