Primary Repair of a Complex Panfacial Fracture by Dog Bite

Abstract

Summary:Facial fractures due to dog attacks have an unknown incidence rate. To date, only 41 cases of canine bite trauma in a pediatric patient, associated with facial fracture, have been reported in the literature. As major species of involving dogs are the American pitbull terrier and rottweiler. Due to the intense kinematics of this trauma, the treatment becomes complex. Thus, attention to the primary repair of such complex lesions ensures satisfactory results, which is the focus of this discussion. The purpose of this review was to analyze how different ways to approach this type of trauma in children for clarification or correct management. In addition, we address the treatment plan of a complex case of panfacial fracture by a canine bite in a 4-year-old patient. According to a review addressed, the main involved are orbit, nasal, and zygomatic. Antibiotic therapy is indicated for infected bite wounds and wounded considerations at risk of infection, with high complexity and when involving important structures such as bones, vessels, and joints. The state of tetanus immunization and the risk of rabies infection should be routinely addressed in the management of the bite wound.

Maxillofacial management of dog bites injuries in an infant: a case report

“…Considering that most infections related to dog bites are a combination of anaerobic and aerobic microorganisms, antimicrobials are recommended, suggesting penicillin the first select; however, amoxicillin and clavulanic acid (gold standard) are the most regularly suggested, succeeded by IV generation cephalosporin and ampicillin with sulbactam (1,12,14). In cases of hypersensitivity, alternative antimicrobials must be advocated.…”

“…Dog bites occasion complicated craniomaxillofacial damages. Functional, cosmetic impairment and probable septicity are demanding for maxillofacial specialists (1). Children under ten years are the most usual victims of dog bites (2), in whom, the most regular damaged parts are the head, face, and neck (3), where the principal affected zones are the nose and the auricles (2).…”

“…The handling for children affected by trauma produced by bites of dogs merits singular care. Besides, aesthetic implications are relevant (1). Considering that the bite injuries are repeatedly situated on the face, an oral and maxillofacial surgeon requires being well known with the therapy of animal bites (4).…”

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

“…19 The time lag between the trauma and the commencement of treatment does have an impact while managing soft tissue injuries involving the head and the neck as delays can affect adversely the outcome. 2 Earlier wound closure offers better results without increasing the wound infection rate. Many authors advise primary repair of uninfected wounds within the initial 24 hours of trauma for the best esthetic and functional results.…”

“…1 The exact incidence of facial dog bites with fractures is unknown. Heitz et al 2 in their case report published earlier this year mention of a total of 41 cases. Tu et al 1 mention that only 5% of the head and neck dog bites are associated with facial bone fractures.…”