RESUMO
A endoscopia dos seios paranasais, denominada sinoscopia, trata-se de técnica minimamente invasiva efetiva para diagnóstico e tratamento das afecções sinusais. Este trabalho teve como objetivo determinar portais para triangulação, a partir dos pontos de sinoscopia já descritos e comparar a utilização de endoscópio rígido e flexível de pequeno calibre durante a sinoscopia em equinos de diferentes idades. Foram realizados, sequencialmente três procedimentos: sinoscopia com endoscópio rígido, sinoscopia com endoscópio flexível e abordagem cirúrgica por técnica de triangulação. A qualidade da imagem obtida com o endoscópio rígido foi superior à do endoscópio flexível, entretanto, a amplitude de visão foi maior com o endoscópio flexível, que permitiu maior mobilidade e aproximação das estruturas anatômicas dos seios paranasais. A partir dos portais situados sobre o seio frontal, foi possível examinar tanto o seio frontal como o maxilar caudal. Através do portal do seio maxilar caudal, foram examinadas as raízes dentárias e demais estruturas localizadas no interior deste. O exame do seio maxilar rostral foi dificultado em alguns casos devido ao acentuado tamanho da raiz do 1°dente molar, principalmente em animais jovens. Os portais para técnica de triangulação foram determinados nos seios frontal e maxilar caudal, permitindo acesso de instrumental cirúrgico às estruturas anatômicas. Através dos resultados obtidos foi possível estabelecer portais para realização de técnicas de sinoscopia e triangulação no diagnóstico e tratamento das afecções sinusais de equinos, utilizando endoscópio rígido ou flexível.
Sinoscopy, the paranasal sinus endoscopy, is a minimally invasive technique used to diagnose and treat sinus disease. The objective of this study was to determine triangulation portals sites from sinoscopy portals previously described and to compare rigid and flexible endoscope of small diameter in horses of different ages. Paranasal sinuses underwent three procedures in sequence: sinoscopy with rigid endoscope, sinoscopy with flexible endoscope and surgical approach to triangulation technique. Rigid endoscope presented higher image quality, although the amplitude of visualization was greater with flexible endoscope that yielded better mobility and proximity of the paranasal sinus anatomical structures. Through frontal sinus portals, the frontal and caudal maxillary sinuses were examined. The structures of maxillary caudal sinus, including the roots of the cheek teeth, were observed through the portal of caudal maxillary sinus. In some animals, the bigger root of the first upper molar teeth, mainly in young horses, made the exam of rostral sinus exam harder. Triangulation portals were determined in frontal and caudal maxillary sinus enabling surgical instrumentation access to anatomical structures. The results enabled the establishment of sinoscopy and triangulation portals to diagnosis and treatment of sinus disease in horses using either flexible or rigid endoscope.
RESUMO
Sinoscopy as an endoscopic investigative method of examining the maxillary sinus offers the advantage of a direct local interpretation in contrast to the usual indirect methods. The beginning of sinoscopy dates back to Hirschmann (1903) and Spielberg (1922). During the last 20 years, this method has been reintroduced and refined. In spite of a large number of articles about sinoscopy from Europe, there have been no articles about sinoscopy from Korea. In the present study, 182 maxillary sinuses were examined by sinoscopy and PNS Xpray for diagnostic reasons. The failure rate in sinoscopy was 3.8% and the rate of incomplete sinoscopy was inferior to X-ray. The detection rate of antral secretion by sinoscopy was higher than by Xpray. In the bacteriological study of antral secretions the percentage of no-growth specimens was 75.7%. In all approximately ten strains of bacteria were isolated from the secretions. Among them, streptococcus was the most common organism found. Therapeutic sinoscopy was performed in 16 patients who suffered from subacute or chronic maxillary sinusitis. In 8 of these patients, local treatment during therapeutic sinoscopy improved the mucosal appearance.