Trans-endoscopic diode laser fenestration of equine conchae via contralateral nostril approach

To describe and report preliminary outcomes of a contralateral trans-nasal endoscopic laser fenestration of the conchae for endoscopic examination and treatment of paranasal sinuses in horses.

Cadaveric experimental and prospective clinical study.

Normal cadaveric equine heads (n = 7) and equine patients (horses n = 7, donkey n = 1) diagnosed with sinusitis.

Ex vivo: a video-endoscope containing a diode laser fiber in the working canal was passed through the nostril and retroflexed in the nasopharynx toward the contralateral conchae. Ventral or dorsal conchae were fenestrated. Duration of surgery, laser energy, visualization quality, and feasibility of sinoscopy through the fenestrations were recorded. In vivo: sinus drainage, sinoscopy 24 hours postoperatively, stoma persistence, and clinical results after 3 months were evaluated in 8 patients.

Fenestrations were performed in 8 dorsal conchae (6 cadavers, 2 patients), 10 ventral conchae (5 cadavers, 5 patients), and 1 dorsal conchal bulla (1 patient). Visualization was good in 6 patients and affected by bleeding in 2 patients. Drainage through the fenestrations was observed in all patients. Trans-nasal sinoscopy was possible in all cadavers and in 6 out of 8 patients. Masses inside the sinuses precluded sinoscopy in 2 patients. Stomata persisted until discharge of the patients (mean of 14 days). Clinical signs improved in 6/8 patients.

The endoscopic approach reported here provides good visualization during the trans-endoscopic laser fenestration of the conchae. The fenestrations may allow a trans-nasal sinoscopic examination and treatment in selected cases of sinusitis in horses.