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Topic:Fractures

Fractures in horses refer to the disruption in the continuity of a bone, often resulting from trauma, excessive stress, or pathological conditions. These injuries can vary in severity, from simple, non-displaced fractures to complex, comminuted fractures involving multiple bone fragments. Fractures can affect any bone in a horse's body, but they are most commonly observed in the limbs due to the high mechanical loads these structures endure. Diagnosis typically involves clinical examination and imaging techniques such as radiography or ultrasound to assess the extent and nature of the fracture. Treatment strategies depend on the type and location of the fracture and may include rest, immobilization, surgical intervention, or a combination of these approaches. This page aggregates peer-reviewed research and scholarly articles focusing on the etiology, diagnosis, management, and outcomes of fractures in horses, providing insights into current veterinary practices and advancements in equine orthopedic care.
Occlusal Fissures in Equine Cheek Teeth: A Prospective Longitudinal in vivo Study.
Frontiers in veterinary science    November 17, 2020   Volume 7 604420 doi: 10.3389/fvets.2020.604420
Pollaris E, Broeckx BJG, Vlaminck L. It has been suggested that fissures of the occlusal surface of equine cheek teeth may develop into crown fractures. To examine the evolution of fissures present on the occlusal surface of cheek teeth. Furthermore, to investigate the presence of a fissure as a risk factor for the development of a subsequent crown fracture. Observational longitudinal study. Bi-annual dental examinations were performed on 36 horses for 3 years. Video-recordings were made to evaluate the evolution of detected fissures. The effect of possible predictors on the development of tooth fractures was investigated by ...
Malunion of an In Utero Metacarpal Fracture in a Standardbred Mare Presenting for Dystocia.
Journal of equine veterinary science    November 10, 2020   Volume 96 103321 doi: 10.1016/j.jevs.2020.103321
Lection J, Delvescovo B, Percival A, Wu T, Southard T, Diel de Amorim M, Cheong SH.In utero fracture and malunion of long bones is a rare condition in horses. Most foals with in utero fractures are aborted, and the identification of a fetal in utero fracture in a mare with dystocia has not been reported. A 7-year-old multiparous Standardbred mare presented to a referral center for correction of dystocia. Assisted vaginal delivery and controlled vaginal delivery attempts were unsuccessful mainly because of contracted tendons impeding mutation. As the foal was alive, a cesarean section was elected. The foal was delivered but ultimately euthanized because of the congenital abno...
Arthroscopic evaluation of the metacarpophalangeal and metatarsophalangeal joints in horses with parasagittal fractures of the proximal phalanx.
Equine veterinary journal    September 24, 2020   Volume 53, Issue 4 746-751 doi: 10.1111/evj.13343
James FM, Smith MRW, Wright IM.Fractures of the proximal phalanx are one of the most common long bone fractures of Thoroughbred racehorses. Although the degree of disruption and damage to the articular surface is generally considered a major prognostic determinant, associated arthroscopic findings have not previously been reported. Objective: To describe the metacarpo/metatarsophalangeal (MCP/MTP) joint lesions associated with parasagittal fractures of the proximal phalanx arthroscopically identified at the time of fracture repair and compare radiographic and arthroscopic appearance of complete fractures. Methods: Retrospec...
Persistent Intracranial Hypertension in a Cranial Vault Remodeling Patient With Open Skull Fractures From Horse Kick.
The Cleft palate-craniofacial journal : official publication of the American Cleft Palate-Craniofacial Association    September 14, 2020   Volume 58, Issue 5 658-661 doi: 10.1177/1055665620957537
Braza ME, Girotto JA.A 4-year-old female with prior cranial vault remodeling for nonsyndromic bilateral coronal craniosynostosis sustained a severe traumatic brain injury with open skull fractures from a horse kick. Her post-traumatic course was complicated by persistently elevated intracranial pressure despite neurosurgical decompressions, maximum medical therapy, and trial of multiple pressure monitoring devices. She eventually had improvement in her intracranial pressures and made a full neurologic recovery. This case highlights the potential severity of horse kick injuries, the possible etiology of persistent ...
Sidewinder gait in horses.
Journal of veterinary internal medicine    August 21, 2020   Volume 34, Issue 5 2122-2131 doi: 10.1111/jvim.15870
Aleman M, Berryhill E, Woolard K, Easton-Jones CA, Kozikowski-Nicholas T, Dyson S, Kilcoyne I.Sidewinder gait in horses is poorly understood and characterized by walking with the trunk and pelvic limbs drifting to 1 side. Objective: To report causes, clinical and diagnostic features. Methods: Horses examined at 2 institutions. Methods: Retrospective study (2000-2019). Cases with sidewinder gait, neurological and orthopedic examination, and diagnostic work up or postmortem evaluation were included. Descriptive statistics were performed. Results: Twenty-four horses (mean age 18.9 years) of various breeds and both sexes were included. Onset was acute (N = 10), subacute (N = 6), and insi...
Plate Removal after Internal Fixation of Limb Fractures: A Retrospective Study of Indications and Complications in 48 Horses.
Veterinary and comparative orthopaedics and traumatology : V.C.O.T    August 16, 2020   Volume 34, Issue 1 59-67 doi: 10.1055/s-0040-1714411
Donati B, Fürst AE, Del Chicca F, Jackson MA. The aim of this study was to determine the indications for, and complications of, plate removal surgery in horses that underwent internal fixation of limb fractures. Methods:  Medical records of horses presented to our hospital between 1990 and 2015 for the removal of plates after treatment of limb fractures were reviewed. Data collected at the time of initial presentation, including signalment, history, fracture features and treatment and information about the indications, timing and complications of implant removal were reviewed. Results:  The most common bones involved were the ulna ...
The Effect of Increasing Fracture Site Stiffness on Bone-Pin Interface Stress and Foot Contact Pressure within the Equine Distal Limb Transfixation Cast: A Finite Element Analysis.
Veterinary and comparative orthopaedics and traumatology : V.C.O.T    August 14, 2020   Volume 33, Issue 5 348-355 doi: 10.1055/s-0040-1714353
Lescun TB, Adams SB, Nauman EA, Breur GJ. The aim of this study was to determine how increasing stiffness of fracture site tissues distal to the pins in an equine distal limb transfixation cast influences stress at the bone-pin interface, within the bones distal to the transcortical pins, and contact pressure between the foot and the cast. Methods:  A transfixation cast finite element model was used to compare the bone-pin interface stress, pin stress, bone stress distal to the pins and contact pressure between the foot and the cast, using six stiffness values for a composite tissue block representing progressive stages of fractu...
Outcome following repair of 63 sagittal fractures of the proximal phalanx in UK Thoroughbreds using either a triangular or linear screw configuration.
Equine veterinary journal    August 12, 2020   Volume 53, Issue 3 524-529 doi: 10.1111/evj.13304
Findley JA, O'Neill HD, Bladon BM.A triangular screw configuration has been suggested as preferable for repair of sagittal fractures of the proximal phalanx. Objective: To assess the outcome of a triangular screw construct for repair of incomplete and complete minimally displaced proximal phalanx fractures under standing sedation in a population of Thoroughbred racehorses, compared with a cohort repaired using a linear screw configuration. Methods: Retrospective cohort study. Methods: Medical records and radiographs were accessed to garner clinical data. Date of return to racing was determined from www.racingpost.com. Survival...
A radiomics platform for computing imaging features from µCT images of Thoroughbred racehorse proximal sesamoid bones: Benchmark performance and evaluation.
Equine veterinary journal    August 7, 2020   Volume 53, Issue 2 277-286 doi: 10.1111/evj.13321
Basran PS, Gao J, Palmer S, Reesink HL.Proximal sesamoid bone (PSB) fractures are the most common fatal musculoskeletal injury in North American racehorses. Computed tomography has the potential to detect morphological changes in bone structure but can be challenging to analyse reliably and quantitatively. Objective: To develop a radiomics platform that allows the comparison of features from micro-CTs (µCT) of PSBs in horses that sustained catastrophic fractures with horses that did not. To compare features calculated with a radiomics approach with features calculated from a previously published study that used quantitative µCT i...
Subchondral focal osteopenia associated with proximal sesamoid bone fracture in Thoroughbred racehorses.
Equine veterinary journal    July 23, 2020   Volume 53, Issue 2 294-305 doi: 10.1111/evj.13291
Shaffer SK, To C, Garcia TC, Fyhrie DP, Uzal FA, Stover SM.Proximal sesamoid bone (PSB) fracture is the most common fatal injury in Thoroughbred (TB) racehorses in the United States. Epidemiological and pathological evidence indicates PSB fracture is likely the acute culmination of a chronic stress-related process. However, the aetiopathogenesis of PSB fracture is poorly understood. Objective: To characterise bone abnormalities that precede PSB fracture. Methods: Two retrospective case-control groups of PSBs from TB racehorses with, and without, unilateral biaxial PSB fracture. Methods: Proximal sesamoid bones were harvested post-mortem from TB raceho...
Retrospective analysis of 15 years of horse-related maxillofacial fracture data at a major German trauma center.
European journal of trauma and emergency surgery : official publication of the European Trauma Society    July 22, 2020   Volume 48, Issue 4 2539-2546 doi: 10.1007/s00068-020-01450-w
Stier R, Tavassol F, Dupke C, Rüter M, Jehn P, Gellrich NC, Spalthoff S.The purpose of this study was to estimate the effect of the mechanism of trauma (fall versus kick), rider demographics, equestrian experience, protective equipment, and whether or not a horse was shod on the anatomic site of a horse-related maxillofacial fracture, operating time, postoperative complication rate, and length of hospital stay. Methods: We retrospectively reviewed the medical records of patients treated for horse-related maxillofacial fractures at a single institution in Germany between January 2000 and March 2015. We used linear and logistic regression to test the above-mentioned...
Arthroscopic debridement of short frontal plane proximal phalanx fractures preserves racing performance.
Equine veterinary journal    July 18, 2020   Volume 53, Issue 2 267-276 doi: 10.1111/evj.13275
Elzer EJ, Bramlage LR.Outcomes have been reported for a limited number of short frontal plane fractures of the proximal phalanx following nonsurgical treatment and internal fixation. Objective: To describe a new approach, arthroscopic debridement, of short frontal plane fractures of the proximal phalanx in flat-racing Thoroughbreds and post-operative racing outcome. Methods: Retrospective case-control study. Methods: Medical records of 81 Thoroughbred racehorses treated with arthroscopic debridement for frontal plane fractures of the proximal phalanx were reviewed. Diagnostic images and operative reports were used ...
Postinjury performance for differing humeral stress fracture locations in the racing thoroughbred.
Veterinary surgery : VS    July 17, 2020   Volume 49, Issue 7 1412-1417 doi: 10.1111/vsu.13447
Henderson B, Bramlage LR, Koenig J, Monteith G.To assess the influence of humeral stress fracture location on the time to return to racing and postinjury performance of thoroughbred racehorses. Methods: Retrospective study (1992-2015). Methods: Thoroughbred racehorses (n = 131) that presented for lameness with the sole diagnosis of humeral stress fractures in the lame limb, as determined by scintigraphy or radiology. Methods: Sex, fracture site, age, starts, earnings, and average earnings per race were examined for differences in pre-stress and post-stress fracture diagnosis for the entire population as well as individual stress fracture l...
Intrasinus bolstering of traumatic maxillary sinus fractures by using Foley catheter balloons in two foals.
Veterinary surgery : VS    April 29, 2020   Volume 49, Issue 6 1255-1261 doi: 10.1111/vsu.13433
Gardner AK, Santschi EM, Mudge MC, Belknap JK, Metzler AG.To describe the repair of unstable facial fractures by using Foley catheter balloons as intrasinus bolsters. Methods: Case report ANIMALS: Two weanling foals with unilateral fractures of the sinus and orbit secondary to kick injuries. Preoperative imaging that included positive contrast dacrocystorhinography and computed tomography confirmed severe comminution of facial fractures and nasolacrimal duct disruption in both foals. Methods: Small bone fragments were surgically removed, and large fragments were retained even when denuded of periosteum. Repair procedures included nasolacrimal canalic...
Injuries outside of horseracing: is it time to focus on injury prevention of jockeys outside of races?
The Physician and sportsmedicine    April 28, 2020   Volume 49, Issue 1 45-50 doi: 10.1080/00913847.2020.1760693
O'Connor S, Warrington G, O'Brien S, McDermott E, McGoldrick A, Pugh J, Cullen S.: Falls and injuries are frequent in professional horseracing. However, professional jockeys spend a large part of their week in horse-related activities outside of racing such as schooling, exercise riding, and yard-related activities. The injury risk related to these activities remains largely unknown internationally. This study aimed to identify the injury prevalence and injury profile of flat and jump jockeys during non-racing activities. : In total 45.6% and 38.5% of all licensed Irish professional flat and jump jockeys completed a cross-sectional self-recall questionnaire examining injur...
Career outcome of Thoroughbred racehorses with metacarpo/metatarsophalangeal joint dorsal chip fracture managed nonsurgically and surgically: A retrospective cohort study.
Equine veterinary journal    April 17, 2020   Volume 52, Issue 6 823-831 doi: 10.1111/evj.13253
Ramzan PHL, Wylie CE.Arthroscopy has been advocated as the treatment of choice for dorsal osteochondral chip fracture of the metacarpo/metatarsophalangeal (MCP/MTP) joint. However, there is no published research on racing performance outcomes of horses with this pathology managed nonsurgically. Objective: To compare racing career outcomes of Thoroughbred racehorses with nonsurgically (non-SX) or surgically (SX) managed MCP/MTP dorsal osteochondral chip fracture alongside a cohort of horses with no dorsal osteochondral chip fracture (unexposed). Methods: Retrospective cohort study conducted between 2006 and 2014. M...
Scapula fracture secondary to metastatic pulmonary carcinoma in a horse: Clinical, sonographic, radiographic, computed tomographic, and pathologic findings.
The Canadian veterinary journal = La revue veterinaire canadienne    March 14, 2020   Volume 61, Issue 3 251-256 
Pye J, Kilcoyne I, Roy M, Vaughan B, Ormond C, Spriet M.A 20-year-old Quarter horse gelding was referred for evaluation of an acute onset non-weight-bearing right forelimb lameness. Marked soft tissue swelling was apparent over the right scapula and shoulder region; no crepitus was palpable. A complete transverse fracture of the scapular neck was suspected based on ultrasonography and radiographs were obtained to confirm the presumptive diagnosis. A complete, oblique fracture of the right scapular neck with mild cranial and proximal displacement of the distal fragment was detected. Computed tomography of the upper right forelimb was performed post-...
Racing performance after surgical repair of medial condylar fracture of the third metacarpal/metatarsal bone in thoroughbred racehorses.
Veterinary surgery : VS    March 4, 2020   Volume 49, Issue 4 648-658 doi: 10.1111/vsu.13403
Boorman S, Richardson DW, Hogan PM, Stefanovski D, Levine DG.To report the performance of thoroughbred racehorses after surgical repair of a medial condylar fracture of the third metacarpal/metatarsal bone. Methods: Retrospective cohort study. Methods: Forty-three horses surgically treated for medial condylar fractures, 30 with previous racing experience, 13 without previous racing experience (nonexperienced). Methods: Medical records (2009-2017) were reviewed for signalment, radiographic fracture characteristics, repair technique, and postoperative morbidity and mortality. Each experienced horse was matched with two horses randomly selected from its mo...
Sagittal plane slab fractures of the third carpal bone in 45 racing Thoroughbred horses.
Equine veterinary journal    February 19, 2020   Volume 52, Issue 5 692-698 doi: 10.1111/evj.13230
Tallon R, O'Neill H, Bladon B.Sagittal plane slab fractures of the third carpal bone are a recognised injury in the racehorse. Currently no published data exist for the UK Thoroughbred racehorse population. Objective: To document return to racing following sagittal slab fracture of the third carpal bone in a UK-based racehorse population, and to compare conservative and surgical management. Methods: Single centre retrospective study. Methods: Computerised medical and racing records were searched over a 15-year period for Thoroughbred racehorses with a simple sagittal slab fracture of the third carpal bone. Horses with comm...
Using time-series analysis techniques to enhance the understanding of musculoskeletal injury in Thoroughbred racehorses.
Equine veterinary journal    February 18, 2020   Volume 52, Issue 5 699-708 doi: 10.1111/evj.13220
Johnston AS, Riggs CM, Cogger N, Benschop J, Rogers CW, Rosanowski SM.Many racing jurisdictions monitor race-day musculoskeletal injury (MSI) but fail to evaluate injuries occurring during training. Additionally, previous risk factor analyses have failed to explore temporal trends in injury occurrence. Objective: To use time-series analysis techniques to identify trends, cyclicity and peaks in MSI incidence, in racehorses training and racing at the Hong Kong Jockey Club (HKJC) from July 2010 to June 2018. Methods: Retrospective longitudinal study. Methods: The monthly incidence of all MSI, superficial digital flexor tendon (SDFT) injury, suspensory ligament inju...
Diagnostic imaging of a basihyoid bone fracture and partial avulsion of the medial pterygoid muscle in a horse.
The Canadian veterinary journal = La revue veterinaire canadienne    January 2, 2020   Volume 61, Issue 1 44-48 
Veerasammy B, Delli-Rocili M, Jensen M, Cribb N, Zur Linden A.A 3-year-old gelding was presented for further evaluation and treatment of a swelling over the left mandible and inability to eat and drink. Radiographs of the mandible were unremarkable. Computed tomography (CT) of the head demonstrated a fracture of the basihyoid bone and partial avulsion of the medial pterygoid muscle. Ultrasound examination was performed to establish a baseline and confirmed the fracture. The gelding was managed conservatively, recovered uneventfully, and was able to return to training after 4 months of rest. Key clinical message: Computed tomography and ultrasonography in...
Multimodal Imaging to Identify and Characterize a P3 Cystic Lesion and Pathologic Fracture.
Journal of equine veterinary science    December 24, 2019   Volume 86 102898 doi: 10.1016/j.jevs.2019.102898
Ball AN, Hoaglund EL, Pool R, Barrett MF, Bass LD.Lameness remains a common cause of retirement in the equine athlete and among hobby enthusiasts. The distal limb is one of the most frequently imaged areas, and recent advances in diagnostic imaging capabilities help practicing veterinarians differentiate normal variants from informative pathology. Although acute, non-weight-bearing lameness is commonly associated with etiologies, such as fractures, abscesses, and laminitis, other uncommon differentials such as cystic lesions and neoplasia might also be considered. This report describes the characterization of a large, cystic lesion in the thi...
Assessment of clinical and computed tomographic findings for association with the outcome of intraoral cheek tooth extraction in horses and ponies.
Journal of the American Veterinary Medical Association    December 4, 2019   Volume 255, Issue 12 1369-1376 doi: 10.2460/javma.255.12.1369
Dubois BB, Dixon JJ, Witte TH.To describe clinical and CT findings for horses and ponies undergoing intraoral cheek tooth extraction and assess potential associations between these features and outcome of the procedure. 74 horses and 7 ponies. Medical records were searched to identify horses and ponies that underwent CT and intraoral extraction of ≥ 1 cheek tooth with standing sedation. Signalment and clinical variables were recorded, and CT scans were reviewed. Anatomic location and measurements of affected teeth; abnormalities of the periodontium, pulp, infundibula, roots, and tooth shape; fracture presence and type; p...
Operative management of equine-related maxillofacial trauma presenting to a Melbourne level-one trauma centre over a six-year period.
The British journal of oral & maxillofacial surgery    November 8, 2019   Volume 57, Issue 10 1126-1130 doi: 10.1016/j.bjoms.2019.10.301
Singleton C, Manchella S, Nastri A.The aim of this study was to examine the pattern of equine-related maxillofacial trauma that required operative treatment in patients who presented to a level-one trauma centre in Melbourne between 2011 and 2016. A total of 28 patients (16 female and 12 male, median (range) age 31 (16-76) years) were identified from a database of all operatively managed maxillofacial trauma cases, and data were collected on demographics, mechanisms and patterns of injury, and management. The most common mechanism was kicking (n=16), which was also the most likely to result in multiple injuries. Half the patien...
Nonsurgical and surgical management of metacarpo/metatarsophalangeal joint dorsal chip fracture in the Thoroughbred racehorse.
Equine veterinary journal    October 28, 2019   Volume 52, Issue 3 399-403 doi: 10.1111/evj.13185
Ramzan PHL, Wylie CE.Arthroscopy is considered the treatment of choice for dorsal osteochondral chip fractures of the metacarpo/metatarsophalangeal (MCP/MTP) joints in the racehorse; however, there is no published research on non-surgical management of this injury. Objective: To compare clinical features, intra-articular medication use and return to racing in Thoroughbred racehorses with non-surgically (non-SX) or surgically (SX) managed MCP/MTP dorsal chip fracture. Methods: Retrospective observational study conducted between 2006 and 2014. Methods: Radiographs of Thoroughbred racehorses were reviewed to identify...
Use of rotational periosteal flaps in primary repair of sinofacial fractures in seven horses.
New Zealand veterinary journal    October 24, 2019   Volume 68, Issue 2 119-125 doi: 10.1080/00480169.2019.1675555
Gustafsson K, Tatz AJ, Dahan R, Kelmer G.Case history: Medical records were reviewed of horses (n = 7) undergoing surgery for fracture of one or more facial bones extending into the paranasal sinuses that was repaired primarily within 24 hours of the time of injury using a rotational periosteal flap, between April 2009 and May 2017. A kick from another horse was the cause of the injury of three horses, and one horse was injured when it collided with a tree. The cause of the injury of three horses was unknown.Clinical findings and treatment: Fractures were of the right maxillary bone in two horses, the left maxillary bone in two h...
A multi-centre cohort study investigating the outcome of synovial contamination or sepsis of the calcaneal bursae in horses treated by endoscopic lavage and debridement.
Equine veterinary journal    October 16, 2019   Volume 52, Issue 3 404-410 doi: 10.1111/evj.13180
Isgren CM, Salem SE, Singer ER, Wylie CE, Lipreri G, Graham RJTY, Bladon B, Boswell JC, Fiske-Jackson AR, Mair TS, Rubio-Martínez LM.Previous studies investigating factors associated with survival following endoscopic treatment of contamination/sepsis of the calcaneal bursa are limited. Objective: To investigate the factors associated with survival in horses with contamination/sepsis of the calcaneal bursae treated endoscopically and to describe the bacterial isolates involved in the synovial infections. Methods: Retrospective analysis of clinical records. Methods: Medical records from 128 horses with contamination/sepsis of the calcaneal bursae treated by endoscopic lavage at seven equine hospitals were reviewed. A follow-...
A candidate-SNP retrospective cohort study for fracture risk in Japanese Thoroughbred racehorses.
Animal genetics    October 14, 2019   Volume 51, Issue 1 43-50 doi: 10.1111/age.12866
Tozaki T, Kusano K, Ishikawa Y, Kushiro A, Nomura M, Kikuchi M, Kakoi H, Hirota K, Miyake T, Hill EW, Nagata S.Fractures are medical conditions that compromise the athletic potential of horses and/or the safety of jockeys. Therefore, the reduction of fracture risk is an important horse and human welfare issue. The present study used molecular genetic approaches to determine the effect of genetic risk for fracture at four candidate SNPs spanning the myostatin (MSTN) gene on horse chromosome 18. Among the 3706 Japanese Thoroughbred racehorses, 1089 (29.4%) had experienced fractures in their athletic life, indicating the common occurrence of this injury in Thoroughbreds. In the case/control association st...
Warmblood fragile foal syndrome type 1 mutation (PLOD1 c.2032G>A) is not associated with catastrophic breakdown and has a low allele frequency in the Thoroughbred breed.
Equine veterinary journal    October 4, 2019   Volume 52, Issue 3 411-414 doi: 10.1111/evj.13182
Bellone RR, Ocampo NR, Hughes SS, Le V, Arthur R, Finno CJ, Penedo MCT.Catastrophic fractures are among the most common cause of fatalities in racehorses. Several factors, including genetics, likely contribute to increased risk for fatal injuries. A variant in the procollagen-lysine, 2-oxoglutarate 5-dioxygenase1 gene (PLOD1 c.2032G>A) was shown to cause Warmblood fragile foal syndrome type 1 (WFFS), a fatal recessive defect of the connective tissue. Screening of multiple horse breeds identified the presence of the WFFS allele in the Thoroughbred. PLOD1 is involved in cross-linking of collagen fibrils and thus could potentially increase the risk of catastrophic b...
Delayed onset vagus nerve paralysis after occipital condyle fracture in a horse.
Journal of veterinary internal medicine    September 26, 2019   Volume 33, Issue 6 2780-2785 doi: 10.1111/jvim.15581
Martin-Giménez T, Cruz AM, Barragán A, Montero E, Sanchez PG, Caballero G, Corradini I.Occipital condylar fractures (OCFs) causing delayed onset lower cranial nerve paralysis (LCNPs) are rare. We present a 7-year-old Friesian horse with delayed onset dysphagia caused by vagus nerve (CNX) paralysis and suspicion of glossopharyngeal nerve (CNIX) paralysis developed several days after a minor head injury. Endoscopic examination revealed right laryngeal hemiplegia and intermittent dorsal displacement of the soft palate. An area of submucosal hemorrhage and bulging was appreciated over the dorsal aspect of the medial compartment of the right guttural pouch. Radiological examination o...