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Paranasal sinus: sinuscopy
Introduction
- Unilateral nasal discharge is often caused by disorders of the paranasal sinuses.
- Definitive diagnosis may be provided by the clinical history and physical clinical examination.
- More likely additional diagnostic techniques will be required such as radiography Head: radiography, nasal endoscopy Respiratory: endoscopy and centesis Paranasal sinus: percutaneous centesis and three-dimensional imaging such as computed tomography (CT).
- Direct endoscopic examination of the sinus or sinuscopy is a useful adjunct in the evaluation of equine sinus disorders.
Uses
- Sinus centesis Paranasal sinus: percutaneous centesis.
- Biopsy sampling Biopsy: overview.
- Sinus lavage Paranasal sinus: lavage.
- Diagnosis of neoplasia Respiratory: neoplasia.
- Some surgical procedures can be carried out, eg:
- Removal of sinus cysts Paranasal sinus: cyst.
- Injection/debridement or laser ablation of progressive ethmoid hematoma Ethmoid: hematoma.
- Removal of bone fragments/clots from cases of sinus trauma Head: fractures.
- Debridement of intra sinus fungal lesions, and removal of inspissated exudate, especially in the ventral conchal sinus Paranasal sinuses: bacterial sinusitis.
Advantages
- Direct visualization of most of the structures in the paranasal sinuses.
- Relatively non-invasive.
- Well-tolerated in standing sedated horse.
- Alternative to exploratory surgery Respiratory: exploratory surgery.
Disadvantages
- Some limitation in surgical procedures that can be carried out.
- Requires some specialist equipment and knowledge.
Technical problems
- Inflammation of parasinus structures, such as the maxillary septal bulla may be difficult to disrupt for full sinuscopic evaluation of all sinuses.
- Hemorrhage may obstruct visualization.
- The patient may resent trephination and sinuscopy.
Alternative techniques
- Other diagnostic procedures, eg:
- Radiography Head: radiography.
- Nasal endoscopy Respiratory: endoscopy.
- Centesis Paranasal sinus: percutaneous centesis.
- Head trephination Head: trephination.
- Paranasal sinus bone flap technique Paranasal sinus: bone flap technique.
- Exploratory surgery Respiratory: exploratory surgery.
Time required
Preparation
- Standing sedation: 10 min.
- Aseptic preparation: 10-15 min.
Procedure
- Unilateral sinuscopy of frontal, caudal maxillary, and visible sphenopalatine sinuses: 20 min.
- Breakdown if maxillary sinus bulla and evaluation of rostral maxillary sinus: 20 min.
- Biopsy sampling or centesis: additional 10-20 min.
Decision taking
Criteria for choosing test
- Additional aid in diagnosis of sinusitis Paranasal sinuses: bacterial sinusitis, sinus cysts Paranasal sinus: cyst, and paranasal sinus neoplasia Respiratory: neoplasia.
Risk assessment
- Risk of hemorrhage is lower than paranasal sinus bone flap technique Paranasal sinus: bone flap technique.
- Patient compliance is key if performed standing.
Requirements
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Preparation
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Technique
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Aftercare
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Outcomes
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Further Reading
Publications
Refereed papers
- Recent references from PubMed and VetMedResource.
- Dixon P M, Kennedy R, Poll K, Barakzai S & Reardon R J M (2020) A long-term study of sinoscopic treatment of equine paranasal sinus disease: 155 cases (2012-2019). Equine Vet J PubMed.
- Morello S L & Parente E J (2010) Laser vaporisation of the dorsal turbinate as an alternative method of accessing and evaluating the paranasal sinuses. Vet Surg 39, 891-899 PubMed.
- Perkins J D et al (2009) Sinuscopic treatment of rostral maxillary and ventral conchal sinusitis in 60 horses. Vet Surg 38, 613-619 PubMed.
- Perkins J D et al (2009) Comparison of sinuscopic techniques for examining the rostral maxillary and ventral conchal sinuses of horses. Vet Surg 38, 607-612 PubMed.
- Barakzai S Z et al (2008) Trephination of the rostral maxillary sinus: efficacy and safety of two trephine sites. Vet Surg 37, 278-282 PubMed.
- Barakzai S & Perkins J (2005) The equine paranasal sinuses - Part 3. UK Vet 10 (2), 5-11.
Other sources of information
- Tremaine H (2007) Sinuscopy of the Paranasal Sinuses. In: Equine Respiratory Medicine and Surgery. Eds: McGorum B, Dixon P, Robinson & Schumacher J. Saunders Elsevier.