Management of complications of paranasal sinus and dental surgery

Surgery involving the dentition or paranasal sinuses involves disruption of soft tissues in a region frequently contaminated by a variety of pathogens, that is anatomically complex and which often involves working in proximity to vital structures such as vessels, nerves and ducts. The opportunities for perioperative complications are many and therefore these can occur commonly, especially where planning is scant or as the result of imprecise technique. The evolution towards less invasive techniques that is current in equine surgery generally also extends to equine maxillo-facial surgery. While reduced morbidity and a good functional and cosmetic outcome are the benefits for the patient, a more precise technique and some additional complication possibilities are the challenge for the surgeon.

Many of the potential problems can be avoided by careful preoperative planning. This involves maximising the benefit of diagnostic imaging techniques and careful clinical appraisal. Recent evolution of digital radiographs, and especially 3d Computed tomography have enabled much more precise preoperative planning1. Accurate surgical technique demands a precise knowledge of regional anatomy, and anticipation of any potential pitfalls in the technique. The majority of maxillofacial and dental procedures are performed in the conscious standing sedated horse nowadays 2, 3, 4, and careful restraint is a prerequisite to precise surgery. The use of continuous rate infusions, synergistic opiate analgesia and tailor-made facilities have all contributed to more ambitions techniques in the conscious horse. Compliance of conscious horses undergoing surgical procedures depends on abolition of pain and the widespread use of regional local analgesia in the head facilitates detailed procedures to be executed with precision on the relatively still patient.

Preoperative antimicrobials and non-steroidal anti-inflammatory drugs may help to ameliorate peri-operative bacteremia and surgical inflammation postoperatively.  [...]