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Vaishnavi V, Shetty MJ, Shekhar AR, Shetty N. Traumatic Hemifacial Avulsion and Degloving Injury With Left Zygomaticomaxillary Complex Fracture: A Case Report. Cureus 2024; 16:e59777. [PMID: 38846196 PMCID: PMC11154018 DOI: 10.7759/cureus.59777] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/06/2024] [Indexed: 06/09/2024] Open
Abstract
Managing gross maxillofacial injuries poses significant challenges due to potential complications such as airway obstruction, cervical spine injuries, and damage to cranial structures. The resultant deformities from these injuries can have enduring psychological effects, which, if left unaddressed, can be devastating. This report outlines an approach for a patient with a history of a bull gore injury wherein a 49-year-old male presented to the Department of Oral and Maxillofacial Surgery, reporting an alleged animal attack. The patient had experienced avulsion of the left eye and degloving injuries affecting the lower eyelids, nose, left cheek, and upper and lower lips, along with skin over the chin, coupled with a left zygomaticomaxillary complex fracture. Subsequently, a comprehensive single-stage primary reconstruction and repair procedure was performed. Immediate single-stage reconstruction has shown success in achieving excellent functional and aesthetic outcomes. Preserving original tissue during debridement is crucial in preventing infection and minimizing flap loss.
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Affiliation(s)
- V Vaishnavi
- Department of Oral and Maxillofacial Surgery, AJ Institute of Dental Sciences, Mangalore, IND
| | - Monisha J Shetty
- Department of Oral and Maxillofacial Surgery, AJ Institute of Dental Sciences, Mangalore, IND
| | - Adarsh R Shekhar
- Department of Oral and Maxillofacial Surgery, AJ Institute of Dental Sciences, Mangalore, IND
| | - Nandesh Shetty
- Department of Oral and Maxillofacial Surgery, AJ Institute of Dental Sciences, Mangalore, IND
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Rocha JLFDN, Leão CCA, Canedo LR, Macedo LFRD, Rosa SC, Macedo JLSD. Epidemiological Profile of Victim Patients of Facial Canine and Human Bites in a Public Hospital. J Craniofac Surg 2023:00001665-990000000-01181. [PMID: 37948634 DOI: 10.1097/scs.0000000000009818] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Accepted: 08/26/2023] [Indexed: 11/12/2023] Open
Abstract
INTRODUCTION Bites are among the most common types of trauma to which humans are exposed. The possibility of disfiguring lesions and the transmission of infectious diseases with high morbidity make this trauma a public health problem. METHOD This was a retrospective, descriptive study that analyzed the medical records of patients treated at the Emergency Unit of the Plastic Surgery Service of the Asa Norte Regional Hospital from March 2019 to March 2020. The variables analyzed included age, sex, origin, time interval from aggression to hospital care, aggressor agent, wound site, lesion characteristics, and treatment. RESULTS A total of 103 patients with a mean age of 25 years were evaluated. Most patients were male (57.3%), and 73.8% were from the Federal District. The most common type of treatment was direct suturing in 77.7% of cases, followed by local flaps (15.5%) or grafts (4.9%). There were no deaths or infections reported. CONCLUSION The predominant profile of a facial bite victim is a young male adult living in the Federal District, bitten by a canine and treated with direct sutures. Adequate treatment for animal bites should include prevention of infection, such as rabies and tetanus, as well as primary wound closure for achieving a better prognosis and satisfactory esthetics for the patient.
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Affiliation(s)
| | | | - Lucas Ribeiro Canedo
- Asa Norte Regional Hospital, Plastic Surgery Service
- Graduate Program in Health Sciences, Foundation for Teaching and Research in Health Sciences
| | | | - Simone Corrêa Rosa
- Asa Norte Regional Hospital, Plastic Surgery Service
- Medical School of the Catholic University of Brasília, Brasília, DF, Brazil
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Lisong H, Lianfu W, Jinhong Y, Haibin Z. Clinical effect analysis of using medical glue versus conventional suturing to treat dog bite in children's maxillofacial region after negative pressure sealing drainage: A randomized trial. Medicine (Baltimore) 2023; 102:e34837. [PMID: 37713853 PMCID: PMC10508562 DOI: 10.1097/md.0000000000034837] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2023] [Accepted: 07/28/2023] [Indexed: 09/17/2023] Open
Abstract
BACKGROUND To compare the clinical effectiveness of applying medical glue versus conventional suturing after primary suturing and continuous vacuum sealing drainage (VSD) technology in the treatment of facial wounds caused by dog bites in children's maxillofacial region, with respect to operation time, wound infection rate, treatment effect, and patient satisfaction. METHODS From May 2020 to July 2022, 68 children with a dog bite in the maxillofacial region were randomly divided into medical glue and conventional suturing groups. The patients in both groups were treated with conventional debridement, tetanus and/or rabies immunization, and antibiotic therapy. The medical glue group was treated with VSD after the first-stage of the loose suture of the wound. After 5 days, the suture was removed, and the wound was tightly bonded with medical glue again. The conventional suturing group was treated with VSD after the first-stage of loose suture of the wound. The primary outcomes were the operation time and satisfaction of the 2 groups, and the secondary outcomes was the wound infection rate. RESULTS The operation time of the medical glue group was significantly lower than that of the conventional suturing group. However, there was no significant difference between the 2 groups in the wound infection rate. Still, the patient satisfaction was significantly better in the medical glue group than the conventional suturing group with statistically significant difference (P < .05). CONCLUSION In conclusion, applying medical glue after using negative pressure sealing drainage in treating maxillofacial dog bites can reduce surgeons work intensity, lessen children's pain, and improve the clinical treatment effect.
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Dog bite injuries to the face: A narrative review of the literature. World J Otorhinolaryngol Head Neck Surg 2022; 8:239-244. [PMID: 36159909 PMCID: PMC9479474 DOI: 10.1016/j.wjorl.2020.11.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2020] [Accepted: 11/01/2020] [Indexed: 11/24/2022] Open
Abstract
Objective Dog bite injuries remain a public health concern for two key reasons: the physical threat to health following attack and the infective sequelae a canine bite can incur. Facial bite injuries can result in significant emotional, psychological and physical trauma to victims involved. This narrative review elucidates the current presentation and management of dog bite injuries to the face. Data Sources and Methods A literature search was conducted electronically using the search terms “dog bite” and “face” and “management” using the National Library of Medicine (Pubmed) and the Cochrane Library. There were no time nor language restrictions. A total of 79 studies were initially retrieved using the search algorithm. After screening of the titles and abstracts, 9 full texts were retrieved, and a total of 7 studies included. Results The number of patients included in each study following a dog bite ranged from 40 to 223. The percentage of children included in each study (aged <18 years old) ranged from 27.5% to 100%. The majority of dog bite injuries to the face were managed by primary repair, ranging from 56.3% to 100%. Prophylactic antibiotics were used in most studies for dog bite injuries, ranging from 81% to 100%. The secondary infection rate following a dog bite ranged from 0 to 35%. Conclusion This review highlights that children are disproportionately affected by canine bite injuries to the face relative to adults. The dog involved in the attack is typically known to the victim, with the lips, the cheek and the nose representing the most common sites of facial injury. More units are managing such injuries with primary repair and prophylactic antibiotics. Reconstructive procedures most commonly involve a local or advancement flap, a full thickness skin graft or a split skin graft. These are typically performed by Plastic Surgery and Maxillofacial Surgery specialists.
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Stanbouly D, Stewart SJ, Harris JA, Chuang SK. Risk factors associated with infection in patients sustaining dog bites to the face. Oral Maxillofac Surg 2022:10.1007/s10006-022-01066-x. [PMID: 35488948 DOI: 10.1007/s10006-022-01066-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2021] [Accepted: 04/23/2022] [Indexed: 11/24/2022]
Abstract
PURPOSE The purpose of this study is to identify which patient-level factors, if any, influence the risk of infection following dog bite wounds to the face. MATERIALS AND METHODS This retrospective cohort study was conducted using the Kids' Inpatient Database (KID). The primary predictor variable was the type of facial injury. The primary outcome variable was the presence of facial infection. SPSS was used to perform statistical analyses and statistical significance was set at a P-value of < 0.05. RESULTS Our final sample comprised a total of 4,420 patients who suffered dog bites to the face, of which 1,237 (28.0%) resulted in infection. Open wound (n = 4,176, 94.5%) was the most common facial injury, followed by bone fractures (n = 105, 2.4%). Relative to children 16-20 years old, children who were 0-5 years old were three times more likely to develop an infection (P < 0.01). Finally, open wounds (P < 0.01) were over seven times more likely to get infected relative to fractures. CONCLUSIONS Young children, particularly those below the age of five, are vulnerable to dog bite wounds to the face. Open wounds posed the greatest risk of getting infected.
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Affiliation(s)
- Dani Stanbouly
- Columbia University College of Dental Medicine, New York, NY, USA
| | - Sara J Stewart
- University of Miami Miller School of Medicine, Miami, FL, USA
| | - Jack A Harris
- Harvard School of Dental Medicine, 188 Longwood Avenue, Boston, MA, 02115, USA.
| | - Sung-Kiang Chuang
- Department of Oral and Maxillofacial Surgery, School of Dental Medicine, University of Pennsylvania, Philadelphia, PA, USA.,Brockton Oral and Maxillofacial Surgery Inc, Brockton, USA.,Department of Oral and Maxillofacial Surgery, Good Samaritan Medical Center, Brockton, MA, USA.,Department of Oral and Maxillofacial Surgery, School of Dentistry, Kaohsiung Medical University, Kaohsiung, Taiwan
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6
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Guo HQ, Yang X, Wang XT, Ji AP, Bai J. Risk Factors for Infection of Sutured Maxillofacial Soft Tissue Injuries. Surg Infect (Larchmt) 2022; 23:298-303. [PMID: 35196172 DOI: 10.1089/sur.2021.358] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Background: Maxillofacial soft tissue injuries (STIs) are common and frequent in emergency departments. The aim of this study was to analyze factors causing infection of maxillofacial STIs. Patients and Methods: Patients with maxillofacial STIs who received sutures and had complete medical records were evaluated. Gender, age, American Society of Anesthesiologists (ASA) grade, diabetes mellitus, wound age, wound length, wound contamination, wound type, and sites were analyzed using univariable analysis and binary logistic regression. Results: There were 3,276 cases included. In the univariable analysis, there was no significant difference in the infection rate between genders or between the wound age groups. In binary logistic regression, age, wound length, wound type, and physician level were risk factors for infection: age of 18-44 years (odds ratio [OR], 2.2; 95% confidence interval [CI], 1.7-2.9), 44-64 years (OR, 3.1; 95% CI, 2.3-4.3), and ≥65 years (OR, 2.6; 95% CI, 1.7-4.1); wound length of 4-8 cm (OR, 1.7; 95% CI, 1.3-2.2) and >8 cm (OR, 2.4; 95% CI, 1.1-5.1); intra-oral wounds (OR, 1.6; 95% CI, 1.1-2.4) and communicating wounds (OR, 3.2; 95% CI, 2.3-4.4); junior specialists (OR, 1.6; 95% CI, 1.2-2.2); and lip (OR, 3.7; 95% CI, 1.1-12.0) and cheek (OR, 4.7; 95% CI, 2.3-17.1) sites. Wound contamination, ASA grade, and diabetes mellitus were not significantly different from wound infection in binary regression analysis. Conclusions: Age (>18 years old), wound length (>4 cm), intra-oral wounds, communicating wounds, suturing by junior surgeons, and lip or cheek injuries may be risk factors for maxillofacial STI infection. Even if the penetrating wound age exceeds 24 hours, it is meaningful to suture if there is no serious infection. For wounds at high risk of infection, further measures should be considered to reduce the possibility of infection, such as improving the surgical training of junior surgeons and improving the patient's wound care.
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Affiliation(s)
- Hua-Qiu Guo
- Department of Oral Emergency, Peking University School and Hospital of Stomatology & National Center of Stomatology & National Clinical Research Center for Oral Diseases & National Engineering Research Center of Oral Biomaterials and Digital Medical Devices & Beijing Key Laboratory of Digital Stomatology & Research Center of Engineering and Technology for Computerized Dentistry Ministry of Health & NMPA Key Laboratory for Dental Materials, Beijing, P.R. China
| | - Xue Yang
- Department of Oral Emergency, Peking University School and Hospital of Stomatology & National Center of Stomatology & National Clinical Research Center for Oral Diseases & National Engineering Research Center of Oral Biomaterials and Digital Medical Devices & Beijing Key Laboratory of Digital Stomatology & Research Center of Engineering and Technology for Computerized Dentistry Ministry of Health & NMPA Key Laboratory for Dental Materials, Beijing, P.R. China
| | - Xiao-Tong Wang
- Department of Oral Emergency, Peking University School and Hospital of Stomatology & National Center of Stomatology & National Clinical Research Center for Oral Diseases & National Engineering Research Center of Oral Biomaterials and Digital Medical Devices & Beijing Key Laboratory of Digital Stomatology & Research Center of Engineering and Technology for Computerized Dentistry Ministry of Health & NMPA Key Laboratory for Dental Materials, Beijing, P.R. China
| | - Ai-Ping Ji
- Department of Oral Emergency, Peking University School and Hospital of Stomatology & National Center of Stomatology & National Clinical Research Center for Oral Diseases & National Engineering Research Center of Oral Biomaterials and Digital Medical Devices & Beijing Key Laboratory of Digital Stomatology & Research Center of Engineering and Technology for Computerized Dentistry Ministry of Health & NMPA Key Laboratory for Dental Materials, Beijing, P.R. China
| | - Jie Bai
- Department of Oral Emergency, Peking University School and Hospital of Stomatology & National Center of Stomatology & National Clinical Research Center for Oral Diseases & National Engineering Research Center of Oral Biomaterials and Digital Medical Devices & Beijing Key Laboratory of Digital Stomatology & Research Center of Engineering and Technology for Computerized Dentistry Ministry of Health & NMPA Key Laboratory for Dental Materials, Beijing, P.R. China
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Agarwal P, Dhiman A, Rashid N, Kataria R. Head and neck injuries after leopard attack: Presentation and management. Chin J Traumatol 2021; 24:389-393. [PMID: 33678537 PMCID: PMC8606610 DOI: 10.1016/j.cjtee.2021.01.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2019] [Revised: 10/10/2020] [Accepted: 11/11/2020] [Indexed: 02/04/2023] Open
Abstract
Leopard attacks on humans are reported most often from the Indian subcontinent. The bite wounds are complex injuries infected with polymicrobial inoculum and may present as punctures, abrasions, lacerations or avulsions. The presentation and acceptable treatment of these injuries vary according to the wound. We hereby describe the clinical presentation and treatment of a male victim with leopard bite injuries on the head and neck region. As bite injuries are commonly found on and around the face, maxillofacial surgeons should be familiar with the therapy. Through thorough clinical and radiological examination, it is essential to prevent missing any hidden injuries, which can easily turn lethal. To benefit the rural population, more health facilities need to be established in remote areas.
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Affiliation(s)
- Padmanidhi Agarwal
- Department of Dentistry and Craniomaxillofacial Surgery, All India Institute of Medical Sciences, Rishikesh, India,Corresponding author.
| | - Ajay Dhiman
- Department of Trauma Surgery, All India Institute of Medical Sciences, Rishikesh, India
| | - Nouman Rashid
- Department of Dentistry and Craniomaxillofacial Surgery, All India Institute of Medical Sciences, Rishikesh, India
| | - Ruby Kataria
- Department of Trauma Surgery, All India Institute of Medical Sciences, Rishikesh, India
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Saha S. Life-Threatening Panfacial Wild Dog Bites in a Child. Wilderness Environ Med 2021; 32:511-516. [PMID: 34446361 DOI: 10.1016/j.wem.2021.07.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2020] [Revised: 06/17/2021] [Accepted: 07/02/2021] [Indexed: 11/30/2022]
Abstract
Infants and toddlers can sustain grievous craniofacial injuries after dog bites, some of which may be life-threatening. An 18-mo-old male child presented to our emergency department with complex panfacial wounds after being bitten by an unvaccinated wild dog 6 h earlier. Primary management, hemostasis, and rabies postexposure prophylaxis were performed near his home. Initially, he was resuscitated from severe hemorrhagic shock and anemia in a pediatric intensive care unit. After stabilization, early primary repair of all facial injuries was performed. Surgical exploration revealed multiple full-thickness avulsions, lacerations, nasal bone fractures, facial muscle injuries, and right ear necrosis. Gentle tissue-handling and meticulous reconstruction satisfactorily restored his facial soft-tissue contours about 64 h after the bite injury. Postoperatively, recovery was uneventful except for localized soft-tissue infection caused by multidrug-resistant Pseudomonas, which resolved with appropriate antibiotics. Nine months later, his face and ear appeared almost symmetrical with well-settled scars. Psychological recovery progressed smoothly, excepting few incidences of panic attacks that were triggered by loud noises. Here, we observed that early primary reconstruction of severely mauled soft tissues after wild dog bites, performed within 72 h with adequate precautions, safely produced satisfying long-term outcomes.
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Affiliation(s)
- Srinjoy Saha
- Department of Plastic Surgery, Apollo Gleneagles Hospital, Kolkata, India.
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9
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Microbiological Characteristics and Surgical Management of Animal-Bite-Related Oral & Maxillofacial Injuries: A Single Center's Experience. Antibiotics (Basel) 2021; 10:antibiotics10080998. [PMID: 34439048 PMCID: PMC8388934 DOI: 10.3390/antibiotics10080998] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2021] [Revised: 08/11/2021] [Accepted: 08/16/2021] [Indexed: 11/16/2022] Open
Abstract
The objective of the current study is to retrospectively evaluate animal-bite injuries and to gain insight into the epidemiology, accident consequences and treatment concept of these accidents in oral and maxillofacial surgery. Data of patients, who were admitted January 2015 and April 2021, were retrospectively evaluated regarding the patients’ characteristics (age, gender), facial distribution of substance defects/partial amputations, duration of hospitalization, operation treatments and antibiotic treatments. Data of 75 patients were included. Patients were bitten by dogs (n = 69.92%), cats (n = 4) and horses (n = 2). Lower eyelid/cheek complex was the most affected region (n = 37, 32.74%). Most of the patients between 0 and 3 years had to be operated on under general anesthesia (p = 0.011), while most of the adults could be operated on under local anesthesia (p = 0.007). In the age group 0–12 years, 30 patients (68%) were operated on under general anesthesia. Ampicillin/Sulbactam (48%) was the antibiotic most used. Antibiotics were adjusted after wound swabs in case of wound infections or critical wound conditions. This means that resistant antibiotics were stopped, and sensitive antibiotics were used. Structured surgical and antibiotic management of animal-bite wounds in the maxillofacial region is the most important factor for medical care to avoid long-term aesthetic consequences. Public health actions and policies under the leadership of an interdisciplinary committee could improve primary wound management, healing outcome and information status in the general population.
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Ko AC, Satterfield KR, Korn BS, Kikkawa DO. Eyelid and Periorbital Soft Tissue Trauma. Oral Maxillofac Surg Clin North Am 2021; 33:317-328. [PMID: 34210399 DOI: 10.1016/j.coms.2021.04.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Facial trauma often involves injuries to the eyelid and periorbital region. Management of these injuries can be challenging due to the involvement of multiple complex anatomic structures that are in close proximity. Restoration of normal anatomic relationships of the eyelids and periocular structures is essential for optimum functional and aesthetic outcome after trauma. This review provides an overview of the current literature involving soft tissue trauma of the eyelid and periorbital tissue, and highlights key steps in patient evaluation and management with various types of injuries.
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Affiliation(s)
- Audrey C Ko
- Division of Oculofacial Plastic and Reconstructive Surgery, UC San Diego Department of Ophthalmology, Shiley Eye Institute, 9415 Campus Point Drive, La Jolla, CA 92093, USA
| | - Kellie R Satterfield
- Division of Oculofacial Plastic and Reconstructive Surgery, UC San Diego Department of Ophthalmology, Shiley Eye Institute, 9415 Campus Point Drive, La Jolla, CA 92093, USA
| | - Bobby S Korn
- Division of Oculofacial Plastic and Reconstructive Surgery, UC San Diego Department of Ophthalmology, Shiley Eye Institute, 9415 Campus Point Drive, La Jolla, CA 92093, USA; Division of Plastic Surgery, UC San Diego Department of Surgery, 9500 Gilman Drive, La Jolla, CA 92093, USA
| | - Don O Kikkawa
- Division of Oculofacial Plastic and Reconstructive Surgery, UC San Diego Department of Ophthalmology, Shiley Eye Institute, 9415 Campus Point Drive, La Jolla, CA 92093, USA; Division of Plastic Surgery, UC San Diego Department of Surgery, 9500 Gilman Drive, La Jolla, CA 92093, USA.
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Abstract
Dogs are the animal most frequently implicated in causing bite injuries to the human face. Dog bite injuries are most prevalent in younger patients. Pasteurella species are commensals of the oral microbiome of dogs and cats and are frequently implicated in infections resulting from dog and cat bite injuries. HIV, hepatitis B, and hepatitis C need to be considered in bites inflicted by humans. All animal bite wounds should be washed out. Most animal bite injuries can be managed in an outpatient setting. Given the cosmetically sensitive nature of the face, bite wounds generally merit suturing, even in delayed presentations.
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Affiliation(s)
- James Murphy
- Oral and Maxillofacial Surgery, Cook County Health, 1969 W. Ogden Avenue, Chicago, IL 60612, USA
| | - Mohammed Qaisi
- Oral and Maxillofacial Surgery, Cook County Health, 1969 W. Ogden Avenue, Chicago, IL 60612, USA; Midwestern University, Chicago, IL, USA.
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12
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Fielding CL, Mayer JR, Dechant JE, Epstein KL, Magdesian KG. Clinical and biochemical factors associated with survival in equids attacked by dogs: 28 cases (2008-2016). J Vet Intern Med 2020; 35:532-537. [PMID: 33274807 PMCID: PMC7848301 DOI: 10.1111/jvim.15979] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2020] [Revised: 11/07/2020] [Accepted: 11/19/2020] [Indexed: 11/28/2022] Open
Abstract
Background Trauma from dog attacks has been associated with mortality rates as high as 23% in some species. However, the prognosis and clinical features of this type of injury have not been described in equids. Hypotheses/Objectives To describe survival rate, signalment, clinical features, and biochemical results in equids presented for emergency care after presumed dog attacks. We hypothesized there would be differences between survivors and nonsurvivors. Animals A total of 28 equids presented for presumed dog attacks from 3 referral centers. Methods A retrospective study was performed using data from 3 hospitals between 2008 and 2016. Survival was defined as survival at 14 days postdischarge. Variables were compared between survivors and nonsurvivors using a t test, Mann‐Whitney U test, or Fisher's exact test as appropriate. Results Overall mortality rate was 21%. Ponies and miniature horses represented 16/28 (57%) of the animals in the study. Full‐sized equids had a lower risk of nonsurvival as compared to smaller patients (odds ratio = 0.02; 95% confidence intervals = 0.00‐0.27; P < .005). Animals with lower body temperatures had increased risk for nonsurvival (P = .0004). Increased admission blood lactate concentrations (P = .003) and decreased serum total protein concentrations (P = .006) were associated with nonsurvival. Conclusions The mortality rate in equids attacked by dogs was similar to what is reported for other veterinary species. Smaller equids and those with increased admission blood lactate concentration, lower body temperature, and lower total serum protein concentrations were less likely to survive.
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Affiliation(s)
| | | | - Julie E Dechant
- Department of Surgical and Radiological Sciences, School of Veterinary Medicine, University of California, Davis, California, USA
| | - Kira L Epstein
- Department of Large Animal Medicine, College of Veterinary Medicine, University of Georgia, Athens, Georgia, USA
| | - K Gary Magdesian
- Department of Medicine and Epidemiology, School of Veterinary Medicine, University of California, Davis, California, USA
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13
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Abebe MW, Tefera T, Mengesha MG, Mengesha MW, Teshome S. Case series of hyena bite injuries and their surgical management in a resource-limited setup: 1-year experience. J Surg Case Rep 2020; 2020:rjaa446. [PMID: 33154816 PMCID: PMC7602521 DOI: 10.1093/jscr/rjaa446] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2020] [Revised: 09/28/2020] [Accepted: 09/29/2020] [Indexed: 11/14/2022] Open
Abstract
Animal bites are a significant cause of morbidity and mortality and pose a major public health problem worldwide. Children are reportedly the most common victims of animal bites. Bites may be limited to superficial tissues or lead to extensive disfiguring injuries, fractures, infections and rarely result in death. Recently, human injuries caused by non-domesticated animals are increasingly common as ecosystems change and humans encroach on previously wild land. Wild animals like hyenas have been reported to prey on humans and cattle in parts of Africa. Discussed here are four children out of 11 patients that presented with hyena bites-the children had severe bites to the face and head with extensive soft tissue loss, fractures and concomitant severe infections that led to high mortality, indicating the necessity for advanced intensive care and multidisciplinary treatment needed in such situations.
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Affiliation(s)
- Metasebia W Abebe
- Plastic and Reconstructive Surgeon, St. Paul Millennium Medical College, Addis Ababa, Ethiopia
| | - Tezazu Tefera
- Plastic and Reconstructive Surgeon, Hawassa University Comprehensive Specialized Hospital, Hawassa, Ethiopia
| | - Mengistu G Mengesha
- Orthopedic Surgery, Hawassa University Comprehensive Specialized Hospital, Hawassa, Ethiopia
| | | | - Sisay Teshome
- General surgery final year resident, Hawassa University Comprehensive Specialized Hospital, Hawassa, Ethiopia
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Ferraro M, Battista RA, Giordano L, Bussi M. Tailored Nasal Reconstruction after Dog-Bite Injury in a Young Woman. Indian J Plast Surg 2020; 53:157-158. [PMID: 32367936 PMCID: PMC7192702 DOI: 10.1055/s-0040-1709811] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Affiliation(s)
- Milena Ferraro
- Department of Otolaryngology-Head and Neck Surgery, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Rosa Alessia Battista
- Department of Otolaryngology-Head and Neck Surgery, IRCCS San Raffaele Scientific Institute, Milan, Italy.,Vita-Salute San Raffaele University, Milan, Italy
| | - Leone Giordano
- Department of Otolaryngology-Head and Neck Surgery, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Mario Bussi
- Department of Otolaryngology-Head and Neck Surgery, IRCCS San Raffaele Scientific Institute, Milan, Italy.,Vita-Salute San Raffaele University, Milan, Italy
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Abstract
Background: Animal bite due to the risk of rabies is a major public health problem. Rabies is of great importance because of fatalities and economic damage. Objective: This study was conducted to investigate the epidemiological patterns of animal bite in Najaf Abad during the years of 2012 to 2017. Methods: This is a cross-sectional study. All records (4,104) were registered in the registration offices of animal bites during the years of 2012 to 2017 at the rabies treatment centres of Najafabad by census method. Demographic characteristics, animal type and sometime clinical patterns of the wounded were examined. Results: The mean age of the injured was 31.28 ± 15.28 years. Of the 4,104 injured, 3648 (88%) were male and the rest of them were women. In terms of residential area, 3645 people (88%) were in urban areas and the rest were in rural areas in the place of occurrence of bites. Most cases of animal biting occurred in dogs (70.9%) and then cat (24.3%). The most affected part was 51% with shoulder and hand. In this study, the incidence of animal bites is estimated as 100,000 people per year in Najaf Abad in in 2012 it was 206.4, with an increasing trend to 212.9 in 2019 (P < 0.001). Conclusion: The results of the study showed that most cases of animal bites were related to dogs, urban areas and male sex variables. The incidence of animal bites was also increasing. Due to the importance of this disease and its financial losses, it is recommended that prevention methods should be used to control stray dogs, vaccination of domesticated dogs and to raise awareness of the people.
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Abstract
PURPOSE OF REVIEW The aim if this review is to provide an update on the existing literature of animal bite treatment strategies and provide a systematic approach to animal bites from presentation to reconstruction. RECENT FINDINGS Dog bites cause 80-90% of animal bites with 26.8-56.5% occurring in the head and neck. Infection rates may be as low as 5.7-9.7%. Primary closure alone is sufficient in 69.8% of dog bites within the first 24 h. SUMMARY Animal bite injuries to the head and neck are common, especially in the younger population. Dogs cause a majority of these bite injuries. Injuries can include simple lacerations or punctures, avulsions with tissue present, or avulsions with loss of tissue. The most common locations are the cheek, nose, and lips. It is important to gather the vaccination status of the animal and patient and to administer tetanus/rabies prophylaxis if indicated. Antibiotics are typically prescribed for 3-5 and 7-14 days for uninfected and infected wounds, respectively. These wounds require evaluation, irrigation, and occasionally debridement or repair in the operating room. The type of repair is determined based on the location and extent of injury and can range from primary closure to microsurgical replantation, skin grafts, flaps, or even facial transplantation.
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Cagetti MG, Marcoli PA, Berengo M, Cascone P, Cordone L, Defabianis P, De Giglio O, Esposito N, Federici A, Laino A, Majorana A, Nardone M, Pinchi V, Pizzi S, Polimeni A, Privitera MG, Talarico V, Zampogna S. Italian guidelines for the prevention and management of dental trauma in children. Ital J Pediatr 2019; 45:157. [PMID: 31801589 PMCID: PMC6894327 DOI: 10.1186/s13052-019-0734-7] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2019] [Accepted: 10/14/2019] [Indexed: 11/10/2022] Open
Abstract
Dental trauma is a frequent occurrence in children and adolescent and a correct diagnosis and treatment are essential for a favourable long-term prognosis. The present Guidelines aim to formulate evidence-based recommendations to assist dentists, paediatricians, surgeons, teachers, school and sport staff, parents in the prevention and first aid of dental trauma in children and to provide a careful assessment of the medico-legal implications, reviewing the first draft of the guidelines published in 2012. A multidisciplinary panel on the behalf of the Italian Ministry of Health and in collaboration with the WHO Collaborating Centre for Epidemiology and Community Dentistry of Milan, developed this document. The following four queries were postulated: 1) Which kind of precautions the health personnel, parents, sports and educational personnel must activate in order to prevent the dental trauma damage? 2) How an orofacial trauma in paediatric patients should be managed either in the Emergency Care Unit and/or in private dental office? 3) What criteria should be adopted by a dentist private practitioner to fill in a certificate in cases of dental and/or tempomandibular joint trauma occurring in children and adolescents? 4) What are the elements that should lead clinicians to suspect a non-accidental dental trauma? A systematic review and analysis of the scientific literature published in English, Italian and French from 2007 to 2017 regarding dental trauma in children and adolescents aged 0-18 years was performed, and about 100 papers were analysed and included. The following four domains were analysed and discussed: Dental Trauma Prevention Strategies and Health Education, First aid in orofacial and dental trauma, Certificate of the dental trauma, Oral and dental signs of child abuse and neglect. Twenty-eight recommendations were draw up and codified by the panel according to the Methodological handbook, produced by the Istituto Superiore di Sanità, in order to guide physicians in the prevention and first aid of dental trauma in children and adolescents. In addition, a careful assessment of the medico-legal implications is reported in this document.
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Affiliation(s)
- Maria Grazia Cagetti
- Department of Biomedical, Surgical and Dental Sciences, University of Milan, Via Beldiletto 1, Milan, IT-20142 Italy
| | | | - Mario Berengo
- Department of Neurosciences, University of Padova, Via Giustiniani 2, 35128 Padova, Italy
| | - Piero Cascone
- Department of Oral and Maxillo Facial Science, “Sapienza” University of Rome, Via Caserta 6, 00161 Rome, Italy
| | - Livio Cordone
- ASST Spedali Civili, Piazzale Spedali Civili 1, 25123 Brescia, Italy
| | - Patrizia Defabianis
- Department of Surgical Sciences, University of Turin, Via Nizza 230, 10126 Turin, Italy
| | - Osvalda De Giglio
- Department of Biomedical Sciences and Human Oncology, University of Bari, Piazza G. Cesare 11, 70124 Bari, Italy
| | - Nicola Esposito
- Associazione Nazionale Dentisti Italiani, Lungotevere Raffaello Sanzio, 9, 00153 Rome, Italy
| | - Antonio Federici
- Unit 2, General Secretariat, Ministry of Health, Lungotevere Ripa, 1, 00153 Rome, Italy
| | - Alberto Laino
- Department of Neuroscience and Reproductive and Odontostomatological Sciences, “Federico II” University, Via Giosuè Carducci, 42 Naples, Italy
| | - Alessandra Majorana
- Department of Pediatric Dentistry, University of Brescia, P. le Spedali Civili 1, 25123 Brescia, Italy
| | - Michele Nardone
- Unit 2, General Secretariat, Ministry of Health, Lungotevere Ripa, 1, 00153 Rome, Italy
| | - Vilma Pinchi
- Department of Health Sciences, University of Florence, Largo Brambilla, 3, 50134 Florence, Italy
| | - Silvia Pizzi
- Department of Medicine and Surgery, University of Parma, Via Gramsci 14, 43126 Parma, Italy
| | - Antonella Polimeni
- Department Oral and Maxillofacial Sciences, Sapienza University of Rome, Via Caserta 6, 00161 Rome, Italy
| | - Maria Grazia Privitera
- Health prevention, Italian Ministry of Health, Viale Giorgio Ribotta, 5 -, 00144 Rome, Italy
| | - Valentina Talarico
- Department of Pediatrics, Pugliese-Ciaccio Hospital of Catanzaro, Viale Papa Pio X, 83, 88100 Catanzaro, Italy
| | - Stefania Zampogna
- Department of Pediatrics, Pugliese-Ciaccio Hospital of Catanzaro, Viale Papa Pio X, 83, 88100 Catanzaro, Italy
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Children Have an Increased Risk of Periorbital Dog Bite Injuries. J Oral Maxillofac Surg 2019; 78:91-100. [PMID: 31568755 DOI: 10.1016/j.joms.2019.08.021] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2019] [Revised: 08/21/2019] [Accepted: 08/22/2019] [Indexed: 11/24/2022]
Abstract
PURPOSE Dog bites to the head, neck, and face (HNF) disproportionately affect children. It is unclear if specific facial regions are uniquely at risk in this population. Both the periorbital region and the central target area (CTA; nose, lips, and cheeks) have been proposed as being at increased risk. This study addressed the following question: Among individuals sustaining a dog bite injury to the HNF, are children, when compared with adults, at greater risk of injury to the periorbital region or CTA? PATIENTS AND METHODS Using a retrospective cohort design, we enrolled a sample composed of patients presenting with HNF dog bite injuries. The predictor variable was age category: pediatric or adult (≥18 years). The primary outcome variable was injury location: isolated periorbital, isolated CTA, both periorbital and CTA, or other HNF location (neither periorbital nor CTA). Other variables included specific facial structures injured, demographic characteristics, injury circumstances, and clinical course. Descriptive and bivariate statistics were calculated. RESULTS The sample consisted of 183 pediatric (58.5%) and 130 adult (41.5%) patients. Isolated periorbital injuries were more common in the pediatric group (relative risk [RR], 2.2 [95% confidence interval (CI), 1.3 to 3.7]; P = .003), as was injury to both periorbital and CTA regions (RR, 2.0 [95% CI, 1.2 to 3.5]; P = .01). Isolated CTA injury was the most common injury pattern overall in both children and adults, but children were at significantly less risk than adults (RR, 0.7 [95% CI, 0.5 to 0.9]; P = .002). Children were also less likely to sustain an injury to other HNF regions (RR, 0.6 [95% CI, 0.3 to 0.97]; P = .038). CONCLUSIONS Children were twice as likely as adults to incur a periorbital dog bite, but no such increased risk was observed for the CTA. This may reflect unique anatomic risks in children or targeting of their eyes by attacking dogs, contributing to higher rates of HNF injury in this population. Public health measures should recommend against children being at eye level with dogs, even if familiar or under adult supervision.
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Dhillon J, Hoopes J, Epp T. Scoping decades of dog evidence: a scoping review of dog bite-related sequelae. CANADIAN JOURNAL OF PUBLIC HEALTH = REVUE CANADIENNE DE SANTE PUBLIQUE 2019; 110:364-375. [PMID: 30378009 PMCID: PMC6964408 DOI: 10.17269/s41997-018-0145-3] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/13/2018] [Accepted: 10/05/2018] [Indexed: 12/25/2022]
Abstract
OBJECTIVES There has been considerable literature published focusing on various sequelae to dog bites over the last three decades. Much of the literature has focused on rabies, particularly canine rabies variant, which accounts for the majority of rabies deaths worldwide. This paper describes the complications, the pathogens, and other sequelae resulting from dog bites documented in the literature. METHODS This paper used evidence found through a scoping review which charted the published peer-reviewed and non-peer-reviewed gray literature and online information relating to dog bite incidents. Each complication or sequela was additionally assessed from the viewpoint of Canadian Indigenous, rural, and geographically remote communities, which experience a high number of dog bite incidents annually. SYNTHESIS Peer-reviewed literature (N = 693; case report, original research, and review articles) provided detailed information on specific pathogens, infections, and diseases of interest, especially rabies. However, in addition to these, the sequelae from dog bites may include moderate to severe injuries that further result in anxiety around dogs or post-traumatic stress disorder (PTSD). CONCLUSIONS While a lot of focus in the literature is on rabies as a sequela to dog bites, the impacts of anxiety and PTSD are not as well articulated. Treatment of dog bite injuries may be standardized; however, improved collaborations between diverse health professionals (physicians, veterinarians, counseling services, animal behaviourists, and others) could be of considerable benefit in decreasing the effects of dog bites.
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Affiliation(s)
- Jasmine Dhillon
- Department of Large Animal Clinical Sciences, Western College of Veterinary Medicine, University of Saskatchewan, 52 Campus Drive, Saskatoon, SK, S7N 5B4, Canada
- Animal Health Science Directorate, Canadian Food Inspection Agency, 1400 Merivale Rd, Ottawa, ON, K1A 0Y9, Canada
| | | | - Tasha Epp
- Department of Large Animal Clinical Sciences, Western College of Veterinary Medicine, University of Saskatchewan, 52 Campus Drive, Saskatoon, SK, S7N 5B4, Canada.
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Modification of Lackmann's classification of facial bite wounds: an aid to assessment and recording. Br J Oral Maxillofac Surg 2018; 56:900-901. [PMID: 30352695 DOI: 10.1016/j.bjoms.2018.09.014] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2018] [Indexed: 11/21/2022]
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İhmal edilmiş hayvan ısırıklarına bağlı yara iyileşmesi gecikmesi ve yumuşak doku enfeksiyonu: bir olgu sunumu. JOURNAL OF CONTEMPORARY MEDICINE 2018. [DOI: 10.16899/gopctd.414019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Heitz C, Louzada GP, Conci RA, Rodrigues RL, Fritscher GG. Primary Repair of a Complex Panfacial Fracture by Dog Bite. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2018; 6:e1719. [PMID: 29876169 PMCID: PMC5977943 DOI: 10.1097/gox.0000000000001719] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2017] [Accepted: 01/23/2018] [Indexed: 11/27/2022]
Abstract
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.
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Affiliation(s)
- Cláiton Heitz
- From the Oral and Maxillofacial Surgery, Post-Graduate Program in Dentistry, Pontifícia Universidade Católica do Rio Grande do Sul (PUCRS), Porto Alegre, RS, Brazil
| | - Guilherme Pivatto Louzada
- Oral and Maxillofacial Surgery, Post-Graduate Program in Dentistry, Pontifícia Universidade Católica do Rio Grande do Sul (PUCRS), Porto Alegre, RS, Brazil
| | - Ricardo Augusto Conci
- Oral and Maxillofacial Surgery, Post-Graduate Program in Dentistry, Universidade Estadual do Oeste do Paraná, Cascavel, PR, Brazil
| | | | - Guilherme Genehr Fritscher
- From the Oral and Maxillofacial Surgery, Post-Graduate Program in Dentistry, Pontifícia Universidade Católica do Rio Grande do Sul (PUCRS), Porto Alegre, RS, Brazil
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Fatima SH, Zaidi F, Adnan M, Ali A, Jamal Q, Khisroon M. Rat-bites of an epidemic proportion in Peshawar vale; a GIS based approach in risk assessment. ENVIRONMENTAL MONITORING AND ASSESSMENT 2018; 190:233. [PMID: 29556789 DOI: 10.1007/s10661-018-6605-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/24/2017] [Accepted: 03/07/2018] [Indexed: 06/08/2023]
Abstract
Contemporary studies demonstrate that rodent bites do not occur frequently. However, a huge number of cases were reported from Peshawar vale, Pakistan during 2016. Two species, the local black rat Rattus rattus (Linnaeus, 1758) and the invasive brown rat Rattus norvegicus (Berkenhout, 1769) might be the suspected cause. Several studies indicated the invasion of brown rats into Pakistan presumably via port city of Karachi. In this study, we modeled geospatial distribution of rodent bites for risk assessment in the region. Bite cases reported to tertiary care lady reading hospital were monitored from January 1 to August 31, 2016. Among 1747 cases, statistically informative data (n = 1295) was used for analyses. MaxEnt algorithm was employed for geospatial modeling, taking into account various environmental variables (temperature, precipitation, humidity, and elevation) and anthropogenic factors (human population density, distance from roads, distance from water channels, and land use/land cover). MaxEnt results revealed that urban slums (84.5%) are at highest risk followed by croplands (10.9%) and shrublands (2.7%). Anthropogenic factors affecting incidence of rodent bites included host density (contribution: 34.7), distance from water channels (3.2), land use/land cover (2.8), and distance from roads (2). Most of the cases occurred within a radius of 0.3 km from roads and 5 km from water channels. Rodent bite incidence is currently at its peak in Peshawar vale. Factors significantly affecting rodents' bite activity and their distribution and dispersal include urbanization, distance from roads, and water channels. Further studies are needed to determine the impact of invasion by brown rat on bite incidence.
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Affiliation(s)
- Syeda Hira Fatima
- Department of Space Science, Institute of Space Technology, Islamabad, 44000, Pakistan.
| | - Farrah Zaidi
- Zoology Department, University of Peshawar, Peshawar, Pakistan
| | - Muhammad Adnan
- Zoology Department, University of Peshawar, Peshawar, Pakistan
| | - Asad Ali
- Department of Space Science, Institute of Space Technology, Islamabad, 44000, Pakistan
| | - Qaiser Jamal
- Zoology Department, University of Peshawar, Peshawar, Pakistan
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Abstract
Although leopards are found worldwide, the incidence of leopard attack on humans is reported most often from India and Nepal. Usually, leopards avoid contact with people, but humans may occasionally be targeted as prey. Animal bite wounds may express as punctures, abrasions, tears, or avulsions. The force and bluntness of the teeth increase the probability of a crush injury with devitalized tissue. The clinical presentation and appropriate treatment of infected bite wounds vary according to extent of the wound. These wounds are considered complex injuries infected with a unique polymicrobial inoculum. As the bite injuries are commonly found on the face, an oral and maxillofacial surgeon should be familiar with the management of animal bites. This article reviews a case of a victim attacked by the leopard, the treatment provided to the victim, and brief notes on the management of such facial animal bite injuries.
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Affiliation(s)
- Sudhir Ramlal Pawar
- Department of Oral and Maxillofacial Surgery, Bharati Vidyapeeth Deemed University, Dental College and Hospital, Pune, Maharashtra, India
| | - Rajesh Ashok Kshirsagar
- Department of Oral and Maxillofacial Surgery, Bharati Vidyapeeth Deemed University, Dental College and Hospital, Pune, Maharashtra, India
| | - Pratik Hemantkumar Raut
- Department of Oral and Maxillofacial Surgery, Bharati Vidyapeeth Deemed University, Dental College and Hospital, Pune, Maharashtra, India
| | - Amod Pramod Patankar
- Department of Oral and Maxillofacial Surgery, Bharati Vidyapeeth Deemed University, Dental College and Hospital, Pune, Maharashtra, India
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Abstract
The management of soft tissue injury after facial trauma poses unique challenges to the plastic surgeon, given the specialized nature of facial tissue and the aesthetic importance of the face. The general principles of trauma management and wound care are applied in all cases. The management of severe injuries to the face is discussed in relation to the location and the mechanism of injury. Facial transplants have arisen in the past decade for the management of catastrophic soft tissue defects, although high morbidity and mortality after these non-life-saving operations must be considered in patient selection.
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Affiliation(s)
- Tara L Braun
- Division of Plastic Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas
| | - Renata S Maricevich
- Division of Plastic Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas
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