Dog bites and maxillofacial surgery: what can we do?

Epidemiological Profile of Victim Patients of Facial Canine and Human Bites in a Public Hospital

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.

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

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.

Intracranial Injury after a Dog Attack in a Neonate

Dog bites are a common event, especially in the pediatric population. Common anatomic site of dog bites is the head. Despite this, intracranial injuries due to dog bites are reported anecdotally, especially in neonates. In this article, we reported a 7-day-old female neonate attacked in the head by the family dog. She presented penetrating bilateral intracranial injuries that required urgent surgery and pediatric intensive care unit (PICU) admission. She received rabies and tetanus prophylaxis, wide-spectrum antibiotic, and anticonvulsive prophylaxis. She was hospitalized in PICU for 9 days, developing intracranial hypertension. One year after the dog bite, she showed moderate psychomotor retardation and focal epilepsy.

Facial dog bites treated at the Massachusetts General Hospital over a 20-year period

OBJECTIVE

The aim of this study was to identify risk factors associated with facial dog bites and discuss prevention strategies.

STUDY DESIGN

This is a retrospective analysis of facial dog bites treated at the Massachusetts General Hospital (MGH) from 1997to 2018. Patients were identified through the Research Patient Data Registry. The predictor variables included demographic characteristics, circumstantial information regarding the injury, and dog characteristics. Other study variables were wound and treatment specifics and follow-up. Descriptive and bivariate statistics were computed.

RESULTS

In total, 321 patients were identified (mean age 29.5 years; range 0.7-81 years). There were 141 males and 180 females. The majority of patients were adults (age > 18 years; n = 223 [69.5%]). Most dogs (n = 281 [87.5%]) were known (P < .00001), and provocation was recorded in 207 cases (64.5%; P < .00001). Bites were preceded by the following behaviors: playing with the dog, feeding the dog, and placing the face close to the dog. Pitbulls led in the number of bites (n = 26 [8.5%]). Location on the face was predominantly the middle or lower third (n = 299 [93.1%]).

CONCLUSIONS

The results of this study suggest that education of dog owners, parents, and children should focus on avoidance of known provoking behaviors. This may help decrease the incidence of these devastating injuries.

Pet dog bites in children: management and prevention

Dog bite injuries are a significant public health problem and many are sustained by children. These injuries can be complex, both physically and psychologically, and in rare cases fatal. This paper will review current evidence-based approaches to treatment, explore identified patterns in biting incidents and discuss the effectiveness of prevention strategies. Safe management of these patients requires a comprehensive approach. Physical injuries need to be accurately assessed with a high index of suspicion for underlying injuries, particularly in younger children less able to communicate. Treatment depends on severity and location, but all bites must be irrigated to reduce the risk of infection but may not always require prophylactic antibiotic use. Careful exploration of the circumstances in which the bite occurred is essential to make safeguarding decisions and prevent future bites. Reducing the incidence of paediatric dog bites requires education of both children and parents that any dog can bite, regardless of breed, and all child-dog interactions must be highly supervised. However, education alone is unlikely to prevent dog bites. Policies that support environmental changes need to be developed such as provision of pet dogs less likely to bite (or bite as severely), through breeding for temperament and appropriate socialisation. Additionally, investment in psychological support for bite victims and their families is required to reduce the long-term impacts of being bitten.

Teaching Children and Parents to Understand Dog Signaling

Safe human-dog relationships require understanding of dogs' signaling. As children are at particularly high risk of dog bites, we investigated longitudinally how children from 3 to 5 years and parents perceive and interpret dogs' distress signaling gestures. All participants were then taught how to link their perception of the dog with the correct interpretation of dogs' behavioral signals and tested again. Results show a significant increase in learning for children and adults, with them showing greater understanding of dogs' signaling after intervention. Better learning effects were found with increasing age and depended on the type of distress signaling of the dogs. Effects endured over time and it can be concluded that children and adults can be taught to interpret dogs' distress signaling more correctly. Awareness and recognition of dogs' stress signaling can be seen as an important first step in understanding the dog's perspective and are vital to enable safe interactions.

Dog Bite Injuries in the Head and Neck Region: A 20-Year Review

Dog bite-related wounds seem to have become a common problem, especially when they relate to the head and neck region. According to Overall and Love, up to 18 per 1,000 people sustain a dog bite every year, of whom 3 need medical attention. Approximately 1 to 2% of bite injuries require hospitalization of the victims. Most of the lacerations are found in the upper lip and the nose regions and they are classified according to severity and concomitant damage to other organs. Bite wounds are considered "dirty" wounds and are prone to infection. When dealing with bite wounds, there is always an indication for antibiotic treatment. Broad-spectrum antibiotics like amoxicillin-clavulanate and/or moxifloxacin cover most of the pathogenic flora and should be administered in every bite wound case at risk of infection. This article would like to present a medical record review: a retrospective analysis of all bite wounds sustained in the head and neck region, treated at the University Hospital of Leuven over the past 20 years. Furthermore, it provides an overview of the current literature and its standings on the treatment of dog bite injuries in the maxillofacial region. We assessed both surgical and medical treatment options, as well as primary management, which includes infection prevention strategies, closure management, and additional vaccination requirements. Secondary management or scar revision methods will be mentioned. After conducting a UZ Leuven database search using keywords such as "dog," "dog bite," "face," "head," "lip," and others, 223 patients were included. Age at the time of injury, location of the injury, treatment method used, and whether secondary infection was present or not were documented. All patients have been divided in age groups. We concluded that 21.52% was 5 years old or younger. Almost half of our patients (49.33%) were 18 years old or younger. Of all patients, 79 were hospitalized (35.43%). Primary closure was the treatment of choice. In 141 patients, the wounds were closed primarily (63.23%), resulting in only 2.24% reported secondary infections. Only one fatality was reported in our center over the course of 20 years (0.45%), a 6-year-old girl who had been attacked by her father's Rottweilers. Most patients who sustained dog bite injuries in the head and neck region seem to be children, specifically toddlers. Due to their height, it is possible they are more prone to dog bite injuries in the head and neck region. It is essential to optimize management of these injuries due to the impact they have on patients. This article provides the epidemiological data and clinical outcome of the approach at our center.

Online videos indicate human and dog behaviour preceding dog bites and the context in which bites occur

YouTube videos of dog bites present an unexplored opportunity to observe dog bites directly. We recorded the context of bites, bite severity, victim and dog characteristics for 143 videos and for 56 videos we coded human and dog behaviour before the bite. Perceived bite severity was derived from visual aspects of the bite. Associations between bite severity and victim, dog and context characteristics were analysed using a Bayesian hierarchical regression model. Human and dog behaviour before the bite were summarised with descriptive statistics. No significant differences in bite severity were observed between contexts. Only age of the victim was predictive of bite severity: adults were bitten more severely than infants and infants more severely than children. Non-neutral codes describing dog body posture and some displacement and appeasement behaviours increased approximately 20 seconds before the bite and humans made more tactile contacts with dogs 21 seconds before the bite. This analysis can help to improve understanding of context in which bites occur and improve bite prevention by highlighting observable human and dog behaviours occurring before the bite.