How to deal with lacerations of the face, eyelids and nostrils

The purpose of this presentation is to provide a guide for the general practitioner about which lacerations of the horse’s face, eyelids and nostrils can be managed in the field. Although the major concern with most of these injuries is based on cosmetic outcome, they can also affect performance in horses engaged in various athletic and nonathletic activities. It is also critical to check for any associated underlying injuries, which, if neglected, could lead to disruption of normal visual or respiratory functions. Although some of these injuries can be managed in the field, many should be referred for further investigation or treatment by a surgeon experienced with plastic surgery, especially if there are concerns about injury to underlying structures or about future athletic potential. For example, an apparently innocuous traumatic injury to the face could be associated with damage to the underlying sinus cavities and nasal passages.
Closed wounds of the sinuses and nasal passages can go unnoticed if the skin detaches from the bone to maintain a normal facial contour. As healing progresses, the haematoma and fracture callus beneath the skin produce a firm, swelling along the fracture line and the depressed bone forms a facial concavity. In horses with such a blemish, fluorocarbon polymer and carbon fibre can be used to restore facial contour, or the healed fracture fragments can be cut with a saw and elevated into position. However, a better cosmetic appearance can be obtained by primary open reduction shortly after injury. For this purpose, the fracture fragments can be exposed through a curvilinear skin flap, blood clots removed, and the sinus cavity flushed with saline. Periosteal elevators, Steinmann pins or retractors can be passed through holes drilled in adjacent intact bone to elevate depressed fragments. Fragments can be wired to parent bone, and small fragments without periosteal attachments are discarded. Healing after repair of acute wounds is usually excellent and cosmetically acceptable, although severe injury to sinuses or nasal passages of young horses can interfere with bone growth and cause facial deformities.  […]