Persistant Sinus Infection / Swelling Side of Face

I posted this a few weeks ago and now I'm reposting with pix - I'm still struggling with a sinus infection in my mare Gracie. The vet has been out 3 times now and we are not sure what is causing it. She has a history of sinus infections - when she was younger she had sinus reconstructive surgery and has had reoccurring sinus infections ever since. Each time, however, she has responded well to SMZ tabs. In addition to the sinus infection, she has a large hard swelling under her eye down to her jawbone (same side as the sinus infection).

She is on SMZ tabs and metrondazole and is not responding. The xrays do not show anything unusual - she does have some bone deterioration, but that could be left over from her surgery when she was younger. Teeth look fine in the xrays. They did cultures on her nasal discarge and also drew serum from the swelling on her face - the cultures showed nothing unusual.

She acts normal - eating and drinking just fine. No fever, no heat in the swelling. She still has nasal discharge with a foul odor - she's been on the meds now for 3 weeks. I just sent the xrays and pix to my former vet (before I moved) to see what she sees. If she sees nothing unusual from the xrays, then we're going to take her to the hospital where they have a great surgeon who specializes in sinus issues.

Ideas anyone?

OH My that poor little thing. How sad,,, I hope a vet finds something to help her soon. I am sorry it has been such a problem finding an answer. She makes my face hurt to see her!!!

OH crap, that's go to hurt. Darn it.

Is she on anything for swelling?

Have they tried running a tube up there as in draining a blocked tear duct?

My only guess would be to get her on something a whole lot stronger as the SMZ's have not kicked in and pull out all the stops on the antibiotics and give it the big guns. Rats.

Yikes, that does look painful. We've had some sinus issues in big and small horses but never had one that extreme. I don't know where you are & whether Carl Mitz works in your area, but it might sure be worth asking if he would take a look at her. He might pick up something that has been missed, just looking from another perspective.

Just a thought - any possibility she might have gotten a thorn or something embedded in her face? I had a big mare years ago that we were convinced had strangles, she had a large swelling under her jaw, nasty oozing etc....but she actually had gotten a thorn stuck in her & it caused an infection - nothing contagious fortunately.

Hope you find the answer.

Jan

[SIZE=12pt]Two things come to mind as I look at your horse! 1. There may be a tooth root protruding into the nasal passage causing an on going infection.[/SIZE]

2. Have your vet scope the gutteral pouch and see if it full of infection! We had this happen to a little mare a few years ago, only it was on both side of the face! She had 2 teeth roots grown into her nasal passage causing a nasty infection! After surgery and a long recovery she did just fine!

Bill

Bill - that's exactly what I'm wondering. The xrays don't show anything unusual, but I'm sure they can see more at the hospital. We discussed a gutteral pouch infection - this vet doesn't feel this is the case and did not feel comfortable scoping a mini. There is a vet up here who will scope minis (he is good) - I guess the question (for me) is if I should have the other vet scope her, or at that point should I just bring her to the hospital for further treatment. Good question, though, about the tooth root. I will call her in the AM and bring it up.

I was thinking the same about a tooth root extending into the sinus cavity--one tooth looks suspect to me on that x-ray, but I am no expert at reading x-rays!

That swelling does look nasty and uncomfortable--glad to hear she is eating and drinking fine, but I hope you can get it figured out & cleared up soon. Best of luck!

Those rear two teeth look like they're in the sinus cavity.

Thanks, Matt. I see what you're looking at and just put a call into the 2nd vet to ask her to specifically look at those 2 teeth when she gets the xrays. Much appreciated...

HI Liz-

My mare that had the sinus infection was scoped twice, actually, and at one point the infection was in the gutteral pouch. We got the gutteral pouch cleared up with Baytril, but the sinus infection that was persistent was caused by the tooth root that didn't show on the xrays, as it was just barely into the sinus, but enough to cause a huge problem. The tooth root was found during the surgery. Our mare had a bone flap surgery and her sinus lining was removed as well as some other work on her tooth root and bones - the lining does grow back. She has been infection free for over a year now. I would encourage you to have your mini scoped by someone proficient in doing this in minis and then proceed from there. My impression is that the bone deterioration could be caused from the infection itself- once the infection gets so deeply imbedded into the lining of the sinus it can affect the bone in this manner. This is precisely what happened to our mare. I hope your 2nd vet can give you some advice in a very timely fashion. I am glad you have a good hospital to take her to.

Give your mare a hug from me~

Please keep us posted.

All the best-

Peggy

[SIZE=14pt]Liz,[/SIZE]

After taking a closer look at the x-ray, I think Matt is right, the 2 back teeth are protruding into the sinis area! I hope your second vet sees what we are seeing! Good luck and keep us posted!

Bill

We're going to take her to the hospital this week. Bill - can you PM me or email about the surgery? I would like to know what's involved, recovery, etc.

Much appreciated...

Liz R.

[email protected]

Liz,

I sent you a message!

Bill

Liz-

Been thinking about you and your mare all week long- did you have a chance to get her in to the hospital? How is she- any better?

Peggy

Hi Peggy -

Thanks for checking in. Gracie has an appointment with their best sinus surgeon on Thursday. If she shows any "signs" before then, of course we'll bring her as an emergency. Right now she is eating, nickering, playing - acting completely normal, which is good. No signs of discomfort, nothing. She acts completely normal.

I had a 2rd vet take a look at the xrays, who sent them to a surgeon she works with. They xrays according to both vets and the surgeon show some bone erosion and a possible polyp in the sinus cavity. They all agreed that we should set up an appointment with Somis hospital for further evaluation. The hospital is going to ultrasound her and also try to locate the cause of the swelling - could be an abcess, tooth root issue, foreign material, or polyp.

Humphrey, Giacopuzzi Equine Hospital (Somis) is one of the best and I absolutely trust their surgeons. I would guess that most of the So. Cal. folks here also use this hospital.

I'll post the results post-surgery next week to let everyone know what they find. Thanks again for asking!

Liz R.

I know sinus problems can be real bad. Back in the 70's when my mare was at U.C.Davis there was a horse that had blown holes in his sinuses (front of his face). He constantly would blow and crud was all up the wall. Poor thing. I don't know if they ever got him closed up again.

I took Gracie (avatar picture) to Somis hospital last week where they did xrays and also did a large biopsy on her cheek. The xray immediately showed substantial bone loss - her cheekbone is gone and the bone around that area was deteriorating. It looked like cancer, but we needed the biopsy results back before we knew for sure.

Something went wrong during the biopsy procedure - Gracie had a horrible reaction within 48 hours and her skin sloughed off on the right side of her face from her eye down her jawbone and across to her mouth. It was horrifying to say the least. It sloughed off through the weekend, and finally stopped late Sunday. Today (Tuesday) it's finally starting to look better (I have pictures but am not sure if I should post them).

Got the biopsy results back last night. She has squamous cell carcinoma in her nasal cavity - this article seems to describe it best:

http://ojs.c3sl.ufpr.br/ojs2/index.php/vet...wFile/3916/3156

We're checking with UC Davis to see if there are any chemo drugs they are now using that might help. If not, the only thing I can do it make sure she's comfortable and continues to eat. They also said to watch for any "neurological" signs, meaning it's spread to her brain.

Believe me, I wish it had been a tooth root issue...but it's not.

Liz R.

Awwww. That's awful. I'm so sorry

I am so sorry to read your latest news about your mare. I went through this with my stallion and when reading your first posts, it sounded all too familiar, but I did not want to post with a false alarm while you were having her diagnosed, as it did seem to be an infection. My boy started with a bump on his face, I had xrays, teeth floated as a routine, as he had a broken tooth in that area and we were thinking it had become infected. I had the expert vet and consultations with the vet school, scoped his nasal tract, etc., but it was the biopsy that confirmed the dreaded news.

Please know that he was comfortable for another year and enjoyed his life during that time as it seemed to be in remission for that time, but it began to grow last summer.

I wrote a farewell about him last fall on the forum. If you want to pm me that is fine, I would be glad to share more if you would like

Again, so sorry for bad news.

I'm so sorry! My prayers are with you.