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Smoke - Skull Fracture & Sequestrum

Smoke was a 13-year-old Quarter Horse used for cattle work. He sustained trauma to the left side of his head (presumably from a kick) during the early summer of 2011. A puncture wound just in front of the left ear base was examined by the primary veterinarian shortly after the injury occurred. Although the wound appeared to be relatively innocuous, Smoke exhibited pain commensurate with a far more serious injury.

Radiographic examination of Smoke's skull revealed the presence of a piece of bone ("shard") that become lodged within the cranium (brain cavity). The bone fragment, originating from implosion of the cranial bone during blunt trauma to the head, appeared to be residing within the left occipital lobe of the brain. The fragment had lost blood supply and had begun the process of necrosis. This process is known as sequestration, and is a chronic source of infection.

 

 

The primary veterinarian used a metal teat cannula as a radio-opaque "probe" to illustrate the location and orientation of the bone fragment relative to the external puncture wound.

 

 

 

The fracture was further evaluated during subsequent ultrasonographic examination of the injury site. A bone fragment measuring approximately 2 cm in length and 1 cm in width was visible within the cranial defect (hole) created by the trauma. The fragment appeared to be larger than the defect in the cranium from which it came, suggesting that it's internal layer was of greater surface area than its external layer.

 

 

 

The radiographic and ultrasonographic images were used to create a 3-dimensional "map" of the injury site. The relative locations of the wound, diptheritic tract, cranium defect and associated bone fragment were identified.

 

 

 

Surgical removal of the sequestrum was warranted to prevent further infectious compromise of brain tissue (left occipital lobe abscessation), blindness and eventual death. Smoke was not considered a good candidate for general anesthesia due to the nature and location of the lesion(s) affecting his brain.

The bone fragment was surgically removed while Smoke was standing, sedated, and locally anesthetized. The procedure took approximately 3.5 hours, and extreme care was taken not to violate any more brain tissue than absolutely necessary. The cranium defect was enlarged to facilitate fragment isolation and removal. The recovered piece of bone mirrored that depicted on the preoperative diagnostic images.

 

 

 

 

The wound healed quickly in the absence of a persistent source of infection (sequestrum), and only a small blemish was evident at the injury site 2 weeks postoperatively.

 

 

Smoke PostOp1

 

 

The occipital lobe of the brain is almost completely devoted to vision. Smoke had an estimated 40% loss of vision in the right eye as a combined result of trauma, ensuing infection and surgical manipulation within his left occipital lobe.

Amazingly, Smoke regained full vision within 6 postoperative weeks, and returned to full work within 8 weeks. He has since resumed his normal lifestyle as if nothing had happened. The brain is an incredible thing!

 

THE ATLANTA EQUINE CLINIC: 1665 Ward Road, Hoschton, Georgia 30548 - ph. 678-867-2577

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