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  Discussion on Cribriform plate and ethmoidal hematoma
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Posted on Wednesday, Nov 22, 2000 - 10:42 am:

Dr O - I read through the article on Nose Bleeds/Epitaxis, but got stuck on the description of the cribriform plate and ethmoidal hematomas. I can't picture exactly where the plate is, and what does "ethmoidal" mean? It doesn't sound like an ethmoidal hematoma is anything to be overly concerned with, but does it warrant treatment in any case? Thanks!

Posted on Wednesday, Nov 22, 2000 - 12:56 pm:

Don't think that an ethmoidal hematoma is nothing much, because such a condition is currently killing my beloved horse. I think a better description would be a bloody tumour, rather than the fancy term ethmoidal hematoma, because the thing grows like a tumour, into every nook and cranny, and just doesn't stop. It is called "ethmoidal" because it is supposed to start in the ethmoid sinus, I think, but it can actually grow in the maxillary sinus, all over.

Desie had a huge hole cut into his cheek for the vets to make sure it was this horrible thing, he has had 6 or 7 injections of formalin into the tumour/hematoma, to no avail. He is too old to have the major surgery to scrape it out, as he couldn't take the anaesthetic and trauma involved - and anyhow, it grows back in a very large % of cases. After the last massive series of x-rays and scopes last month by vets and professors, he will not be given any more treatment.

His nasal passages are now affected, and his breathing capacity seriously compromised, because the tumour is pushing inwards, so the nasal stem has bent to compensate, hence both nasal passages are narrowed - and the side with the tumour is now also full of polyps. He's just been on antibiotics for a month as he is getting infection after infection.

It is really horrible to live with. He is being very clever and adapting his lifestyle to live with his reduced levels of breathing - he doesn't play with the other two, very occasionally has a little trot, but just walks quietly about grazing. He likes to come in earlier than he did before. I've managed to keep his condition up by dint of careful feeding and many small meals - and we are in early summer so the grass is good. The vets are so terrified of my tears that they are very vague and refuse to get to the point when I ask for more information - but I don't believe we have too long to go.

I don't know how I will know when it is enough, but I pray I do - I guess he will start to lose condition and let me know.

Take it seriously!

Posted on Wednesday, Nov 22, 2000 - 1:59 pm:

Oh Alexa, I'm so sorry to hear this! I must have misinterpreted the information in the article. A horse I've known for the last 11 years is living on borrowed time due to a gutteral pouch infection, so on a lesser scale I know what you are going through. Did you have your horse scoped? I started reading this article because a horse I know was tentatively diagnosed with the ethmoidal hematoma, but upon scoping nothing was found.

Posted on Thursday, Nov 23, 2000 - 4:22 am:

My mare also has very large cysts in her sinuses, they are not "classic" ethmoidal, but slow growing fatty cysts in her sinuses. She does have her breathing compromised out of her right nostril, but there is no infection and the cysts are fairly stable. I also opted not to go with surgery, as the cysts are pretty widespread and I did not want to put her thru the surgery at her age.
Alexa, I am sorry to hear about your horse, trust me, your beloved horse will let you know when it is time to go. It will just feel like the right thing to do in your heart.
I know Ruby does not get as much air as she should, so she is retired and enjoying life. She has also adjusted extremely well to her disability. Her quality of life is good and she is happy.

Posted on Thursday, Nov 23, 2000 - 8:40 am:

Hello Jordana,
I think you are confusing the early diagnostic criterion, "mild hemmorage" with the severity of the process: an enlarging piece of very vascular granulation tissue that will not probably not resolve without surgical or medical intervention. I have edited the article to reflect this and some of the clinical signs associated with this change.

Concerning the anatomy, the ethmoid bone is one of the skull bones located in the very back of the nasal cavity, If you where looking at a horse this would lie at about the level of the eye but of course deep to it. "Ethmoidal" means associated with the ethmoid bone. The cribriform plate of the ethmoid bone fits into the ethmoidal notch of the frontal bone and supports the olfactory lobes of the cerebrum. I will be gone next week to the AAEP and when I get back I will see if I can get a good picture in here of the sagital section of the horses head.
DrO
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