Suture exostosis is a relatively frequent and complex disorder that should always be considered when evaluating equine craniofacial swellings. Although isolated case reports have appeared in the literature, no extensive series has yet been described. The current research presents a multicenter retrospective analysis of confirmed cases of suture exostosis. Data from horses diagnosed with this condition in the facial area were retrospectively reviewed. Details, including breed, sex, age, case history, imaging outcomes, treatments administered, therapeutic response, and follow-up observations were compiled. A total of 105 cases from different breeds were analyzed. Evaluation showed that cases could be categorized into four distinct origins: 45 occurred after sinonasal surgery, 23 followed traumatic incidents, seven were associated with sinus pathology, and 25 had no identifiable cause. Treatments included removal of bone sequestra, plate fixation, antimicrobial and anti-inflammatory therapy, or, in some cases, no intervention. Local discomfort usually subsided within several days or weeks, while swelling typically diminished or resolved completely between 3 months and 1.5 years. The pathogenesis of suture exostosis appears multifactorial. Detecting any underlying factor—especially sequestrum formation or infection—can greatly facilitate recovery and should be ruled out before classifying a case as idiopathic. During sinusotomies, minimizing surgical trauma is essential to reduce the likelihood of suture exostosis as a postoperative complication.
