Sinus Fracture

Abi Abi is a beautiful, good-natured dog who got a little too close to a horse’s hoof.  Actually, she got kicked in the head.  It turns out to be not as cool as when Dean Martin sang about it.  Incredibly, she is walking around like nothing much happened.


Closeup When you look at a close-up of the cut, you might say that it doesn’t look too bad, and it doesn’t.  What you can’t see is that every time she breathes, the skin on top of her head puffs up like a balloon.  She also has some bloody nasal discharge.  In fact, there is a hole in her lateral frontal sinus.


Sinus cavities (2) Part of the skull is a double-wall construction.  If the hoof impact had been farther back, it would have hit the brain-case.  In this case, it broke through into the space outlined in green on this diagram.  [This is from The Viscera of the Domestic Mammals.  It’s not computer-generated, but is old-school — they injected the sinuses with different colors of plastic and dissolved away the bone to make this image.]




We watched Abi for a couple of hours, and she never showed any signs of central nervous system depression or shock, so we went ahead and anesthetized her for surgery.  We also gave her a lot of pain medicine. Despite her chipper disposition on presentation, she has GOT to have a headache.

Dimple We had called the Veterinary Medical Teaching Hospital at the University of Missouri to ask for advice.  Apparently this is a pretty uncommon injury.  The resident had to call the surgeon, who had to call some other surgeons.  Dr. Carol made at least four phone calls before we  ever did much of anything besides monitor the dog and give pain medicine.  Here is my finger showing where the hole in her skull is.

Fragment Here is one of the fragments I fished out of the sinus before we wired it all back together.  Unfortunately, the top of her sinus resembled the end of Bad Leroy Brown — it looked like a jigsaw puzzle with a couple of pieces gone.  It took me about an hour to get things cleaned up, drilled, wired, and closed up.


All Done Here she is, all closed up.  She went home with a lot of pain medicine and we’ll be following up.  I’m worried about the crushing done to her skin and muscle above the broken bone.

25 thoughts on “Sinus Fracture

  1. phillip banzet says:

    my dog just ran into the end of my trailer. When he hit the same injury that i see her accrued. What they did was nothing to the fracture. The said in time it will heal. I’m not happy with that.

  2. Doc says:

    Hello, Phillip,

    It is difficult for me to comment on your dog’s injury. If there is a crack without a “floating” fragment then it is very likely to heal without intervention.

    I can understand your concern, but there is no advantage to putting your dog through a surgery when it is likely to heal on its own.

    Since you are unhappy with what they have told you, I would ask for a more detailed explanation of is going on the injury and what they expect to happen during the healing process. That way you will know if things are not going according to plan.

    Alternatively, you could seek a second opinion from another doctor. I don’t think it will be possible for anyone to give you good advice without seeing the dog.

    Good luck.

  3. Sarah lewis says:

    My dog reciently got hit in the head by a moose hoof. they said he fractured his sinus bone because everytime he breaths out of his nose his forehead will puff like a balloon as well. i opted out of an xray only because they said if it is fractured they cant do anything for him. so i have taken him home and he seems to be doing ok. they did give me anti inflamatories and antibiotics so i am just curious if i have done the right thing in just letting time heal the fracture or do you think i should have spent the time and money to get an xray?

  4. Doc says:

    Hello, Sarah,

    I think in this case the best thing to do will be to monitor the dog’s progress closely. I would suggest making regular recheck appointments with your veterinarian, say every 2 weeks for a while.

    If you see anything that seems to be worse today than yesterday, then I would let your veterinarian know right away.

    This may do fine, but you should be alert for complications.

  5. Marian Sewade says:

    My 12 week old yorkie Jack mix got bir by a lab with fraxture to the sinus lobe. Bone has come out throygh the skin. One piece about 3/4 in long by 1/2 in wide. Then the mext morning a larger piece was pushing its way out. He lost that piece of frontal lobe as well. Puppy is playing, eating and drinking well. Playing wirh mom normally. The holes wheere the sinus bone came out have healed. Took him to vet who had no idea how to fix it so sent us home on antibiotics. He is still acting normally for a puppy. This has taken three weeks to heal. I know he has a hole where the bone came out so not letting him out till course of anribiotics is done. What will tje long ladting effects be. Will the bone grow back. He is now 15 weeks old.

  6. Doc says:

    Hello, Marian,

    If the infection is handled, then I would expect your puppy to lead a normal life. If there are large chunks of bone missing, it is not likely that a big hole will fill in, the way that a crack would. However, I think he is very likely to have normal function for the most part.

  7. Thomas mcknoulty says:

    My staffie has been smashed on his nose to get him to let go of other people’s dogs now he breaths Hervey and has a large lump on his nose will he be ok I had a stroke and others couldn’t get him to let go of their dogs I’m not happy and I feel responsible I wasn’t there for him I’m very worried

  8. Doc says:

    Hello, Thomas,

    It’s hard to say without seeing the dog or taking an X-ray. I’d say there’s a good chance it is just swelling from bruising. We call it a hematoma (blood-filled swelling), but when I was a kid we called it a “pump knot”. If so, it will probably get better in a few days. If it is just the first day, I’d put a cold compress on it for 20 minutes, three times daily. If a couple of days old, use a warm compress instead, same schedule.

  9. leah says:

    my 7 wk old pit bull puppy got bit by a neighbors dog his tooth went through her nose fractured her bone and has left a hole every time she breathes air comes through the hole in her nose along with blood and her face is swollen we took her to the vet but we cant afford the $900 vet bill to get her surgery i just don’t know what else to do…..i feel so hopeless that i cant help her

  10. Doc says:

    Hello, Leah,

    With a dog that young, you have a better chance of healing if you can control infection. I have been amazed at what recoveries I have seen.

    Talk to the doctor about a course of antibiotic therapy (like clindamycin) and good nursing care (and pain meds, too).

  11. Sam says:

    My dog, Russell, was hit by a car. I was not with my family when they took Russell to the emergency room. He was delirious, had a bloody nose, and a puncture wound on his head. My family said the vet said it was just a concussion and no X-ray was necessary. They gave him some anti-inflammatory meds and went home the next day. I finally had the opportunity to inspect him closely as he was sleeping. After searching online of the anatomy of the dogs sinuses I have concluded it’s a puncture wound through his “frontal sinus” and possible fracture? causing air to come out every time he exhales. It is like a second breathing hole right through his frontal sinus. Palpated directly on it and it was crepitus. Is this something that heals overtime or does it need to be addressed once again? Thanks

  12. Doc says:

    Hello, Sam,

    That does sound like a crack into the frontal sinus. I’ve seen that go both ways, healing spontaneously, and needing surgery. So, I can’t really answer your question at this point. I think it would be okay to give him some time.

  13. Ozzie says:

    My dog got bit by another dog in the face area right next to her eye and when she breathes her forehead puffs up like ballon took to get they cleaned her up and gave her antibiotics but couldn’t tell me was wrong with her and suggested I take her to a larger hospital what should I do

  14. Doc says:

    Hello, Ozzie,

    It is difficult for me to tell you what to do here. It does sound like the sinus has been punctured. If there are bone fragments in there, they need to be removed.

    I would ask the doctors who suggested a larger hospital who them recommend and get the dog evaluated there.

  15. Nate says:

    My hunting beagle Marley got hit by car today. I brought her to the vet and there is a hole with missing bone and a crack in the middle of her skull approximately an inch above her eyes. Vet said it’s recommended to have surgery to find and remove the bone. If the bone is left, what would happen.

  16. Doc says:

    Hello, Nate,

    The concern is that the bone fragment, having lost its connection to its blood supply, will die. The dead piece of bone then acts as a foreign object, and the body tries to reject it. It would be like having a piece of wood stuck in there. Could get pretty nasty.

  17. Kirianna says:

    Hi doc! I have a Kelpie who also got kicked by a horse and presented with the same fracture and floating pieces as the case above. After a 6-week check-up surgery, the vet determined it didn’t need surgery as the fragments hadn’t moved from the same floating spot they were after the initial incident.

    It seems that since the incident (about four months ago now) she’s been up and down more with her energy levels, and isn’t able to handle the summer heat at all anymore without a 1-2 day recovery of low energy and sleeping. She just turned three and has plenty of energy so the behaviour developing since summer has kicked in has been questionable.

    I’m wondering if there is any literature or information on the frontal sinus being responsible for heat dissipation/regulation or if having that I operated sinus break could cause an issue with heat or activity (like, can dogs get headaches or could that hole in her sinus create an inability to regulate heat expansion?)?

    • Doc says:

      Hello, Kirianna,

      Great questions. I feel sure that dogs can get headaches and that we usually don’t know it. I see many dogs with abscessed teeth where the owner is unaware that the dog has any pain at all. Yet when we remove the tooth, they see an improvement in the dog’s attitude and behavior.

      I don’t think that the sinus plays much role in cooling. Dog’s sweat very little, just their noses and foot-pads. Panting has some evaporation from the tongue, but is largely a “heat pump” exchanging hot inside air for cooler outside air. That doesn’t work too well when it’s 100 outside.

      Many large dogs will dig holes to expose cool moist earth. They can lie against this to wick away excess heat, just like lying down on a cold tile floor.

      I am sorry that I cannot give you more meaningful information as to the possibility of a connection between the injury and the apparent heat intolerance.

  18. Pauli says:

    My dog suffered injuries on a flight and I got him back with broken canines on one side and torn mouth on the other. I am guessing that he fell flat on his face sometime. The gums have gotten damaged as well and he still can’t eat on his own sometimes. Though now he’s healing well, but he seems to be snoring very loudly and gave a disruptive sleep. Is there something wrong with his nasal tract? He never snored before this and doesn’t snore otherwise when he’s awake. (We moved from a tropical country to a cold country. )

    • Doc says:

      Hello, Pauli,

      The canine tooth has an enormous root that almost touches the nasal passages. It is possible that your dog has developed a communication between the mouth and the nasal passages with this injury. Usually that would result in sneezing or nasal discharge, rather than snoring.

      I would recommend that you ask your veterinarian to examine your dog’s throat and teeth under anesthesia, checking the soft palate and taking dental X-rays.

  19. Patricia says:

    Our dog is going to be biopsied to confirm nasal aspergillosis. If it is that, assuming our 10 year old pup recovers, he will be left with a hole (thumb width) that currently accumulates nasal fluid and infection. He also has AIHA. Are there any viable options for dogs as far as plugging the hole in the nasal bone? I realize it’s early days, but I wondered if that sort of thing has been done. (I don’t want to torture him)

    • Doc says:

      Hello, Patricia,
      In my limited experience with this sort of thing, the skin can usually be reconstructed, and the dog would live a normal life, despite a defect in the bone.

      I would speculate that your baby had been under some immunosuppressive treatments for the AIHA, which would make him more susceptible to the fungus infection. However, with that stopped the antifungal drugs can still be effective.

  20. Haley says:

    Hello, a little over a week ago my basset hound was attacked by our lab mix. She had some bite wounds on her head that punctured her sinus cavity. She was sent home with pain meds and an antibiotic. She has been being her normal self and is doing great.

    My worry is that this morning when I was betting her head a felt something different. I think it may be a fragment of bone. Upon further investigation I noticed that she does still have 2 small hole in the top of her head. When she breaths the skin no longer puffs up though. What I am wanting to know is if the bone will grow back or if she will permanently have the holes in her skull.

    Thank you!

    • Doc says:

      Hello, Haley,
      Two things would concern me. One is whether or not any bone fragments were depressed into the sinus cavity. If so, they can lose circulation and act as a foreign object, just as though it weren’t part of the body to start with (like a wood splinter or something).

      The second thing is, “how small is small”? If the holes are 3mm or less (and I’m guessing at that number), they will probably fill in. Larger holes may remain as a “dimple” with just skin over them, unless some sort of grafting procedure is performed.

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