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Journal of clinical medicine2026; 15(16); 6189; doi: 10.3390/jcm15166189

The Impact of a Horse Kick: A Systematic Review of Horse-Related Maxillofacial Trauma.

Abstract: : To systematically review the evidence on horse-related maxillofacial trauma, with emphasis on horse-kick injuries, anatomical patterns, associated injuries, management, outcomes, and prevention. : This systematic review followed the PRISMA 2020 statement. PubMed/MEDLINE, Scopus, Web of Science, and the Cochrane Library were searched for original clinical studies reporting facial, craniofacial, orbital, dental, or maxillofacial injuries related to horse-associated activities. Data were extracted on study characteristics, demographics, mechanism, mounted/unmounted status, anatomical site, associated injuries, treatment, complications, outcomes, mortality, and protective equipment. Due to substantial heterogeneity in study design, denominators, and outcome reporting, a structured narrative synthesis was performed without formal meta-analysis. : Twenty-eight original clinical studies were included. Maxillofacial-specific series consistently identified horse kicks as a major mechanism, especially among unmounted individuals. Injuries most frequently involved the midface, orbit, zygomaticomaxillary complex, mandible, nasal region, and dentoalveolar structures. Severe presentations included optic nerve avulsion, orbitocranial penetrating trauma, naso-orbito-ethmoid and frontal sinus fractures, airway compromise, intracranial injury, and multisystem trauma. Management ranged from conservative treatment to operative fixation, orbital reconstruction, soft tissue repair, advanced airway management, and multidisciplinary care. Helmet use was often absent or poorly documented, particularly during unmounted activities. : Horse kicks represent a distinct localized high-energy mechanism of maxillofacial trauma. Prevention should extend beyond riding and include facial protection, protective eyewear, and safety protocols for ground-based horse handling.
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Publication Date: 2026-08-10 PubMed ID: 42652593PubMed Central: PMC13513070DOI: 10.3390/jcm15166189Google Scholar: Lookup
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Summary

This research summary has been generated with artificial intelligence and may contain errors and omissions. Refer to the original study to confirm details provided. Submit correction.

Overview

  • This research article systematically reviews studies focused on facial and head injuries caused by horses, particularly those resulting from horse kicks.
  • The review analyzes injury patterns, treatments, outcomes, and prevention strategies related to horse-related maxillofacial trauma.

Introduction and Objectives

  • The study aims to gather and assess existing clinical evidence on maxillofacial injuries caused by horses, emphasizing injuries from horse kicks.
  • Focus areas include anatomical injury patterns, related injuries, clinical management, patient outcomes, and possible prevention methods.
  • It highlights that horse-related trauma is a significant cause of facial injuries, but there is limited systematic synthesis specific to horse kicks.

Methodology

  • The review followed the PRISMA 2020 guidelines, ensuring a structured and transparent approach to systematic literature review.
  • Databases searched were PubMed/MEDLINE, Scopus, Web of Science, and the Cochrane Library for clinical studies on facial and craniofacial injuries related to horse activities.
  • Injuries considered included those affecting the face, orbit (eye socket), dental structures, and bones of the maxillofacial region.
  • Data extracted from studies included:
    • Study characteristics and populations (demographics, whether the person was mounted or unmounted at injury time)
    • Mechanism of injury, anatomical sites involved
    • Associated injuries beyond the face
    • Treatment methods (e.g., conservative vs. surgical intervention)
    • Complications, patient outcomes, mortality rates
    • Use and documentation of protective equipment like helmets
  • Due to variability across studies in design, population, and how outcomes were reported, a meta-analysis wasn’t feasible; instead, narrative synthesis of findings was used.

Findings

  • A total of 28 original clinical studies met the inclusion criteria and were analyzed.
  • Key findings identified horse kicks as a major cause of facial trauma, especially among people who were on the ground (unmounted) rather than riding.
  • Commonly injured anatomical areas included:
    • Midface region (central face structures)
    • Orbit (eye socket) including complex fractures
    • Zygomaticomaxillary complex (cheekbone and upper jaw bones)
    • Mandible (lower jaw)
    • Nasal region (nose)
    • Dentoalveolar structures (teeth and surrounding bone)
  • Severe injuries documented included:
    • Optic nerve avulsion (tearing away of the nerve, leading to blindness)
    • Penetrating trauma involving the orbit and brain (orbitocranial injuries)
    • Complex fractures of the naso-orbito-ethmoid and frontal sinus bones
    • Airway compromise risking breathing ability
    • Intracranial (brain) injuries
    • Multisystem trauma from the force of the kick

Management and Outcomes

  • Treatment varied widely depending on injury severity:
    • Conservative management for minor fractures or soft tissue injuries
    • Operative procedures such as internal fixation of fractures, reconstructive surgery for the orbit, and soft tissue repair
    • Advanced airway management when breathing was compromised
    • Multidisciplinary care including maxillofacial surgeons, ophthalmologists, neurosurgeons, and emergency physicians for complex trauma
  • Outcomes reflected the complexity of injuries, with some cases resulting in life-altering impairments like vision loss or functional deficits.
  • Mortality was low but present in cases with severe intracranial or multisystem injuries.

Prevention and Safety

  • Helmet use was frequently absent or inadequately documented, especially in individuals injured while unmounted (on the ground, not riding).
  • The research highlights the need for protective measures to extend beyond riding helmets to include:
    • Facial protection such as face shields or guards
    • Protective eyewear to prevent eye injuries
    • Safety protocols during ground-based activities like grooming, leading, or stable work, which are high-risk for kicks
  • Overall, the study underlines horse kicks as a serious yet distinct mechanism of high-energy facial injuries that require targeted safety strategies.

Conclusion

  • Horse kicks represent a unique and significant cause of maxillofacial trauma, with distinct injury patterns and risks.
  • Prevention strategies should not only focus on riding but also on ground handling to reduce the incidence and severity of these injuries.
  • Comprehensive protective gear and safety protocols tailored to horse-handler activities are advocated to minimize trauma risk.
  • Further research and consistent documentation of safety equipment usage are necessary to better understand and mitigate these injuries.

Cite This Article

APA
Vaira LA, Qadeer H, Stellino S, Lechien JR, Maniaci A, Maglitto F, Consorti G, Cirignaco G, Woźniak Ł, Navarro-Cuéllar C, Antonowicz B, Borys J, Salzano G, De Riu G. (2026). The Impact of a Horse Kick: A Systematic Review of Horse-Related Maxillofacial Trauma. J Clin Med, 15(16), 6189. https://doi.org/10.3390/jcm15166189

Publication

Journal of clinical medicine
ISSN: 2077-0383
NlmUniqueID: 101606588
Country: Switzerland
Language: English
Volume: 15
Issue: 16
PII: 6189

Researcher Affiliations

Vaira, Luigi Angelo
  • Maxillofacial Surgery Operative Unit, Department of Medicine, Surgery and Pharmacy, University of Sassari, 07100 Sassari, Italy.
Qadeer, Hareem
  • Maxillofacial Surgery Operative Unit, Department of Medicine, Surgery and Pharmacy, University of Sassari, 07100 Sassari, Italy.
  • PhD School of Biomedical Sciences, Department of Biomedical Science, University of Sassari, 07100 Sassari, Italy.
Stellino, Sebastiano
  • Maxillofacial Surgery Operative Unit, Department of Medicine, Surgery and Pharmacy, University of Sassari, 07100 Sassari, Italy.
Lechien, Jerome R
  • Department of Surgery, Mons School of Medicine, UMONS Research Institute for Health Sciences and Technology, University of Mons (UMons), 7000 Mons, Belgium.
  • Department of Otolaryngology-Head Neck Surgery, Elsan Polyclinic of Poitiers, 86000 Poitiers, France.
Maniaci, Antonino
  • Department of Medicine and Surgery, University of Enna Kore, 94100 Enna, Italy.
Maglitto, Fabio
  • Head and Neck Section, Department of Neurosciences, Reproductive and Odontostomatological Science, Federico II University of Naples, 80131 Naples, Italy.
Consorti, Giuseppe
  • Division of Maxillofacial Surgery, Department of Neurological Sciences, Marche University Hospitals-Umberto I, 60100 Ancona, Italy.
  • Department of Biomedical Sciences and Public Health, Polytechnic University of Marche, 60121 Ancona, Italy.
Cirignaco, Giulio
  • Division of Maxillofacial Surgery, Department of Neurological Sciences, Marche University Hospitals-Umberto I, 60100 Ancona, Italy.
  • Department of Medicine, Section of Maxillo-Facial Surgery, University of Siena, Viale Bracci, 53100 Siena, Italy.
Woźniak, Łukasz
  • Department of Dental Surgery, Medical University of Bialystok, 15-276 Bialystok, Poland.
Navarro-Cuéllar, Carlos
  • Maxillofacial Surgery Department, Hospital Gregorio Marañon, Universidad Complutense de Madrid, 28040 Madrid, Spain.
Antonowicz, Bożena
  • Department of Dental Surgery, Medical University of Bialystok, 15-276 Bialystok, Poland.
Borys, Jan
  • Department of Maxillofacial and Plastic Surgery, Medical University of Bialystok, 15-276 Bialystok, Poland.
Salzano, Giovanni
  • Head and Neck Section, Department of Neurosciences, Reproductive and Odontostomatological Science, Federico II University of Naples, 80131 Naples, Italy.
De Riu, Giacomo
  • Maxillofacial Surgery Operative Unit, Department of Medicine, Surgery and Pharmacy, University of Sassari, 07100 Sassari, Italy.

Conflict of Interest Statement

The authors declare no conflicts of interest.

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