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Standing Sinus Surgery

This horse presented with a history of poor performance and a significant nasal discharge down one nostril. X rays of the head were taken at our clinic using our digital radiography system. Images were available immediately which confirmed the likely diagnosis of sinusitis (inflammation and infection within one of the sinus cavities). The infection was actually in the maxillary sinus. The horse remained at the clinic overnight and was operated on the following day. Sinus flap surgery was performed while the horse was heavily sedated and restrained in our stocks. The sinus was entered via the frontal sinus. The skin was incised and reflected enabling good access to the bone which was entered using an oscillating saw. All the infected material was removed and drainage to the nasal cavity was restored and improved by creating communication holes between the sinuses and the nose. The front sinus was repaired using stitches and staples to pull the skin together. A catheter was left in situ to facilitate aggressive flushing of the area. Our nursing team flushed the sinus three times daily using five litres of dilute hibiscrub at a time. The horse was flushed without using sedation and did not find the procedure at all distressing. The horse was also treated with antibiotics.

The horse returned to the clinic several weeks later for follow up radiographs. These clearly showed that the infected soft tissue mass had been cleared. A slight nasal discharge persisted so a swab of the discharge was submitted to the lab for cultural and sensitivity analysis. This enabled us to ensure the correct antibiotic had been chosen to treat the infection effectively. A change of antibiotic and further flushing of the sinus via the catheter enabled the horse to make a full recovery. It is now back in work.