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  Discussion on Facial puncture wound, crepitus, and epitaxis
Author Message
New Member:
dukie76

Posted on Sunday, Apr 5, 2009 - 9:37 pm:

Hi,

I have a 40 y.o. Appaloosa mare. I rescued her 18 months ago and she's survived severe starvation, severely contracted heels, and abuse at the hooves and teeth of her pasture mates. It seems that her owner (who owned her mother) died four years ago and left her to his "best friend" who threw her out in a field with his other horses and left her to die. I bought her for $100.

She has been doing so well. On Monday my vet came out to do shots on my four horses and we discovered that Horse (yes, that is her name) had a big bump on her right facial bone slightly under he eye, with some oozing of "gassy" blood from a tiny puncture wound (or something that might be the "path of least resistance" for a draining tract). She had crepitus extending up the side of her face to above her eye.

My vet treated the injury as if it was a puncture wound with an infection (i.e. 12 SMZs twice a day with 30cc of injectable penicillin twice a day).

Two days into her drugs, Horse has minor bleeding from the nostril on that side. No biggy.

Yesterday, my vet came out to see if Horse had an abcessed tooth (she didn't) and then scoped her nostril. She had bleeding that appeared to be coming from her guttural pouch. My vet didn't want to try to look inside the pouch.

My vet's diagnosis was that Horse had experienced a puncture wound with an infection (which has now cleared up) and that she also likely had a guttural pouch mycosis (that caused the bleeding) and that the injury and the infection are completely unrelated, even 'though they are on the same side.

This seems a little odd to me. Horse still has an asymmetry in the bone on the injured side of her face, the bleeding has subsided, as has the crepidus.

Might Horse have sustained a fracture that sucked in air from her sinus and which also caused some bleeding out of her nostril?

BTW, this vet is great with routine care, but her differential diagnosis skills are not stellar. A few years ago, she diagnosed what turned out to be a deep digital flexor tendon injury on a hind leg as a sacro-illiac injury (with no radiological diagnostics).

So, what does everyone think? Should I be preparing for Horse to bleed out and die?

Thanks,
Still Kicking On
Member:
36541

Posted on Monday, Apr 6, 2009 - 3:49 am:

Hi Still Kicking On(SKO if you don't mind), welcome to HA. Wow, a 40yo rescue! You are surely her angel. I think your diagnostic thoughts are reasonable. I would say "no" to the "bleed out and die" cause she has too many years for this new mystery to hurt her much, although I read your comment as tongue in cheek! Are the antibiotics scheduled for 10 or more days? You will likely hear form Dr. O in the am, and there are members here who have experience with guttural pouch problems as well. Best wishes, and welcome again. Stacy
Moderator:
DrO

Posted on Monday, Apr 6, 2009 - 9:09 am:

Welcome SKO,
I am with Stacy and find your explanation very plausible. The crepitus, if not due to clostridial infection, is nearly diagnostic for a connection by fracture to the sinuses. The entrance of the sinus underlying the lacrimal or zygomatic bones of the skull would drain into the oropharynx and I could see it collecting around the guttural pouch opening. This does not rule out g.p. mycosis however.

Have radiographs of the skull been contemplated? Considering age and expense I certainly can understand a wait and see attitude however. From a treatment stand point good wound care and appropriate antibiotics seems reasonable if further expense not warranted.
DrO
New Member:
dukie76

Posted on Monday, Apr 6, 2009 - 9:19 am:

Thanks Stacy and Dr. Oglesby! Horse completed 5 days of penicillin and is finishing up her SMZs. She eats, poops, and moves around with relative ease, so I am being optimistic that she is in little or no discomfort. She still has a "bump" under and further right than her right eye, but it is not nearly the size that it was a week ago. I am taking a "time will tell" approach and my vet was out Saturday and didn't want to do anything more than the scope she did.
Moderator:
DrO

Posted on Tuesday, Apr 7, 2009 - 8:26 am:

Seems like a reasonable plan to me, let us know how it all works out.
DrO
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