Extranasal approach for ventral nasal conchotomy in horses: An ex‐vivo study

Summary Background The diagnosis of ventral conchal sinusitis is difficult and requires a combination of physical examination and imaging modalities. Access to the ventral conchal sinus is limited, and different techniques help treat sinusitis. Objective To describe an extranasal approach for ventral nasal conchotomy in horses. Study design Ex‐vivo experimental study. Methods Twelve cadaveric heads obtained from adult horses were used. Two endoscopic portals were created for fenestration of the maxillary septal bulla. The rigid endoscope was introduced via the caudal maxillary sinus portal to check the distance between the infraorbital canal and tooth roots. The medial maxillary lamina was perforated to gain access to the ventral conchal sinus. A blunt Steinmann pin was used to fenestrate the medial conchal wall under endoscopic guidance. Following the completion of fenestration procedures, specimens were dissected and inspected. Results Successful ventral nasal conchotomy was achieved in 66.67% (16/24 hemipheres) of specimens. In 16.67% (4/24 hemipheres) of cases, ventral conchal sinus fenestration resulted in injury to the infraorbital canal. In 8.33% (2/24 hemipheres) of cases, the procedure was not completed due to fracture of the infraorbital canal during fenestration of the maxillary septal bulla. In 8.33% (2/24 hemipheres) of cases, drill hole deviation led to accidental penetration of the ventral nasal meatus instead of the ventral conchal sinus. Main limitation Surgeons must be aware of potential complications. Conclusion Extranasal approach described in this study allows successful ventral nasal conchotomy in adult horses. The proximity of the infraorbital canal and the maxillary cheek teeth root apices is a matter of concern, given the risk of permanent injury to adjacent structures.