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  Discussion on Space Occupying Mass in sinus area of 24yo TB
Author Message
New Member:
leahh

Posted on Saturday, Oct 31, 2009 - 4:47 pm:

Hello Dr O~

It has been awhile since I have posted but now find the need for your advice.

My 24yo Cushing's/IR horse has been diagnosed with a mass in his sinus area.

He has had a yellow thick discharge with a foul order that comes and goes for the last 5 weeks. It only drains from his right nostril.

For 3 1/2 weeks he has been on Uniprim with no resolution.

Last week my vet took rads of his head and found this mass. Part of it is pressing on the root of his first molar. Part is pressing on his septum. His septum is not yet deviated but very close!

A front nasal standing flap to remove the mass has been suggested.

We do not know if the mass is an abscess, cyst, tumor or ethmoid hematoma. It is a thick walled mass.

He does not have any bleeding. I seem to recall several months back a slight trickle of blood but it did not last and just did not leave a strong enough impression for me to recall which nostril and if it really did happen (that sound silly I know).

My concerns are several. First and foremost his age.

He has had 3 founder episodes in the last 5 years-not a LOT but they have happened.

I have his IR controlled through diet and he is starting pergolide this week.

He was previously able to manage with the use of chasteberry but it no longer is helping his cushing's symptoms. (I tried pergolide in the past and he did not respond well but he is progressing to the point where I must try again).

I understand the standing procedure is not complicated but I have been reading about severe complications from the ethmoid hematoma.

This horse has been a wonderful amazing horse for the 15 years I have owned him.

I do not want to create suffering for him for my benefit but do not want to ignore something that could be simply treated.

I understand there is no sure way to identify the mass from radiographs.

Is there a non invasive way to identify this mass?

How painful is the flap procedure and what are the risks of complications with an aged horse in his condition?

I thought of waiting 30 days and taking additional films to see how fast it is growing but don't know if that really me much.

Thank you for any insight you can provide to educate me in this challenging decision.
New Member:
leahh

Posted on Saturday, Oct 31, 2009 - 4:59 pm:

I forgot to add-before the radiographs were taken he did have a dental exam.

There were no obvious issues with his teeth.

He has does several small growths in his mouth and on his tongue.

In 2008, he had 2 small cauliflower shaped growths in his gumline (bilateral) and 2 accompanying growths on his tongue. The biopsy results were not very helpful-but they were not cancerous. The dentist at that time debrided them and they came back and have never grown.

I do not know if any of these things are connected.

I also know Cushing's horses are prone to funky oral and sinus issues and can have trouble healing and fighting bacterial infections-so another concern of proceeding forward.
Moderator:
DrO

Posted on Saturday, Oct 31, 2009 - 11:48 pm:

Hello Leah,
To identify the mass is going to require a biopsy, which will be a invasive procedure. I do not think a standing sinus flap procedure is going to be that painful with judicious use of a alpha 2 sedative like detomidine, local anesthetic, and a little bute or flunixin (reduced dosages because of the age) should keep him comfortable post op.
DrO
New Member:
leahh

Posted on Sunday, Nov 1, 2009 - 2:28 pm:

Thanks Dr O-

I have been reading more and more and am wondering if there are any benefits to a more conservative approach than going straight to the flap.

The foul odor and contact of the mass with the root of the first molar leads to a tooth abscess.

Of course other signs lead in a different direction!

Anyway, if it is a abscess that is showing a thick wall, can antibiotics even be effective? Or does the thick wall preclude that as a treatment option.

I am just trying to gather all information I can before making a decision on how to proceed.
Moderator:
DrO

Posted on Monday, Nov 2, 2009 - 9:09 am:

Walled off abscesses are very difficult to treat with antibiotics because it is difficult to penetrate the wall see Diseases of Horses » Skin Diseases, Wounds, and Swellings » Swellings / Localized Infection / Abscesses » Abscesses and Localized Infection for more on this.

Is it possible the abscessed tooth root is causing the problem? If so removal of the tooth and cleaning up the abscess through the tooth's alveolus might be an option.
DrO
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