Page 255 - Equine Clinical Medicine, Surgery and Reproduction, 2nd Edition

230 CHAPTER 1

VetBooks.ir (Fig. 1.433). Other radiographic signs suggestive sedation, dexamethasone and/or NSAID medica-
tion. An emergency tracheostomy may be required.
of basilar skull fractures include soft-tissue (blood)
opacity within the guttural pouches, ventral devia-
attended to before attempting to transport it for
tion of the dorsal pharyngeal wall and irregular If the horse is severely ataxic, it should initially be
bone opacities ventral to the skull base. In some assessment at a referral centre. However, the longer
cases the diagnosis cannot be confirmed radio- a horse remains recumbent after a cranial injury, the
graphically. CT examination of the head provides worse the prognosis generally becomes.
a much more comprehensive assessment of such Many small, non-displaced facial fractures will
lesions (Fig. 1.434). Ultrasonographic examination heal spontaneously, although there is a risk of the
is also useful in the identification of fractures of the previously mentioned complications. Where cos-
paranasal and nasal regions, especially those that metic appearance is important, and with larger
are non-displaced. displaced fragments, surgical correction may be
Endoscopic examination of the nasal passages indicated. Any wounds should be lavaged and
is useful to directly identify regions of stenosis or debrided, plus any regions of the upper airway
blood emanating from the sinus drainage angle, that are involved. Fragments can be wire-sutured
which would suggest haemorrhage in this region together once elevated into position after local
(Fig. 1.435). Bilateral endoscopic examination of lavage, debridement and flushing of the wound and
the guttural pouches is used to identify injuries to sinuses. The periosteum should be preserved where
the rectus capitus muscle and stylohyoid bone that possible and sutured over the defect. Transposition
may be associated with basilar skull trauma. flaps of periosteum and skin have been used to
treat large defects resulting in sinocutaneous or
Management nasocutaneous fistulation. In some cases, place-
If examined immediately after a fall or collision, ment of an indwelling catheter into the affected
the horse should be rapidly assessed for significant sinuses through a small trephine hole is indicated
concomitant injuries and signs of neurological (Fig. 1.436) to permit repeated lavage of the sinuses
and respiratory debilitation. First aid should be if the haemorrhage is ongoing or there is obvious
administered as appropriate, and this may include evidence of contamination.

1.433 1.434

Fig. 1.433 Lateral radiograph of the maxilla
of a horse that sustained a blow to the head and
which clearly shows a ventrally displaced fracture
of the frontal bone into the paranasal sinuses. Fig. 1.434 CT cross-sectional reconstruction showing
(Photo courtesy Graham Munroe) a depression fracture of the left maxillary bone.