Every horse has a head: the essential toolkit for treating equine head cases

Posted on September 01, 2016 by Henry Tremaine

Equine head injury by Henry TremaineIn the last week or so I have encountered a yearling that smashed its jaw overnight in the stable, another horse that injured its head in transit to the hospital for an unrelated condition, some racehorses with dynamic airway diseases, a brace of horses with malodorous catarrh streaming down their noses, a hunter that has carried an extra tooth around for many years, an ageing pony losing weight and a small pony that suffered a sudden extreme nosebleed.

All of these have suffered problems involving their heads and have been directed to my attention by astute primary care veterinarians. After a range of further diagnostics, varying from a careful examination with the naked eye to Computed Tomography (CT), and after a variety of treatments, some more complicated than others, all are on the road to recovery.

The head drives the horse

As I reflect on a typical week, I am reminded that this specialised anatomical area contains much of interest, but that can be challenging and perhaps even daunting to the primary care veterinarian in ambulatory practice.

However, this needn’t be the case. While some animals require quite specialised diagnostic techniques and treatments, much can be learnt from a careful examination undertaken in optimal circumstances.

Whilst I was drawn to this speciality as a result of both scientific interest and market need, every horse has a head and most of its other functions originate in this zone so a basic understanding of useful tips concerning it is essential.

Examining a horse’s head - the clues are in front of you

The basic toolkit for examining a horse’s head in the field must include a good set of eyes and ears, a headlight, an oral speculum, a dental mirror, a probe and nowadays I would add a camera-phone.

An ophthalmoscope is a wise addition and a head-stand very quickly becomes essential once you get used to it or past the age of 40. Modern ancillary equipment is highly portable, often battery operated and increasingly wireless, all of which adds to the possibilities available in the field situation. I would therefore also load a flexible endoscope and a portable x-ray machine of the history suggests.

With the tools above, most diseases can be diagnosed and moreover, in some of the cases I have treated this week that have undergone an extensive ancillary work up, the clues were visible to the careful clinical observer without the need for further tests.

A confident working knowledge of the optimal sedatives for the horse and their appropriate use in different situations can be the difference between frustration and a ‘eureka’ moment.

A hard hat is also prudent for a vet in a confined space, as while the hooves are often considered the most dangerous area of a horse, the head is a close second, especially when the patient is wearing a heavy speculum. Despite the horse’s tendency to go up or away when alarmed – with good restraint techniques and appropriate pharmacology, horses will tolerate the most invasive procedures and precise techniques to be undertaken while they stand.

A horse's maxillary tooth with apical pulpitis

This maxillary tooth with apical pulpitis belongs to a horse that underwent an extensive CT examination but this fissure in the occlusal secondary dentine provides the diagnosis.

Learn more about equine head cases

Join me at the upcoming BVA CPD course, Coping with equine head cases on 27 October. Although the title might mistakenly be presumed to apply to some of our patients’ owners, I will actually be illustrating a range of clinical diseases affecting the horse’s head and how to approach them. 

I will use examples to illustrate what is possible with regard to examination and treatment in the horse’s head, what is reasonable to attempt in the field and what is not reasonable, what can be done elsewhere and where to seek further information and help.

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Written by Henry Tremaine

BVetMed MPhil Cert ES DipECVS DipEVDC MRCVS

RCVS and European Specialist in Equine Surgery 
Senior Lecturer at the Department of Clinical Veterinary Science, University of Bristol

Henry worked in mixed and equine practice before undertaking a residency in equine soft tissue surgery. Since then he has worked at Ohio State University and completed research in equine upper respiratory tract disease and dentistry. Henry is an RCVS and European specialist in equine surgery and has lectured internationally and in the UK.