Page 636 - Equine Clinical Medicine, Surgery and Reproduction, 2nd Edition

Respir atory system: 3.2 Surgical conditions of the respir atory tr act 611

VetBooks.ir 3.32 3.33

Fig. 3.32 Radiograph of a recently purchased horse. Fig. 3.33 Conchal ulceration as a result of empyema
Pre-purchase examination had not established that the of the conchal bulla.
horse was missing a tooth. Sinusitis developed shortly
after purchase and radiographs revealed a fragment
of dental material (arrows) associated with the dental
socket. (Photo courtesy Malcolm Morley)

paranasal sinusitis. The pathogenesis is presumed to lavage, frontonasal flap surgery or tooth removal,
be very similar to primary sinusitis. as indicated. The anatomical location of the con-
chal bulla is assessed from CT scans and endoscopic
Clinical presentation examination. Drainage is then established by tran-
The clinical presentation is identical to primary sendoscopic laser dissection of the conchus.
sinusitis, with chronic (weeks to months), frequently
malodourous, unilateral nasal discharge. There may Prognosis
be facial swelling. The prognosis is good. Following drainage of the
conchal bulla and removal of any sequestra and
Differential diagnosis inspissated pus, the nasal discharge usually resolves.
Primary sinusitis is the principal differential diagno-
sis. Conchal inspissation is an extension of sinusitis, FUNGAL SINUSITIS
which complicates the management of the condition.
Definition/overview
Diagnosis Fungal sinusitis is an infrequent condition of the
The diagnosis may be suspected by clinical examina- paranasal sinuses, often secondary to another dis-
tion and particularly as the cause of poor response to ease process. The disease is a frequent complication
treatment following management of primary sinus- of the treatment of sinusitis and should be antici-
itis. Many horses do have endoscopically evident pated where possible. As with many fungal condi-
ulceration and discharge of the dorsal or ventral tions, there is a common history of treatment with
conchus overlying the bulla (Fig. 3.33). Diagnosis antibiotics and/or antiseptics.
requires a CT head scan.
Aetiology/pathophysiology
Management As with most fungal infections in temperate climates,
Treatment requires drainage of the conchal bul- the condition is usually secondary. One of the princi-
lae, as well as management of paranasal sinusitis by pal causes of mycotic sinusitis is prolonged antibiotic