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NA S A L D I S C H A R G E
Kero Lad is a five year old thoroughbred
gelding starting his ridden career. He was
being investigated for gastric ulceration;
however, the owner also described that a
small nosebleed had occurred the previous
week. Other than a few small, healing grazes
on his head, Kero Lad was not showing any
other symptoms so the nosebleed was
attributed to a minor trauma.
Three weeks later Kero Lad returned as a
large swelling had appeared within 24 hours.
It was round his left eye, extending towards
the middle of his head and seemed to be
extremely painful. In the previous five days,
the owner had seen occasional trickles of
blood from his right nostril, which had
gradually become yellowy-brown.
We x-rayed and ultrasound scanned his head
and found he had fractured his skull across his
frontal bones (between his eyes). The images
showed multiple, tiny chips of bone lying
along the fracture line. He had obviously
given his head more than a gentle bump!
The fracture was right over the air-filled sinuses
of the head so blood and infection from the
fracture site had been draining from the
sinuses into the nasal passages.
Small chips of bone can stop healing as they
die off and become a focus of recurrent
inflammation and infection. These small chips
are called sequestrae and can either become
incorporated into the healing fracture and
cause no further problems, or they can
require surgical removal. In Kero Lad's case,
although surgery was discussed, the fragments
looked so small we opted for the conservative
treatment option of antibiotics and strong
anti-inflammatories. Within 72 hours the
swelling was receding and Kero Lad
was allowed home for his owners to
continue treatment.
Unfortunately the swelling returned within two
weeks so Kero Lad was re-admitted and the
area re-imaged (see Figure 1). At this time,
on x-ray, there were some bigger chips of
bone visible and they could be seen 'floating'
within areas of fluid when we ultrasound
scanned the area. This suggested the chips
were still causing problems and required
surgical removal.
The surgery was done under standing
sedation and local anaesthetic to reduce
the risk associated with general anaesthetic.
This allowed us open the skin then 'debride'
or scrape away all the dead bone and tissue
before closing the wound. As the fracture line
was so extensive, we had to do this in three
different sites. Kero Lad was hospitalised for
a further four days after which he was sent
home with antibiotics. The wound healed
without any problems and no further nasal
discharge was seen.
Kero Lad returned to the clinic for a follow
Case Study:
Nasal discharge; a bleeding nose
Figure 3
Appearance of the torn manica
flexoria seen through the camera placed in
the windgall. The torn manica is in the centre
of the screen and was found to be adhered
to the lining of the sheath behind it. The
adhesions were broken down and the torn
portion removed guided by the scope.
Vicky Rowlands BVM&S CertEP MRCVS
, Willows Ashbrook Equine Hospital
Nosebleeds (or epistaxis) in horses can be caused by trauma, tumours or fungal
infections in the guttural pouches (two small sac-like areas at the top of the
throat). In some cases, nose bleeds can be life threatening so it is important to
seek veterinary advice.
Veterinary Surgeon
Vicky Rowlands
XLVets Equine Practice
Willows Ashbrook
Equine Hospital
Figure 1
The x-ray showed a fractured frontal
bone with chips visible (arrow)
AUTUMN 2012 ISSUE
EQUINE MATTERS
16
Figure 2
Kero Lad following surgery
Figure 3
Five months after surgery the site
was well healed with just a small lump visible