Trans-endoscopic diode laser fenestration of equine conchae via contralateral nostril approach.

This research explores a new endoscopic process for the examination and treatment of paranasal sinuses in horses and donkeys. Specifically, it looks at a diode laser fenestration of the conchae via the nostril on the opposite side of the animal’s face and recorded its effect on visualization during surgery, feasibility, and post-operative effects over three months.

Research Methodology

• The study implemented a two-fold approach using cadaveric and clinical study methods. Seven normal cadaveric equine heads and eight patients (seven horses and one donkey) diagnosed with sinusitis were incorporated in this study.
• The ex vivo method involved passing a video endoscope containing a diode laser fiber through the nostril and retroflexing it in the nasopharynx toward the contralateral conchae. This endoscope would then fenestrate the ventral or dorsal conchae. Parameters like duration of surgery, laser energy, visualization quality, and feasibility of sinoscopy through the fenestrations were recorded.
• The in vivo method evaluated aspects such as sinus drainage, sinoscopy 24 hours post operation, stoma persistence and clinical results after 3 months in the eight patients.

Research Findings

• The results showed that fenestrations were performed in eight dorsal conchae (6 cadavers, 2 patients), ten ventral conchae (5 cadavers, 5 patients), and one dorsal conchal bulla (1 patient).
• Good visualization was reported in six patients while two patients were affected by bleeding during the procedure. Drainage through the fenestrations was observed in all patients.
• Trans-nasal sinoscopy was feasible in all cadavers and in six out of the eight patients. It was however hindered in two patients due to the masses inside the sinuses.
• Stomata persistence was recorded until the discharge of the patients, with a mean duration of 14 days.
• The clinical symptoms improved in six out of the eight patients post-operation.

Conclusion

• Based on these findings, the research concludes that the endoscopic approach described provides good visualization during the trans-endoscopic laser fenestration of the conchae.
• The fenestrations offer the possibility of a trans-nasal sinoscopic examination and treatment option in selected cases of sinusitis in horses.