Subcutaneous Emphysema Caused By A Skull Fracture

Recently my horse Mocha fractured a small bone in the sinus region of her face causing subcutaneous emphysema, which means gas or air is trapped beneath the layer of skin. It is not a hot or hard swelling; it feels like it crackles and is crunchy to the touch, a sensation known as crepitus. I had never seen anything like this before and called Dr. Julia Hecking right away. She asked me to look for a puncture wound that could be leaking air into the skin, however there was not a wound present.

Dr.Hecking thought it was best to take radiographs of her head to look for any fracture that may be causing air leakage. There was indeed a small fracture in her sinus region which explained her head being enlarged. However, we were unsure if that was causing the enlarged throat latch area and neck, or if there could be a secondary problem. We passed a scope through her nostril into her trachea and esophagus to make sure there were no tears or bleeding present. There were no tears or bleeding that she could see, however, the scope the doctors use in the field is much shorter than the one we have at the hospital, so it’s hard to see the entire area. This is often the reason a doctor chooses to refer a horse to the hospital for a better look with a longer endoscope.

If you ever encounter this type of swelling in the head or neck region of one of your horses, it is important to call your veterinarian immediately, and keep the horse quiet and in a confined area until the vet arrives. He/she will appreciate knowing if your horse is eating, drinking, and breathing normally, and if a fever is present.

After one week, the swelling is decreasing. Mocha continues to eat, drink, breathe and act normally with no indication of fever or discomfort, so we expect it to resolve on its own. Dr. Steve Trostle has seen similar cases and says it may be a few weeks until the swelling completely disappears.