Horses often suffer wounds to the head and face due to many situations. Loading and trailering often contribute to these types
of injuries as horses can rear when entering a trailer and cause a flap-like scalping injury to the top of the head. Because
of the close quarters in trailers, horses can bump and injure their heads during travel, too. Protective headgear is recommended
to prevent these problems.
Horses often suffer head injuries that include sinus bone fractures and fractures of the zygomatic arch above the eye because
of direct trauma from kicks, mallet strikes (in polo ponies), from falls while on a cross-country course or in a jumping arena,
as well as from becoming cast and struggling in a stall. Lacerations to the nostrils, eyelids, and corners of the mouth, lips
and tongue are all commonly seen. These injuries are most often due to interaction with environmental objects such as wire,
other fence material, nails, bucket hooks and similar protruding obstructions or from bite trauma.
Inaccurate closure of the eyelids can result in excessive tear loss from the eye and marking of the side of the face as well
as possible corneal irritation and visual difficulties.
Head wounds are relatively easy for owners and barn managers to notice, so they usually are brought to a veterinarian's attention
quickly. Exceptionally good blood supply and pliable tissue that is not generally under much tension, except for the midline
of the forehead, generally allows for effective surgical repair. Because of the potential for underlying bone damage, all
injuries to the head and face should be carefully evaluated, and radiographs should be taken if needed. Thorough debridement
and flushing of head wounds sometimes will identify small bone fragments or bits of foreign material that must be cleared
from the wound before closure is attempted.
Wounds that penetrate into a sinus usually can be closed because serum and blood forming below the wound will drain to the
sinus and be resolved there. These horses often will show significant nasal discharge for a few days following trauma, and
owners should be advised of this complication. Antibiotic therapy and occasionally even flushing of the sinuses will reduce
the potential for post surgical complications in these types of injuries.
Lacerations to the eyelids, lips, tongue, mouth and nostrils require precise anatomical closure for both functional and cosmetic
reasons. Inaccurate closure of the eyelids can result in excessive tear loss from the eye and marking of the side of the face
as well as possible corneal irritation and visual difficulties. Problems with correct closure of injuries to the nostrils
are more likely to result in a poor repair that can be cosmetically unacceptable to the owner and can reduce the value of
that horse in the future. In extreme cases, poor nostril closure may affect airflow in conditions of maximal exercise. Problems
with closure of injuries to the mouth, tongue and lips can result in eating difficulties or problems with the bit but usually
fall into the category of poor cosmetics. Often these failed first surgical attempts can be repaired at a later date, but
good accurate closure of a primary injury is still the best approach when possible.
In order to achieve this good anatomical closure, the wounds should be cleaned and evaluated to ensure that the surgeon is
attempting to reposition tissue correctly and that healthy tissue is being used for the repair. Injuries to the nostrils,
mouth and lips often include thin strips of tissue or pieces of skin that have undergone blunt trauma. This can damage blood
supply to this tissue resulting in devitalized material that will die and subsequently slough. Utilization of this damaged
tissue in wound repair will doom that repair to failure.
Occasionally, a surgeon will use such damaged tissue knowingly because there are no other alternatives for closure, and even
partial repair for a short time will allow for the beginning of a granulation response in tissue below the injury. This is
a situation where a second reconstructive surgery will be planned from the start, and this probable progression should be
communicated to the owner.