Comparison of equine paranasal sinus trephination complications and outcome following standing computed tomography, radiography and sinoscopy guided approaches for the treatment of sinusitis.

OBJECTIVE: The recent availability of standing computed tomography (CT) for equine paranasal sinus disease has enhanced diagnosis and enabled more targeted surgery compared to radiography and sinoscopy. To date, there have been no studies which have critically evaluated the benefit of preoperative CT versus radiography and sinoscopy on complications and outcome in horses undergoing sinus trephination. STUDY DESIGN: Retrospective study. ANIMALS: A total of 229 equids. METHODS: The medical records of equids (229) presented for sinusitis treated via trephination that had CT, radiography and/or sinoscopy at time of surgery between 2009 and 2022 were reviewed. Outcome and complications were evaluated for six different pre- and intraoperative imaging modalities. RESULTS: The six groups did not differ in demographics or disease category, though equids with less weight (p = .0179) and shorter disease duration (p = .0075) were more likely to have radiography and sinoscopy based surgical planning. Short-term postoperative complications occurred in 30.1% and were higher in groups using preoperative CT imaging (p = .01), with hemorrhage being the most common surgical complication. Following initial trephination surgery, 57.0% (127/223) of cases resolved and there was no difference between the imaging groups. Final resolution after follow-up medical or surgical treatment increased to 94.6% (211/223) and was not different between the imaging groups or between primary or secondary sinusitis. Additional nasal fenestrations to improve sinonasal drainage, maxillary septal bulla fenestrations and trephinations to treat nasal conchal bullae were made in the CT groups. CLINICAL SIGNIFICANCE: CT provided additional diagnostic information and enabled different surgical approaches but did not improve resolution in this study population.

[Extraction of diseased mandibular incisors in the guinea pig (Cavia porcellus) via ventral mandibular trepanation]. / Extraktion erkrankter Unterkieferinzisivi beim Meerschweinchen (Cavia porcellus) via ventraler Mandibulatrepanation.

OBJECTIVE: This retrospective study describes the use of ventral mandibular trepanation for extraction of diseased mandibular incisors in guinea pigs and evaluates the clinical outcome. MATERIAL AND METHODS: In 40 guinea pigs with abnormal feed intake, at least one mandibular incisor was extracted via ventral mandibular trepanation. The diagnosis of primary mandibular incisor disease was based on the findings of the clinical general examination and intraoral and radiographic examination under general anesthesia. Following the procedure radiographs were taken and the patients were monitored and cared for as inpatients until discharge. Regular re-examinations were undertaken in order to assess and treat the surgical sites. RESULTS: A total of 42 altered mandibular incisors were extracted via ventral mandibular trepanation. Macrodonts (25/42) and periapical and alveolar changes (8/42) were the main reasons for extraction. Tooth residuals of unknown etiology (4/42) as well as such resulting from failed conventional extraction attempt using luxators (3/42) and traumatically loosened incisors (2/42) were also extracted. Tooth-associated jaw abscesses were found in 40 % of the guinea pigs. In addition, 40 % of the animals presented secondary elongation of the molars requiring occlusal equilibration. In all patients, it was possible to completely remove the altered incisors or residuals. On average, independent feed intake was observed 2 days after surgery and the animals were discharged. Complete healing of the surgical site was observed on average after 39 days (minimum 9 days, maximum 98 days). A total of 22 animals were evaluated 6 months following surgery and showed no further tooth-associated complaints. CONCLUSION AND CLINICAL RELEVANCE: Ventral mandibular trepanation allows diseased mandibular incisors in guinea pigs to be removed entirely within one surgery and thus represents a curative procedure. Unlike the conventional extraction with luxators, it does not bear the risk of tooth fractures resulting in tooth fragments remaining in the alveolus.

Earliest Animal Cranial Surgery: from Cow to Man in the Neolithic.

The earliest cranial surgery (trepanation) has been attested since the Mesolithic period. The meaning of such a practice remains elusive but it is evident that, even in prehistoric times, humans from this period and from the Neolithic period had already achieved a high degree of mastery of surgical techniques practiced on bones. How such mastery was acquired in prehistoric societies remains an open question. The analysis of an almost complete cow cranium found in the Neolithic site of Champ-Durand (France) (3400-3000 BC) presenting a hole in the right frontal bone reveals that this cranium underwent cranial surgery using the same techniques as those used on human crania. If bone surgery on the cow cranium was performed in order to save the animal, Champ-Durant would provide the earliest evidence of veterinary surgical practice. Alternatively, the evidence of surgery on this cranium can also suggest that Neolithic people practiced on domestic animals in order to perfect the technique before applying it to humans.

Computed tomographic assessment of a new nonsurgical sinus trephination technique using a medical bone marrow drill.

The objective of this study was to determine the feasibility of trephination of the frontal sinus and injection of antifungal cream using a medical bone marrow drill in dogs. Results were compared with frontal sinus trephination using a standard surgical technique. Bilateral trephination of the frontal sinuses was carried out in the heads of 11 cadavers using a medical bone marrow drill and a surgical bone chuck. The time taken to carry out the procedure using both techniques was compared. Before and after injection of antifungal cream into the frontal sinuses, computed-tomography (CT) scanning was done to assess for iatrogenic trauma and to determine the degree to which the sinuses were filled with each technique and evaluate the diffusion of the cream into the nasal cavity of each dog. The mean volume of the sinuses was 8.8 mL (3.1 to 14.3 mL). Trephination, flushing, and injecting of antifungal cream were significantly faster using the medical technique. There was no significant difference in the mean filling of the frontal sinuses between the medical (82.7%) and the surgical (82.4%) technique (P-value = 0.3). Filling of the nasal cavity was classified as very good in 6/11 cases, with evidence of trauma caused by the surgical trephination technique in 1 head. Findings suggest that use of the medical bone marrow drill is highly feasible for frontal sinus trephination. Injection of antifungal cream into the frontal sinuses using the bone marrow needle resulted in good diffusion into the ipsilateral nasal cavity and could be used to treat aspergillosis when debridement or sinusoscopy is not deemed necessary.

L'objectif de cette étude est d'évaluer l'utilisation d'une perceuse de moelle osseuse pour la trépanation du sinus frontal et l'injection de crème antifungique chez le chien. Les résultats sont comparés à la trépanation du sinus par une technique chirurgicale classique. Les sinus frontaux de 11 têtes de cadavres de chiens ont été trépanés, en utilisant une perceuse pour moelle osseuse ou un trépan chirurgical. La durée de la procédure avec chaque technique est comparée. Les sinus frontaux sont examinés par tomodensitométrie avant et après injection de crème antifungique, afin de noter de potentielles lésions iatrogéniques, d'évaluer le degré de remplissage du sinus frontal pour chaque technique, et d'apprécier la diffusion de la crème dans les cavité nasales pour chaque chien. Le volume moyen des sinus était de 8,8 ml (3,1 à 14,3 ml). La trépanation, le flush et l'injection de crème antifungique étaient significativement plus rapide avec la perceuse médicale. Il n'y avait pas de différence significative entre le remplissage moyen des sinus par la technique médicale (82,7 %) ou chirurgicale (82,4 %) (P = 0,3). Le remplissage des cavités nasales était qualifié de très bon dans 6 cas sur 11. Une lésion iatrogénique fut constatée dans un cas, avec la technique chirurgicale. Ces résultats semblent montrer qu'une perceuse médicale pour moelle osseuse est facilement utilisable pour trépaner le sinus frontal chez le chien. L'injection de crème dans le sinus frontal par le trocart de la perceuse pour moelle osseuse permet un bon remplissage de la cavité nasale ipsilatérale, et pourrait donc être utilisée dans le cadre du traitement de l'aspergillose canine, dans les cas où un débridement du sinus n'est pas nécessaire.(Traduit par Docteur Serge Messier).

Standing equine sinus surgery.

Trephination of the equine sinuses is a common surgical procedure in sedated standing horses. Standing sinus flap surgery has become increasingly popular in equine referral hospitals and offers several advantages over sinusotomy performed under general anesthesia, including reduced patient-associated risks and costs; less intraoperative hemorrhage, allowing better visualization of the operative site; and allows surgeons to take their time. Other minimally invasive surgical procedures include sinoscopic surgery, balloon sinuplasty, and transnasal laser sinonasal fenestration. Despite the procedure used, appropriate indications for surgery, good patient selection, and familiarity with regional anatomy and surgical techniques are imperative for good results.

Trephination of the equine rostral maxillary sinus: efficacy and safety of two trephine sites.

OBJECTIVE: To examine 2 rostral maxillary sinus (RMS) trephine sites for safety and efficacy using skulls of horses of varying age. STUDY DESIGN: Descriptive study. ANIMALS: Cadaveric equine skulls (n=40). METHODS: Two RMS trephination sites (rostral, caudal) were made in each skull. Radiographic projections using markers at each site were used to determine if sites were within the RMS and directly overlying a cheek tooth. Sinusotomy in 14 skulls was used to determine correlation between radiographic and anatomic location of trephine sites, and of the rostrolateral aspect of the maxillary septum. Age-related risk of trephine site being directly over a cheek tooth was determined using logistic regression. RESULTS: Trephine site was within the RMS in 98% of skulls using the rostral portal and 68% using the caudal portal. The rostral site was over a cheek tooth in 18% of skulls compared with 10% using the caudal site. There was a significant negative relationship between the trephine site overlying a tooth and horse age for rostral (P=.02) and caudal (P=.03) sites. The radiographic appearance of the maxillary septum correlated to the rostrolateral portion of the septum in 12 of 14 skulls that had sinusotomy. CLINICAL RELEVANCE: The rostral RMS trephine portal is more reliable than the caudal site for entering the RMS. Horses

Hoof wall surgery in the horse: approaches to and underlying disorders.

Because of the hoof capsule, surgery of the equine foot is often perceived to be quite difficult. Knowledge of the specific disease entities that require surgical intervention as well as an in-depth understanding of the anatomy of the tissues beneath the hoof capsule is a definite prerequisite to successful surgical treatment. This article details the surgical approaches used to treat septic navicular bursitis, septic pedal osteitis, infection of the collateral cartilages, and keratomas. The principles used to treat these conditions can be applied to a variety of other conditions for which access through the hoof wall is required.

Treatment of progressive ethmoidal haematoma using intralesional injections of formalin in three horses.

Three Thoroughbred horses with unilateral progressive ethmoid haematomas were treated using intralesional injections of 10% formalin (4% formaldehyde solution). Injections were performed in the standing sedated horse through the nasal passages under endoscopic guidance and, when the ethmoid haematoma involved the paranasal sinuses, through holes trephined into the affected sinus. Regression of the lesions occurred in all cases after repeated injections. This technique appears to be a safe and effective treatment for progressive ethmoid haematomas in the horse.

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.

Comparison of topical administration of clotrimazole through surgically placed versus nonsurgically placed catheters for treatment of nasal aspergillosis in dogs: 60 cases (1990-1996).

OBJECTIVE: To examine the clinical response to topical administration of clotrimazole in dogs with nasal aspergillosis, to compare effect of surgically placed versus nonsurgically placed catheters used for administration on outcome, and to examine whether subjective scoring of computed tomographic images can predict outcome. DESIGN: Retrospective case series. ANIMALS: 60 dogs with nasal aspergillosis. PROCEDURE: Information including signalment, history, diagnostics, treatment method, and outcome was retrieved from medical records of dogs with nasal aspergillosis treated between 1990 and 1996 at the University of California School of Veterinary Medicine or cooperating referral practices. Final outcome was determined by telephone conversations with owners and referring veterinarians. Images obtained before treatment were subjectively assessed to develop an algorithm for predicting outcome. RESULTS: Clotrimazole solution (1%) was infused during a 1-hour period via catheters surgically placed in the frontal sinus and nose (27 dogs) and via nonsurgically placed catheters in the nose (18). An additional 15 dogs received 2 to 4 infusions by either route. Topical administration of clotrimazole resulted in resolution of clinical disease in 65% of dogs after 1 treatment and 87% of dogs after one or more treatments. The scoring system correctly classified dogs with unfavorable and favorable responses 71 to 78% and 79 to 93% of the time, respectively. CLINICAL IMPLICATIONS: Topical administration of clotrimazole, using either technique, was an effective treatment for nasal aspergillosis in dogs. Use of non-invasive intranasal infusion of clotrimazole eliminated the need for surgical trephination of frontal sinuses in many dogs and was associated with fewer complications.

Removal of inspissated purulent exudate from the ventral conchal sinus of three standing horses.

Primary paranasal sinusitis, complicated by inspissated purulent exudate in a ventral conchal sinus, was diagnosed in 3 horses. Partial nasal obstruction, caused by axial deviation of the ventral concha, was detected endoscopically in 2 of the horses. A mass, dorsal to the maxillary molars, was detected via a lateral radiographic view of the skull of 3 horses and on the dorsoventral view of 1 of the horses. Inspissated purulent exudate was removed from the ventral conchal sinus of the horses via trephination of the conchofrontal sinus and penetration of the caudal wall of the ventral conchal sinus. The procedure was performed with the horses standing and sedated.

Study of long-term survival after transsphenoidal hypophysectomy in clinically normal dogs.

Experimental hypophysectomies were performed in 7 clinically normal dogs, using a new modification of the transsphenoidal approach. This approach facilitated centering of the sphenoid bone trephination and allowed safe exposure of the hypophysis regardless of the size or shape of a dog's skull. Complications did not occur during surgery and all dogs recovered well from surgery. Growth hormone secretory capacity was measured over a 3-month period to assess completeness of hypophysectomies. One dog was euthanatized 2 months after surgery, 4 dogs were euthanatized at 3 months after surgery, and 2 dogs were allowed to survive and their progress was followed for 2.5 years. Soft palate dehiscence and keratoconjunctivitis sicca developed in 2 of the dogs. The technical deficiencies responsible for these complications were corrected shortly after the beginning of the study. In 4 of the 5 necropsied dogs, minute remnants of adenohypophyseal tissue were found in the sellae turcica. Measurement of in vivo growth hormone secretory capacity revealed that these remnants had an altered stage of functional activity. Although complete hypophysectomy was not achieved consistently, the main technical obstacle of hypophysectomy, the reliable identification and the avoidance of the vascular structures surrounding the hypophysis, has seemingly been overcome. The surgical technique proved to enhance the safety of hypophysectomy, and the procedure can be recommended to treat clinical cases of canine pituitary-dependent hyperadrenocorticism. The clinical significance of potential subtotal hypophysectomy remains yet to be evaluated.