Management of facial injuries

Because of the excellent blood supply to the head region, superficial lacerations to the soft tissue structures of the head generally heal rapidly without treatment. Lacerations of the equine tongue frequently go unnoticed because difficulty in eating usually is not apparent. The majority of lacerations heal if left untreated, with no loss in function. Surgical repair is indicated to promote healing and prevent deformity, to amputate a severely compromised apex, and to alter a scar or defect that is unacceptable to the owner. Surgical principles to be adhered to include thorough debridement and copious lavage, multiple layer closure, and placement of tension sutures away from the primary suture line and tied on the dorsum of the tongue. Full-thickness lip lacerations should be repaired using multiple-layer closure and tension sutures tied on the skin surface away from the primary suture line. Reconstructive techniques have been described for extensive lip lacerations when primary repair was inadequate or tissue loss was severe. Thorough evaluation of the equine lid, adnexa, and orbit is essential in determining severity of injury and appropriate treatment methods as well as for establishment of a prognosis. The injury may be minor or more severe, leading to blindness, disfigurement, or loss of the eye itself. Depression fractures involving the frontal, maxillary, or nasal bones are frequently open fractures. Skin abrasions, epistaxis, facial deformity, crepitus, and pain are clinical signs seen with this type of injury. Bone and soft tissue reconstruction should be performed to minimize potential complications. Facial fractures left untreated can result in facial deformity, sequestration, sinusitis, and osteomyelitis.