Management of maxillofacial injuries in bear mauling cases: a review of 20 cases

Rationale: Bear mauling is the most common wild animal-inflicted injury in India. Ideally, these injuries should be managed early with fracture fixation, wound debridement, and appropriate coverage. Delay may lead to devascularization and a more severe deformity, which needs complex and multi-staged procedures for optimal outcome. Patient Concerns: Facial deformity in bear mauling is upsetting to the patient. Apart from facial aesthetics, the victim has difficulties in speech, eating, and respiration when the midface is involved. Diagnosis and Treatment: Patients require proper assessment of the soft tissue and bony defects by clinical assessment and imaging before planning any reconstruction. Outcome: The complex defect was managed in stages by both microsurgical and nonmicrosurgical methods including debridement, fracture fixation, local flaps, free flap, and prosthesis. Take-away Lessons: Systematic approach in categorizing each component of the problem, finding the best possible solution for each of them, and inter-departmental collaboration are important.

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“…Tissue loss requires loco-regional or free flaps depending on the availability of the tissue and reconstructive needs. [ 5 ]…”

Section: Discussionmentioning

confidence: 99%

Management of a Late Presentation of Bear Mauling with a Complex Maxillofacial Defect in a Tertiary Care Hospital - A Case Report

Mishra

Sahu

et al. 2021

Annals of Maxillofacial Surgery

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“…3 Complex surgical repairs, including reconstruction with skin flaps or skin grafts, are required in 25% of patients presenting with craniofacial injuries. 23 Bear attack victims may present with extremity fractures as well. Upper extremity injuries (notably humerus, clavicle, and forearm fractures) are more common than lower extremity injuries, 27 particularly when victims protect their face with their arms.…”

Section: Discussionmentioning

confidence: 99%

Polytrauma from a North American Black Bear Attack

Cassone

Vollmer

Factor

et al. 2020

Wilderness & Environmental Medicine

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Bear attacks, although rare, can inflict life-threatening injuries. We present the case of a 50-y-old woman from rural Pennsylvania who was attacked by a North American black bear, Ursus americanus. She sustained multiple complex injuries including near-complete scalp avulsion, bilateral ear avulsions, and fractures of the face, ribs, and pelvis. These injuries are similar to those sustained in other bear maulings reported in the literature and required both acute intervention and a multidisciplinary approach to recovery.

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“…11 In contrast one study reported no surgical site infections in any patients. 13 In a study found that 41% out of 58 victims reported serious head injuries and 5% of the victims to the fatal injuries leading to death. 8 In present study overall mortality was found to be 2% due to head injury.…”

Section: Complicationsmentioning

confidence: 99%

Study of Bear Bite Injury and Management in Tribal Belt of Chhattisgarh, India

Siddharth¹,

Kujur²,

Shivhare³

et al. 2020

jebmh

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BACKGROUND Bear injuries are unusual, but a trend is often observed in areas of bear habitats. Northern part of Chhattisgarh, a tribal belt is surrounded by bear habitat dense tropical moist deciduous forest. Industrialization and human invasion in their habitats resulting in frequent attacks by bear and victims present to the health care center with grievous injuries and psychological trauma. METHODS Present study included 50 victims of bear attacks admitted in the Department of Surgery, Government Medical College, Ambikapur, Surguja, Chhattisgarh, from 2016 to 2018. Data included are age, sex, precision time of attack, seasons, body parts involved, types of injuries and activity of victims during attack including the course of management. RESULTS In our study of 50 cases, most of the victims were attacked early in the morning and most of the attacks were in winter and monsoon. Common age group encountered was young adults to middle age ranging from 21-40 years. Out of 50 cases studied, 31 (62%) were males and 19 (38%) were females with a male: female ratio of 1.63:1. Attacked victims were usually engaged in cattle grazing activity (40%) and common tendency of attack observed was on face in 46%, followed by scalp in 24% and upper limb in 14%. Commonest injuries made in chronological order were laceration 76% followed by punctured wound in 48%, and avulsion injuries in 16%. Common major complications observed were wound infections 26%, followed by wound dehiscence 10%, with a fatality rate of 4%. CONCLUSIONS Human and bear interactions are accidental and unusual, but frequency is found to be increasing due to encroachment of forest by humans. Victims are usually villagers of near forest. Face and scalp are most commonly attacked body parts but no part is spared and the attack is sometimes fatal. Laceration injury was most common, and mostly on the face and scalp. Management of bear injury required multispecialty approach due to the variety of injuries with involvement of eye, ear, fractures, head injury including reconstruction surgery, to minimise complications.

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Management of maxillofacial injuries in bear mauling cases: a review of 20 cases

Cited by 10 publications

References 12 publications

Management of a Late Presentation of Bear Mauling with a Complex Maxillofacial Defect in a Tertiary Care Hospital - A Case Report

Management of a Late Presentation of Bear Mauling with a Complex Maxillofacial Defect in a Tertiary Care Hospital - A Case Report

Polytrauma from a North American Black Bear Attack

Study of Bear Bite Injury and Management in Tribal Belt of Chhattisgarh, India

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