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Sinus flaps and trephination of the equine head

Talk Description
Sinus flaps and trephination are useful surgical technique when investigating and treating dental and paranasal sinus disease in the horse. The large size of the equine head lends itself to mostly easy access to the paranasal sinuses (PNS) however a detailed knowledge of the complex anatomy and normal landmarks is paramount. There are six paired paranasal sinuses and conchal sinuses, each of which either directly or indirectly communicate with each other and the nasal passage.
Trephination of the PNS is a procedure that can be performed in the field with a relatively small amount of equipment.  It is important that the practitioner is familiar with the normal anatomy and appearance of the sinus as disease readily distorts normal architecture and is further complicated by the presence of fluid (purulent material or blood), foodstuff or inspissated pus.

Most commonly trephination or sinus flaps are made over the rostral maxillary, caudal maxillary and conchofrontal sinuses. Trephinations are useful for investigation (fluid sampling, endoscopic examination) and some treatment (removal of purulent material and lavaging), while sinus flaps generally give a larger field of view and access for soft tissue removal (neoplasms and masses) and removal of inspissated pus.

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