Trephination and the Seldinger technique achieve comparable sinonasal distribution of clotrimazole cream in canine cadavers.

The Seldinger technique achieves sinonasal clotrimazole distribution comparable to trephination, with weight-based volume guidance provided.

This prospective experimental cadaver study compared two delivery techniques for sinonasal clotrimazole cream distribution in dogs: frontal sinus trephination and the Seldinger technique. Twenty-two of 25 enrolled cadavers met inclusion criteria; three were excluded, including one with intracranial penetration during trephination. Contrast-enhanced clotrimazole cream was instilled and distribution assessed via CT with volumetric analysis spanning regions from the frontal sinus to the naris. Both techniques achieved excellent frontal sinus filling (>75%) with comparable overall sinonasal distribution. Mean instillation volumes required for ipsilateral naris filling correlated positively with body weight, ranging from 2.4 mL/kg in dogs under 10 kg to 4.5 mL/kg in dogs over 40 kg, providing practical weight-based dosing guidance. CT-guided measurements were necessary in cadavers under 20 kg to minimize trephination-related complications, highlighting anatomical challenges in small-breed patients. Notably, the Seldinger technique—a less invasive, catheter-based approach—achieved sinonasal filling comparable to surgical trephination without requiring bony penetration, suggesting potential advantages in procedural safety and accessibility. However, the study was conducted in cadavers with normal sinonasal anatomy, limiting direct clinical applicability, particularly for patients with fungal rhinosinusitis-associated tissue destruction. The authors emphasize that further prospective studies in live patients are needed to evaluate procedural feasibility, complication rates, and therapeutic effectiveness before widespread clinical adoption of either technique.

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