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A 7-year-old Thoroughbred gelding presented with a history of mild unilateral right-sided epistaxis and facial swelling over the right caudal maxillary sinus and zygomatic arch. Eleven months previously a progressive ethmoid hematoma had been surgically removed from the right caudal maxillary and conchofrontal sinus. Computed tomography identified a large expansile soft-tissue attenuating mass in the right caudal maxillary sinus, with protrusion into the conchofrontal sinus, that extended into the zygomatic arch. Lytic expansion and thinning of the cortex with pneumatization of the zygomatic arch was present. The mass was surgically excised after a biopsy had confirmed the recurring progressive ethmoid hematoma., (© 2021 American College of Veterinary Radiology.)

Background: There is little objective information concerning the intra- and post-operative complications or the long-term outcome of sinoscopic treatment of equine sinus disorders., Objectives: To document the long-term outcome, including intra-operative complications, reasons for treatment failure and other complications, in horses undergoing standing sinoscopic treatment of sinus disorders., Study Design: Retrospective clinical study., Methods: Records of sinus disease cases presented to The University of Edinburgh Veterinary School between January 2012 and July 2019 were reviewed. Follow-up information was obtained from clinical records and a telephone questionnaire., Results: Long-term follow up for 155 cases treated sinoscopically showed that 108/155 (69.7%) fully responded to their initial treatment. Concurrent intranasal lesions were identified in 37.4% of cases. Sinusotomy was later required in 10 cases to improve surgical access or sinonasal drainage. Reasons for failure to fully respond to the initial treatment (n = 47) included: intra-sinus bone sequestra (n = 9), inspissated exudate (n = 6) or insects (n = 2); similar material and/or infected conchal bullae in the middle meatus (n = 7); persistent oro-maxillary fistulae (n = 4), misdiagnosed dental apical infections (n = 4); impaired sinonasal drainage (n = 4), progressive ethmoid haematoma regrowth (n = 3) and undiagnosed causes (n = 5). Further treatment of 43 of these cases (67% as outpatients) showed 34/43 cases fully responding to their second treatment. Only 4/155 cases (2.6%) required sinonasal fenestration. In the long term, 149/155 cases (96.1%) showed full and 2/155 cases (1.3%) showed partial improvement. Sinoscopy portal wound infection occurred in nine cases., Main Limitations: The length of time between treatment and obtaining follow-up information in some cases. Advances in knowledge and techniques over the duration of the study., Conclusions: Sinoscopic treatment is a minimally-invasive technique causing minimal morbidity and was successful in 96.1% of cases. Meticulous care should be taken to ensure that bony sequestrae and inspissated exudate are fully removed from the sinuses and nasal cavity during sinoscopic treatments., (© 2020 EVJ Ltd.)

The anatomy of the equine paranasal sinuses is critical to understand to assess the extent of the disease process, the optimal surgical approach, and the ability to drain through the normal nasomaxillary pathway. By following established anatomic landmarks, direct sinus access can be used to further explore the sinus compartments, remove compromised cheek teeth, remove any purulent debris or feed contamination, and establish drainage. Many complications can be avoided or minimized by thoroughly evaluating all sinus compartments and critically assessing the ability of the sinus to drain., Competing Interests: Disclosure No disclosures., (Copyright © 2020 Elsevier Inc. All rights reserved.)

The nasal conchal bullae (dorsal and ventral) are separate, air-filled structures within their respective dorsal and ventral nasal conchae. Computed tomography scans have assisted with the increasing diagnosis of empyema of the nasal conchae. This condition is usually associated with dental or sinus disease. Drainage of affected bullae is considered critical for resolution of clinical signs. The ventral conchal bullae can be easily viewed with a standard 10 mm diameter flexible endoscopy via the middle nasal meatus. This approach can also be used for fenestration of the bullae, using a diode laser, equine laryngeal forceps, or bipolar vessel sealing device., Competing Interests: Disclosure The authors have no conflicts of interest to disclose., (Copyright © 2020 Elsevier Inc. All rights reserved.)

Background: Computed tomography (CT) is commonly used to investigate equine paranasal sinus disease, however, only limited information is available in the literature about the detailed CT appearance of equine paranasal sinus cysts., Objectives: To investigate if paranasal sinus cysts have specific characteristics in CT images that allow differentiation from other sinus diseases., Study Design: Retrospective observational study., Methods: Evaluation and comparison of CT studies of eight horses with surgically and/or histopathologically confirmed paranasal sinus cysts and 10 horses with other confirmed paranasal sinus diseases., Results: A discrete hyperattenuating wall-like structure was detected in the periphery of the sinus lesion in precontrast acquisition in 7/8 horses with paranasal sinus cysts. A similar wall-like structure was detected in 3/10 horses with other sinus diseases, however, in contrast to horses with paranasal sinus cysts, two of these also had hyperattenuating regions within the contents of the sinus lesion. Bone destruction and formation affecting cancellous and cortical bone and dental disease were frequent in horses with paranasal sinus cysts. No significant difference in attenuation values was found when the fluid/soft tissue attenuation contents of lesions in horses with paranasal sinus cysts (mean 28.9 ± SD 9.2 HU) were compared with other sinus diseases when ethmoid haematomas were excluded (30.4 ± 12.9 HU, P = .8)., Main Limitations: Low number of cases., Conclusions: Detection of a hyperattenuating cystic wall is a helpful feature for identifying paranasal sinus cysts in CT images of horses. In contrast, measurement of attenuation values of the soft tissue/fluid contents of the sinus lesions was not helpful in identifying paranasal sinus cysts., (© 2019 EVJ Ltd.)

Cryptococcosis, caused by the Cryptococcus gattii and C. neoformans species complexes, is an environmentally acquired mycosis affecting a broad range of host species. Among 9 communally housed ferrets, a 5-y-old castrated male ferret domiciled in an outdoor enclosure in Sydney, Australia was diagnosed with sinonasal cryptococcosis. Clinical signs resolved during 18 mo of itraconazole therapy, but the ferret was eventually euthanized because of splenic hemangiosarcoma. At postmortem, microscopic foci of persistent cryptococcosis were detected. The diagnosis raised concerns that the owners and other ferrets were exposed to a common environmental source of infection, thus prompting an investigation. Soil samples, swabs of a hollow eucalypt log (used for behavioral enrichment), and nasal swabs from 8 asymptomatic ferrets were collected. Nasal exudate (obtained at diagnosis) and tissues (collected at postmortem) were available from the clinical case. Bird seed agar culture resulted in a heavy growth of Cryptococcus spp. from one environmental site (the log), one nasal swab, and nasal exudate and tissues from the clinical case. All other samples were culture-negative. Sub-cultured isolates from the log were a mixture of C. gattii molecular type VGI and C. neoformans molecular type VNI. Ferret isolates were a similar mixture of C. gattii VGI (all disease isolates) and C. neoformans VNI (nasal-colonizing isolate). Multilocus sequence typing further revealed the ferret isolates as identical to environmental isolates collected from the log, confirming the log as the source of clinical disease and nasal colonization. The log was removed to prevent further exposure to a high environmental load of Cryptococcus spp.

Bilateral paranasal sinus diseases are rarely reported in horses. Treatment using a bilateral frontonasal bone flap on a standing, regular-sized adult horse has not been described previously. A 13-year-old Thoroughbred gelding was evaluated for bilateral mucopurulent nasal discharge. Radiographic, endoscopic and computed tomographic examinations revealed bilateral sinus pathological changes consistent with an ethmoid haematoma involving the maxillary and frontal sinuses. A bilateral frontonasal bone flap was created under standing sedation and local anaesthesia. A tracheotomy was performed initially to ensure a patent airway during the procedure. Additional analgesia had to be given to transect the dorsal part of the nasal septum while elevating the flap. The sinus masses were removed and communications with the nasal cavities created uneventfully. Small sequestra were removed transendoscopically from the left caudal maxillary sinus 4 weeks after the initial procedure. The horse made a complete recovery with an excellent cosmetic outcome. Histopathology revealed the mass to be a sinus cyst. We concluded that a bilateral sinus bone flap can be used in adult regular-sized horses to access the left and right paranasal sinuses simultaneously. Regional nerve blocks should be performed in order to increase analgesia. A temporary tracheotomy prevents any airway obstruction during the procedure. The post-operative cosmesis is excellent.

Background: Paranasal sinus cysts (PSC) are a common cause of equine secondary sinusitis. The outcome and associated complications have not been frequently reported., Objectives: To review the associated clinical signs, associated morbidities and outcomes of horses treated for PSC., Study Design: Retrospective multicentre case series., Methods: Retrospective analysis of case records and telephone follow up survey., Results: Subjects were 37 horses 1-24 years old that were presented with nasal discharge (n = 31), facial swelling (n = 25) and epiphora (n = 19). Radiography and computed tomography allowed identification of the cyst-induced changes including concomitant tissue destruction (n = 31), leading among other things to local nerve damage causing headshaking (n = 6) and unilateral blindness (n = 1). Radiographic changes to adjacent dental apices were present in 10 horses. Horses over 10 years old showed more of the named associated problems. Post-operative complications included surgical site infection (SSI) (n = 11), nasofrontal suture periostitis (n = 6) and sequestration (n = 1) following removal of the PSC via osteotomy. The long-term response to treatment was available for 28 cases with 22 horses (78.6%) fully cured, 4 (14.3%) partially cured and 2 (7.1%) not responding to treatment. In 7 horses (18.9%) there was recurrence of the cyst post-operatively., Main Limitations: Due to the study being a multicentre retrospective case series with collection of data over an extended period, there may be inconsistency in data recording and absence of reporting of some findings., Conclusions: Overall, the diagnosis and treatment of sinus cysts is relatively straightforward and carries a good prognosis. In long-standing cases complications secondary to the expansive growth of cysts will dramatically affect the prognosis for full recovery due to pressure-induced changes to facial bones, cheek teeth and nerves. These secondary complications mainly occurring in older horses may be due to a combination of a relatively longer period of affection and the inflexibility of older horses' bones. Cyst recurrence following treatment can occur in up to 19% of cases., (© 2018 EVJ Ltd.)

Conditions of the head requiring surgery in cattle are not uncommon when considering the incidence of conditions such as ocular squamous cell carcinoma and requests for surgical dehorning. Surgery involving the eyes in cattle is relatively common, whereas surgery of the paranasal sinuses is less common. Generally speaking, however, surgery for conditions of the head tend to have a more favorable prognosis when there is early intervention., (Copyright © 2016 Elsevier Inc. All rights reserved.)

Objective: To describe the anatomical location of the ethmoidal nerve in the equine periorbital region and to determine the accuracy of a technique used to deposit local anesthetic solution adjacent to the nerve., Study Design: Prospective experimental study., Animals: Adult equine cadaver heads (n=6 for preliminary dissection; n=15 [30 nerve sites] for evaluation of injection technique)., Methods: Preliminary dissections were performed to identify landmarks for injection of local anesthetic adjacent to the ethmoidal nerve. For evaluation of the injection technique a 20 gauge 6 cm spinal needle was inserted into the rostromedial aspect of the supraorbital fossa, where the caudal aspect of the zygomatic process emerges from the frontal bone caudal and medial to the globe. The needle was inserted to its hub at an angle of 110° to the long axis of the head using a protractor, in both a sagittal plane and a transverse plane, and 0.5 mL of new methylene blue dye was injected as a marker. The ethmoidal nerve was identified by dissection immediately after each injection and inspected for proximity of the dye., Results: Dye was observed surrounding the nerve in 27 of 30 sites (90%) or lying within 5 mm of the nerve at the other 3 sites., Conclusion: The described technique of perineural injection of the ethmoidal nerve proved reliable and simple. Anesthetizing the ethmoidal nerve may be helpful in desensitizing portions of the ipsilateral paranasal sinuses and nasal cavity innervated by the nerve when sinonasal surgery is performed in the standing horse., (© Copyright 2016 by The American College of Veterinary Surgeons.)

Progressive ethmoid hematoma is frequently reported among the pathologies of the upper airways in horses. While several hypotheses have been proposed such as repeated trauma, inflammatory processes and/or chronic infections, congenital phenomena, complication of hemangiomas, and neoplastic processes, the aetiology of this condition is yet unknown. Clinical symptoms are non-specific and includes haemorrhagic nasal discharge, respiratory noise not related to physical exercise and, in most severe cases, phenomena of coughing. The purpose of this case report is to contribute to a correct diagnostic approach to this particular pathology of upper respiratory tract in horses. Magnetic Resonance allows for a very detailed imaging of the development of the disease and suggests appropriate therapeutic choices.

Canine nasal and paranasal diseases have variable causes. Presumptive diagnosis is based on clinical manifestations; however, high similarity of clinical signs often calls for diagnostic imaging modalities and rhinoscopy before a definitive diagnosis can be reached. This study sets out to determine the value of rhinoscopy, radiography, and computed tomography (CT) of the head for canine nasal and paranasal disease diagnosis using a purposely developed comparative score. In all, 20 dogs presenting with clinical signs consistent with nasal disease were used. Patients were submitted to radiographic, CT, and rhinoscopic assessment; rhinoscopy-guided biopsy collection was performed in cases presenting with tissue proliferation, ulceration, or other nasal mucosal lesions. Rhinoscopy and rhinoscopy combined with CT significantly contributed to nasal disease diagnosis. Rhinoscopy and CT are complementary diagnostic modalities. Rhinoscopy proved helpful for confirmation of presumptive diagnosis and allowed image-assisted biopsy collection whereas CT contributed to effective determination of lesion extension and involvement of adjacent structures. Yet, histologic confirmation remains vital for definitive diagnosis., (Copyright © 2015 Elsevier Inc. All rights reserved.)

The equine head is an anatomically complex area, therefore advanced tomographic imaging techniques, such as computed tomography or magnetic resonance imaging (MRI), are often required for diagnosis and treatment planning. The purpose of this multicenter retrospective study was to describe MRI characteristics for a large sample of horses with head disorders. Horses imaged over a period of 13 years were recruited. Eighty-four horses met the inclusion criteria, having neurological (n = 65), sinonasal (n = 14), and soft tissue (n = 5) disorders. Magnetic resonance imaging accurately depicted the anatomy and allowed identification of the primary lesion and associated changes. There were good correlations between MRI findings and intraoperative or postmortem results. Magnetic resonance imaging showed the exact localization of the lesions, their size, and relation to surrounding structures. However, in the neurological group, there were 45 horses with no MRI abnormalities, 29 of which had a history of recurrent seizures, related to cryptogenic epilepsy. Magnetic resonance imaging was otherwise a valuable diagnostic tool, and can be used for studying a broad range of head disorders using either low-field or high-field magnets., (© 2014 American College of Veterinary Radiology.)

We examined 131 European badgers Meles meles (Linnaeus, 1758) from 67 localities in central Germany for the presence of the cranial trematode Troglotrema acutum, as previous studies based on museum skulls might have underestimated the prevalence of the parasite in this host. We detected the flatworm in only three individuals that originated from the Rhoen Mountains (Thurigina and Bavaria). While the cranium of one host individual showed the lesions and the sponge-like widening of certain regions of the skullcap that are typical of a T. acutum infection, the skulls of the two remaining badgers did not show any deformations. The three badgers were infected by eight, 20, and 49 T. acutum individuals, respectively. Eggs of the trematode parasite were detected in the paranasal sinuses of two badgers. While badgers infected with T. acutum may not show any surface bone lesions, the results of the present study do not contradict the conclusion that the badger is only an accidental host of T. acutum.

Objective: To report meningoencephalitis as a complication after paranasal sinus surgery in 5 horses., Study Design: Case series., Animals: Adult horses (n = 5)., Methods: Medical records (2005-2010) of 5 horses that developed neurologic signs after sinus surgery were reviewed to identify potential risk factors, cause(s), or common pathways for infection., Results: Underlying diseases were primary (n = 1) and secondary sinusitis (4) because of apical dental infection (1), sinus cyst (2), or masses in the ethmoturbinate region (2). Horses were treated by conventional surgical approaches and aftercare including repeated sinus lavage. Four horses had undulating pyrexia postoperatively despite antimicrobial therapy. All horses developed neurologic signs, eventually unresponsive to treatment. Suppurative meningoencephalitis was diagnosed macro- and/or microscopically on necropsy in all horses., Conclusion: Meningitis is a rare but fatal complication after sinus surgery in horses., (© Copyright 2014 by The American College of Veterinary Surgeons.)

Objective: To report headshaking and presumptive trigeminal neuritis as a potential complication after paranasal sinus surgery in horses., Study Design: Retrospective case series., Animals: Horses (n = 5) that developed headshaking within 45 days of paranasal sinus surgery., Methods: Medical records (2007-2010) of horses that had been evaluated for headshaking after paranasal sinus surgery were reviewed., Results: Of 5 horses that developed headshaking within 45 days of paranasal sinus surgery, resolution occurred after treatment in 2 horses. One horse was euthanatized because clinical signs associated with headshaking could not be controlled. Headshaking persisted in the other 2 horses but was either adequately controlled with analgesics or was considered infrequent and transient enough to not warrant therapeutic intervention. Only 2 of 5 horses returned to full work after development of headshaking., Conclusions: Headshaking because of presumptive trigeminal neuritis is a possible career-ending or fatal complication of paranasal sinus surgery in horses., (© Copyright 2014 by The American College of Veterinary Surgeons.)

Dental and sinus disorders are relatively common and of major clinical importance in equine medicine. Advanced diagnostic imaging has become an integral part of equine veterinary medicine. Advanced imaging has progressed the understanding, diagnosis, and treatment of dental- and sinus-related diseases. As a clinician, it is important to realize the value of advanced diagnostic imaging. Although computed tomography and magnetic resonance imaging are both significantly more expensive compared with other diagnostic tools, the financial cost of inaccurate diagnosis and treatment can often result in higher overall costs., (Copyright © 2013 Elsevier Inc. All rights reserved.)

The diagnosis and treatment of equine dental-related sinus disease is often challenging. Dental-related sinus disease is common and knowledge of these diseases is becoming increasingly important in veterinary medicine. Diagnostic capabilities are continually improving, leading to early diagnostic and therapeutic successes. With advanced imaging modalities, such as computed tomography and magnetic resonance imaging, understanding of the intimate anatomic relationship between teeth and the paranasal sinuses continues to progress. There are many therapeutic options available for the treatment of these common and challenging disorders. A complete understanding of the disease, therapeutic options, and potential complications is vital to overall successful resolution of clinical signs in equine dental-related sinus disorders., (Published by Elsevier Inc.)

Objective: To describe successful surgical treatment of bilateral mucocele in an American Miniature horse using a single bone flap to approach right and left paranasal sinuses simultaneously., Study Design: Clinical report., Animal: A castrated 6-year-old American Miniature Horse with a bilateral mucocele of the paranasal sinuses., Methods: A single bilateral frontonasal sinus flap was used in a standing procedure to access the left and right conchofrontal sinuses simultaneously to remove the mucous contents and to establish permanent drainage into the nasal cavities., Results: The novel procedure used in this horse allowed excellent access to right and left paranasal sinuses simultaneously and completely resolved nasal discharge and difficulty breathing., Conclusions: A single, bilateral frontonasal sinus flap can be used successfully as a standing procedure to treat bilateral sinonasal disease in horses., (© Copyright 2013 by The American College of Veterinary Surgeons.)

Diseases of paranasal sinuses and nasal passages in horses can be a diagnostic challenge because of the complex anatomy of the head and limitations of many diagnostic modalities. Our hypothesis was that magnetic resonance (MR) imaging would provide excellent anatomical detail and soft tissue resolution, and would be accurate in the diagnosis of diseases of the paranasal sinuses and nasal passages in horses. Fourteen horses were imaged. Inclusion criteria were lesions located to the sinuses or nasal passages that underwent MR imaging and subsequent surgical intervention and/or histopathologic examination. A low field, 0.3 tesla open magnet was used. Sequences in the standard protocol were fast spin echo T2 sagittal and transverse, spin echo T1 transverse, short-tau inversion recovery (STIR) dorsal, gradient echo 3D T1 MPR dorsal (plain and contrast enhanced), spin echo T1 fatsat (contrast enhanced). Mean scan time to complete the examination was 53 min (range 39-99 min). Lesions identified were primary or secondary sinusitis (six horses), paranasal sinus cyst (four horses), progressive ethmoid hematoma (two horses), and neoplasia (two horses). The most useful sequences were fast spin echo T2 transverse and sagittal, STIR dorsal and FE3D MPR (survey and contrast enhanced). Fluid accumulation, mucosal thickening, presence of encapsulated contents, bone deformation, and thickening were common findings observed in MR imaging. In selected horses, magnetic resonance imaging is a useful tool in diagnosing lesions of the paranasal sinuses and nasal passages., (© 2012 Veterinary Radiology & Ultrasound.)

Objective: To determine whether CT provides unique information about the treatment or prognosis for horses with ethmoid hematoma (EH)., Design: Retrospective case series., Animals: 16 horses with EH., Procedures: Horses with a diagnosis of EH that had undergone a diagnostic CT study were included. Clinical features, treatment, outcome, radiographic and CT images, and histologic specimens were reviewed., Results: CT provided new diagnostic information that affected treatment in 10 of 16 horses. Bilateral disease occurred in 8 of 16 horses and was undetected in 5 horses prior to CT. Paranasal sinus involvement occurred in all horses, but was incompletely defined prior to CT in 7 of 16 horses. The sphenopalatine sinus was affected in 6 of 16 horses as detected on CT; 4 of 6 of these were bilaterally affected. Medical and surgical treatments were performed. Six of 10 horses had a successful outcome, with recurrence in 4 of 10. Five of 6 patients in which treatment addressed all lesion sites identified by CT had a successful outcome. Bilateral disease did not confer a poor prognosis when all affected sites were treated. Sphenopalatine sinus involvement may have been associated with recurrence., Conclusions and Clinical Relevance: CT provided anatomic information that may facilitate effective treatment of horses with EH, particularly in patients with bilateral disease and paranasal sinus involvement. Computed tomography is recommended for patients in which the lesion cannot be viewed endoscopically, when sinus involvement or multifocal disease are suspected, or when the lesion has been unresponsive to treatment.

Advanced diagnostic imaging and histopathological investigation were performed in an adult horse with chronic facial swelling due to a bone sequestrum and abscessation. In contrast to other cases, there were no draining tracts, difficulty eating, weight loss, head shaking, or fistula formation between the oral cavity and the maxillary sinus.

Reasons for Performing Study: There is a lack of objective information on the value of ancillary diagnostic techniques used to investigate equine sinus disease, and also on which sinus compartments are commonly affected in this disorder., Objectives: To record the ancillary diagnostic findings used to investigate equine sinus disease and to document which compartments are affected., Materials and Methods: The clinical case records of 200 consecutive cases of sinus disease, including subacute (<2 months' duration) primary (n = 52); chronic (>2 months' duration) primary (n = 37); dental (n = 40); traumatic (n = 13); sinus cyst (n = 26); sinus neoplasia (n = 10); dental related oromaxillary fistula (n = 8); mycotic sinusitis (n = 7) and intra-sinus progressive ethmoid haematoma (n = 7) were retrospectively examined., Results: Nasal endoscopy showed exudate draining from the sino-nasal ostia in 88% of cases and a sino-nasal fistula was present in 15% of cases. Sinoscopy was performed in 79% of cases and was of great diagnostic value. More recently, 22% of cases had fenestration of the ventral conchal bulla performed to allow sinoscopy of the rostral sinus compartments. Radiography was performed in 97% of cases and showed intra-sinus fluid lines to be common (69% prevalence) in subacute primary sinusitis. Radiographic dental apical changes were not specific to dental sinusitis, e.g. 29% of chronic primary sinusitis cases had radiographic dental changes. Scintigraphy was performed in 20% of cases and was helpful in identifying dental apical changes when radiography was inconclusive. Overall, the caudal maxillary (78% involvement) and rostral maxillary (61%) sinuses were most commonly affected, with the ventral conchal sinus (VCS) (54% involvement) and conchofrontal sinuses (48%) less so. The VCS showed the greatest tendency to contain inspissated pus (present in 46% of all affected VCS)., Conclusions: Nasal endoscopy, sinoscopy and skull radiography are of great value in diagnosing the presence and causes of equine sinus disease., (© 2011 EVJ Ltd.)

Reasons for Performing Study: There is limited objective information available on the treatment and the long-term response to treatment of the different types of equine sinus disease., Objectives: To document the treatments and long-term response to these treatments in 200 cases of equine sinus disease (1997-2009)., Methods: The treatments of horses affected with subacute primary sinusitis (n = 52); chronic primary sinusitis (n = 37); dental sinusitis (n = 40); sinus cyst (n = 26); traumatic (n = 13); dental-related oromaxillary fistula (n = 8); sinus neoplasia (n = 10); mycotic sinus disease (n = 7); and intrasinus progressive ethmoid haematoma (n = 7) and the long-term response to these treatments were retrospectively reviewed., Results: Treatments evolved throughout the study and latterly were as conservative as possible, including sinoscopic lavage and standing sinusotomy, with a maxillary sinusotomy approach preferred for the mainly mature horses treated in this study. Removal of intrasinus inspissated pus, including transendoscopically (by sinusotomy and via existing sinonasal fistulae), was the main treatment for chronic primary sinusitis and sinonasal fistulation was seldom performed latterly. Attempted oral extraction of infected cheek teeth, even if unsuccessful, facilitated subsequent dental repulsion, resulting in few post operative problems. Sinus cyst removal carried an excellent prognosis. Except for cases of sinus neoplasia (only 22% cured), an excellent long-term response to treatment (91% fully cured, 7% partially cured) was obtained for all other types of sinus disease following a median of one treatment., Conclusions: More conservative treatments, including removal of intrasinus inspissated pus by sinoscopy, pre-existing sinonasal fistula or sinusotomy, are effective for chronic primary sinus disease. Standing sinusotomy, mainly using a small maxillary site, was suitable for most cases of sinus disease in mature horses., (© 2011 EVJ Ltd.)

In this retrospective study of 41 cats with chronic nasal disease diagnoses included nasal neoplasia (n = 19), idiopathic chronic rhinosinusitis (ICRS) (n = 12), nasopharyngeal polyps (n = 3), foreign bodies (n = 2), nasopharyngeal stenosis (n = 1) and nasal aspergillosis (n = 1). In 3 cats diagnosis could not be established despite thorough work-up. Gender, indoor or outdoor housing, quality or quantity of nasal discharge, bacteriological findings of nasal flushes, radiology and CT findings did not differ significantly between cats with neoplasia and cats with ICRS. Cats with neoplasia were older (3 - 15, median 11 years) and showed clinical signs for a shorter period of time (1 - 8, median 2 months) than cats with ICRS (age 1 - 13, median 7.5 years; signs: 1 - 36, median 5 months). In all cats with neoplasia a mass was detected rhinoscopically, while this was only seen in 30 % of cats with ICRS. The exact diagnosis has to be established by examination of biopsy samples. A combination of physical examination, imaging studies and rhinoscopy with cytological and histopathological examination of samples enhances the likelihood for a correct diagnosis.

Aetiology, clinicopathological findings and treatment outcomes were documented in 23 cats (1.5-13 years of age) with sinonasal (SNA, n=6) or sino-orbital (SOA, n=17) aspergillosis. Cases recruited retrospectively and prospectively were included if fungal hyphae were identified on cytological or histological examination and the fungal pathogen was identified by PCR and DNA sequencing (ITS1 or ITS1-5.8S-ITS2 regions, rDNA gene cluster). Fungal culture was positive in 22/23 cases. In cases of SNA, the fungal pathogen was Aspergillus fumigatus (n=4), Neosartorya fischeri or A. lentulus (n=1) or a non-speciated Neosartorya spp. (n=1). In all cases of SOA (n=17), the fungal pathogen was identified as Neosartorya spp. Nine cats had brachycephalic conformation. Cats with SNA were more likely to be infected with A. fumigatus and had a better prognosis than cats with SOA., (Copyright © 2011 Elsevier Ltd. All rights reserved.)

Involvement of the ventral conchal sinus (VCS) is an important diagnostic and prognostic feature in cases of the equine sinus disease. The authors aimed to ascertain if the caudo-dorsal extension of the VCS, the ventral conchal bulla (VCB) is identifiable on plain radiographs of cadaver skulls without sinus disease. Bilateral frontonasal sinus flaps were made in 10 equine cadaver skulls. Plain lateral, lateral oblique and dorso-ventral radiographs were then obtained followed by the same views taken with stainless steel wire outlining the caudal border of the VCB. Plain radiographs were randomised and blindly evaluated by two observers who marked where they believed the VCB to be positioned. This was then correlated with the true position of the VCB using radiographs with wires in place. The ease of identification of the VCB was classified as 'easy' or 'difficult'. The VCB was correctly identified in 70 per cent of lateral radiographs, but only 45 per cent of lateral oblique radiographs and 17 per cent of dorso-ventral radiographs. If a clinician was confident that he or she could identify the VCB, they were usually correct. Conversely if the clinician judged VCB identification as 'difficult', they usually identified it incorrectly. In the authors' clinical experience, the VCB of horses with sinusitis involving this compartment is more radiologically evident than in clinically normal horses. Knowledge of the normal radiographic anatomy of this structure should aid clinicians in identifying horses with sinusitis affecting the VCS.

The historical and clinical findings in 200 referred cases of equine sinus disease were reviewed retrospectively. Univariable and multivariable analyses were performed to detect significant differences in historical or clinical features between various categories of sinus disease. The causes of sinus disease were classified as subacute primary (less than two months duration) (n=52), chronic primary (more than two months duration) (n=37), dental (n=40), sinus cyst (n=26), traumatic (n=13) or mycotic sinusitis (n=7), sinus neoplasia (n=10), dental-related oromaxillary fistula (n=8) and intrasinus progressive ethmoid haematoma (n=7). The majority of sinus disorders were of chronic duration at the time of referral and most (including 97 per cent of chronic primary sinusitis cases) had not responded to previous antibiotic therapy and/or sinus lavage in some cases. Clinical signs included unilateral nasal discharge in most cases, including purulent or mucopurulent discharge in all horses with primary, dental and mycotic sinusitis. Haemorrhagic nasal discharge was a feature of traumatic sinusitis and intrasinus progressive ethmoid haematomas. Firm facial swellings and nasal airflow obstruction were features of sinus cysts and neoplasms. Ipsilateral lymphadenitis was a more prominent feature of sinus disease with active infections such as primary, dental or mycotic sinusitis.

The paranasal sinus system of horses is complex, comprising six pairs of sinuses. Disease processes that can develop in the sinuses include ethmoid hematomas, cysts, neoplasia, and bacterial and fungal infections. Horses that develop paranasal sinus disease vary widely in age. A significant number of clinical conditions involving the paranasal sinuses require a combination of diagnostic tests to determine the specific pathologic process. Because of the anatomic location of the paranasal sinuses and associated chronic conditions that affect many patients, many disease processes involving the paranasal sinuses require surgical correction for a favorable prognosis. Fungal and neoplastic processes of the equine paranasal sinuses have a less favorable prognosis than bacterial and other disease processes.

Reasons for Performing Study: Results of surgical treatment of sinonasal disease in horses have been reported previously; however, this paper describes the outcome of horses in which a specific post operative treatment protocol was used., Objectives: The objectives of the study were to determine: 1) short- and long-term outcome; 2) complications; and 3) recurrence rates of different disease processes, when horses were treated with a specific treatment protocol., Methods: Medical records of horses presented for surgical treatment of sinonasal disease from 1996-2007 were reviewed. Results and duration of surgical exploration were recorded. Post operatively, the sinus flaps were re-opened with the horses standing and sedated. Number of horses requiring further treatment (debridement and/or lavage), median number of post operative days when the flap was re-opened, median number of times the flap was opened and median duration of hospitalisation were recorded. Short- and long-term survival and complication rates were determined., Results: Ninety-one horses were included in the study. The sinus flaps were re-opened with the horses standing a median of 3 days post operatively. Thirty-nine horses (43%) required further treatment at this time and 89 horses (97%) survived to discharge. Incision infection was the most common complication encountered (29%). No horse required a blood transfusion. Recurrence rates were 5% for paranasal sinus cysts, 12% for progressive ethmoid haematoma and 50% for neoplasia., Conclusions: Rapid removal of the primary lesion followed by packing the sinuses and re-evaluating in the standing horse in a more controlled environment offers a safe and effective means to thoroughly assess and treat sinonasal disease., Potential Relevance: Surgical time, intraoperative haemorrhage, long-term complications and recurrence rates of paranasal sinus diseases treated via frontonasal or maxillary sinus flap may be reduced using this technique., (© 2010 EVJ Ltd.)

Disease of the paranasal sinuses of the horse is common and treatment often involves lavage and sometimes surgery. The development of minimally-invasive, sinus-specific treatments, such as balloon sinuplasty, requires a thorough understanding of this complex anatomical region. To improve this understanding, 10 heads from dead horses of various ages were grossly dissected. The heads were transected sagittally and each half was dissected to expose the left and right nasomaxillary apertures and associated structures which were then photographed and measured. Entrances from the rostral and caudal maxillary sinuses into the maxillary aperture were found that led to a common exit at the middle nasal meatus. The caudal and rostral maxillary sinuses had their own, completely distinct outlets (entrances into the nasomaxillary aperture). There was no significant effect of side on measured variables., (Copyright © 2009 Elsevier Ltd. All rights reserved.)

Objective: To evaluate the use of sinoscopy for detection and treatment of ventral conchal sinus (VCS) and/or rostral maxillary sinus (RMS) disease in horses., Study Design: Case series, Animals: Horses (n=60) with suspected paranasal sinus disease., Methods: Horses were evaluated by sinoscopy through a conchofrontal sinus (CFS) portal with ventral conchal bulla (VCB) fenestration. Other endoscopic sinus approaches and adjunctive diagnostic tests; oral examination, computed tomography, radiography, scintigraphy and endoscopic examination of the upper portion of the respiratory tract were used in some horses., Results: The CFS approach permitted adequate observation of the RMS and VCS in 53 horses (88%). Hemorrhage caused by VCB fenestration prevented examination of the RMS and/or VCS in 12 horses (21%). Observation of lesions was possible in all horses diagnosed with neoplasia, sinus cysts, and progressive ethmoidal hematomas. Endoscopy of the paranasal sinuses was useful diagnostically in 82% of horses with primary sinusitis. Other diagnostic modalities were usually required to confirm a diagnosis of dental sinusitis., Conclusions: Trephination into the CFS with VCB fenestration is a minimally invasive technique that provides consistent access to the RMS and VCS. It facilitates diagnosis of many sinus disorders and endoscopically guided treatment of many horses with sinus cysts and primary sinusitis, in combination with sinus lavage., Clinical Relevance: Many diseases affecting the RMS and VCS can be diagnosed and resolved endoscopically using a CFS approach with VCB fenestration, thus avoiding the need for osteoplastic sinus surgery and its associated risks and complications.

Objective: To develop a reliable technique for sinoscopic examination of the ventral conchal (VCS) and rostral maxillary sinuses (RMS) of horses, Study Design: Descriptive study, Animals: Cadaveric equine heads (n=40), Methods: The VCS and RMS were examined endoscopically using: (1) rostral trephination of the RMS (rostral RMS approach); (2) caudal trephination of the RMS (caudal RMS approach); (3) conchofrontal sinus (CFS) trephination followed by RMS trephination at a site identified by endoscopic transillumination of the maxillary bone at the most rostral aspect of the caudal maxillary sinus (CMS) (light-indicated RMS approach); (4) CFS trephination with fenestration of the ventral conchal bulla (VCB; frontal VCB approach); (5) CMS trephination with VCB fenestration (caudal VCB approach); and (6) CFS and CMS trephination with VCB fenestration (combined VCB approach)., Results: Success in observing the rostral and caudal aspects of the VCS and RMS with each approach were: (1) rostral RMS approach (0 horses; 16 horses [40%]); (2) caudal RMS approach (0 horses; 11 horses [28%]); (3) light-indicated RMS approach (3 horses [8%]; 24 horses [60%]); (4) frontal VCB approach (24 horses [60%]; 29 horses [73%] respectively); (5) caudal VCB approach (16 horses [40%] both structures); and (6) combined VCB approach (27 horses [68%]; 35 horses [88%])., Conclusions: Trephination into the CFS coupled with fenestration of the VCB provided consistent access to both the rostral and caudal aspects of the RMS and VCS. A trephine hole into the RMS provided poor access to the VCS, and placed the reserve crowns of the maxillary cheek teeth at risk of damage., Clinical Relevance: The RMS and VCS can be best examined endoscopically using approaches with fenestration of the VCB.

Bilateral cysts in the frontal and caudal maxillary sinuses in a filly treated by endoscopic sinus surgery (sinoscopy) and triangulation technique are described. Sinoscopy has the advantage of being a minimally invasive technique and permits a complete inspection of the frontal and maxillary sinuses, which is not possible through flap sinusotomy.

Case Description: A 13-year-old female Miniature Horse was evaluated for progressive unilateral exophthalmia of the left globe of 3 weeks' duration., Clinical Findings: Results of a physical examination were unremarkable. Ophthalmic examination identified exophthalmus of the left globe with complete resistance to retropulsion and mild blepharoconjunctivitis. Computed tomography revealed a large, space-occupying mass within the left caudal maxillary and left conchofrontal sinuses. The mass extended into the left retrobulbar space and contacted the cribriform plate. Trephination yielded copious amounts of turbid yellow fluid. The diagnosis was a sinonasal cyst., Treatment and Outcome: Subtotal surgical excision of the cyst via a frontonasal osteoplastic flap was curative, with complete resolution of the exophthalmus. Histologic examination confirmed diagnosis of a sinonasal cyst. There was no evidence of cyst recurrence by 4 months after surgery., Clinical Relevance: Sinonasal cyst should be a differential diagnosis for retrobulbar disease in horses. Exophthalmia may be the only clinical finding in horses with a sinonasal cyst.

A 13-year-old female spayed Domestic Shorthair cat presented with a history of right-sided mucopurulent nasal discharge for 18 months. Computed tomography revealed a mass within the right nasal cavity and the right frontal sinus. The animal was euthanized, and a postmortem examination was performed. On macroscopic examination, the right nasal cavity and the right frontal sinus were partially occluded by a soft whitish mass. Microscopically, the mass was composed of well-differentiated plasma cells that were immunopositive for immunoglobulin G and lambda light chains. These findings were consistent with a mature-type sinonasal plasmacytoma. In addition, there was right-sided mucopurulent rhinitis and sinusitis caused by a Pasteurella infection, which probably developed secondary to the sinonasal plasmacytoma. To the authors' knowledge, this is the first report of a sinonasal plasmacytoma in a cat. The present communication shows that feline sinonasal plasmacytomas should be included in the differential diagnosis for tumors located in the upper respiratory tract of cats.

Long-term outcomes (mean 38+/-17 months) were evaluated in 27 dogs with sinonasal aspergillosis after successful medical treatment using intranasal infusions of 1% or 2% enilconazole (1%, n=15; 2%, n=12). Long-term outcomes with both treatment protocols were good, with half of the dogs being asymptomatic throughout the follow-up period. The remaining dogs showed mild clinical signs compatible with chronic rhinitis/sinusitis. These clinical signs were interpreted as chronic lymphoplasmacytic rhinitis/sinusitis and episodes of bacterial rather than fungal infection. Three dogs had confirmed reinfection or relapse 2 to 36 months after clinical resolution.

Background: Sinonasal disease is common in cats; chronic inflammatory disease and neoplasia are diagnosed most frequently. Radiographic and computed tomographic (CT) findings in nasal disease have been reported, although involvement of other cranial structures has not been fully described to our knowledge., Hypothesis: We hypothesized that neoplastic or inflammatory obstruction of the auditory tube associated with sinonasal disease could result in CT evidence of effusive bulla disease in affected cats., Animals: 46 cats with sinonasal disease, 18 control cats., Methods: CT images acquired in cats with (n = 46) and without (n = 18) sinonasal disease were reviewed for evidence of concurrent bulla effusion. CT findings of soft tissue or fluid opacity within the tympanic bulla or thickening of the bone of the bullae were considered evidence of effusive bulla disease., Results: The prevalence of bulla effusion in cats with sinonasal disease was 28% (13/46) and was significantly higher than that observed in cats without sinonasal disease (1/18, P = .043). CT findings that were found in association with effusive bulla disease included imaging features of sinusitis and nasopharyngeal disease. The most common neoplasm associated with bulla effusion was nasopharyngeal lymphoma. Bulla effusion was not observed in any cat with nasal carcinoma., Conclusions and Clinical Importance: Findings of this study suggest that auditory canal dysfunction may play a larger role in feline sinonasal disease than was previously recognized. The implications of these findings for management of cats with chronic inflammatory or neoplastic sinonasal disease require further investigation.

Reasons for Performing Study: The spectrum of clinical presentation, methods of diagnosis, management and prognosis in cases of sinunasal cysts (SNCs) requires more extensive study. Despite the extensive nature of SNCs, the prognosis for afflicted horses appears to have improved since earlier studies were conducted., Objectives: To evaluate prognosis and cosmetic outcome of surgical ablation in 52 cases of SNCs., Methods: Fifty-two case records (1982-2005) of horses affected with SNCs were retrieved from the archives. Subject details, clinical signs, diagnostic techniques, surgical management and post surgical complications were extracted. Owners and referring veterinarians were contacted to assess the results of treatment., Results: There was no biphasic age distribution. The major presenting signs in descending order of frequency were facial swelling, mucopurulent nasal discharge, nasal airflow obstruction and abnormal respiratory noise. Common endoscopic findings included narrowed nasal meati, a cyst in the nasal cavity and a cyst visible caudal to the nasal septum viewed from the contralateral unaffected nasal meatus. Typical radiological signs included a discrete mass in the sinunasal region, a diffuse increase in opacity over the sinunasal region, free fluid lines, nasal septal deviation, expansion of the ventral conchal sinus and distortion of dental apices. Cyst extirpation using an osteoplastic flap provided a successful outcome. Forty-five of 48 horses showed complete resolution of clinical signs after subtotal or total extirpation of the cyst wall. Follow-up information was not available for the other 3 horses. Thirty-nine of 45 horses had a good to fair cosmetic appearance, judged to be good in 26 horses, fair in 13 and poor in 6. Results confirmed that the prognosis for full recovery has improved since a previous report of 15 cases., Conclusions and Potential Relevance: Equine sinunasal cysts may arise in horses of any age; presenting signs should alert clinicians to their likely presence. A discrete well-circumscribed mass found during radiographic examination provides supporting evidence of a cyst. The vivid yellow, translucent, seromucoid fluid aspirated from cysts is characteristic of the condition.

The purpose of this retrospective study was to determine the association between clinical characteristics, computed tomography (CT) characteristics, and histologic diagnosis in 43 cats with sinonasal disease. All cats were evaluated with CT and nasopharyngeal endoscopic examination, with histologic diagnosis based on nasal biopsy. Fifteen cats were diagnosed with sinonasal neoplasia and 28 cats were diagnosed with rhinitis. Clinical characteristics determined to be significantly associated with neoplasia were unilateral ocular discharge (odds ratio [OR] 9.6) and the presence of a nasopharyngeal mass during endoscopic examination (OR 18.9). CT characteristics found to be significantly associated with neoplasia included: unilateral lysis of ethmoturbinates (OR 11.0), unilateral lysis of the dorsal (OR 8.3) and lateral maxilla (OR 6.9), lysis of the vomer bone (OR 6.7) and ventral maxilla (OR 28.8), and bilateral lysis of the orbital lamina (OR 4.1); unilateral abnormal soft tissue/fluid within the sphenoid sinus (OR 15.3), frontal sinus (OR 10.4), and/or and retrobulbar space (OR 12.2). Lysis of the maxillary turbinates, nasal septum, nasal bone, palatine bone, and cribriform plate were not significantly associated with sinonasal neoplasia.

Diseases of the nasal cavity and sinuses can be frustrating problems for owners and veterinarians alike. Initial physical examination and routine blood work are often unrewarding in directing the clinician at a diagnosis. Diagnostic imaging can help characterize the disease process and direct treatment or further diagnostics. Radiographs of the skull are an excellent first-line diagnostic step in the analysis of nasal disease. The following article reviews basic techniques, positioning, and interpretation of radiographs of the nasal cavity and paranasal sinuses.

In a mixed sex sample of ten adult gibbon (Hylobates moloch) skulls, one cranium of a male with maxillary sinus atelectasis of the left side was identified. While external inspection revealed a slight drop of the left orbital floor, serial coronal computer tomography (CT) scans show characteristic changes of the left maxillary sinus and its surrounding structures. In addition to the sunken orbital floor, radiological features of the specimen include an inward bowing of the medial sinus wall, sinus opacification, and a reduction in maxillary sinus size to a slit-like cavity, which suggest a diagnosis of silent sinus syndrome. This report is the first, to our knowledge, of maxillary sinus atelectasis in a non-human primate. This finding is valuable for the understanding of the pathogenesis and etiology of maxillary sinus atelectasis. At the same time, however, paleoanthropologists and primatologists may refer to this information when dealing with the interpretation of maxillary sinus pneumatization of partially broken archaeological and fossil skulls.

Objectives: To describe and analyze subjective and objective scintigraphic findings in horses with paranasal sinus disorders., Animals: Horses with suspected disorders of the paranasal sinuses or cheek teeth (n = 48) and control horses (n = 30)., Methods: 99Technetium-methylenediphosphate (99Tc-MDP; 7500 MBq) was administered for scintigraphic examination of the skull. Abnormal patterns of increased radionuclide uptake (IRU) were identified and subjectively described. Scintigrams and radiographs were blindly assessed by 2 clinicians and the accuracy of the imaging modalities was compared. Objective analysis was performed by comparing regions of interest (ROI) drawn over areas of abnormal IRU to the equivalent area on the unaffected side using the Mann-Whitney test. An ROI ratio (affected:non-affected sides) was also calculated for each lesion., Results: Twenty-eight horses were diagnosed with primary (15) or secondary (13) sinusitis. Nine primary sinusitis cases had focal area(s) of moderate or marked IRU in addition to a more diffuse uptake in the affected sinus(es). kappa was marginally higher for scintigraphic assessment of paranasal sinus disorders than for radiographic assessment. There were significant differences in mean counts/pixel in ROI drawn on the affected side compared with the non-affected side. There was considerable overlap between the magnitudes of ROI ratios found with many different disorders., Conclusions: Scintigraphy can be useful for differentiation of sinusitis of dental origin from other causes of sinusitis. Quantitative analysis of scintigrams is not reliable for identification of particular disorders., Clinical Relevance: Focal areas of moderate or marked IRU may be observed with primary sinusitis. Careful 3-dimensional localization of the lesion, along with consideration of other clinical and diagnostic findings should be performed to prevent false-positive diagnoses of periapical infection in such instances.

Reasons for Performing Study: Previous studies of sinus surgery on standing horses have been based on techniques which utilise powered hand bone saws and preserve the bone flap, which was thought to be essential for a good cosmetic result. This report describes a simplified technique applied to the standing horse where the sinus flap construction used a large skull trephine and where the bone flap is necessarily discarded., Objectives: To assess whether the modified standing frontonasal flap (SFF) surgery offers an effective method to investigate and/or treat sinunasal disorders in the horse., Methods: The case records of 60 horses subjected to modified SFF surgery were reviewed to analyse the efficacy of the technique when applied to a range of sinunasal disorders in terms of diagnosis, surgical findings, complications and long-term outcomes, including cosmetic effect., Results: Resolution of clinical signs was achieved in 54 out of 60 horses, and for the remainder the SFF technique proved useful on a diagnostic basis. The cosmetic result was, in the opinion of the owners, excellent or satisfactory in 48 of 56 (86%) horses., Conclusions: The modified SFF technique was found to be practicable and provided satisfactory exposure of the sinus contents for diagnosis and removal of diseased tissue in a range of disorders. An acceptable cosmetic result can be obtained in the majority of horses despite rejection of the disc of overlying bone. Apart from avoiding the risks associated with general anaesthesia, the advantages of the modified SFF sugery are: a reduction of haemorrhage in the standing horse; reduced mucosal engorgement; straightforward anatomical orientation; a comfortable working height; and reduced surgery time. A sound knowledge of the functional anatomy of the area is a prerequisite before embarking on any form of sinunasal surgery. Complications are infrequent and usually transient., Potential Relevance: The modified SFF technique is a valuable alternative to other invasive methods of sinunasal surgery.

An 18-month-old, spayed female, domestic shorthaired cat was presented with clinical signs of depression and reluctance to walk, which progressed to nonambulatory tetraparesis. Increased opacification of both frontal sinuses and a cyst-like abnormality causing compression and displacement of the right frontal lobe were seen on computed tomography. Bilateral frontal sinus trephination and right transfrontal craniotomy revealed clear, viscous fluid in the right frontal sinus and rostral fossa, compatible with an intracranial mucocele. At a 6-month follow-up examination, no signs of recurrence were appreciated.

A two-year-old, female spayed Australian cattle dog was diagnosed with nasal aspergillosis. The dog was treated topically with clotrimazole. Clinical signs recurred two months later and the clotrimazole treatment was repeated and 5 mg/kg itraconazole twice daily was added to it. The recommended dose of itraconazole for nasal aspergillosis is 5 mg/kg twice daily administered orally. The dog's symptoms completely resolved, but it developed an adverse febrile reaction to the Itraconazole. The Itraconazole was discontinued and the dog remained asymptomatic for four years. The dog then developed mucopurulent discharge from the right nostril and was diagnosed as having recurrent nasal aspergillosis. Itraconazole at 5 mg/kg twice daily was prescribed, which again induced a fever. When the itraconazole was decreased to 5 mg/kg once daily there were no fever episodes, but the nasal discharge was not completely resolved. The dog was then treated with topical clotrimazole Infusion, and maintained on 5 mg/kg itraconazole daily. To the authors' knowledge, this case is unique because of the delayed recurrence of nasal aspergillosis. Additionally, the idiosyncratic febrile reaction to the itraconazole has not previously been reported in the veterinary literature, but is similar to reports of drug-induced fever in humans.