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Paranasal sinus: bone flap technique – standing surgery
Introduction
- Standing sinus surgery offers an alternative to sinus surgery under general anesthesia Paranasal sinus: bone flap technique:
- The procedure is done using sedation Anesthesia: standing chemical restraint and local anesthesia Anesthesia: local - overview.
- The method described here involves making a bone flap in the frontal bone, which is then replaced (better cosmetic outcome) or discarded.
- A thorough knowledge of the relevant anatomy is essential.
- The procedure can be used for diagnostic and therapeutic reasons.
- The most commonly treated conditions are primary sinus empyema, sinus cysts, mass debulking, and progressive ethmoid hematomas.
Uses
- The procedure can be used for diagnostic and therapeutic reasons.
- The most commonly treated conditions are primary sinus empyema, sinus cysts, mass debulking, and progressive ethmoid hematomas.
Advantages
- No risk of general anesthesia.
- Better orientation of the anatomy with less engorgement from recumbency.
- No cost of general anesthesia.
- Less blood loss than in a recumbent horse.
- Less engorgement of anatomical structures.
Disadvantages
- Requires a thorough knowledge of the anatomy of the head and the sinuses:
- Inadequate anatomical knowledge can result in severe hemorrhage necessitating a GA and tamponade packing of the sinuses.
- Inadequate knowledge of the procedure can → damage of the nasolacrimal duct or infra-orbital canal.
- Not recommended for sinonasal fenestration or for dental repulsion Teeth: repulsion.
Technical problems
- Trephines of a suitable size can be difficult to obtain and to sharpen:
- Bone flap creation with an oscillating saw/mallet and osteotome results in a more cosmetic outcome.
- The horse must be kept quiet on a proper headstand.
- Certain sinus conditions, such as sinusitis or neoplasia, may increase hyperalgesia and render the patient reactive.
- Good quality radiographs Head: radiography or computed tomography (CT) Computed tomography of the skull is often necessary for surgical planning, especially in cases of facial distortion caused by masses or with dental pathology.
Alternative techniques
- Sinus surgery under general anesthesia Paranasal sinus: bone flap technique:
- Usually reserved for procedures such as neoplasia removal or tooth removal.
- Standing and surgery under GA can be performed in which the bone flap is preserved and replaced:
- The flap can either be cut on three sides and bent backwards at the fourth side or cut on all four sides.
- The flap can be replaced, and the periosteum sutured with absorbable suture material before subcutaneous and skin closure.
- The flap can be replaced using stainless steel wires passed through small drill holes:
- This procedure requires some extra time and equipment and does not necessarily improve the cosmetic outcome over flap replacement and periosteal suturing.
Time required
Preparation
- 15 min for sedation, clipping and prepping.
Procedure
- Depends on the pathology.
- 20 min to 1 h.
Decision taking
Criteria for choosing test
- Applicable to most causes of sinus pathology but not recommended for tumor removal, dental repulsion or sinonasal fenestration.
Risk assessment
- Examination of patient to ensure safe sedation.
- Patient must be reasonably tractable.
Requirements
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Preparation
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Technique
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