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EQUINE VETERINARY EDUCATION / AE / FEBRUARY 2022


a)


b)


c)


d)


Fig 2: Initial computed tomography examination of the head. Transverse plane images, a) at the level of the 3rd molar (rostral), b) at the ethmoidal conchae just caudal to the orbits (orbital), c) at the level of the guttural pouches (caudal) and d) at the C1-C2 articulation (cervical). Enlargement of the soft tissues is seen across the right side of the head, with emphysema present contouring the abaxial (a, b) and axial (b, c) aspects of the mandible (white arrows). Additionally, there is gas within the periorbital space (b – dashed arrow) and soft tissue/fluid attenuation present within the right conchofrontal (a), caudal maxillary (a) and sphenopalatine (b) sinuses (arrowheads). There is marked swelling of the nasopharynx (b) and deviation of the larynx (c). The emphysema was limited to the head region and did not extend into the cervical musculature (d).


showed a persistent mildly elevated fibrinogen (6 g/L), improved thrombocytopenia (81,000 platelets/µl) and resolution of the previous lymphopenia (2200 lymphocytes/µl).


Second CT examination and further surgical treatment


At Day 4 post-fasciotomy, the gelding was persistently tachycardic and had an intermittent fever (highest temperature 39.0°C), despite a decrease in the facial


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swelling and improvement in the palpebral reflux. Subsequently, a second CT to evaluate the response to treatment was performed. This showed a significant improvement in the emphysema abaxial to the right mandible within the masseter muscle, but more emphysema present axial to the horizontal ramus and within the right periorbital space (Fig 3). Additionally, new, pathological emphysema tracts were identified along the ventrolateral cervical soft tissues, dorsal and lateral to the cranial trachea. Based on these findings, which were felt to indicate


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