Unilateral, Rostral Maxillary Sinusitis Resulting from Displacement and Retention of an Alveolar Plug in a 4-Year-Old Horse.

The research describes a case of sinusitis in a four-year-old thoroughbred mare that developed from the retention of an alveolar plug following the extraction of a molar tooth. The sinusitis was treated successfully by removing the alveolar plug, followed by additional sinus lavage for an abscess that formed later.

Introduction

• The article delves into an instance of a horse developing sinusitis subsequent to dental disease, especially after the extraction of the cheek teeth which can bring varying degrees of complications.
• Postoperative displacement and retention of alveolar plugs have been identified as potential complications, however, cases of resulting sinusitis are seldom reported.

The Case: A Horse with Sinusitis

• The subject of the study is a Thoroughbred mare presented with chronic unilateral left-sided mucopurulent nasal discharge, two months after the extraction of her left maxillary second molar tooth.
• Radiographic and computed tomographic (CT) scans showed soft tissue opacity in the left rostral sinus compartment, and an intraoral examination discovered feed impacted in the alveolus of the previously extracted tooth, as well as an oral sinus fistula.
• Upon conducting an upper airway endoscopy, a thick, purulent material at the nasomaxillary aperture was found, however sinoscopy revealed rather clean frontal, dorsal conchal and caudal maxillary sinuses.

Treatment and Resolution

• The alveolar dental plug left behind from the previous tooth extraction was found in the sinus and subsequently removed through the sinoscopy portal.
• Progressive clearance of the sinusitis was confirmed with repeat endoscopies during the horse’s hospitalization.
• Three months later, however, the unilateral nasal discharge recurred due to an abscess that had formed within the sinus. With further sinus lavage and lancing the abscess, the sinusitis was eventually resolved thoroughly.

Significance of the Study

• The study underscores the usefulness of sinoscopy through a frontal sinus trephination portal in the diagnosis and treatment of sinusitis in horses.
• It allowed for a quick, detailed evaluation of the structures and facilitation of adequate drainage and communication between all sinus compartments without the requirement of osteoplastic surgery.