Trephination of the frontal sinuses and instillation of clotrimazole cream: a computed tomographic study in canine cadavers.

OBJECTIVE: To use computed tomography (CT) to assess the distribution of surgically administered clotrimazole cream and associated filling of the frontal sinuses and caudal aspect of the nasal cavities in canine cadavers. STUDY DESIGN: Observational study. ANIMALS: Small (n = 1) and medium-large (n = 11) breed canine cadavers. METHODS: CT scans of 12 cadaveric canine heads were used to confirm absence of sinonasal disease. Then after creating an opening into the left and right frontal sinuses with a 3.2 mm Steinmann pin at standardized landmarks, clotrimazole cream (20 g) was instilled into each side. Postoperative CT scans of the heads was used to assess the distribution and degree of filling of the sinonasal cavities with clotrimazole cream, and to identify any damage to local structures. RESULTS: Filling was excellent in 22 sinuses, very poor in 2, and excellent in all caudal nasal cavities. Two cadavers had damage: unilateral penetration of the cranium (2) and unilateral penetration of the lateral sinus wall (1). CONCLUSION: Excellent filling of most of the frontal sinuses and caudal nasal cavity of cadavers with clotrimazole cream is achieved when administered by this technique. Damage to local structures may occur intraoperatively using this technique.

Mycotic encephalitis, sinus osteomyelitis, and guttural pouch mycosis in a 3-year-old Arabian colt.

Mycotic encephalitis caused severe ataxia and other neurologic deficits in a horse. The finding of a single, large focus of cerebral malacia, with histopathologic evidence of fungal elements, suggested infection was a result of direct transfer from the frontal sinuses, rather than hematogenous spread from the guttural pouch.

Frontal sinusitis in adult beef bulls: 18 cases (1999-2014).

OBJECTIVE: To characterize frontal sinusitis unrelated to standard dehorning procedures in adult beef bulls. ANIMALS: 18 beef bulls > 2 years of age treated for frontal sinusitis at a veterinary medical teaching hospital between May 1999 and May 2014. PROCEDURES: Medical records were reviewed. Information obtained for each bull included signalment, history, findings from physical examination and diagnostic procedures, treatment, and survival to discharge. Long-term follow-up (≥ 1 year) was obtained from owners by telephone. RESULTS: 18 bulls were included, and 17 were bucking bulls. Median age and duration of signs were 4.5 years and 23 days, respectively. The most common owner complaints were nonspecific signs (eg, separation from the herd, hypo- or anorexia, and weight loss; n = 10) and suspected horn or sinus infection (7). Only 8 bulls had nasal discharge, and only 7 of the 17 bulls for which the rectal temperature was recorded were febrile. Results of radiography indicated frontal sinusitis in 12 of 13 bulls, with increased opacity of the affected sinus (n = 11) noted most commonly. Seventeen bulls were discharged from the hospital alive. Long-term follow-up was obtained for 14 bulls, including 13 bucking bulls. All 14 bulls recovered fully, and 9 of the 13 bucking bulls performed well after treatment. CONCLUSIONS AND CLINICAL RELEVANCE: Results suggested that frontal sinusitis should be considered as a differential diagnosis in beef cattle examined for nonspecific clinical signs and that, with appropriate treatment, the prognosis is good for long-term survival in affected beef cattle.

Minimally invasive treatment of sino-nasal aspergillosis in dogs.

BACKGROUND: Sino-nasal aspergillosis is a common nasal disease in dogs. Recommended treatment protocols typically involve trephination of the frontal sinuses or the use of an antifungal solution instilled into the frontal sinus under anesthesia, both of which have associated morbidity and complications. OBJECTIVES: To assess a minimally-invasive topical treatment protocol for sino-nasal aspergillosis in dogs. ANIMALS: Twelve client-owned dogs diagnosed with sino-nasal aspergillosis that completed recommended treatment. METHODS: Medical records were retrospectively reviewed to identify dogs with sino-nasal aspergillosis that received treatment. Fungal plaques were manually debrided and irrigated via frontal sinuscopy in 12 dogs that then were treated topically with 1% topical clotrimazole cream. Irrigation and topical medication application was achieved using a catheter placed retrograde directly into the frontal sinuses using the Seldinger technique over a guidewire, thereby avoiding the need for frontal sinus trephination. Invasion into the calvarium was recorded before treatment but was not considered a criterion for exclusion. Debridement and cream deposition was repeated every 2 weeks as needed until negative culture and histopathologic findings were obtained. RESULTS: All dogs were cured (negative results for Aspergillus on endoscopy, fungal culture, and histopathology) with a median of 2 treatments. Treatments were well tolerated, with minimal adverse effects reported. Three dogs had evidence of erosion into the calvarium on computed tomography imaging. CONCLUSIONS AND CLINICAL IMPORTANCE: This protocol appears to be an effective and well-tolerated minimally invasive treatment for sino-nasal aspergillosis, including in dogs with erosion into the calvarium. Only mild adverse effects were noted.

A fungal granuloma of the frontal sinus in a llama.

A 12-year-old, castrated male llama (Lama glama) presented with a 12-cm diameter cranial mass. Computed tomography and postmortem examination revealed that the mass invaded the calvarium and compressed the rostral part of the brain. Light microscopic examination confirmed a fungal granuloma.

The prevalence of nasal mite (Pneumonyssoides caninum) infection in Norwegian dogs.

In a prospective study, the skulls of 250 dogs submitted for necropsy during 1993 at the Norwegian College of Veterinary Medicine were examined for the presence of parasites. All skulls were cleaved sagitally, and the frontal sinuses and nasal cavities were visually inspected. Eighteen dogs (7%) had Pneumonyssoides caninum infection at necropsy. No other parasites were observed. Sixteen dogs had heavy or moderate infection scores and 60% of these had concurrent sinusitis. The infected dogs belonged to 14 different breeds, 10 were male and eight were female and they varied in age from four months to 10 years old. Breed distribution, sex and age of the infected dogs did not differ significantly from the total study population. This study indicates that nasal mite infection occurs commonly in Norwegian dogs.

Chronic frontal sinusitis in dairy cattle: 12 cases (1978-1989).

Chronic frontal sinusitis in 12 dairy cattle most often was associated with a history of dehorning, in which the sinus was entered (67%), or with respiratory tract disease (25%). The most common organisms isolated were Actinomyces pyogenes and Pasteurella multocida. Signs of infection did not develop for months in some cattle and were often intermittent. The most common clinical signs included anorexia, lethargy, fever, frontal bone distortion, exophthalmos, abnormal posture, nasal discharge, and neurologic abnormalities. Treatment consisted of trephination at 2 sites, drainage and lavage of the sinus cavity, and administration of antibiotics and analgesics. Eight cattle responded well to treatment and were discharged, but 4 others had signs of CNS involvement and died or were euthanatized. Trephination of the frontal sinus cavity at carefully chosen sites and antibiotic treatment are indicated when sinusitis is suspected. Drainage of the sinus cavity is imperative to avoid extension of the infection into the CNS.

Lymphosarcoma of the frontal sinus and nasal passage in a cow.

A 5-year-old cow was evaluated because of a 2-week history of ataxia and other vague neurologic signs. Previous treatments included intravenous and orally administered calcium, but improvement was not seen. Bilateral mucoserous nasal discharge and a pair of firm, smooth masses caudodorsal to the eyes were found on the frontal bones on physical examination. The cow's condition deteriorated rapidly within 48 hours; head pressing and inability to rise were observed. The frontal sinuses were radiographically normal. Trephination of the frontal sinuses revealed a space-occupying mass that was interpreted on histologic examination to be lymphosarcoma. Other evidence of neoplasia was not discovered on gross necropsy or histologic examination. Primary lymphosarcoma has not been described at this location in cows. Clinically it resembles chronic frontal sinusitis, and trephination may be necessary to differentiate the 2 diseases.

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.