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

Objective: To compare the volumetric distribution of clotrimazole cream within the sinonasal cavities of cadaver dogs using frontal sinus trephination or the Seldinger technique. Methods: Cadaver dogs with normal sinonasal cavities underwent frontal sinus trephination or the Seldinger technique in this prospective experimental study between October 2022 and March 2023. Contrast-enhanced clotrimazole cream was instilled into the sinonasal cavities, and distribution was assessed using CT. Volumetric measurements were performed using open-source medical imaging software spanning regions from the frontal sinus, cribriform plate, canine tooth, and maxillary premolar 4 to the naris. Results: 25 cadaver dogs were enrolled; 22 met the inclusion criteria, and 3 cadavers were excluded (1 due to intracranial penetration via trephination). Both techniques achieved excellent frontal sinus filling (> 75%). Mean instillation volumes required for ipsilateral naris filling increased with body weight: 2.4 ± 0.2 mL/kg (cadavers < 10 kg), 3.0 ± 0.2 mL/kg (cadavers 10 to < 20 kg), 3.6 ± 0.2 mL/kg (cadavers 20 to < 40 kg), and 4.5 ± 0.6 mL/kg (cadavers > 40 kg). Computed tomography-guided measurements were required for cadavers < 20 kg to minimize complications during trephination. Conclusions: The Seldinger technique achieved sinonasal filling comparable to trephination in healthy cadavers. The volume of cream required varies for patient weight groups. Clinical Relevance: Both techniques achieved comparable sinonasal clotrimazole filling; however, procedural feasibility may be influenced by small‑breed cadavers and those with normal sinonasal anatomy. Further studies in live patients are required to determine procedural feasibility, complication rates, and effectiveness.