Conservative management of large avulsions of the lip and local landmarks

Clinical Presentation, Causes, Treatment, and Outcome of Lip Avulsion Injuries in Dogs and Cats: 24 Cases (2001-2017)

Lip avulsions are a common result of orofacial trauma in dogs and cats. Vehicular trauma and bite wounds are common causes. Surgical therapy is highly successful with early decontamination and tension-free closure. This retrospective case series assessed the signalment, causes, lesion location, treatment and outcome of lip avulsion injuries in dogs and cats. A total of 23 patients with 24 lip avulsion injuries were included in the study. They were comprised of 11 dogs and 12 cats. The patients were generally young, with 68.2% under 3 years of age and 36.4% under 1 year of age. The most common known causes were animal bites (26.1%) and vehicular trauma (21.7%). In cats, the most common cause was vehicular trauma (25%). In dogs, the most common cause was an animal bite (45.4%). Bilateral rostral upper lip avulsion was most common in dogs (36.3%), whereas bilateral rostral lower lip avulsion was most common in cats (53.8%). Concurrent injuries were frequent in both species with tooth fractures reported in 34.7%. All lip avulsion injuries were treated via wound debridement and lavage followed by appositional repair with absorbable suture material. The most common short-term complication was wound dehiscence (21.4%). Surgical therapy was highly successful with no significant long-term complications reported. The results suggest that lip avulsion injuries are primarily seen in younger dogs and cats, usually result from vehicular trauma or animal bites, and are successfully managed with surgical repair.

Animal Bite Injuries in Children: Review of Literature and Case Series

Introduction

Maxillofacial region in children is particularly vulnerable to animal bite injuries. These injuries may range from insignificant scratches to life-threatening neck and facial injuries. Children are the common victims, particularly of dog bites.

Materials and methods

Three cases of animal bite injuries in children with their clinical presentation and their management are being presented along with review of literature. Surgical management included cleansing and primary closure of the wound. Rabies and tetanus prophylaxis were given.

Discussion

The most common site of injury was the face. For the facial injuries, the most frequently affected area was the middle third (55%), also called as the “central target area.” The small stature of children, the disproportionate size of the head relative to the body, their willingness to bring their faces close to the animal, and limited motor skills to provide defense are believed to account for this. The resulting soft-tissue injuries can vary in relation to their extent. Treatment involved initial surgical exploration, and secondary repair later depending on the severity of the injury.

Conclusion

Prompt assessment and treatment can prevent most bite wound complications. Early management of such injuries usually guarantees satisfactory outcome. Prevention strategies include close supervision of child-dog interactions, better reporting of bites, etc.

How to cite this article

Agrawal A, Kumar P, Singhal R, Singh V, Bhagol A. Animal Bite Injuries in Children: Review of Literature and Case Series. Int J Clin Pediatr Dent 2017;10(1):67-72.

Overview of Wound Healing and Management

Wound healing is a highly complex chain of events, and although it may never be possible to eliminate the risk of experiencing a wound, clinicians' armamentarium continues to expand with methods to manage it. The phases of wound healing are the inflammatory phase, the proliferative phase, and the maturation phase. The pathway of healing is determined by characteristics of the wound on initial presentation, and it is vital to select the appropriate method to treat the wound based on its ability to avoid hypoxia, infection, excessive edema, and foreign bodies.

Late revision or correction of facial trauma-related soft-tissue deformities

Surgical approaches used in accessing the facial skeleton for fracture repair are often the same as or similar to those used for cosmetic enhancement of the face. Rarely does facial trauma result in injuries that do not in some way affect the facial soft-tissue envelope either directly or as sequelae of the surgical repair. Knowledge of both skeletal and facial soft-tissue anatomy is paramount to successful clinical outcomes. Facial soft-tissue deformities can arise that require specific evaluation and management for correction. This article focuses on revision and correction of these soft-tissue-related injuries secondary to facial trauma.

Facial dog attack injuries

The exposed position of the face makes it vulnerable to dog bite injuries. This fact combined with the short stature of children makes them a high-risk group for such attacks. In contrast to wounds inflicted by assaults and accidents, dog bite wounds are deep puncture type wounds compounded by the presence of pathologic bacteria from the saliva of the attacking dog. This, combined with the presence of crushed, devitalized tissue makes these wounds highly susceptible to infection. Key to successful management of such wounds are meticulous cleansing of the wound, careful debridement, primary repair, appropriate antibiotic therapy, and rabies and tetanus immunization where indicated. This review presents an overview of the epidemiology, presentation, management of such emergencies, and the recent advances in the care of such patients.

Treatment of nipple hypertrophy by a simplified reduction technique

BACKGROUND

Nipple hypertrophy is associated with physical and psychological sequelae, leading patients to seek corrective treatment.

OBJECTIVES

The authors present a simple surgical technique to reduce nipple height with minimal tissue manipulation.

METHODS

Between November 2000 and October 2010, the senior author (CM) employed a nipple amputation technique to correct nipple hypertrophy in 30 consecutive patients. A horizontal incision was made through the distal portion of the nipple in the nonerect state to remove the predetermined nipple height. After nipple amputation, epinephrine-soaked gauze was applied to the surgical site for 5 minutes, followed by a postoperative dressing of nonstick gauze with antibacterial ointment. In 29 of the 30 patients, simultaneous breast procedures were also performed, primarily breast augmentation.

RESULTS

A total of 60 nipple reductions were performed on 29 women and 1 man (mean age, 37.8 ± 7.14 years). The mean follow-up was 35.9 weeks. All patients reported being satisfied with the procedure. Three patients noted decreased sensation, 1 noted a size discrepancy requiring further surgical intervention, and 1 noted persistent oozing from the surgical site on postoperative day 1. One patient who became pregnant postoperatively was identified; this patient was able to lactate in the postpartum period but was not able to produce enough milk bilaterally to perform breastfeeding.

CONCLUSIONS

This simplified surgical technique for correction of nipple hypertrophy was easy to perform, both alone and in combination with additional surgical procedures, and provided reproducible, satisfactory aesthetic results in this case series.

LEVEL OF EVIDENCE

4.