1. Interactive Case Tutorial

2.  Review the history and signalment for the client  Evaluate the radiographs provided  Explore the interactive images and compare the answers given with your own interpretations. When you’ve clicked on the image, click the same spot again to make the label disappear.  Answer the questions regarding a diagnosis and recommendations  Review the radiologist’s findings

3.  Signalment: 20 year old Appaloosa gelding  History: presents for evaluation of dental and sinus disease due to several months of nasal discharge  Study: lateral, DV, right over left oblique, left over right oblique of nasal passages

4. Granular soft tissue and mineral material in maxillary and frontal sinuses Diastema Short tooth roots due to age

5. Granular soft tissue and mineral material in maxillary and frontal sinuses Granular soft tissue and mineral material in nasal cavity

6. Sclerosis Granular soft tissue and mineral material in maxillary and frontal sinuses Diastema

7. Sclerosis Granular soft tissue and mineral material in maxillary and frontal sinuses Diastema

8.  Provide a diagnosis based on your findings. Submit The findings are suggestive of impacted feed material in the sinuses and nasal cavity secondary to oro-nasal fistula Feedback Continue

9.  Provide your recommendation for this client. Submit Frontonasal sinusotomy. Sinuses were completely packed with fetid feed material and pus. Diastema between teeth 110/111 and 210/211 communicate with the maxillary sinuses and are the likely source of the problem. Polymethylmethacrylate was used to fill the diastema from the sinus side. Sinuses were thoroughly lavaged and flushed daily through catheters Feedback Continue

10.  Within the maxillary and frontal sinuses bilaterally is a large quantity of granular soft tissue to mineral opacity material which also extends into the nasal cavity bilaterally  Sclerosis is present surrounding the roots of the fourth premolar and all three molars in both maxillary arcades  Diastema present between second and third maxillary molars bilaterally

11.  The procedure was repeated several times over the next two years  Three years later the patient died