Horseshoe Headrest Guide: Gel Pads, Positioning and Pressure-Injury Prevention

When a horseshoe headrest replaces pins

Skull pins give rigid fixation, which is essential when the head must not move at all, for example during microsurgery under high magnification or with navigation registered to the skull. A horseshoe headrest is the better choice when the head only needs to be supported and kept in a stable position: many posterior fossa and cervical approaches, ENT and maxillofacial work, and lower-risk cranial cases where the surgeon accepts a small amount of freedom.

It is also the natural option for infants and children, whose skull is thin and where pin pressure is a concern, and for patients in whom pinning is undesirable. The decision belongs to the surgeon; the buyer's task is to make sure the OR owns both options. For a comparison of the available designs see skull clamp types.

Mayfield horseshoe head holder and the DORO alternative

Many surgeons use the term Mayfield horseshoe head holder generically for any horseshoe-type support. When you compare suppliers, look at the same features regardless of the name: table attachment, adjustability, pad material and cleaning.

The DORO Horseshoes from Black Forest Medical Group support the head on shape-taking gel pads. Adult and paediatric pads fit the same base, the base width is adjustable, and vertical and lateral adjustment help with positioning. Versions include the standard swivel horseshoe, a radiolucent Horseshoe RS with extra space for imaging systems, models for carbon tabletops and an ENT version with extra clearance under the head.

Gel headrest choices

A gel headrest spreads contact pressure over a larger area than foam and moulds itself to the occiput and face. In the DORO range the gel pads are shape-taking, removable and easy to clean, which matters for turnover between cases. Having both adult and paediatric pads on one base reduces the number of accessories to stock.

Check the contact surface for wear before every case, and replace pads that are cracked, stiff or no longer recover their shape. Ask the supplier which cleaning agents are approved for the gel and the frame, and keep that guidance at the point of use.

• Pad size matched to patient age and head circumference
• Frame width adjusted so the pad cradles the head rather than pinching it
• Radiolucent version if intra-operative imaging is planned
• ENT or carbon-tabletop version where the table design requires it

Horseshoe headrest in prone position

In the prone position the face rests on the support, so the contact points are the forehead, cheeks and chin. This is where pressure injuries and eye complications are a real risk. The frame must keep the airway and endotracheal tube accessible, leave the eyes free of pressure, and allow the anaesthetist to see the face where the set-up permits.

Positioning is a team task. Agree the head position before draping, check the eyes, nose and ears after the final position is set, and re-check at intervals during long cases according to your hospital's protocol. For the wider positioning workflow read patient positioning for craniotomy.

Document the final head position, pad type and skin checks in the positioning record so that the next shift and the recovery team know what to look for.

Questions to ask a supplier

Confirm compatibility with your OR table side rails and any carbon tabletop, availability of paediatric pads, approved cleaning agents, and whether accessories such as retractors can be mounted. Compare the full Black Forest Medical range so that horseshoes, skull clamps and bases share interfaces.

Beckfinity can advise on a combination that suits your case mix; request a quote and our specialists will respond.