Prevalence and pattern of maxillofacial injuries and treatment outcome after bear attacks in Jharkhand population

Abstract

Introduction: Sloth bear, a native species of Indian subcontinent, has a population estimate of 1200–1500 in Jharkhand. Human habitats in proximity to forest reserve cause frequent human–bear interactions and thus bear attack injuries. Face is the most common site affected. This is a prospective study performed to evaluate the incidence and pattern of maxillofacial trauma after bear attack and the outcome of the treatment provided to them. Materials and Methods: Patients with bear attack injuries reporting to the outpatient department were recruited for the study. The incidence was recorded in terms of time, month, and site. Details of maxillofacial wounds and fractures were noted. The variables used to analyze the outcome of the treatment were ugly scar, facial asymmetry (eyelid, nose, cheek, and lips), facial nerve paralysis, loss of vision, and alopecia. Results: Majority of the cases were reported in April and March. Victims were from Ranchi 4 (26.6%), Gumla 3 (20%), Lohardaga 2 (13.3%), Latehar 2 (13.3%), Simdega 1 (6.6%), Ramgarh 1 (6.6%), Khunti 1 (6.6%), and West Singhbhum 1 (6.6%) districts of Jharkhand. Zygoma (10) was the most affected fractured bone, followed by frontal (9) and mandible (6). Minor ugly scar was found in 14 (93.3%) of the patients, postoperative facial deformity in 12 (80%), unilateral facial paralysis in 2 (13.3%), and alopecia patch in the scalp in 1 (13.3%). Conclusion: Spring and early summer are the breeding seasons of sloth bears in Jharkhand. Mahua petal which attracts the wild bear falls from trees during these months causing such human attacks. Loss of vision describes the mutilating nature of bear attack.

Polytrauma Caused by a Bear Attacking a Human with a Benign Outcome

“…Because of a bear attack, a person will receive multiple injuries, necessarily including the head [ 10 , 11 , 17 , 18 , 19 , 20 , 21 ]. The cranio-maxillofacial region is the most common and vulnerable site affected during a bear attack [ 12 ]. Thus, we found confirmation of the bloodthirstiness of bears in Robert Armitage Sterndale’s book “Mammalia of India” (1884) in the following description: “the victim being often terribly disfigured even if not killed, as the bear strikes at the head and face” [ 22 ].…”

“…A total of 45% of fractures of the facial bones include injuries to the mandible, 35% include injuries to the zygomatic bone, 20% include injuries to the maxilla, and 10% include injuries to the nasal bones [ 19 ]. According to Vishal et al (2022), the zygomatic orbital complex (66.6%), mandible (40%), and maxilla (27%) are most affected [ 12 ]. Research conducted in Nepal in 2015 showed that most of the victims had injuries to the facial bones, among which the zygomatic bone was injured more often than the others [ 23 ].…”

“…This feature may reflect the behavior of a hungry predator. The literature indicates that bear attacks are topically different from attacks by other wild animals in that the face is the most common target [ 12 ]. This is consistent with the findings of Maurer M. et al (2023), who noted the prevalence of trauma to parts of the face, such as the perioral and periorbital regions, ears, and nose [ 21 ].…”

“…In Russia, Canada, and the United States, the bear–human conflict remains highly tense [ 1 , 2 , 3 , 4 , 5 , 6 ], manifested not only by human deaths but also by severe combined injuries complicated by shock, septic inflammation, and the risk of rabies and tetanus infection [ 8 , 9 , 10 , 11 ]. As recommended by the WHO, patients attacked by a bear are vaccinated against rabies and injected with tetanus anatoxin [ 12 ].…”

“…According to Floyd T., the predominant oral fluid flora of black bears is sensitive to penicillin [ 13 ]. Vishal et al (2022) report that it is important to perform initial surgical debridement, and work on deep defects, including injuries of both soft tissues and bones, should be carried out with both the patient’s own tissues from the wound zone and artificial biocompatible scaffolds [ 12 ].…”