Recent advances in local anaesthetic techniques have enabled us to perform almost all dental extractions and sinus surgeries on the standing horse, reducing cost and complication rates. Further refinement of these techniques has lead to the use of endoscopic, minimally invasive electro surgery on sinuses. The majority of surgical sinus cases can be resolved without the need for general anaesthesia, via small incisions, returning the horse to work in less than a month and near free of blemishes.