Injury to face - why wont it heal!?

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Switchthehorse

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Hi

Not sure if anyone has had a similar experience?

My mare has managed to get a hole from inside her mouth all the way out through her skin, just where the cavesson goes. about a 2 inch hole on the outside 4in wide inside her mouth just on her gumline at the back of her mouth.

The vet came and stitched it on the outside and put her on antibiotics. Five days later she ripped a stitch out and the swelling still hadnt gone down but no sign of infection.

Vet thinks each time she eats she is poss opening up wound inside her mouth with her teeth so he manages to put a couple of stitches in inside her mouth, still no sign of infection, but still swollen. Gives her another course of antibiotics and also anti-inflammatories. Also another stitch to the outside

Now 8 days after it first happens (and 3 days since last vet visit) it is still really swollen and hard, cut on her face is weeping (but no pus) and she is still finding it awkward to eat. I cant work out why the lump isnt going down!

She is happy in herself, apart from quidding her feed a bit and dropping it a lot, but she is rubbing the stitches on her leg a lot (or on anything else) so guess that is partly to blame

not sure what i am after really, just so frustrated! I guess a) anyone had experience of an injury like this before? b) any ideas why the swelling isnt going down (its rock hard now) c) any tips on how i can stop her rubbing? We cant put any bandaging on her face as this will then push cut inside her mouth onto her top teeth! i was thinking bandaging her legs will make that more cushioned but they will always find something to itch on!!

I guess just help!! :(

thanks so much and sorry for the essay!
 
Switchthehorse said:
My mare has managed to get a hole from inside her mouth all the way out through her skin, just where the cavesson goes. about a 2 inch hole on the outside 4in wide inside her mouth just on her gumline at the back of her mouth.

The vet came and stitched it on the outside and put her on antibiotics. Five days later she ripped a stitch out and the swelling still hadnt gone down but no sign of infection.

Vet thinks each time she eats she is poss opening up wound inside her mouth with her teeth so he manages to put a couple of stitches in inside her mouth, still no sign of infection, but still swollen. Gives her another course of antibiotics and also anti-inflammatories. Also another stitch to the outside

Now 8 days after it first happens (and 3 days since last vet visit) it is still really swollen and hard, cut on her face is weeping (but no pus) and she is still finding it awkward to eat. I cant work out why the lump isnt going down!

She is happy in herself, apart from quidding her feed a bit and dropping it a lot, but she is rubbing the stitches on her leg a lot (or on anything else) so guess that is partly to blame

not sure what i am after really, just so frustrated! I guess a) anyone had experience of an injury like this before? b) any ideas why the swelling isnt going down (its rock hard now) c) any tips on how i can stop her rubbing? We cant put any bandaging on her face as this will then push cut inside her mouth onto her top teeth! i was thinking bandaging her legs will make that more cushioned but they will always find something to itch on!!

I guess just help!! :(

thanks so much and sorry for the essay!
Click to expand...

Swelling in this case esp if it is rock hard means there is likely to be infection there. If it's not healing and there's discharge that also correlates with infection.

Wounds don't heal for several reasons; commonly movement, infection, foreign body, inflammation, physical irritation, wrong pH of the tissues, chemical irritation (e.g. neat hibiscrub!), granulation tissue formation and others.

In this case there is likely to be infection, inflammation, physical irritation and excessive skin movement. If the wound is that big and communicates with the oral cavity do you know how it happened? Could there be persistant infection i.e. tooth involvement? Is there foreign material accumulating in the wound e.g. food material packing in there.

I would keep the food sloppy and easy to eat...minimise hay intake...use feeds that require little chewing for now.
Take some photos, email them to your vets and ask them to be emailed onto to Prof Knottenbelt at Liverpool for a second opinion....(he's great ;)) - knotty@liv.ac.uk

May not be responding to antibiotics because of the other factors - ongoing physical trauma, internal contamination or just wrong antibiotics. Swab the wound. Xray the head if needs be and scan the cheek to rule out FB.:o

Sounds like a very unusual wound...can you post up photos for a better idea. ultimately primary repair may not be achievable and you may have to let it granulate in in time....wouldn't be a first choice. Generally head wound heal well, good blood supply and all, so there must be an underlying reason IMO.

In terms of preventing the physical trauma, I don't think you have a lot of choice bar cross tying the horse to prevent him using his knees....but he'll still be able to use the wall etc....I guess the question is is he causing the wound breakdown, or is the irritation a symptom of another problem in the wound...:confused:

Photos would be great in this case.
Imogen
 
i would be asking for a second opinion! if the edges of the hole have died off it might need debriding to enable new flesh to meet new flesh to allow healing to occur. surely there must be a foreign body or sharp tooth aggravating the healing process? could you find an old neck cradle to fit on the underside of her neck which would limit the ability to rub? or cross tie for 2 weeks ? i would also suggest syringing the mouth out with saline after each bucket feed, and every couple of hours if poss to flush the hole from the inside to remove any food that might be in there. Hope it starts to heal soon.
 
In humans the cells in the mouth are the fastest growing in the body (according to my dentist niece) so presumably the same in horses? Not healing suggests some sort of infection or foreign body in the wound.

(Not horse connected but one of my stable cats had a horrid wound on its leg that wouldn't heal despite me putting on stuff on and bathing it. After a bit I had a very close look and discovered some straw inside, when that was removed it cleared up straight away.)
 
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