Experiences of complications post sinus flap surgery

[glymer]

HellHh Hello, I am new to the forum and hoping for support from people who have experienced similar problems. My young horse recently had to have 2 molar teeth removed due to a fracture and sinus flap surgery secondary to tooth infection. Unfortunately following successful surgery the healing skin began to break down whilst still under hospital care and died and the bone underneath was infected leading to a large hole in his face with no skin protection. As you can imagine this has been very stressful and there have been many tears. I have a care regime for him from the equine clinic but concerned about complications of infection of an open cavity and would like to know if anyone has been through similar with a positive outcome as all feels doom and gloom at the moment. .

 

[Louby]

Hi, so sorry to hear about your horse. My story isnt the same but involves a similar procedure. My horse had a cheek tooth removed as a 4 yr old, it was fractured and infected but broke fully whilst they tried to remove it under sedation, so he had a GA to knock it out from the outside in. This involved removing a piece of his face over his sinus about 3inches x 2 inches and thankfully the op went well and he looked almost normal after the op. My problem was infection afterwards, it just wouldnt go away, this was the original tooth root infection caused by the fracture. The smell was horrendous and it took about 3 years for us to resolve it and he had lots of different antibiotics, trephines into both sinuses and basically a miserable horse. It did however clear up but 10 years later we have problems again, he has had pus coming out of the old trephine site which goes then comes back again a few days or weeks later. I am not putting my horse through surgery again or trephines and we have tried unsuccessfully to resolve it with weeks of ABs. I was told again that tooth root infections, sinus infections are notoriously difficult to treat and to be prepared for a re run of 10 years ago. Im at a loss what to do at the moment as it seems the ABs arent working and we are only treating the symptom not the cause. I need to xray really but having decided he is not having invasive surgery again Im wondering rightly or wrongly whether theres any point as the next step is trephining, which again is treating the symptom and not the cause. My horse was miserable and in pain last time this was done and its not fair when theres no guarantee of it ever resolving.
I really hope your horse comes through this.

 

[putasocinit]

The problem with sinus infections or tooth root is the antibiotics cannot get right into where the pus is, so only a removal of the pus is what will clear it, i would ask your vet to try different antibiotics so if no improvement after 7 days of one type then another clurse of another type.

As for the horse with the hole, shame i hope he is okay but again suggest different antibiotics, will the hole ever close, can they do a skin graft.

 

[glymer]

Hi both of you. Louby, I have heard sinus problems can be recurrent and some horses unfortunately have persistent problems but unfortunately I have not idea what the best course of action would be it is such a difficult situation to be in... In relation to my boys problem a skin graft has not been suggested, I have been advised to do regular wash outs into the cavity hole (approx. 10cm squared so large) with salt water, to keep on top of internal scabs etc using cotton wool to remove them. Manuka honey is being used around the wound to keep the living skin around it in best condition and then a waiting game! I have been told it is rare and will take months to see a major change but at the moment it is hard to believe this will have any possibility of healing by surrounding tissue. If anyone knows of any horse owner who has been through this I would greatly appreciate contact as I can find very little via the internet on outcomes or images of recovery. I was hoping to post an image to make it clearer what has happened but don't know if you are able to add photographs.

 

[whizzer]

How large is the hole? My horse has had extensive sinus surgery a number of times & after every surgery was left with a hole through his forehead that I could fit my little finger through. Everytime it's healed up without issue,we kept his head dressed & covered the hole & any other broken down areas covered in Manuka honey.

 

[glymer]

Hi whizzer,

Unfortunately this is not the small hole left by the flush tube (he also has that) this is a huge hole which is the size of the cut from the sinus flap surgery basically about 10cm by 10com squared looking into his sinus cavity wall and bone structure and he is breathing through it. The whole piece of skin died over the wound and the bone was too infected to save. Very gruesome this morning had to remove scabs which had formed in the cavity over his bone structure. I am also using manuka honey around the large hole.

 

[Louby]

Gosh, I ddint realise it the piece of bone flap was missing too. Is it always going to be like this? What has the hospital said? I knew of a horse with an horrendous injury that eventually healed to a tiny scar but that didnt involve bone too. My horse was stabled at the vets at the time as a livery not patient and it was amazing to see this wound recover but it involved pretty agressive treatment to encourage healthy tissue growth to fill the large hole. Poor you, Im sorry I didnt realise your horse had an open sinus cavity.

 

[whizzer]

Gosh, I ddint realise it the piece of bone flap was missing too. Is it always going to be like this? What has the hospital said? I knew of a horse with an horrendous injury that eventually healed to a tiny scar but that didnt involve bone too. My horse was stabled at the vets at the time as a livery not patient and it was amazing to see this wound recover but it involved pretty agressive treatment to encourage healthy tissue growth to fill the large hole. Poor you, Im sorry I didnt realise your horse had an open sinus cavity.

Sorry, read your other post too quickly & didn't realise it was the whole flap that had gone. Crikey, don't know what to suggest. My horse had 2 bone flaps done at 1st op & we had a lot of wound breakdown plus an area where a bony distortion
inwards,had to dress his head for nearly 3 months but it did all heal really well in the end. I'm a VN & I found all the initial breakdown & the open trephine hole quite difficult to deal with! Hope things start to improve soon.

 

[whizzer]

*Ooops quoted wrong post above!

 

[glymer]

Hi, wishing I was a VN at this time Whizzer unfortunately went into human health care profession and don't have to deal with gore very often. Was the wound break down on your horses surgery where the incision had been made for the sinus flap? and how bad was it? The vet is hopeful that the skin surrounding the hole will eventually knit together once granulated to form a new cover of skin but leave a concave section as no bone underneath. The hole is about 10cm squared so very large and disturbing as you can see all his open cavity and he breathes though it :-( I was hoping someone would come forward with a similar situation with great news that 4-6 months later they were thriving and leading a normal life with no hole. I am currently giving antibiotics, pain killers and cleaning the hole with salt water and cotton wool to remove scabbing and mucus build up :-/ so anxious it is traumatic for my boy, though he seems to cope reasonably well. Thanks for the well wishes x

 

[whizzer]

Mine had 2 flaps & there was breakdown on both. Smallest flap below his eye broke down all the way round the excision,there was also a hole trephined through this small flap & it was on an area where he had a facial distortion due to the mass he had so the whole lot caved in! It was a mess but healed well & just left him with a dent in that area. The large flap on his forehead also broke down all around the whole excision with the worst area breaking down to the bone. This was the bottom corner, his surgeon said that invariably this happens at the bottom corner with these flaps, but they're not really sure why. We dressed his head for about 10 weeks post surgery & the cosmetic results are good,especially as he went on to have surgery twice more. I did a lot if reading into this stuff at the time & can't recall seeing any info on the sort of problem you're describing. Fingers crossed that you get it sorted.