Fractures of the head, particularly of the mandible, are common in horses. The main causes are a kick from another horse, collision with a solid object or falls during which the horse’s head hits a hard surface. The paucity of soft tissue makes the head especially vulnerable to fractures and about 80% of the head fractures are open fractures. Injuries to the head range from small lesions, which may only be apparent as small indentations in the bone, to severe, multifragment fractures with secondary involvement of vital structures such as teeth, sinuses, eyes, nerves or major blood vessels. The extent and type of these secondary lesions are usually the most important prognostic factors. Head fractures are commonly missed or their significance underestimated.