The Cat’s Out of Breath: Cracking the Sinus Case-Just look at the picture.....

Frontal Sinus Trephination and Repeated Irrigation in a Cat with Chronic Rhinosinusitis: A Case Report

Hyomi Jang, Hyojun Kwon, Sunyoung Kim, Jiheui Sohn, Jong-in Kim, Dong-In Jung

Background
Feline chronic rhinosinusitis (FCRS) is a persistent inflammatory condition affecting the nasal passages and frontal sinuses in cats. The disease is often refractory to medical treatment and leads to substantial morbidity. This case report addresses the challenges of managing FCRS and presents surgical intervention as a potential solution when traditional medical therapies fail.

Methods
A 2-year-old neutered female domestic shorthair cat with a history of chronic nasal discharge unresponsive to antibiotics, antivirals, and anti-inflammatory medications underwent detailed diagnostic workup, including CT imaging and PCR testing. When medical therapy proved ineffective, the cat was treated with frontal sinus trephination, physical removal of purulent exudate, placement of a drainage catheter, and repeated sinus irrigation over several weeks.

Results
Initial CT scans revealed nasal and frontal sinus obstruction with fluid accumulation and osteolytic changes. Despite targeted antimicrobial and antifungal therapy, symptoms persisted. Frontal sinus trephination revealed viscous purulent material, and irrigation was repeated postoperatively. PCR testing detected Aspergillus fumigatus and Mycoplasma felis, though cultures were negative. Two years post-procedure, the cat exhibited substantial improvement, with only mild intermittent serous nasal discharge and no recurrence of obstructive symptoms.

Limitations
Being a single case report, generalizability is limited. Histopathological samples were not obtained due to mucosal fragility. Additionally, the varied and often inconclusive results from PCR and culture testing highlight diagnostic limitations. The lack of standardized protocols for surgical intervention in feline rhinosinusitis also constrains interpretation.

Conclusions
This report demonstrates that surgical management, specifically frontal sinus trephination with repeated irrigation, can significantly improve outcomes in cats with refractory FCRS. Surgical intervention should be considered in cases unresponsive to prolonged medical therapy. Future studies are needed to standardize treatment strategies and clarify the pathophysiology of FCRS.

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