ISSN 2398-2977      

Ethmoid: hematoma - chemical ablation

pequis

Synonym(s): Transendoscopic chemical ablation


Introduction

  • Formaldehyde coagulates proteins by hydrolysis → reduction in tissue volume and reduced hemorrhage.
  • Ethmoid hematomas Ethmoid: hematoma: progressive ethmoid hematomas (PEH) cause clinical signs relating to impingement in the paranasal sinuses and nasal passages, secondary infection and spontaneous bleeds.

Uses

  • Reduction in mass of ethmoid hematoma Ethmoid: hematoma:
    • Small lesions ideal.
    • Location in the nasal passage ideal.
  • Follow up treatment of recurring lesions that have been surgically ablated.

Advantages

  • Done in standing sedated horse Anesthesia: standing chemical restraint.
  • Minimum specialized equipment required.
  • Can be repeated.
  • Easy to evaluate.
  • High percentage of cases result in remission of clinical signs.

Disadvantages

  • Formaldehyde (formalin) is toxic and irritant.
  • 60% complete resolution of lesion by endoscopic evaluation.
  • Access by endoscopy may be inadequate → need to use trephine Head: trephination and/or bone flap Paranasal sinus: bone flap technique to access lesions projecting into paranasal sinus.
  • Not suitable for large lesions that are causing acute clinical signs.

Requirements

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Preparation

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Procedure

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Aftercare

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Outcomes

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Prognosis

  • Guarded: recurrence of lesions is likely.
  • Frequent re-evaluation by transnasal endoscopy or radiography is recommended, as regrowth can be controlled with repeated intralesional formalin injections.

Further Reading

Publications

Refereed papers

  • Recent references from PubMed and VetMedResource.
  • Barker W J, Perkins J D & Witte T H (2013) Three horses with bilateral sinonasal progressive haematomas not associated with the ethmoidal labyrinth. Equine Vet Ed 25 (10), 503-507 WileyOnline.
  • Frees K E, Gaughan E M, Lillich J D et al (2001) Severe complication after administration of formalin for treatment of progressive ethmoidal hematoma in a horse. JAVMA 219 (7), 950-952 PubMed.
  • Schumacher J et al (1998) Transendoscopic chemical ablation of progressive ethmoidal hematomas in standing horses. Vet Surg 27, 175-181 (Detailed description of the technique and case results) PubMed.

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