Diseases of equine head and neck

Question 1

How could you diagnostically image the head

Answer 1

ENDOSCOPY
RADIOGRAPHY
SINOSCOPY
CT
Ultrasonography

Question 2

what are the different forms of endoscopy

Answer 2

resting endoscopy
excercising endoscopy
dynamic respiratory endoscopy

Question 3

what are common radiographic views of radiographs of the equine head

Answer 3

latero-lateral
lateral-oblique
dorsal-ventral (Assessment of paranasal sinuses, nasal septum and teeth)

Question 4

what is the lateral-oblique view mainly used for

Answer 4

assess the periapical regions of the

cheek teeth for evidence of infection

Question 5

what are other less commonly used radiographic angles

Answer 5

intra-oral (radiograph incisors)
Open mouth oblique
Tangential views

Question 6

what are the 7 paired sinuses of the horse and their functional groups?

Answer 6

Rostral group:

rostral maxillary
ventral conchal

caudal group:

caudal maxillary
frontal
dorsal conchal
ethmoid
sphenopalatine

Question 7

whats another way of exploring/monitoring the sinuses

Answer 7

sinoscopy

Easily performed under standing sedation
with local anaesthesia but more invasive than endoscopy

Question 8

what is the gold standard in diagnosis of the equine head

Answer 8

CT scan

Question 9

what are dental related problems commonly presented with

Answer 9

nasal discharge / respiratory noise / facial swellings / poor performance

Question 10

name four causes of equine nasal disorders

Answer 10

Trauma –lacerations
Facial nerve paresis / paralysis
Nasal atheroma (cyst)
Alar fold collapse

Question 11

what are the three conchae of the nasal passage

Answer 11

dorsal
middle
ventral

Question 12

3 common causes of nasal trauma

Answer 12

Epistaxis
Kick / blunt trauma
Iatrogenic - trauma during nasogastric intubation / endoscopy (common)

Question 13

how to avoid iatrogenic trauma

Answer 13

– Ensure tube placement in the VENTRAL 
meatus not middle meatus (more likely to 
traumatise ethmoturbinates)
– Use a smooth tube
– Lubricant on the end of the tube
– Do not force the tube when you meet 
resistance

Question 14

what is a progressive ethmoid haematoma and what are the sign

Answer 14

a locally invasive, encaspluated non metastasising mass within the nasal passage/sinuses

signs are intermittent epistaxis and facial swelling

Question 15

what are the treatment options for PEH

Answer 15

within the nasal passage: intra-lesional formalin or lazer excision
within sinus: sinus flap surgery

(recurrence common)

Question 16

what are the dorsal and ventral conchal bullae

Answer 16

enclosed cavity within nasal conchae

Question 17

what are the common signs of paranasal sinus diseases

Answer 17

unilateral nasal discharge
facial swelling
facial deformity
reduced nasal airflow

Question 18

how would you diagnose sinusitis

Answer 18

ENDOSCOPY
– Visualise purulent material coming from the
sinus drainage angle

• RADIOGRAPHY
– Fluid lines on lateral views
– Increased radiodensity in sinus(es) on DV views
– Poor sensitivity for identifying cause of
secondary sinusitis

• Computed tomography
– Gold standard 
• differentiating Primary v’s Secondary sinusitis
– Teeth
• Greater sensitivity
– Useful for pre-operative planning

Question 19

what is the main cause of primary sinusitis and how would you treat

Answer 19

bacterial colonisation
(streptococcus spp most commonly)

Treat with one course of antibiotics
trimethoprin sulphonamides

Question 20

most common cause of secondary sinusitis in horses is dental issues.
What teeth are in close proximity to the rostral/caudal maxillary sinuses?

Answer 20

08/09=rostral maxillary sinus
10/11=caudal maxillary sinus

treatment often means removal of tooth

Question 21

what are common sinus neoplasia

Answer 21

– SCC
– Adenocarcinoma
– Fibro-osseous tumors
– Myxoma