Ciência Rural, Santa Maria, v.46, n.

7,Comparison
p.1262-1267, jul, 2016
between http://dx.doi.org/10.1590/0103-8478cr20141478
three techniques for videosinuscopy in cattle. 1262
ISSN 1678-4596 CLINIC AND SURGERY

Comparison between three techniques for videosinuscopy in cattle

Comparação entre três técnicas para videosinuscopia em bovinos

Fernando Zanlorenzi BassoI Eduarda Maciel BusatoI Jéssica Rodrigues da SilvaI

Rogério Luizari GuedesII Ivan Roque de Barros FilhoIII Peterson Triches DornbuschIII

ABSTRACT Foram selecionadas oito cabeças de bovinos provenientes de

abatedouro comercial, sendo realizada a trepanação dos seios
Cattle have extensive paranasal sinuses that are maxilares e frontais de ambos os lados (um orifício por seio).
susceptible to disease, most commonly sinusitis. The sinuscopy Cada seio foi inspecionado com três óticas: um colonoscópio
can be used to evaluate these structures, although there are no flexível com 10mm de diâmetro e até 180º de angulação, um
descriptions of this region for endoscopic anatomy, especially laparoscópio rígido de 10mm e 0º e um artroscópio rígido de
regarding the trocar position and the most appropriate type 4mm e 30º. Na região caudal do seio maxilar, os alvéolos e
of endoscope. This study aimed to standardize the surgical abertura maxilopalatina foram visualizadas com todas as
approaches to sinuscopy in cattle by comparing the use of óticas. A região caudodorsomedial e rostral do seio maxilar
three endoscopes. Four accesses by trephination (one hole for foram observadas com a ótica flexível e a rígida de 4mm, sendo
each of the maxillary and frontal sinuses) were made in eight que apenas esta adentrou no seio palatino. O seio frontal é de
heads of slaughtered cattle. Each hole was inspected with three difícil visualização, devido à tortuosidade de suas projeções
endoscopes: a 10mm flexible colonoscope with up to 180º of ósseas e sua porção cranial não foi observada pelo acesso
angulation, a 10mm 0° laparoscope and a 4mm 30º arthroscope. proposto. A região caudal do seio frontal, o divertículo nucal
It was observed that all regions of the maxillary sinus were better e a área caudal à órbita tiveram o maior número de estruturas
visualized with the 4mm endoscope, and the structures of this visualizadas com a ótica rígida de 4mm, seguida da flexível. A
sinus were less well visualized with the 10mm laparoscope. The análise comparativa demonstra que a técnica utilizando a ótica
frontal sinus was difficult to evaluate due to the tortuosity of its rígida de 4mm permite a visualização de um maior número de
bony projections, and the cranial portion was not observed by
estruturas com maior detalhamento e é a que mais se adapta à
the proposed accesses. The caudal regions of the frontal sinus
sinuscopia em bovinos.
such as the nuchal diverticulum and the back of the orbit had the
greatest number of structures visualized by the 4mm endoscope,
Palavras-chave: endoscopia, videocirurgia, seios nasais,
followed by the colonoscope. The comparative analysis showed
sinusite, bovino.
that the 4mm endoscope was most efficient and could be adapted
to sinuscopy in cattle.

Key words: endoscopy, videosurgery, nasal sinus, sinusitis, bovine. INTRODUCTION

RESUMO
The sinuses in cattle have peculiar
Os bovinos apresentam seios paranasais extensos e characteristics, are underdeveloped in calves and
passíveis de afecções, como a sinusite. A sinuscopia, técnica já acquire their full size after several years (DYCE
utilizada em outras espécies, avalia os seios paranasais de modo
pouco invasivo e não é descrita em bovinos. O presente estudo
et al., 2010). The frontal sinus presents rostral and
objetivou padronizar os acessos cirúrgicos para sinuscopia caudal compartments that extend to the cornual
em bovinos, testando três técnicas de videoendoscopia. processes. The maxillary sinuses are unique and

I
Programa de Residência Multiprofissional em Saúde, Universidade Federal do Paraná (UFPR), Curitiba, PR, Brasil.
II
Programa de Pós-graduação em Ciências Veterinárias, Universidade Federal do Paraná (UFPR), 80035-050, Curitiba, PR, Brasil. E-mail:
[email protected]. Corresponding author.
III
Departamento de Medicina Veterinária, Universidade Federal do Paraná (UFPR), Curitiba, PR, Brasil.
Received 10.06.14 Approved 01.15.16 Returned by the author 04.08.16
CR-2014-1478.R3 Ciência Rural, v.46, n.7, jul, 2016.
1263 Basso et al.

large, and enable communication with the palatine MATERIALS AND METHODS
sinuses. They must be accessed via the hard palate,
making the surgical approach quite difficult (SISSON Eight cattle heads were used, obtained from
& GROSSMAN, 1998). commercial slaughterhouses in Curitiba and nearby
Among the pathologies of the sinuses, cities. The heads were received skinless, dehorned
an inflammatory process called sinusitis stands and partially stripped. The access to the sinuses was
out. In cattle, the leading cause of frontal sinusitis carried out by a trepanning technique, first with a
is associated with dehorning, as about 2% of drill, making a small skull opening, then amplified by
surgically dehorned animals develop this disease rotational moves with a 20mm circular trephine. The
(FIORAVANTI et al., 1999; SILVA et al., 2008). It chosen sites for trepanation were based on the species
can also be associated with respiratory infections, anatomy and facilitated by bone visualization, aiming
trepanations or fractures with frontal sinus for a bilateral evaluation of the frontal, maxillary and
exposure, cysts or nasal cancer (SMITH, 2006). palatine sinuses. The access holes for the maxillary
Surgery by unqualified surgeons, the presence of sinuses were located 3.7±0.9cm rostral to the eyeball
foreign bodies and improper postoperative therapy and 2.1±0.3cm dorsal to the facial crest (Figure 1A).
are also important etiologic factors in this species The access holes for the frontal sinuses were located
(FIORAVANTI et al., 1996). 4.9±1.6cm rostral to the nuchal ridge and 2.8±0.5cm
The diagnosis of sinusitis in cattle is lateral to the midline (Figure 2A).
based on history and clinical examination findings The equipment used for cavity inspection
(DIRKSEN et al., 1993). In several species, in addition included a flexible colonoscope with a diameter of
to a general clinical examination, some diagnostic 10mm and angles up to 180° (Karl Storz, Germany), a
methods can be used such as regional radiographs, 10mm and 0° laparoscope (Karl Storz, Germany), and
sinucentesis, surgical exploration (sinusotomy), a 4mm and 30° arthroscope (Karl Storz, Germany);
tomography and sinuscopy; the latter is performed all were coupled to a laparoscopic unit composed by
with rigid or flexible endoscopes (ALLISON, 1999; a LED monitor, a microcam and a xenon light source
EMSHOFF et al., 1999; SMITH, 2006). (Telepack®, Karl Storz, Germany). The sinuses were
Sinuscopy has been performed in humans inspected with the three endoscopes, trying to identify
(BERTRAND & ROBILLARD, 1985; PETRUSON,
2004), horses (PERKINS et al., 2009a) and dogs
(JOHNSON, 2006), due to its practicality and lower
postoperative morbidity compared to conventional
exploration techniques (SILVA et al., 2009). In
horses, sinuscopy is widely used to properly inspect
the sinuses as well to collect samples and perform
biopsies on those sites. In this procedure, the animal
can be kept sedated in the quadrupedal position; sinus
access occurs through trepanation, which allows for
the introduction of endoscopes (PERKINS et al.,
2009a; O’LEARY & DIXON, 2011). Until now, there
have been no studies regarding sinuscopy in cattle,
in terms of systematically describing the endoscopic
anatomy of the region, the access portals and the most
appropriate type of lens.
This study aimed to compare the
effectiveness of three different endoscopes in
sinuscopic evaluation of the maxillary, palatine
and frontal sinuses of cattle in a postmortem study.
The experiment also aimed to standardize the Figure 1 - Illustration of the sinuses in a bovine head in a left
minimally invasive surgical access for sinuscopy in lateral view. A: access hole to the maxillary sinus;
B: caudal and caudo-dorsomedial areas from
this species and to improve anatomical knowledge maxillary sinus; C: maxilo-palatine opening; D:
with an emphasis on the endoscopic anatomy of dental alveoli. Adapted from BUDRAS & HABEL,
those regions. 2003.

Ciência Rural, v.46, n.7, jul, 2016.

 Comparison between three techniques for videosinuscopy in cattle. 1264

During this study, a 20mm diameter circular

trephine was used, but smaller diameters such as 14 or
15mm may be used for the same purpose (PERKINS
et al., 2009b). MACHADO & SILVA (2013) carried
out an 8mm trepanation to compare rigid and a flexible
sinuscopy in horses, using a 4mm 30° rigid endoscope
and a flexible endoscope 4.8mm in diameter. Due the
10mm endoscope used in the present study, it was not
possible to work with smaller trephines.
The trephination areas and sinuses were
selected based on anatomy, but they may be modified
according to the purposes of the exam (SMITH,
2006). The main identified areas are displayed in
figure 3. Through the frontal sinus access, a caudal
observation was made of this region, the nuchal
diverticulum, the caudal region of the eyeball, but the
exploration was complicated by the presence of large
numbers of intrasinusal lamellae (Figure 3C).
Figure 2 - Illustration of the sinuses in a bovine head (cranial Data in percentages referring to viewing
view). A: access hole to the frontal sinus; B:
nuchal diverticulum; C: frontal sinus caudal
capacity from different areas and techniques are
area; D: caudal area to the eyeball. Adapted from compiled on table 1. The visualization of the caudal
BUDRAS & HABEL, 2003. frontal sinus area (Figure 2C) varied according to
the equipment used; the 4mm 30° arthroscope was
most efficient (viewing rate of 87.5%). It was not
possible to see the desired structure in only one of
the highest number of structures possible, according the eight heads, bilaterally, due the greater presence
to the literature and the local anatomy of this species, of bone irregularities therein. The colonoscope with
being classified as 1: visible or 2: not visible. All a diameter of 10mm and angles up to 180° ranked
inspections were documented individually for further second, with 62.5% successful visualizations, while
assessment, recording and the identified structures the 10mm 0° endoscope had the lowest viewing rate
were tabulated. Three independant evaluators were among all tested endoscopes, as it was effective in
selected, one with experience in videoendoscopic/ less than half of the heads (43.75%). Observation
videolaparoscopic procedures in another species, and of the nuchal diverticulum was possible only with
the other two with knowledge of cattle anatomy. The the arthroscope and colonoscope, in 81.25% and
efficiency of these endoscopes was verified through 12.50% of accesses, respectively (Figure 2B). During
their viewing capability and identification of structures the experiment, the caudal area to the eyeball was
by the surgeon evaluator. The group findings were visualized by some accesses with the arthroscope
statistically compared by the non-parametric Kruskal- (56.25%) and colonoscope (25%). The laparoscope
Wallis test, followed by Dunn’s multiple comparison, proved to be ineffective for this purpose.
using Graphpad Prism software, V5. The rostral region of the frontal sinus
presents a tortuous anatomy, marked by intrasinusal
RESULTS AND DISCUSSION lamellae, resulting in irregular areas (BUDRAS &
HABEL, 2003; DYCE et al., 2010), which prevent
The literature concerning cattle sinuscopy the insertion of endoscopes through the proposed
is rare, making it difficult to compare the literature with access. The cornual processes were not visible
the data obtained in this study. In horses, sinuscopy is because the heads were obtained from previously
a tool used for the diagnosis, treatment and evaluation dehorned animals.
of sinusitis (PERKINS et al., 2009b; DIXON et al., Inspection of the maxillary sinuses was
2012.). Besides horses, there are reports of sinuscopy easier and didactic when compared with the frontal
in dogs, but it is difficult to draw interrelationships sinuses, because the maxillae have a small number
between studies of these species with cattle because of tortuous bones and a more regular anatomy. This
they have anatomically different paranasal sinuses finding is in counterpoint to the purpose of the
(PETRUSON, 2004; JOHNSON, 2006). examination, since the major diseases of the bovine

Ciência Rural, v.46, n.7, jul, 2016.

1265 Basso et al.

Figure 3 - Explored anatomical areas identified during the video sinuscopy in cattle. A: dental alveolus; B:
maxilo-palatine opening; C: tortuosity from frontal sinus; D: maxillary sinus, caudo-dorsomedial
portion; E: palatine sinus; F: maxillary sinus, caudal portion; G: maxillary sinus, rostral portion; H:
palatine sinus.

paranasal sinuses are associated with dehorning, (Figure 3E; Figure 3H) could not be accessed in all
and therefore good visualization of the frontal sinus heads. The most effective endoscopic access to the
would be interesting (SILVA et al., 2008). palatine sinus was achieved with the arthroscope,
The caudal area of the maxillary sinuses which attained a 93.75% viewing rate, with only
achieved excellent viewing with all endoscopes one not evaluated due a narrower maxillopalatine
used (Figure 1B; Figure 3F). The caudodorsomedial opening than the others. The other endoscopes
portion of the same area (Figure 1B; Figure 3D) had showed poor efficiency to this area, with a viewing
slightly limited inspection when the laparoscope was rate of 25% with the colonoscope and a 6.25% with
used, because it was ineffective in three of the 16 the laparoscope. The rostral region of the maxillary
views. The dental alveoli (Figure 1D; Figure 3A) sinus (Figure 3G) was inspected with 100% efficiency
and the maxillopalatine opening (Figure 1C; Figure when using the arthroscope and 87.5% efficiency
3C) were readily observed with all three endoscopes with the colonoscope; however, this viewing area
(viewing rate of 100%); however, the palatine sinus was not accessible with the laparoscope.

Ciência Rural, v.46, n.7, jul, 2016.

 Comparison between three techniques for videosinuscopy in cattle. 1266

Table 1 - View capacity (percentage and total number of animals) of the anatomical regions from paranasal sinuses in the evaluated cattle
heads during the video-endoscopy techniques (n=16).

Viewed area Rigid optic 4mm e 30° Flexible optic 10mm e 180° Rigid optic 10mm e 0°
Frontal sinus (rostral portion) 0% (0)a 0% (0)a 0% (0)a
Frontal sinus (caudal portion) 87.5% (14)a 62.5% (10)ab 43.8% (7)b
Nuchal diverticulum 81.3% (13)a 12.5% (2)b 0% (0)b
Eyeball (caudal portion) 56.3% (9)a 25% (4)ab 0% (0)b
Maxilar sinus (rostral portion) 100% (16)a 87.5% (14)a 0% (0)b
Maxilar sinus (caudal portion) 100% (16)a 100% (16)a 100% (16)a
Maxilar sinus (caudo-dorsomedial portion) 100% (16)a 100% (16)a 81.3% (13)a
Palatine sinus 93.8% (15)a 25% (4)b 6.3% (1)b
Maxilo-palatine opening 100% (16)a 100% (16)a 100% (16)a
Dental alveoli 100% (16)a 100% (16)a 100% (16)a

ab
Values with different superscripts in the same row are statistically different according to the Kruskal-Wallis test (P<0.05), followed by the
Dunn`s multiple comparison test (P<0.05), using the software Graphpad Prism, V5.

CONCLUSION DIRKSEN, G. Sistema digestivo. In: ROSENBERGER. Exame clínico

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FIORAVANTI, M.C.S. et al. Treatment of Subcutaneous Abscesses
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