Maxillofacial Injuries Due to Animal Bites

Abstract

As the bite wounds are frequently located on the face, an oral and maxillofacial surgeon needs to be familiar with the treatment of animal bites, pitfalls in management and to educate patients on ways to avoid future bite injuries. The management of animal bites is an evidence poor area and most recommendations are based on small case series, microbiological data and expert opinion. The main controversies include whether wounds should or should not undergo primary closure and the use of prophylactic antimicrobials.

Primary Closure of a Complex Facial Wound with Underlying Fractures. Deconstructing Dogmas

“…The nose, cheek, and lips are commonly injured within the face. 15 A dog bite can often be categorized into abrasions, puncture wounds, avulsions, crush injuries with underlying fractures, foreign bodies, and also nerve and tendon injuries. 15 Modified Lackmann's classification (Table 1) for facial wound can be used to assess the severity.…”

“…15 A dog bite can often be categorized into abrasions, puncture wounds, avulsions, crush injuries with underlying fractures, foreign bodies, and also nerve and tendon injuries. 15 Modified Lackmann's classification (Table 1) for facial wound can be used to assess the severity. 16 The common dog bite causes a combination of tissue tears and adjacent punctures ("hole and tear" effect).…”

“…17 Canine bites resulting in maxillofacial trauma should ideally be evaluated as an activated trauma according to ATLS guidelines. 15,18,19 Imaging using CT scan is important in planning the optimal management. 1,20 High index of suspicion for a fracture should be raised especially when large dog breeds are involved (Great Dane in our case) capable of crush injuries with considerable force.…”

“…Pasteurella is the commonest genus with Pasteurella canis being the predominant species. 15,17 Gram positive bacteria are the commonest oral microorganisms found in canines and antibiotics should be tailored to cover Staphylococcus, Pasteurella, and Streptococcus. 18 The anaerobes commonly found are Fusobacterium nucleatum, Bacteroides tectum, Prevotella heparinolytica, and Porphyromonas.…”

“…17,21 According to current recommendations, amoxicillin/clavulanate is the prophylactic antibiotic of choice. 15,18,22,23 For penicillin (PCN), allergy clindamycin plus either ciprofloxacin or trimethoprimsulfamethoxazole (TMP-SMX) are used. The usual duration of therapy is 3-5 days and 10-14 days with bone involvement.…”