Clinical and complementary diagnosis of sinus neoplasia in horses

Background: Sinus neoplasms are reported as low frequency in horses. Its clinical characteristics are often nonspecific, depend on complementary methods for diagnosis, and when diagnosed, generally they are already advanced, limiting therapeutic possibilities. The objective of this case series was to detail clinical aspects and complementary exams for sinus neoplasms for early diagnosis, comparing them with the literature. Cases: Four horses were treated at the College of Veterinary Medicine and Animal Science of the University of São Paulo, with different clinical signs and previous diagnoses, which when evaluated by respiratory endoscopy, radiography, oral cavity evaluation and histopathological exams, revealed the diagnosis of anaplastic carcinoma, poorly differentiated carcinoma, ossifying fibroma and lymphoma. Previous diagnosis, based mainly on clinical signs, were sinusitis secondary to apical infection, ethmoidal hematoma, sinus cyst and sinusitis secondary to periapical disease. The cases of anaplastic carcinoma (case 1) and lymphoma (case 4) presented with an advanced degree of the disease with involvement and destruction of paranasal structures and adjacent tissues, in addition to a poor general condition, which made surgical treatment impossible and led to euthanasia. In these cases, previous treatment was made to apical infection and periodontal disease with secondary sinusitis, but negative evolution led to suspicion of neoplasia, confirmed by histopathological exam of incisional biopsy of the mass in oral cavity. Benign ossifying fibroma (case 3) presented with progressive respiratory difficulty due to occlusion of the lumen of some nasal meatus and radiographic signs of invasion and deformation of the adjacent bones, it was submitted for surgical excision and there was no recurrence until hospital discharge. The poorly differentiated carcinoma (case 2) was a multilobulate neoformation in the ethmoidal region, similar to ethmoid hematoma in endoscopic and radiographic evaluation, it was submitted for excision and two sessions of electrochemotherapy with bleomycin, associated with administration of piroxicam, which obtained a good result until the period of 1 year after discharge. Discussion: It was found that many characteristics are common with these types of neoplasms, and the clinical signs, such as nasal secretions, airway obstruction, increased facial volume, severe alterations in oral cavity, although unspecific, suggest the differential diagnosis for neoplasms. It is important to differentiate from other diseases noting the evolution and growth of these tumors, like in cases 1 and 4, especially the growth to internal tissues, using complementary methods described here, like endoscopic and radiographic examination. Late identification or even manipulation of neoplasms, without proper diagnosis, leads to a few prognoses regarding life. When it is possible to perform surgical excision, complementary methods are important to guide the procedure, and definitive diagnosis is made through histopathologic exam and some need immunohistochemistry analysis. Cases 2 and 3 had surgical access, were submitted to excision and treatment with good results, both with close monitoring in first months and prolonged quality of life. These results highlight the importance of complementary methods for early diagnosis, correct intervention and monitoring of evolution.

Primary paranasal maxillary hematoma: clinical characteristics, diagnosis and surgical treatment

Background: The equine paranasal sinus have a complex anatomy and large compartiments. For this reason, deseasesthat affect these structures may develop for long periods before the animal show any clinical signs, making it difficult tostablish a definitive diagnosis and institute an adequate treatment. Usually, maxillary hematomas reports come from progression of ethmoidal hematomas, and the descriptions of primary maxillary hematomas are rare. This study aims to reportthe clinical features, diagnosis and treatment of a case of a maxillary hematoma not associated with ethmoidal turbinates.Case: An 8-year-old male horse, Mangalarga Paulista, was referred to the Centro de Apoio ao Ensino e Pesquisa FMVZUSP with history of nasal bleeding for over a year. The animal presented deformity on the right side of the face, with significant volume increase on the maxillary bone region and dull sound at percussion, in addition to great painfull sensibilitywhen palpated. The right nare had no airflow, suggesting complete obstruction of the right nasal cavity. In order to betterevaluate, endoscopic and radiographic exams were performed. At the radiographic exam, in ventrodorsal projection, itwas observed an increase of volume and radiopacity, occupying the right antimer of the nasal cavity, with left nasal septum deviation. In the right dorsoventral oblique projection, it was observed the filling of the rostral and caudal maxillarysinus with the content radiopacity as previously described. At endoscopy exam of the right nasal cavity, it was observeda rounded greenish structure on the middle meatus The diagnosis of maxillary paranasal sinus cist was suggested andsurgical removal, through maxillary sinusotomy was recommended. During the surgical procedure...

Primary paranasal maxillary hematoma: clinical characteristics, diagnosis and surgical treatment

Background: The equine paranasal sinus have a complex anatomy and large compartiments. For this reason, deseasesthat affect these structures may develop for long periods before the animal show any clinical signs, making it difficult tostablish a definitive diagnosis and institute an adequate treatment. Usually, maxillary hematomas reports come from progression of ethmoidal hematomas, and the descriptions of primary maxillary hematomas are rare. This study aims to reportthe clinical features, diagnosis and treatment of a case of a maxillary hematoma not associated with ethmoidal turbinates.Case: An 8-year-old male horse, Mangalarga Paulista, was referred to the Centro de Apoio ao Ensino e Pesquisa FMVZUSP with history of nasal bleeding for over a year. The animal presented deformity on the right side of the face, with significant volume increase on the maxillary bone region and dull sound at percussion, in addition to great painfull sensibilitywhen palpated. The right nare had no airflow, suggesting complete obstruction of the right nasal cavity. In order to betterevaluate, endoscopic and radiographic exams were performed. At the radiographic exam, in ventrodorsal projection, itwas observed an increase of volume and radiopacity, occupying the right antimer of the nasal cavity, with left nasal septum deviation. In the right dorsoventral oblique projection, it was observed the filling of the rostral and caudal maxillarysinus with the content radiopacity as previously described. At endoscopy exam of the right nasal cavity, it was observeda rounded greenish structure on the middle meatus The diagnosis of maxillary paranasal sinus cist was suggested andsurgical removal, through maxillary sinusotomy was recommended. During the surgical procedure...(AU)

Comparação de acessos cirúrgicos e equipamentos endoscópicos para a fenestração da bulha do septo maxilar em equinos

As sinusites secundárias a alterações dentárias são frequentes nos equinos e a sinuscopias têm se mostrado uma ferramenta importante permitindo a visualização direta das cavidades sinusais. Desta maneira, auxiliam tanto na identificação da extensão da lesão como no tratamento. O presente trabalho buscou comparar diferentes acessos cirúrgicos sinuscópicos para a avaliação das estruturas da cavidade sinusal e fenestração da bulha do septo maxilar, permitindo a comunicação entre as estruturas paranasais de maneira minimamente invasiva. Para isso, foram selecionados dois modelos endoscópicos, ambos rígidos e com 4mm de espessura, onde um possuía lente de 0º e outro lente de 30º, além de possuírem evidentes diferenças quanto à estrutura do endoscópio e fonte de luz. Para a avaliação dos diferentes acessos selecionados, foram utilizadas 6 cabeças de equinos adultos quimicamente preservadas. Foram realizadas quatro trepanações por antímero, sendo dois acessos cirúrgicos realizados na região frontal, e outros dois na região do seio maxilar caudal, todos tendo 10mm de diâmetro ao final do procedimento. Tanto o endoscópio com lente de 30º quanto o com lente de 0º permitiram que o procedimento de triangulação fosse realizado utilizando os acessos frontais e maxilares caudais selecionados. Ao término do experimento, foi possível inspecionar a cavidade sinusal e também explorar a bulha do septo maxilar, permitindo a retirada de tecido em caso de fenestração de maneira satisfatória. Além disso, constatou-se que os acessos frontais, principalmente F1, sendo utilizado como portal para o endoscópio associado ao acesso maxilar caudal MC2 para a manipulação do instrumental foram a melhor combinação para a realização da fenestração.

Secondary sinusitis to dental changes are common in horses and sinuscopies have been shown to be an important tool allowing direct visualization of sinus cavities. Thus, it helps both in identifying the extent of the lesion and in treatment. The present work sought to compare different sinuscopic surgical approaches for the evaluation of the structures of the sinus cavity and fenestration of the bulla of the maxillary septum, promoting communication between the paranasal structures in a minimally invasive way. For this, two endoscopic models were selected, both rigid and measuring 4mm in thickness, where one had a 0º lens and the other a 30º lens, in addition to having evident differences in the structure of the endoscope and light source. For the evaluation of the different surgical approaches, six chemically preserved horse heads were used. Four trepanations were performed per antimere, with two surgical accesses carried out in the frontal region, and another two in the region of the caudal maxillary sinus, all with a diameter of 10mm at the endo f the procedure. Both the endoscope with a 30º lens and the one with a 0º lens allowed the triangulation procedure to be performed using the selected frontal and caudal maxillary surgical approaches. In addiction, it was found that the frontal accesses, mainly F1 being used as a portal for the endoscope associated with the maxillary caudal access MC2 for the manipulation of the instruments, were the best combination to perform the fenestration.

Hematoma etmoidal progressivo em equino revisão de literatura e relato de caso / Progressive ethmoid hematoma in horses review and case report

O hematoma etmoidal progressivo (HEP) trata-se de uma massa não neoplásica que se expande a partir de hemorragias sucessivas da camada submucosa do labirinto etmoidal ou dos seios paranasais. Técnicas de diagnóstico, como endoscopia das vias aéreas superiores, radiografia e tomografia computadorizada, visam determinar a extensão das lesões. O tratamento é preconizado de acordo com o tamanho e localização do HEP, além da disponibilidade de equipamentos. As opções de tratamento incluem a ressecção cirúrgica, redução da massa por aplicação de agentes criogênicos ou laser e, a injeção de formaldeído intralesional. O prognóstico a longo prazo é reservado a desfavorável devido a alta taxa de recidivas da lesão. Este artigo fornece uma visão geral sobre a doença e descreve um caso de HEP tratado com sucesso pelo uso de injeção de formaldeído intralesional.

Progressive ethmoid hematoma (PEH) is a non-neoplastic mass which expands following repeated hemorrhage in the submucosa of the ethmoidal labyrinth or paranasal sinuses. Diagnostic techniques, as upper airway endoscopy, radiography and computed tomography, aims to determine the extent of the lesions. Treatment is based on size and location of the PEH, along with consideration of equipment availability. Treatment options include surgical resection, mass reduction with application of cryogens or laser, and intralesional formaldehyde injection. Prognosis for long-term resolution remains guarded to poor due to high rates of recurrence. This article provides an overview of the disease and reports a case of PEH successfully treated by the use of intralesional formaldehyde injection.

Hematoma etmoidal progressivo em equino revisão de literatura e relato de caso / Progressive ethmoid hematoma in horses review and case report

O hematoma etmoidal progressivo (HEP) trata-se de uma massa não neoplásica que se expande a partir de hemorragias sucessivas da camada submucosa do labirinto etmoidal ou dos seios paranasais. Técnicas de diagnóstico, como endoscopia das vias aéreas superiores, radiografia e tomografia computadorizada, visam determinar a extensão das lesões. O tratamento é preconizado de acordo com o tamanho e localização do HEP, além da disponibilidade de equipamentos. As opções de tratamento incluem a ressecção cirúrgica, redução da massa por aplicação de agentes criogênicos ou laser e, a injeção de formaldeído intralesional. O prognóstico a longo prazo é reservado a desfavorável devido a alta taxa de recidivas da lesão. Este artigo fornece uma visão geral sobre a doença e descreve um caso de HEP tratado com sucesso pelo uso de injeção de formaldeído intralesional.(Au)

Progressive ethmoid hematoma (PEH) is a non-neoplastic mass which expands following repeated hemorrhage in the submucosa of the ethmoidal labyrinth or paranasal sinuses. Diagnostic techniques, as upper airway endoscopy, radiography and computed tomography, aims to determine the extent of the lesions. Treatment is based on size and location of the PEH, along with consideration of equipment availability. Treatment options include surgical resection, mass reduction with application of cryogens or laser, and intralesional formaldehyde injection. Prognosis for long-term resolution remains guarded to poor due to high rates of recurrence. This article provides an overview of the disease and reports a case of PEH successfully treated by the use of intralesional formaldehyde injection.(AU)

Avaliação de quatro protocolos terapêuticos para a sinusite pós-descorna plástica em bovinos / Evaluation of four treatment protocols to sinusitis after plastic dehornig in cattle

A descorna plástica em bovinos adultos pode resultar em diversas complicações trans e pós-operatórias. Uma das possíveis sequelas deste procedimento é a sinusite, um processo inflamatório que acomete os seios paranasais, como consequência da exposição do seio frontal. No presente estudo, avaliou-se a eficácia de protocolos terapêuticos contendo hipoclorito de sódio, policresuleno, iodopovidona e solução isotônica de cloreto de sódio no tratamento da sinusite pósdescorna em 60 bovinos, distribuídos em quatro grupos experimentais de 15 animais, GI, GII, GIII e GIV. Durante o acesso ao seio frontal para proceder ao tratamento local, atentou-se para a presença de corpos estranhos, sendo observadas esquírolas ósseas, hastes de capim, fios de sutura e farpas de madeira. O escoamento da secreção mucopurulenta e a remoção do excesso de soluções empregadas no local infectado foi facilitada, girando a cabeça do animal e posicionando a abertura do seio frontal o mais ventralmente possível. Empregando o teste do Qui-quadrado, observou-se diferença significativa entre os tratamentos. O hipoclorito de sódio e a iodopovidona foram os tratamentos mais eficazes, podendo ser recomendados no tratamento desta enfermidade.

Plastic dehornig in adult cattle can result in several trans and postoperative complications. Sinusitis is an important sequela, resulting from an inflammatory process affecting the exposed frontal sinuses. In the present study, treatment protocols efficacy was evaluated in 60 bovines. Therapeutic protocols included sodium hypochlorite, policresulen, povidone-iodine and isotonic sodium chloride solution, which were divided into four experimental groups of 15 animals, GI, GII, GIII and GIV. During frontal sinus access to institute local treatment, attempts to identify foreign bodies, bone fragments, grass stems, suture material and wood splints were made. Mucous-purulent liquid drainage and excess solutions removal were facilitated by laterally rotating the animal’s head and placing the frontal sinus gap as ventral as possible. Using chi-square test, there was significant difference between treatments. Sodium hypochlorite and povidone-iodine were the most effective treatments, being recommended as part of sinusitis therapeutic protocol.

Avaliação de quatro protocolos terapêuticos para a sinusite pós-descorna plástica em bovinos / Evaluation of four treatment protocols to sinusitis after plastic dehornig in cattle

A descorna plástica em bovinos adultos pode resultar em diversas complicações trans e pós-operatórias. Uma das possíveis sequelas deste procedimento é a sinusite, um processo inflamatório que acomete os seios paranasais, como consequência da exposição do seio frontal. No presente estudo, avaliou-se a eficácia de protocolos terapêuticos contendo hipoclorito de sódio, policresuleno, iodopovidona e solução isotônica de cloreto de sódio no tratamento da sinusite pósdescorna em 60 bovinos, distribuídos em quatro grupos experimentais de 15 animais, GI, GII, GIII e GIV. Durante o acesso ao seio frontal para proceder ao tratamento local, atentou-se para a presença de corpos estranhos, sendo observadas esquírolas ósseas, hastes de capim, fios de sutura e farpas de madeira. O escoamento da secreção mucopurulenta e a remoção do excesso de soluções empregadas no local infectado foi facilitada, girando a cabeça do animal e posicionando a abertura do seio frontal o mais ventralmente possível. Empregando o teste do Qui-quadrado, observou-se diferença significativa entre os tratamentos. O hipoclorito de sódio e a iodopovidona foram os tratamentos mais eficazes, podendo ser recomendados no tratamento desta enfermidade.(AU)

Plastic dehornig in adult cattle can result in several trans and postoperative complications. Sinusitis is an important sequela, resulting from an inflammatory process affecting the exposed frontal sinuses. In the present study, treatment protocols efficacy was evaluated in 60 bovines. Therapeutic protocols included sodium hypochlorite, policresulen, povidone-iodine and isotonic sodium chloride solution, which were divided into four experimental groups of 15 animals, GI, GII, GIII and GIV. During frontal sinus access to institute local treatment, attempts to identify foreign bodies, bone fragments, grass stems, suture material and wood splints were made. Mucous-purulent liquid drainage and excess solutions removal were facilitated by laterally rotating the animals head and placing the frontal sinus gap as ventral as possible. Using chi-square test, there was significant difference between treatments. Sodium hypochlorite and povidone-iodine were the most effective treatments, being recommended as part of sinusitis therapeutic protocol.(AU)