Proceedings of the 55th Annual Convention of the American Association of Equine Practitioners

Summary

Reasons for performing study: There is limited objective information available on the treatment and the long-term response to treatment of the different types of equine sinus disease.



Objectives: To document the treatments and long-term response to these treatments in 200 cases of equine sinus disease (1997–2009).



Methods: The treatments of horses affected with subacute primary sinusitis (n = 52); chronic primary sinusitis (n = 37); dental sinusitis (n = 40); sinus cyst (n = 26); traumatic (n = 13); dental-related oromaxillary fistula (n = 8); sinus neoplasia (n = 10); mycotic sinus disease (n = 7); and intrasinus progressive ethmoid haematoma (n = 7) and the long-term response to these treatments were retrospectively reviewed.



Results: Treatments evolved throughout the study and latterly were as conservative as possible, including sinoscopic lavage and standing sinusotomy, with a maxillary sinusotomy approach preferred for the mainly mature horses treated in this study. Removal of intrasinus inspissated pus, including transendoscopically (by sinusotomy and via existing sinonasal fistulae), was the main treatment for chronic primary sinusitis and sinonasal fistulation was seldom performed latterly. Attempted oral extraction of infected cheek teeth, even if unsuccessful, facilitated subsequent dental repulsion, resulting in few post operative problems. Sinus cyst removal carried an excellent prognosis. Except for cases of sinus neoplasia (only 22% cured), an excellent long-term response to treatment (91% fully cured, 7% partially cured) was obtained for all other types of sinus disease following a median of one treatment.



Conclusions: More conservative treatments, including removal of intrasinus inspissated pus by sinoscopy, pre-existing sinonasal fistula or sinusotomy, are effective for chronic primary sinus disease. Standing sinusotomy, mainly using a small maxillary site, was suitable for most cases of sinus disease in mature horses.

Equine paranasal sinus disease: A long-term study of 200 cases (1997–2009): Treatments and long-term results of treatments

The diagnosis and treatment of diseases of the paranasal sinuses and conchae of horses are complicated by the large size of these structures, their complex anatomy, difficulties of access to them, and the advanced state of many diseases before diagnosis is made. Improved diagnostic methods include nuclear scintigraphy, computed tomography, and direct endoscopy of the sinuses. Treatment of some sinus diseases can be enhanced by access through direct sinus endoscopy for focal lesions, use of large frontal bone flaps for diffuse sinus lesions, standing surgery through a frontal flap for a variety of sinus disorders, and intralesional formalin for progressive ethmoidal hematomas.

Review articleSinus disease

A 7-year-old female Thoroughbred was admitted with a history of labored breathing, stridor, and exercise intolerance Examination revealed a mass in the left paranasal sinuses that was determined to be an ossifying fibroma Initial treatment consisted of surgical removal of the mass alone; however, the mass recurred 9 months after surgery The mass was again removed, and adjunctive radiotherapy consisting of 3,000 cGy of cobalt radiation was administered This time, the tumor did not recur for > 6 years A third surgery was performed to remove the mass, and adjunctive radiotherapy consisting of 4,000 cGy of photon beam radiation from a linear accelerator was administered The mass did not recur during the subsequent 3 years Ossifying fibromas are uncommon tumors that frequently recur if incompletely excised Results in this horse suggest that adjunctive radiotherapy may delay or prevent tumor recurrence in affected horses

Radiotherapy of a recurrent ossifying fibroma in the paranasal sinuses of a horse.

Objective

(i) To report the successful treatment of 10 cases of equine periocular squamous cell carcinoma (PSCC) with surgical excision and photodynamic therapy (PDT) using verteporfin. (ii) To evaluate time to first tumor recurrence between PDT-treated horses and horses treated with surgical excision and cryotherapy.



Methods

A total of 24 equine PSCC cases were included: group 1 (n = 14) had excision and cryotherapy (1993–2003), group 2 (n = 10), excision and local PDT (2006–2010). Evaluated data: signalment, treatment method, tumor location, size, and time to first recurrence. Groups were compared via chi-square test for categorical variables and Wilcoxon rank-sum test for numeric variables. Time to tumor recurrence was examined using Kaplan–Meier product-limit survival analysis.



Results

Of 24 cases, nine breeds were affected. Mean age at treatment in years: 14 (range 5–24) in group 1; 11 (range 8–18) in group 2. Median tumor size: 163 mm2 (range 20–625 mm2) in group 1; 195 mm2 (range 45–775 mm2) in group 2. Signalment, tumor laterality, and size were not significantly different between groups. Time to recurrence was significantly different between groups (Logrank test, P = 0.0006). In group 1, 11/14 horses had tumor regrowth with median time to recurrence in months: 10 (range 1–44). In group 2 (minimum follow-up of 25 months; range 25–50), no horse demonstrated tumor recurrence after one treatment with excision and PDT.



Conclusions

This represents the first report of local PDT using verteporfin for treatment of equine PSCC. Following surgery, the likelihood of tumor recurrence was significantly reduced with local PDT compared with cryotherapy.

Local photodynamic therapy delays recurrence of equine periocular squamous cell carcinoma compared to cryotherapy

Three adult horses underwent aggressive treatment of squamous cell carcinoma of the nasal cavity and paranasal sinuses, using course-fractionated cobalt 60 radiotherapy. Squamous cell carcinoma of the nasal cavity and paranasal sinuses is not commonly diagnosed in horses. Historically, horses with this type of neoplasm have not been treated or have undergone some form of surgery. The prognosis for long-term survival or cure has been poor. Long-term results of cobalt 60 radiotherapy were good to excellent and exceeded those usually reported for horses treated surgically. On the basis of these results, use of radiotherapy for these neoplasms is recommended.

Cobalt 60 radiotherapy for treatment of squamous cell carcinoma of the nasal cavity and paranasal sinuses in three horses.

What is your diagnosis? Focal osteolysis involving the third and fourth metacarpal bones.

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Cobalt 60 radiotherapy for treatment of squamous cell carcinoma of the nasal cavity and paranasal sinuses in three horses.

What is your diagnosis? Focal osteolysis involving the third and fourth metacarpal bones.