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2015 Fracture of the Nasal Bones in a Horse by Nathalie

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2015 Fracture of the Nasal Bones in a Horse by Nathalie GHENT UNIVERSITY FACULTY OF VETERINARY MEDICINE Academic year 2014 - 2015 Fracture of the Nasal Bones in a Horse By Nathalie HILMO Promotors: Prof. Dr. L. Vlaminck Clinical Case report as a part Veterinary Thomas Van Bergen of the Master’s Dissertation © 2015 Nathalie Hilmo The author and the promoters agree this thesis is to be available for consultation and for personal reference use. Every other use falls within the constraints of the copyright, particularly concerning the obligation to specially mention the source when citing the results of this thesis. The copyright concerning the information given in this thesis lies with the promoters. The copyright is restricted to the method by which the subject investigated is approached and presented. The author herewith respects the original copyright of the books and papers quoted, including their pertaining documentation such as tables and illustrations. The author and the promoters are not responsible for any recommended treatments or doses cited and described in this study. GHENT UNIVERSITY FACULTY OF VETERINARY MEDICINE Academic year 2014 - 2015 Fracture of the Nasal Bones in a Horse By Nathalie HILMO Promotors: Prof. dr. L. Vlaminck Clinical case report as a part Veterinary Thomas Van Bergen of the Master’s Dissertation © 2015 Nathalie Hilmo PREFACE I would like to express my very great appreciation to my promotor Prof. L. Vlaminck for his indispensable guidance trough this case study. I also wish to thank my second promotor Thomas Van Bergen. Dr. I. Gielen provided me with medical images, for which I am very grateful. I am particularly grateful to my boyfriend Sindre Stordahl for providing technical help and emotional support when I needed it the most. Marte Ingvild Stordahl has offered very good help with proofreading the paper, for which I want to thank her. Last, but not least, I would like to offer my special thanks to my family for encouragement and invaluable help throughout my whole study period. Table of Contents ABSTRACT ................................................................................................................................................ 1 SAMENVATTING ....................................................................................................................................... 2 INTRODUCTION ........................................................................................................................................ 4 1. CASE HISTORY .................................................................................................................................. 5 1.1. ANAMNESIS ............................................................................................................................. 5 1.2. CLINICAL EXAMINATION .......................................................................................................... 5 1.3. INITIAL TREATMENT ................................................................................................................. 5 1.4. MEDICAL IMAGING .................................................................................................................. 6 1.4.1. Radiography ..................................................................................................................... 6 1.4.1. Computed Tomography ................................................................................................... 7 1.5. DIAGNOSE ................................................................................................................................ 8 1.6. TREATMENT ............................................................................................................................. 8 1.6.1. Surgery ............................................................................................................................. 8 1.6.2. Follow-up ......................................................................................................................... 9 2. LITERATURE REVIEW ...................................................................................................................... 10 2.1. ANATOMICAL CONSIDERATIONS ........................................................................................... 10 2.2. INJURY .................................................................................................................................... 11 2.3. DIAGNOSIS ............................................................................................................................. 12 2.3.1. Physical examination ..................................................................................................... 12 2.3.2. Medical imaging ............................................................................................................. 13 2.3.2.1. Radiography ........................................................................................................... 13 2.3.2.2. Computed tomography .......................................................................................... 13 2.4. TREATMENT ........................................................................................................................... 14 2.4.1. Initial management of the injured horse ....................................................................... 14 2.4.2. Conservative treatment ................................................................................................. 15 2.4.3. Surgical treatment ......................................................................................................... 16 2.4.4. Aftercare ........................................................................................................................ 19 2.5. PROGNOSIS ............................................................................................................................ 19 DISCUSSION ........................................................................................................................................... 20 REFERENCES ........................................................................................................................................... 23 ABSTRACT A horse was exposed to blunt trauma and was presented with bilateral epistaxis, dyspnea and distortion of the facial contour. Initially, the treatment focused on calming the horse down, managing pain, and stopping the bleeding. Proper subsequent treatment was dependent on an adequate diagnosis and assessment of severity. Hereby, radiography was performed to evaluate the fracture of the nasal bones and involvement of the sinuses. Additionally, pre-operative computed tomography (CT) was performed to depict the fracture configuration and involvement of internal structures. In some cases conservative management of facial structures can provide a functional outcome, however, facial deformities are commonly reported complications. Surgical intervention is often indicated to reconstruct the facial contour, maximize airflow and decrease the risk of complications. Different reconstructive techniques have been described for facial fractures of the paranasal sinuses and nasal cavity. The decision whether fixation is required and which material to use depends on the stability of the fractured fragments after reduction. In this case surgery was performed, consisting of elevating the fracture into good alignment followed by fixation with a compression plate. Other alternatives such as the FlapFix system, or interfragmentary wiring with stainless steel wire or polydioxanone sutures can also be used for fixation. Despite contamination from the respiratory tract, facial fractures which are treated properly generally have good results. Key words: horse – trauma – nasal fracture – examination – dyspnea – fixation 1 SAMENVATTING In deze casuïstiek wordt een klinisch geval beschreven van een neusfractuur bij het paard. Aan de hand van een literatuurstudie wordt een overzicht gegeven van de diagnostische mogelijkheden en de verschillende chirurgische technieken, die toegepast kunnen worden bij traumatische letsels van de neus bij het paard. Een 8 jaar oude warmbloed ruin werd aangeboden in de kliniek voor heelkunde en anesthesie van de grote huisdieren op de faculteit diergeneeskunde, te Merelbeke. Tijdens aquatraining raakte hij in paniek en liep tegen een ijzeren paal.Hij had een ernstige neusbloeding en een uitwendig zichtbare deformatie van de neus. De doorverwijzende dierenarts diende dexamethasone en meloxicam intraveneus toe, om de pijn en ontsteking te verminderen. Daarna verwees hij het paard door naar de faculteit voor verdere behandeling. Traumatische letsels en depressiefracturen ter hoogte van de neusbeenderen, behoren tot de meest voorkomende aandoeningen van het respiratoire stelsel van het paard. Doordat de beenderen van de neus en het voorhoofd een dunne cortex en gering bovenliggend weefsel hebben, zijn ze erg gevoelig voor traumata. Klinisch onderzoek van het paard toonde een normale ademhalingsfrequentie, maar wel een bemoeilijkte ademhaling. Zijn capillaire vullingstijd was minder dan twee seconden en zijn lichaamstemperatuur was 38,7°C. Bij visuele inspectie en palpatie was ter hoogte van het rostrale deel van de neus een transverse depressie fractuur, van twee tot drie centimeter, zichtbaar en voelbaar. Er was een duidelijke zwelling rostraal van de fractuurlijn aanwezig en lichte pijn bij palpatie. Als initiële behandeling werd benzylpenicilline intramusculair en flunixine meglumine intraveneus toegediend. Phenylephrine
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