A tooth in the hand is worth a washout in the operating theater

[Mammal bite management]

BACKGROUND

Animal bites are a major public health problem, it is estimated that 2% of the population is bitten each year. Most bites are by dogs and the risk factors include young children, men, certain breeds of dogs and untrained dogs. The risk of infection after bites differs between animal species and depends on the animal teeth and oral flora.

CONCLUSIONS

Animal bites are still a major cause of morbidity in patients of all ages and have caused several preventable childhood deaths. These wounds often become infected. If the wound requires it, early surgical evaluation must be performed. The use of antibiotics is only recommended for high risk bite wounds.

The tooth, the whole tooth: an unusual fight bite with an unnoticed embedded tooth in the hand

A 19-year-old man presented to the plastic surgeons with a wound between his fourth and fifth metacarpophalangeal joints, with associated hand swelling and pain. He admitted to accidentally striking his brother in the mouth the previous evening. His brother reportedly made a hasty exit, and the patient dismissed the wound to his hand until waking up the next morning with swelling, pain and ascending lymphangitis. Radiographs revealed the unusual extent of his 'fight bite' injury with an entire human tooth embedded in his hand. Removal of the tooth and aggressive debridement was performed in theatre. Establishing an accurate account of events in these injuries can be difficult, with the orientation of the tooth in the soft tissues being more consistent with an uppercut than the reported jab. The patient made a good recovery following elevation, intravenous antibiotics, rigorous surgical debridement and postoperative hand therapy.

Managing human bites

Human bites are frequently overlooked in making a diagnosis in the emergency room. They are particularly notorious due to the polymicrobial nature of human saliva inoculated in the wound and the risk they pose for transmission of infectious diseases. Early treatment, appropriate prophylaxis and surgical evaluation are the key to achieving desired treatment outcomes. Through this article, we have tried to summarize the diagnostic features, complications as well as the recommended treatment alternatives for human bites based on the current available evidence.