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For perhaps years Bert had an infection in the sinuses on the
right side of his face. In horses the back teeth communicate with
the sinuses, so a rotting tooth can cause sinusitis. For this
reason most equine sinus infections are dental in origin.
Long ago Bert had a tooth removed seemingly because of this problem,
but the infection persisted.
Antibiotics failed to clear up the problem. We took radiographs
which ruled
out the possibility of another rotting tooth. At that point the
decision was made to create a hole in Bert's sinus and insert a tube
which could be used to flush the infection. This page is a chronicle
of this "trephination" procedure.
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Bert was sedated and placed in stocks to immobilze him during the
procedure. Then the site was prepared by shaving an area on Bert's
head. This area was then swabbed with antiseptic. Local anaesthetic
was injected around the area where the hole was to be created.
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A trephine was used to create a hole into the sinus cavity. The vet
explained that we horses have three sinus cavities on each side that
are connected top to bottom. Since we don't know exactly were the
infection is he made the hole in the top cavity so that when we flush
the fluid passes through all three sinuses.
He also warned me that I would heard a "crunch" as the trephine broke
through. He was right, and it was still unsettling even though I was
expecting it.
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It's really too bad this one blurred. This is the hole that was created.
What you can't really see is that it is a perfect tear-drop shape. Despite
the appearance, it bled very little.
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Here the vets are feeding the catheter into the hole. The hole was
sutured around the catheter to hold it in. Also, pieces of tape were
folded around the catheter to make flaps, then these flaps were sutured
to Bert's face to keep the catheter in position. Oddly enough, this
bothered me more than any other part of the procedure. The idea of
having something sewn to one's face is just nasty.
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This is the finished product! The end of the catheter that was on the
outside was plugged with a syringe plunger to keep foreign particles out.
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Here the surgeon is demonstrating to me how to flush Bert's sinus. The
solution is a mixture of sterile normal saline and Betadine. As you can
see, the solution flows right out of Bert's right nostril. I was
instructed to flush the sinuses in this manner with 300 mL of solution twice
daily for ten days. Bert was a real trooper for this. I could do it in
his stall without even putting a halter on him.
I'm happy to say that since this procedure Bert has had no sinus infections.
His sub-mandibular lymph nodes were constantly enlarged before the procedure,
but have been normal since.
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