Now That’s a Headache: Facial Trauma and Fractures in Horses
Head wounds can be simple lacerations involving only the skin and requiring a few sutures from your veterinarian. Lacerations involving the eyelids, nostrils, or lips are more challenging to repair with a cosmetic, functional outcome. Things get more complex when the trauma is severe enough to fracture facial bones: the bony orbit protecting the eye, the nasal bones overlying the nasal passages, or the bones overlying the paranasal sinuses. These types of fractures often result in multiple small pieces, a bit like a jigsaw puzzle.
If you suspect your horse has fractures and/or trauma to his skull bones, have your veterinarian examine him as soon as possible. With these injuries, you might notice cuts or breaks in the skin overlying the fractures, and some of the fracture fragments might be visible. If fractures involve the sinuses with no break in the skin, air might accumulate beneath the skin. Fractures involving the sinuses and/or nasal passages usually exhibit bleeding from the nose on the affected side(s). You might also notice swelling of varying degrees, particularly if the injury is more than a few hours old.
An initial veterinary examination of the horse will likely include a thorough physical exam, sedation, and gentle cleaning and palpation of the wounds. The vet might take radiographs of the skull to get a better idea of which bone(s) are involved and the extent of the fractures. Fractures involving the nasal passages, particularly if both sides of the nose are affected, can result in swelling severe enough to impair breathing. For these cases, a temporary tracheostomy (placing a tube in the trachea for the horse to breathe through) might be needed.
Treatment course depends on the severity and extent of the injuries. Less extensive fractures with minimal displacement might warrant only repair of the skin lacerations, allowing the fractures to heal on their own. Surgical repair of the fracture fragments, usually under general anesthesia, might be recommended for more extensive fractures of the sinuses and nasal passages. Fractures involving the bony orbit surrounding the eye typically require surgical fixation as well. In very severe cases, the veterinarian might recommend advanced imaging in the form of a CT scan before going to surgery, to obtain prognostic information for the horse and help the surgeon plan for the repair.
Veterinarians can make surgical repairs of skull or facial fractures via a variety of methods. Often, they use larger sutures or stainless-steel wire to reattach the fragments. In some cases, they use small reconstructive bone plates. Very small pieces of bone might need to be discarded if they can’t be wired into place. If left where they are, they’ll likely die and become drainage sources. If the sinus cavities are involved, the veterinarian will perform a thorough lavage of the sinus cavities. Bleeding into the sinuses that occurs with facial trauma sets up a nice environment for bacterial infection to occur, so a lavage of the sinuses, or at least a course of broad-spectrum antibiotics, is often indicated. Once the veterinarian repairs fracture fragments, he or she can close the skin wounds.
Recovery for skull or facial fracture patients can be tricky. The goal is to minimize additional trauma to the head and keep the horse from rubbing its face on a stall or fence to avoid harming the delicate repair. As mentioned, the horse will likely be placed on broad-spectrum antibiotics, as well as Bute or Banamine for pain.
Following facial trauma, several complications might occur that warrant additional treatment. These can include:
- Secondary sinus infection;
- Sequestration of bone fragments (where small pieces of bone become devitalized and act as a source of drainage); and
- Fistula formation (due to incomplete healing of bone, a communication forms between the skin and the sinus).
In very severe cases, horses might exhibit neurologic signs such as dull mentation or incoordination. These indicate a poorer prognosis for the patient and warrant additional diagnostics and treatments.
Many equine facial fractures heal well and relatively cosmetically with early and appropriate treatment. Contacting your veterinarian right away gives your horse the best chance for a successful recovery.
About the author: Megan Williams, DVM, Dipl. ACVS (Large Animal), is an assistant professor of equine surgery at Oklahoma State University’s College of Veterinary Medicine. She is board-certified in large animal surgery and a diplomate of the American College of Veterinary Surgeons (Large Animal). Her research interests include equine lameness, particularly regarding suspensory ligament pathology.
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