EQUINE CARE

Horses sometimes experience mouth or tongue injuries--punctures from sharp objects, an accident with a bit, something jammed between the teeth or a broken tooth. A common injury is being kicked in the jaw or incisors when horses live in groups. This may result in fracture of a tooth, laceration of gums, cheeks or surrounding tissue, or may cause nerve damage that leaves the tongue and/or lip drooping on that side.

Melinda Freckleton, DVM, Firestar Veterinary Services, Catlett, Va. says there is often bleeding, and it looks like there’s more blood than there really is, because it’s mixed with saliva. “The horse drools more because of the taste of blood and may try to spit it out rather than swallow it,” she says.

“Some mouth injuries are hidden, however. We may do a colic exam or try to discover why a horse is uncomfortable or isn’t eating. If there’s something wedged between the teeth or impaled in the tongue, it may not be found until more common problems have been ruled out and the veterinarian takes a look farther into the mouth,” says Freckleton. A speculum is used, to hold the mouth open for deeper inspection.

Signs may be subtle; perhaps the horse is not eating, or doesn’t seem right, or is vaguely uncomfortable. One veterinarian tells of a horse that was treated for ulcers for 30 days because the horse was off feed and grinding its teeth. When the owner brought the horse in to the clinic, the

veterinarian looked in the mouth to check the teeth and saw part of a plastic pop bottle lodged between the teeth and the cheek.

Horses are notorious for finding ways to injure themselves. A fall may result in splitting a lip or chipping/fracturing a tooth. Curious horses chew on all kinds of things. Injuries can be caused by a horse chewing on a bucket and getting the handle snap hooked onto the corner of the mouth.

“There are many ways tongue injuries can happen, including rough use of a bit, or tying with reins and the horse pulling back,” says Freckleton. A horse wandering loose with a bridle, dragging the reins, may step on a rein and jerk his head up, cutting the tongue with the bit. “Occasionally a trainer lets a young horse wear the bit for awhile in the stall, to get used to the feel of it. If the horse snags the bit on something, this could cause severe injury.”

A horse may accidentally bite his tongue if he falls or suffers a blow or kick that closes the teeth on the tongue. A cut tongue can be difficult to suture and the repair may come apart. You can’t immobilize the tongue like you might immobilize the sutured skin on a foot or leg with a cast or bandage. “Mouth tissues are constantly bathed in saliva, which also tends to break down sutures,” says Freckleton. “Motion of the tongue itself may undo suture knots. We try to suture a cut tongue, and there are many successes, but there are also failures,” she says.

Though tongues bleed dramatically when cut, this sign may be missed—if the horse is swallowing blood rather than spitting it out, or is at pasture and not observed and it’s stopped bleeding before you see the horse. “The tongue may heal on its own in an odd position,” says Freckleton.

Tongue and cheek lacerations may occur if teeth are sharp. “Usually these cuts aren’t deep, but irritation of rubbing against the sharp tooth may cause chronic ulceration and soreness. Yet you might not notice the problem unless it bleeds,” she says.

A severe mouth or tongue injury may bleed profusely if it’s deep. If the main artery is cut, there will be dramatic blood loss. This is an emergency; the horse must be sedated and the wound ligated. This can be challenging, however, due to lack of working space inside the mouth.

Dr. Bruce Connally, an equine veterinarian in Colorado, has seen many tongue injuries during his 40 years as a veterinarian. Most had already healed--discovered when looking into the mouth for some other reason. “I’ve seen huge ulcers and holes in tongues caused by sharp, misplaced teeth,” says Connally. “One horse was brought to me because he was constantly drooling whenever he had a bit in his mouth. I sedated the horse and took a look. He’d gotten kicked some time earlier, which pushed one of his lower cheek teeth so that it was leaning inward, poking under his tongue. He had a hole about two inches in diameter in the bottom of his tongue,” says Connally.

With a bit holding the tongue down, the horse couldn’t lift his tongue away from the sharp tooth. “That was a hard one to figure out because I couldn’t see the hole. But when I finally stuck my hand in his mouth and felt around, I could feel it. Then I rolled his tongue over enough to see it. I ground that tooth down and he no longer had the irritation and drooling.”

Occasionally something sharp in the feed can poke into the tongue or tear it. “We often see foxtail abscesses in tongues, and sometimes stickers and sticks jammed into the tongue. I’ve pulled pieces of wire out of tongues,” Connally says. sooner than later, in hopes to minimize any

“A few years ago I examined a horse that deviation as it heals. There are horses in every was salivating and eating oddly. When I got discipline that do fine, however, with oddmy hand back a ways in the mouth I was able shaped tongues due to old injuries.” to find and pull out a 2 ½ inch piece of wire There have been some unusual cases. In that was stuck into the side of the tongue—alone instance, a mare bit off her tongue during most as far back as the last cheek tooth. When a dental exam. It’s common practice when hanwe got the wire out, the horse did fine.” The dling a horse’s mouth for dental work to hold horse’s tongue is agile and horses are good at the tongue out the side to keep the mouth open sorting foreign material out of their feed or spit“ The important thing when doing a ting out strange things, mouth examination and holding the tongue out but sometimes something sharp may injure or the side of the mouth is to hold onto the tongue poke into the tongue. and halter together. Even if the horse doesn’t

If a horse bites off bite his tongue if he tries to pull away, there is part of the tongue it usudanger of pulling on the tongue hard enough ally heals. “As long as the missing part is in to paralyze it. ” —Dr. Bruce Connally front of the frenulum—the little tether at the for easier access to look at or work on the teeth. base of the tongue at the back—the horse usuThe mare’s owner was holding onto her tongue ally does well,” says Freckleton. “He can still in the usual fashion, but the mare jerked backeat. You can’t reattach a piece if it’s comward and the tongue came off in his hand. She pletely gone. If the cut-off portion is still bit it in two as she clamped her teeth and pulled hanging there, we usually try to reattach it. back. The veterinarian sutured it back together, The tongue has a good blood supply, and it’s but five days later the tongue came off again; amazing how well it can heal.” the repair wasn’t successful. The severed edge

Even if part of the tongue is gone, the healed well, and the mare was left with a stub horse can still eat and drink; the rest of the of tongue in the back of her mouth. tongue is mobile enough for swallowing and For the first ten days after the accident, this maneuvering food. A tongue or mouth injury mare was fed through a stomach tube because may necessitate change in feed, depending on the owner was afraid she would not be able to the injury. Sometimes the horse must be kept eat. Then she was put back out on pasture and on soft feeds that are easy to chew and swalhad no trouble grazing. low. In other instances, you need to feed long“The important thing when doing a mouth stemmed hay that won’t get packed into examination and holding the tongue out the certain areas of the mouth. side of the mouth is to hold onto the tongue

“Even when we reattach them, resultant irand halter together. Even if the horse doesn’t regularities in the tongue can create difficulbite his tongue if he tries to pull away, there is ties in bitting. This is good reason for getting danger of pulling on the tongue hard enough any kind of tongue laceration taken care of to paralyze it,” says Connally. Tongue Surgery Dr. Tia Nelson, a veterinarian in Helena, Mont. bought a horse many years ago at an

KRAMER PHOTO

auction. “She’d been raced and all she knew how to do was run. She was hard mouthed, and when I looked into her mouth I saw she had a deep tongue laceration that had healed. This might have happened if someone used a double-twisted wire snaffle, cutting the tongue with the bit.”

About 10 years ago, Nelson worked on a stallion that suffered severe tongue injury. The

owner had two stallions, kept next to each other. They were quarreling and one stallion grabbed the other stallion through the fence, by his tongue. “It was a bizarre injury, cutting the tongue all the way through, more than halfway across,” says Nelson.

“I wanted to try suturing it back together, and thought if I could protect the stitches while it started to heal, we could give it a chance. His tongue healed perfectly,” she says. That horse had no problems eating or drinking, and today you’d never guess he had an injury.

The tongue is very flexible and agile, with strong muscles. “The part we see is flat, but there’s a big lump at the back that aids in swallowing,” says Connally. “A horse that has lost much of the tongue will eat differently, but generally does ok. If a cow loses her tongue, she starves, because she uses it to pull food into her mouth.” Horses can grab feed with their teeth, and pull things into their mouth with their lips.

The bulge at the back of the tongue, used as an aid in swallowing, is generally still there; most injuries occur farther forward. “About the only thing that could harm the tongue at the rear of the mouth would be an abscess or something caused by sharp feed as the horse was ready to swallow. The rear part of the tongue is attached to the epiglottis, so a severe injury clear at the back could interfere with swallowing,” Connally says.

Horses sometimes get deep, nasty ulcerations in the mouth. “These may become infected, especially in an immune-compromised or older horse, or one with Cushing’s,” says Freckleton. “A healthy horse probably wouldn’t get infected because the mouth has such good blood supply and the wound is continually flushed with saliva. The tongue keeps moving material out of the laceration. But I’ve seen immune-suppressed horses and some older Cushing’s horses that developed infected lacerations.”

Horses don’t get as many mouth abscesses as cattle because they do a better job of sorting out foreign material or sharp seed awns that can puncture or get stuck in the mouth tissues. On occasion a puncture occurs, however, and an abscess may develop. “Our practice sees at least one or two abscessed tongues each year,” says Freckleton. Stickery weeds, foxtail, cheat grass and other plants with sharp seed awns sometimes get baled in hay, and if the horse isn’t able to sort them out, these may puncture or become embedded in mouth tissues. Usually you don’t find the offending sliver. It disintegrates or gets pushed out with the pus that forms around it.

A small lip injury, split or laceration usually doesn’t need treatment because these tissues heal quickly. “When in doubt, call your veterinarian to see if suturing might enable it to heal faster or more cosmetically,” says Freckleton. “Some lacerations should be repaired as quickly as possible.”

On one occasion, a horse suffered mouth injury when turned out wearing a halter. The horse caught the halter on something and pulled back, ending up with the noseband jammed in the corner of the mouth--where it injured the lip tissue. This was resolved by removing the halter and applying ointment to the cut in the corner of the mouth.

Injury may result from using a chain shank (through the mouth) too aggressively. If a person yanks too hard, this may tear the corners of the mouth. Inappropriate use of a twitch may cause injury if the twitch has a wire loop. If a horse is restrained with that type of twitch and pulls away, the thin wire can cut CONNALLY PHOTO

Bit scar

through the skin of the lip.

Oral, lip and face wounds generally heal faster than wounds on the rest of the body, because there’s more blood circulation. Surgical repairs are rarely needed because often these tissues realign themselves fairly well. An exception might be a fractured jaw that’s displaced; it needs surgical intervention to wire the jaw back into place.

“Even though horses are good at sorting out foreign material in their food (compared to a cow that wads everything in and tries to swallow it), and generally leaves behind sticks or tiny bits of glass or metal, once in awhile we have to pull splinters or chunks of metal out of the tongue,” says Freckleton.

She sent one horse to a referral hospital because the tongue was swollen. “We suspected something was in it but couldn’t find it. They found a small sliver of metal, using xray, then put the horse under general anesthetic to retrieve it,” she says.

“On one farm call, the barn manager told me about a farm where she used to work, where everyone wore walkie-talkies. Someone’s walkie-talkie had fallen off in the stall of a young colt and he’d wedged it between his teeth. They had to sedate the horse and pry it out of his mouth,” she says.

Foals are notorious for chewing on things and occasionally suffer mouth injuries. “We sometimes see sticks or other things wedged between their teeth, or wedged and stabbed into the tongue, or wedged against the roof of the mouth. Usually you suspect something’s wrong because the horse is making mouth faces and trying to dislodge the object. If the horse looks like he’s trying to spit something out and can’t, you need the veterinarian to look into the mouth,” says Freckleton. In one horse, the veterinarian found a piece of wire 10 centimeters long embedded under the tongue where the horse was unable to dislodge it. The wire had been there awhile and was deeply embedded. That horse had to be referred to an equine hospital for surgical removal of the wire. In another situation, a foal picked up a small hypodermic needle that had been lost in the stall bedding. It was lodged in his mouth and he was given a local anesthetic to remove the needle, after using ultrasound to locate it.

Depending on where a mouth injury is, it may result in paralysis if certain nerves are damaged. A major nerve runs under the tongue on either side, and may be affected if a foreign object is jammed against it and punctures or lacerates it. If this nerve is damaged, the horse has a hard time using his tongue for eating and drinking. Damage to this nerve may also result in paralysis of the lower lip. ■