A Large Frontonasal Bone Flap for Sinus Surgery in the Horse

A large frontonasal bone flap was created to treat diseases of the paranasal sinuses in 14 horses. The bone flap was made as wide as possible within the confines of the nasolacrimal duct so the floor of the frontal sinus and the dorsal and ventral conchae could be opened. These openings exposed the nasal passages, maxillary sinuses, and ventral conchal sinus thereby facilitating removal of diffuse and localized lesions from these sites. Diseases treated were ethmoid hematomas (4 horses), sinus cysts (5 horses), cryptococcal granuloma, osteoma, hemangiosarcoma, pus in the ventral conchal sinus, and periapical infection of a second molar. Four horses were euthanatized during or after surgery, one because of postsurgical pleuritis and pneumonia (horse with osteoma) and three because of their primary problems (cryptococcal granuloma, hemangiosarcoma, pus in the ventral conchal sinus). Skin suture abscesses that responded to treatment developed in four horses. Ten horses returned to their intended uses, the sinus flaps healed without blemish, and the original problems did not recur. The frontonasal flap technique provided greater access to all paranasal sinuses than methods described previously.     

Paranasal sinus surgery through a frontonasal flap in sedated, standing horses

OBJECTIVE: To report experience with paranasal sinus surgery through a frontonasal flap in sedated, standing horses. STUDY DESIGN: Treatment of 10 horses with naturally occurring paranasal sinus disease through a frontonasal bone flap created with the horses standing. ANIMALS: Ten adult horses. METHODS: After restraint and sedation, local anesthetic was injected subcutaneously along the proposed incision line over the conchofrontal sinus and was instilled into the sinuses through a small hole created in the frontal bone. A 3-sided, rectangular, cutaneous incision that extended through the periosteum was created over the frontal and nasal bones. The incision was extended into the conchofrontal sinus using a bone saw, and the base of the flap, on the midline of the face, was fractured. The sinuses were explored, and the horse was treated for the disease encountered. The flap was repositioned; subcutaneous tissue and skin were sutured separately. RESULTS: The horses had few signs of discomfort during creation of the bone flap and during disease treatment. Diseases encountered included inspissated exudate in the ventral conchal sinus (five horses), feed and exudate throughout the sinuses (one horse), occlusion of the nasomaxillary aperature (one horse), polyp (one horse), osteoma (one horse), and progressive ethmoidal hematoma (one horse). CONCLUSION: In selected cases, surgery of the paranasal sinuses can be performed safely on sedated and standing horses through a frontonasal bone flap. CLINICAL RELEVANCE: Performing surgery through a frontonasal bone flap with the horse standing and sedated, rather than anesthetized, eliminates risks and expense of general anesthesia.     

Congenital Osteoma of the Frontal Bone in an Arabian Filly

Congenital frontal osteoma has not been previously described in horses. This report records—for the first time—a congenital osteoma of the frontal bone in a 4-month-old Arabian filly. The filly had a frontal hard mass that was present at birth and then showed a slow and continuous growth. This mass appeared as a solitary, painless, oval dense tumor of compact bone, about 2 cm in diameter and 3 cm in length. The tumor was asymptomatic, and the skin over the mass was normal. Radiography revealed a well-defined oval, radio-dense mass projecting from the surface of the right frontal bone with no local invasion. The tumor had a broad-based attachment to frontal bone with normal frontal sinus. The mass caused disfigurement; therefore, it was removed at the owner’s request. The mass was diagnosed histopathologically as osteoma. The surgical excision of the osteoma was successful without any complications, and the filly adapted remarkably well after surgery. No recurrence was reported 20 months after the surgery. In conclusion, osteoma should be listed during the differential diagnosis of the congenital craniofacial masses in horses. Early diagnosis of the frontal osteoma guarantees a successful surgical treatment and consequently prevents the future complications.     

Radiographic examination of the facial, nasal and paranasal sinus regions of the horse: I. Indications and procedures in 235 cases

The radiographic procedures used for examination of the facial area and paranasal sinuses of 235 horses are reported. Clinical indications for these examinations and the diagnoses made are reviewed. Unilateral nasal discharge was the commonest reason for radiography, accounting for about one third of cases, most of which had radiological signs of paranasal sinus disease recognisable on erect lateral films. Oblique projections were required to obtain further information about the maxillary dental arcades and ventro-dorsal views demonstrated sinus expansion and extension of disease into the nasal cavity. In 24 horses with bilateral nasal discharge, the origin was usually shown to be in the lower respiratory tract and radiographic abnormalities were found in only 20 per cent of cases. Facial swelling was a feature of 25 per cent of cases; the commonest causes were premolar periapical disease, best shown on oblique views with the patient recumbent, and suture periostitis, easily demonstrated on erect lateral films. Other causes of facial swelling, which required multiple radiographic projections for evaluation, were sinus cysts and tumours and peripheral soft tissue masses. Epistaxis for which no cause could be found in the lower respiratory tract was the indication for radiography in a further 10 per cent of cases. In almost half of these a radiopaque shadow representing an ethmoid haematoma could be seen on an erect lateral film. A sinus cyst and a tumour were also recorded but most other causes of epistaxis failed to produce radiographic signs.(ABSTRACT TRUNCATED AT 250 WORDS)     

EQUINE PARANASAL SINUSOGRAPHY

Contrast paranasal sinusography was a simple procedure that enhanced evaluation of the paranasal sinuses in the standing horse. Two techniques of positive-contrast paranasal sinusography were developed using cadavers and sedated horses. For both techniques, 37% organically bound iodine was used. For the first technique, the conchofrontal sinus was injected with 30 ml of contrast medium followed by an additional 100 ml and 70 ml. For the second technique, the rostral maxillary sinus was injected with 20 ml followed by an additional 50 ml. Each technique enhanced visualization of different paranasal sinuses, and each was necessary for complete positive-contrast radiographic evaluation of the paranasal sinuses. The techniques of positive-contrast radiographic evaluation of the paranasal sinuses are described.     

USING SEMI‐AUTOMATED SEGMENTATION OF COMPUTED TOMOGRAPHY DATASETS FOR THREE‐DIMENSIONAL VISUALIZATION AND VOLUME MEASUREMENTS OF EQUINE PARANASAL SINUSES

The system of the paranasal sinuses morphologically represents one of the most complex parts of the equine body. A clear understanding of spatial relationships is needed for correct diagnosis and treatment. The purpose of this study was to describe the anatomy and volume of equine paranasal sinuses using three‐dimensional (3D) reformatted renderings of computed tomography (CT) slices. Heads of 18 cadaver horses, aged 2–25 years, were analyzed by the use of separate semi‐automated segmentation of the following bilateral paranasal sinus compartments: rostral maxillary sinus (Sinus maxillaris rostralis), ventral conchal sinus (Sinus conchae ventralis), caudal maxillary sinus (Sinus maxillaris caudalis), dorsal conchal sinus (Sinus conchae dorsalis), frontal sinus (Sinus frontalis), sphenopalatine sinus (Sinus sphenopalatinus), and middle conchal sinus (Sinus conchae mediae). Reconstructed structures were displayed separately, grouped, or altogether as transparent or solid elements to visualize individual paranasal sinus morphology. The paranasal sinuses appeared to be divided into two systems by the maxillary septum (Septum sinuum maxillarium). The first or rostral system included the rostral maxillary and ventral conchal sinus. The second or caudal system included the caudal maxillary, dorsal conchal, frontal, sphenopalatine, and middle conchal sinuses. These two systems overlapped and were interlocked due to the oblique orientation of the maxillary septum. Total volumes of the paranasal sinuses ranged from 911.50 to 1502.00 ml (mean ± SD, 1151.00 ± 186.30 ml). 3D renderings of equine paranasal sinuses by use of semi‐automated segmentation of CT‐datasets improved understanding of this anatomically challenging region.     

Paranasal sinus fibromatosis in a horse

A case of paranasal sinus fibromatosis in an 11‐year‐old Thoroughbred gelding is reported. At admission the gelding underwent a unilateral frontal sinusotomy and a paranasal sinus mass was extensively debulked. The mass was diagnosed via histopathology as a desmoid fibromatosis with bone invasion, reactive osteoclastic osteolysis and osteoproliferation. The gelding had radiographic evidence of slow recurrence of the mass 8 months post operatively. The histopathological appearance and short‐term outcome are presented for this previously undiagnosed condition of the horse. Recognition of paranasal fibromatosis and the resultant differentiation from other types of paranasal sinus neoplasia may allow for improved prognostication of equine sinus lesions.     

RADIATION THERAPY COMMUNICATION: NASAL PASSAGE AND PARANASAL SINUS LYMPHOMA IN A PONY

An aged pony with extensive paranasal sinus and nasal passage B-cell lymphoma was treated with palliative radiation therapy. Sixteen gray were administered in two fractions, 7 days apart. A lateral field was used for the first fraction and a dorsal field for the second. Because of tumor being present in the left frontal sinus, gross tumor was knowingly excluded from the treated volume in the lateral field. The tumor regressed within 2 months and the pony remained free of clinical disease for 2.5 years. Acute, temporary blindness developed shortly after the second radiation fraction, but a direct causal relationship with the radiation therapy was not confirmed. The only radiation side effect was leukotrichia. Palliative treatment was successful in improving and prolonging the quality of life. These results suggest that localized equine B-cell lymphoma is radiosensitive, and that palliative radiation therapy is a reasonable consideration for large tumors, even when tumor volume prevents all gross tumor from being irradiated.     

Calcified tumours of the paranasal sinuses in three horses

Three horses, a 10-year-old Thoroughbred mare, a 9-year-old Thoroughbred gelding and a 6-year-old Arab gelding, with calcified tumours of the paranasal sinuses, are described. All horses presented with purulent nasal discharges and facial distortion. Exophthalmos, blepharospasm and ocular discharge were also a feature in individual horses. A presumptive diagnosis of a calcified tumour was made on the basis of clinical signs and radiographic and endoscopic findings. The tumours ranged from 15 to 25 cm in diameter. A large frontonasal bone flap was used to expose the tumours, which were cleaved into several pieces with an osteotome and removed. Histological examination of the masses identified cementomas in two cases and an osteoma in the third. Long term follow up from 18 months to 5 years after surgery indicated that there was no recurrence. This case series demonstrates that, although calcified tumours of the paranasal sinuses are rare in horses, they should be considered in the differential diagnosis of purulent nasal discharge, facial swelling and ocular distortion, and are amenable to surgical treatment.     

Psittacine paranasal sinus--a new definition of compartments.

Documentation of the psittacine paranasal sinuses has been limited. To provide more published detail, spiral computed tomography (CT) was used to scan the cephalic and cervical region from cadavers of 10 psittacine birds (Ara ararauna, Ara chloroptera, Ara macao, and Anodorhynchus hyacinthinus). Skeletal studies, histologic examinations, and evaluation of deep-frozen sections and anatomic preparations confirmed the results of the CT scans. New morphologic details of the paranasal sinus and some compartments were discovered. The paranasal sinuses of these macaws consist of two unpaired rostral compartments, followed caudally by eight paired compartments. Histologic examinations revealed that the walls of the paranasal sinuses consist of flat or cubic monolayer epithelium with underlying connective tissue. The described method of CT examination of these macaws, especially the positioning, scan orientation and parameters, and documentation of the normal paranasal sinus, provides a basis for future clinical use of CT.     

CT and cross-sectional anatomy of the paranasal sinuses in the Holstein cow

The structure of paranasal sinuses in cattle is difficult to understand due to its complexity, age-related changes, and insufficient published data. In this prospective, anatomic study, we described the anatomy of the paranasal sinuses in the Holstein cow using computed tomography (CT) and cross-sectional anatomic slices. Twelve healthy adult Holstein cow heads were used for this study. The heads were scanned using CT, and frozen anatomical sections were taken. The locations, borders, and relationships of the paranasal sinuses were defined on the anatomical sections and CT images. The paranasal sinuses on each side of the head consisted of conchal (dorsal, middle, and ventral), maxillary, lacrimal, palatine, frontal, sphenoid sinuses, and ethmoidal cells. The frontal sinus pneumatized all bones surrounding the cranial cavity, except for the ethmoidal and body of basisphenoid bones. The sphenoid and ventral conchal sinuses were the most asymmetrical, and the middle conchal sinus was the simplest. The ventral conchal sinus was detected in eleven animals, one of which was unilateral. This sinus communicated with the middle nasal meatus (13/21) and ventral nasal meatus (8/21). Findings can be used as background for interpreting CT studies of cattle with clinical signs of sinonasal region diseases. Future cross-sectional radiological and reconstructive anatomical studies and investigation of the postnatal development of related structures in cattle are needed.     

Three-dimensional analysis of rodent paranasal sinus cavities from X-ray computed tomography (CT) scans

Continuous isometric microfocal X-ray computed tomography (CT) scans were acquired from an AKR/J mouse, Brown-Norway rat, and Hartley guinea pig. The anatomy and volume of the paranasal sinus cavities were defined from 2-dimensional (2-D) and 3-dimensional (3-D) CT images. Realistic 3-D images were reconstructed and used to determine the anterior maxillary, posterior maxillary, and ethmoid sinus cavity airspace volumes (mouse: 0.6, 0.7, and 0.7 mm³, rat: 8.6, 7.7, and 7.0 mm³, guinea pig: 63.5, 46.6 mm³, and no ethmoid cavity, respectively). The mouse paranasal sinus cavities are similar to the corresponding rat cavities, with a reduction in size, while the corresponding maxillary sinus cavities in the guinea pig are different in size, location, and architecture. Also, the ethmoid sinus cavity is connected by a common drainage pathway to the posterior maxillary sinus in mouse and rat while a similar ethmoid sinus was not present in the guinea pig. We conclude that paranasal sinus cavity airspace opacity (2-D) or volume (3-D) determined by micro-CT scanning may be used to conduct longitudinal studies on the patency of the maxillary sinus cavities of rodents. This represents a potentially useful endpoint for developing and testing drugs in a small animal model of sinusitis.     

Heterotopic polydontia as a cause for a cystic lesion in the paranasal sinus of a Thoroughbred filly

A 1-year-old Thoroughbred filly with left bony facial distortion was diagnosed with a multilobar expansile mass within the caudal maxillary and frontal sinuses on computed tomography (CT). Typical findings associated with a sinus cyst, including expression of amber fluid from the mass and a thick lining that could be peeled from the sinus walls, were found on surgical exploration of the sinus under general anaesthesia. Histological examination of firm structures within the fluid-filled cyst contained all components of embryologically normal dental tissue. The filly recovered well and entered training to race as a 2-year-old, as remodelling of the bony distortion and narrowing of the nasal passage was sufficient for airflow. Previous reports of paranasal cystic lesions in horses suggest developmental abnormalities as a causative factor, especially in young horses. Furthermore, heterotopic polydontia is reported as the underlying aetiology in some human paranasal sinus cysts. While polydontia has been reported in the paranasal sinuses and nasal passages of horses, this is the first case report that finds them associated with a cystic lesion within the paranasal sinus.     

Osteoma of paranasal sinuses of a horse

A 2-year-old Quarter Horse gelding was examined for torticollis, facial protuberances over the frontal and maxillary sinuses, and persistent nasal discharge unresponsive to antibiotics. Radiograph revealed an osseous mass in the right paranasal sinuses. Histologic examination of the biopsied mass led to a diagnosis of osteoma. The mass was removed surgically in sections from the right frontal and maxillary sinuses through separate bone flaps, and sinuses were irrigated with saline solution for 8 days after surgery. Two weeks after surgery, radiography revealed small osseous opacities in the right paranasal sinuses. These opacities remained unchanged in radiographs obtained up to 23 months after surgery.     

Sinoscopic Treatment of Rostral Maxillary and Ventral Conchal Sinusitis in 60 Horses

Objective— To evaluate the use of sinoscopy for detection and treatment of ventral conchal sinus (VCS) and/or rostral maxillary sinus (RMS) disease in horses.
Study Design— Case series
Animals— Horses (n=60) with suspected paranasal sinus disease.
Methods— Horses were evaluated by sinoscopy through a conchofrontal sinus (CFS) portal with ventral conchal bulla (VCB) fenestration. Other endoscopic sinus approaches and adjunctive diagnostic tests; oral examination, computed tomography, radiography, scintigraphy and endoscopic examination of the upper portion of the respiratory tract were used in some horses.
Results— The CFS approach permitted adequate observation of the RMS and VCS in 53 horses (88%). Hemorrhage caused by VCB fenestration prevented examination of the RMS and/or VCS in 12 horses (21%). Observation of lesions was possible in all horses diagnosed with neoplasia, sinus cysts, and progressive ethmoidal hematomas. Endoscopy of the paranasal sinuses was useful diagnostically in 82% of horses with primary sinusitis. Other diagnostic modalities were usually required to confirm a diagnosis of dental sinusitis.
Conclusions— Trephination into the CFS with VCB fenestration is a minimally invasive technique that provides consistent access to the RMS and VCS. It facilitates diagnosis of many sinus disorders and endoscopically guided treatment of many horses with sinus cysts and primary sinusitis, in combination with sinus lavage.
Clinical Relevance— Many diseases affecting the RMS and VCS can be diagnosed and resolved endoscopically using a CFS approach with VCB fenestration, thus avoiding the need for osteoplastic sinus surgery and its associated risks and complications.     

CONTRAST PARANASAL SINUSOGRAPHY FOR EVALUATION OF DISEASE OF THE PARANASAL SINUSES OF FIVE HORSES

Positive-contrast paranasal sinusography was employed to evaluate 5 horses with disease of the paranasal sinuses. Diseases of the paranasal sinuses of these horses were progressive ethmoidal hematoma, bacterial sinusitis secondary to dental disease, and neoplasia. Positive-contrast sinusography allowed more complete evaluation of disease of the paranasal sinus of the horse than did survey radiographs.     

Clinical anatomy of the equine sphenopalatine sinus

REASONS FOR PERFORMING STUDY: Disorders of the equine sphenopalatine sinus, including empyema and neoplasia, have been reported to cause damage to cranial nerves II and V. However, the clinical anatomy of these sinuses is not well described in horses. OBJECTIVE: To examine the anatomy of the sphenopalatine sinuses in a range of equidae and, in particular, to examine the relationship of these sinuses to adjacent major nerves and vessels. METHODS: The anatomy of the sphenoidal and palatine paranasal sinuses was examined in 16 equidae, primarily using transverse skull sections. Relevant structures were documented and photographed. RESULTS: There was much variation between individual horses in sphenopalatine sinus anatomy. The sphenoidal sinuses were small in young horses and appeared to become larger and more complex with age. Variation was present in the extent that the sphenopalatine sinus extended into the basisphenoid bone. The septum dividing left and right sphenoidal sinuses was frequently not midline, but was intact in all cases. The sphenoidal and palatine sinuses communicated in most horses. In such cases, what could accurately be termed the (combined) sphenopalatine sinuses usually drained directly into the caudal maxillary sinuses. Additionally, in 5 out of 16 cases, some compartments of the sphenoidal sinus also drained into the ethmoidal sinus. The dorsal and lateral walls of the sphenoidal sinus were very thin and directly adjacent to cranial nerves II, III, IV, V and VI and major blood vessels. CONCLUSIONS: The equine sphenoidal and palatine sinuses are very variable in their anatomy, but are always in close proximity to multiple cranial nerves and major blood vessels. POTENTIAL RELEVANCE: Many cranial nerves and blood vessels could be damaged with disorders involving the sphenopalatine sinus, potentially causing major and variable neurological syndromes, haemorrhage and extension of sepsis.     

Endoscopic Examination and Treatment of Paranasal Sinus Disease in 16 Horses

Sixteen horses with suspected paranasal sinus disease had endoscopic examination of the paranasal sinuses with a 4.0 mm arthroscope either while standing and sedated (14 horses) or under general anesthesia (two horses). Endoscopic diagnosis included sinusitis (four horses), sinus cyst (three horses), hemorrhage (three horses), neoplasia (three horses), and tooth root abnormalities (two horses). No abnormalities were detected in one horse. Endoscopic findings concurred with the radiographic findings in 13 horses (81%). Samples of sinus contents for bacteriologic (eight horses) and histologic examinations (five horses) were obtained using sinus endoscopy. Diagnostic sinus endoscopy was combined with debridement, lavage, and suction as a therapeutic technique in 10 horses. In three horses, sinus exploration was performed after diagnostic endoscopy confirmed sinus disease, whereas in three horses, further therapy was not recommended after sinus endoscopy. Clinical signs of sinus disease resolved in 11 horses (69%) overall and in eight of 10 horses (80%) with sinusitis, cyst formation, or hemorrhage using endoscopic techniques alone. Mild, local subcutaneous emphysema occurred at the portal sites in all horses, but healing occurred without additional complications, latrogenic damage to sinus structures occurred in one horse. Sinus endoscopy was useful in the diagnosis and management of paranasal sinus disease and avoided the need for exploratory sinusotomy in some horses.     

Reoccurrence of a paranasal osteoma following surgical removal in a 6-month-old Warmblood filly

A 6-month-old Warmblood filly presented for evaluation of a left sided unilateral mucopurulent discharge of 5 weeks' duration. Upper airway endoscopy revealed a large, smooth mass in the region of the ethmoturbinates. Dorso-ventral and lateral radiographs of the head revealed a large osseous mass in the left paranasal area. A biopsy was performed under general anaesthesia and an osteoma was diagnosed. A computed tomography (CT) examination was performed to guide surgical removal. Surgery was performed under general anaesthesia and a large mass was removed ~15 × 9 cm. A CT examination 3 months following surgery revealed three small areas of mineralisation. It was difficult to differentiate if these were areas of regrowth or portions of the original mass that were not entirely removed. A CT examination 8 months later revealed one of the areas had increased moderately in size. A second surgery was performed standing to remove the growth. A final CT 8 months later revealed no further evidence of a bone growth. This report describes the successful removal of an osteoma regrowth following initial surgical removal and, to the best of the authors’ knowledge, is the first to describe the reoccurrence of an osteoma after surgical intervention. It also describes a successful rhinotomy in the standing equine patient. This case highlights the importance of serial follow-up imaging after surgical removal as osteoma regrowth occurred in this case.     

Calvarial Osteoma with Cranial Vault Invasion in the Skull of a Ferret (Mustela putorius furo)

Osteoma is an uncommon tumor found in various animal species and is particularly rare or underreported in ferrets. A 2-year-old neutered male ferret (Mustela putorius furo) presented with an asymmetrical firm mass affecting the right dorsolateral skull. Radiographic images and computed tomography scans revealed a well-marginated mineralized mass involving the dorsal right calvarium that was growing concentrically into the cranium. A surgical biopsy sample was obtained and yielded a cytological diagnosis of sarcoma with reactive osteoblasts and osteoclasts and a histopathological diagnosis of osteoma. It was suspected that only the outer bony rim of the mass was submitted for histopathological evaluation, thereby adversely affecting the diagnostic quality of the sample. Based on interpretation of the combined imaging, cytological, and histopathological findings, a multilobular tumor of bone was suspected. Because of reduction in quality of life, the animal was euthanized 4 months after presentation, and postmortem examination yielded a definitive diagnosis of osteoma. This is the first report of an osteoma with cranial vault invasion in a ferret and is one of very few reports of this tumor diagnosed in this species. Lack of neurological signs in the patient, marked and extensive growth of the mass over several months, and the similar clinical appearance to other bony tumors leading to diagnostic ambiguity contributed to the distinctiveness of this case.