Bite Trauma Research Articles

Nasal Reconstruction with Composite Axial Paramedian Forehead Flap – Case Report

Background. Post-traumatic, acute or secondary nasal reconstruction or after tumor ablation involves various techniques that use local, loco-regional or distant flaps, transpozitioned or freely transferred. The reconstruction can be performed at the same time in the case of acute trauma of the nasal pyramid or secondary, at a later time if the local and general situation of the patient requires this. The median frontal flap, simple or composite, ensures a good quality reconstruction of all the aesthetic subunits of the nasal pyramid. The versatility of the flap and the aesthetic quality of the reconstruction result make the median frontal flap a choice solution for nasal pyramid reconstructions where local flaps are not indicated. The reconstruction can be done in two steps or in one step if the pedicle flap is subcutaneous. Case report. The article presents a case of total reconstruction of the nasal lobe after a complex dog bite trauma in which a composite median frontal flap, doubled with auricular cartilage, was used to restore the alar and columella cartilages. Conclusion. The axial paramedian forehead flap is a valuable technique in nasal reconstruction, offering favorable aesthetic outcomes when performed by skilled surgeons.

Eurasian Grey and White wolf ancestors—800,000 years evolution, adaptation, pathologies and European dog origins

AbstractThe oldest known wolf appears 800,000 years ago (Marine Isotope Stage 21) in Eurasia with the unspecialized short‐legged old Mammoth steppe wolf Canis lupus bohemica nov. spec. From this species, about 600,000–420,000 years ago (MIS 15‐11), the interglacial Canis lupus mosbachensis (Soergel, 1925) short‐legged Mosbach grey wolf subspecies roamed Eurasia. In the late Middle Pleistocene, there are two lineages, the southern interglacial grey and northern glacial White wolves in Eurasia. Since 320,000 (MIS 8), the short‐legged White wolf Canis lupus spelaeus (Goldfuss, 1823) was the glacial Mammoth steppe‐adapted wolf. Parallel to the “cave wolf” (found in the German Zoolithen Cave), the warm climate grey wolf Canis lupus brevis Kuzmina and Sablin, 1994 existed. C. l. spelaeus relates to the Holocene (MIS 1) extant Holarctic Greenland Canis lupus arctos and Siberian Canis lupus albus (Kerr, 1792). The Late Palaeolithic (MIS 2) “Gravettian Goyet dogs” fall into the DNA pool of C. l. spelaeus and are identified herein as pathological bite trauma individuals, which braincase shortened during the healing process. European prehistoric Neolithic dogs seem to have been imported from Central Asia with the Bandkeramik people (approx. 7000 BP) first, which have the stepped frontals originating from grey wolves.

Surgical management of facial dog bite trauma: A contemporary perspective and review.

To perform a review evaluating management of and complications stemming from dog bite trauma sustained to the head and neck over the past decade. PubMed and Cochrane Library. The authors searched the PubMed and Cochrane Library databases for relevant published literature. A total of 12 peer-reviewed canine-exclusive series inclusive of 1384 patient cases describing facial dog bite trauma met inclusion criteria. Wounds including fractures, lacerations, contusions, and other soft-tissue injuries were evaluated. Demographics related to clinical course and management, operating room requirements, and antibiotic usage were compiled and analyzed. Initial trauma and surgical management complications were also assessed. 75.5% of patients sustaining dog bites required surgical intervention. Of these patients, 7.8% suffered from postsurgical complications, including hypertrophic scarring (4.3%), postoperative infection (0.8%), or nerve deficits and persistent paresthesias (0.8%). Prophylactic antibiotics were administered to 44.3% of patients treated for facial dog bites and the overall infection rate was 5.6%. Concomitant fracture was present in 1.0% of patients. Primary closure, often in the OR may be necessary, with few cases requiring grafts or flaps. Surgeons should be aware that the most common complication is hypertrophic scarring. Further research is needed to elucidate the role of prophylactic antibiotics.

Children at risk of domestic accidents when are locked up at home: the other side of COVID-19 outbreak lockdown

BackgroundWe proposed to analyze thoroughly the impact of the COVID-19 lockdown (CL) in changes of profiles and in trend of the domestic accidents (DAs) in children.MethodsThis was a single experience, cross-sectional study conducted at the emergency department (ED) of III trauma center. We enrolled children under 18 years admitted to ED with a diagnosis of DAs comparing the CL period from 10th March 2020 to 4th May 2020 with the same period of the previous year,10th March 2019 to 4th May 2019.ResultsIn CL period, the cumulative incidence of ED visits for DAs increased from 86.88 to 272.13 per 1,000 children and the cumulative incidence of hospitalizations for DAs increased from 409.72 to 534.48 per 1,000 children. We reported in CL a decrease in the severity of ED presentation assessed by proxy measures: the level of priority ED visits reduced by 67% in CL period (OR: 0.33; 95%CI 0.22–0.48; p < 0.001); the likelihood of delayed time of presentation to ED increased by 65% in case of domestic injuries occurring in CL period (OR: 1.65; 95% CI: 1.17–2.34; p = 0.004); the odds of transfer from other hospital decreased by 78% in CL (OR: 0.15–0.33; p < 0.001). Children were more at risk of poisoning (OR:3.35–106.11; p = 0.001), of body foreign ingestion (OR: 1.83–14.39; p = 0.002) and less at risk of animal bite trauma (OR:0.05–0.35; p < 0.001).ConclusionAlthough the need to stay home has made a decisive breakthrough on the spread of COVID-19, the experience from this study underlines how this preventive measure has also had a downside in term of increased cumulative incidence of ED visits and of hospitalizations for DA.

Frequency, Pattern and Management of Dog Bite injuries in Children in a Developing Country

Aims: To collect and analyze data regarding frequency, pattern, and management of dog bite injuries in children so that it can be reported to health authorities to launch preventive measures plan against dog bite trauma in children and make sure availability of immunoglobulin and vaccine in proper quantity at proper place to prevent its misuse and expiry. Study design: Observational descriptive study. Setting: Department of Pediatric Surgery King Edward Medical University/ Mayo Hospital Lahore. Duration of study: One year from January 2018 to December 2018. Methods: All patients with dog bite injuries admitted through emergency in department of Pediatric Surgery King Edward Medical University/ Mayo Hospital Lahore were included in the study. Demographic data regarding age, gender, mechanism and severity of dog bite trauma and management recorded on detailed Performa. Results: During one year period a total of 445 patients with dog bite injuries presented in pediatric surgical emergency. Out of these 37.8% patients were admitted and 62.2% patients with minor injury were discharged on same day after proper wound management and vaccination in emergency department. Majority were males and most common age at presentation was from 4-8 years. Conclusion: As dog bite injuries are preventable so there is need to give education to children and families about preventive measures against dog bite injuries and proper treatment like immunoglobulin and vaccination. Keywords: Dog bite trauma, children, Frequency, management

Traumatic orbital ligament avulsion diagnosed with cross-sectional imaging in three dogs

The aim of the study was to describe the clinical and imaging findings of three dogs diagnosed with orbital ligament avulsion. Three immature dogs presented following a facial bite trauma,...

Top predators at war—Ice Age lions versus competing spotted hyenas

AbstractIn the fossil record, 3.097 studied bones including 40 skulls of grown‐up individuals from 81 German, Czech and English and Spanish extant spotted hyena Crocuta crocuta spelaea den sites let to distinguish two main types of pathologies. Ageing pathologies in the form of arthritis are typical for elderly hyenas. Their strong tooth use or losses and canine damages due to intensive bone crushing made them finally defenceless. Bite trauma on the sagittal crests of the crania is the secure proof for battles between top predators: lions and hyenas. A full crest healing resulted in a strong convex‐deformed skull shape. Other complete upper/lower jaw bites made by lions are found at a hyena skeleton shoulder, in which scapulae are partly healed. This hyena died in its den cave finally; as such, it is known for another Ice Age spotted hyena that was found recently as a skeleton in a Spanish cave, but with a non‐healed strong sagittal crest bite trauma. The postcranial bite traumas in the Ice Age spotted hyenas are predominantly on the distal hind legs (tibia/fibula—68% of all traumas). This correlates to African relatives because spotted hyenas attack its guilt and enemies from “behind.”

Oral self-mutilation: a repetitive tongue trauma

An 18-year old woman was referred to the department of oral and maxillofacial surgery with 1 to 2 week episodes of tongue ulcerations that had lasted for a year. Food intake was limited due to pain, resulting in a loss of 10 kg during the previous year. Following a clinical diagnosis of 'aphthous ulcers', she was treated with tetracycline and clobetasol mouthwash, which had little effect. An injection with triamcinolone acetonide did not prove effective either. Some time later, the patient reported at the emergency department with a deep, ulcerative wound to the tongue with characteristic features of bite trauma. She said she had consistently worn her protective mouthguard. The symptoms suggested self-mutilation. The patient was admitted to a psychiatric department, where a diagnosis of anxiety disorder and self-mutilation was reached.

Complex regional pain syndrome following a centipede bite: a case report

Context: Complex Regional Pain Syndrome (CRPS) is a chronic neuropathic pain condition associated with autonomic features. To date, the development of CRPS following centipede bite has not been reported. We report a case of CRPS likely secondary to a centipede bite.Case details: A 31-year-old female was bitten by a centipede on the right 2nd toe. She was initially treated with analgesics, and two weeks later developed severe pain, allodynia, pruritus, and edema of the right foot, with hyperpigmentation over the affected toe. The X-ray, ultrasound, electromyography, nerve conduction velocity studies of the foot, blood chemistries, and erythrocyte sedimentation rate showed no abnormalities. The patient was diagnosed with CRPS type 1 by fulfilling the Budapest criteria. She was treated with gabapentin, amitriptyline, desloratadine, and fluoxetine, along with physical rehabilitation. Clinical symptoms gradually improved, and resolved at approximately 9 months with persistent hyperpigmentation.Discussion: Centipede bite may be an eliciting event for CRPS. It is unknown whether direct bite trauma or envenomation was the primary etiology in this case. Awareness of this condition is important for early diagnosis and appropriate management.

Modulation of arbovirus infection by mosquito saliva

Arboviruses constitute a major public health problem, in particular mosquito-borne arboviruses that continue to emerge and re-emerge. Arbovirus infection of mammals is enhanced by the presence of a mosquito bite at the inoculation site, in comparison to virus experimentally administered by needle inoculation in the absence of a bite. Inflammatory responses to bites appear to be a key factor in this enhancement. However, the experimental inoculation of mosquito saliva with virus inoculum by needle, in the absence of bite trauma, also has the ability to enhance viral infections. In this study, we have studied the mechanistic basis for these observations. We have studied whether saliva from different mosquito species can enhance virus infection. Interestingly, while saliva from Aedes genus enhanced virus infection, An. gambiae saliva did not. Instead, An. gambiae saliva actively inhibited infection compared to inoculation with virus alone. This could partly explain why An. gambiae mosquitos are unsuitable vectors for transmitting most arboviruses. By comparing the effects that saliva of these different mosquitoes have at the bite site we have further specified which inflammatory responses at the inoculation site modulate arbovirus infection in the skin. Using an in vivo mouse model we have shown that An. gambiae causes significantly less oedema but a higher up-regulation of key inflammatory genes in the skin than A. aegypti. As such, we are providing important insights into how mosquito saliva modulates infection. A better understanding of this will aid the development of anti-viral treatments by targeting factors within the mosquito bite that are common to many distinct infections.

Physiological and immunological responses to Culicoides sonorensis blood-feeding: a murine model

BackgroundHematophagous Culicoides spp. biting midges are of great agricultural importance as livestock, equine, and wildlife pests and as vectors of the orbiviruses bluetongue, epizootic hemorrhagic disease and African horse sickness. To obtain a blood meal, midges deposit saliva containing allergens, proteases, and anti-hemostatic factors, into the dermis to facilitate feeding. Infected midges deposit virus along with the myriad of salivary proteins during feeding. The extreme efficiency with which midges are able to transmit orbiviruses is not clearly understood, as much is still unknown about the physiological trauma of the bite and immune responses to saliva deposited during feeding. Of particular interest are the first few hours and days after the bite; a critical time period for any midge-transmitted virus to quickly establish a localized infection and disseminate, while avoiding the hosts’ immune responses.ResultsA mouse-midge feeding model using colonized Culicoides sonorensis midges was used to characterize innate mammalian immune responses to blood-feeding. Histological analysis of skin, and cellular and cytokine profiles of draining lymph nodes show Culicoides midge feeding elicited a potent pro-inflammatory Th-mediated cellular response with significant mast cell activation, subcutaneous hematomas, hypodermal edema and dermal capillary vasodilation, and rapid infiltration of leukocytes to the bite sites. Mast cell degranulation, triggered by bite trauma and specifically by midge saliva, was key to physiological and immunological responses and the ability of midges to feed to repletion.ConclusionsMidge feeding causes physiological and immunological responses that would be highly favorable for rapid infection and systemic dissemination orbiviruses if delivered during blood-feeding. Recruitment of leukocytic cells to bitten skin brings susceptible cell populations in proximity of deposited virus within hours of feeding. Infected cells would drain to lymph nodes, which become hyperplastic in response to saliva, and result in robust viral replication in expanding cell populations and dissemination via the lymph system. Additionally, saliva-induced vasodilation and direct breaches in dermal capillaries by biting mouthparts exposes susceptible vascular endothelial cells, thereby providing immediate sites of virus replication and a dissemination route via the circulatory system. This research provides insights into the efficiency of Culicoides midges as orbivirus vectors.

Pulmonary lobe eventration in a dog: case report

A mixed breed dog, six years old was referred, after an episode of thoracic trauma bite, with posterior swelling in the thoracic region, to perform chest radiographs due to dry cough after physical exertion or dorsal position. Through radiographs, pulmonary protrusion through the fifth left intercostal space was observed. Thoracotomy and resection of cranial portion of the left cranial pulmonary lobe and eventration repair were performed. Postoperative chest radiographs confirmed the normal expansion of the remaining left cranial lobe. The intercostal eventration should be considered a differential diagnosis in cases of increased thoracic volume and episodes of trauma.

Thoracic bite trauma in dogs and cats: a retrospective study of 65 cases.

To report a case series of thoracic bite trauma in dogs and cats and to evaluate risk factors for mortality. A retrospective study concerning thoracic bite wounds in dogs and cats was performed. Lesions were categorized by depth of penetration: no wound, superficial, deep or penetrating. Thoracic radiographic reports were reviewed. Lesion management was classified as non-surgical, wound exploration, or explorative thoracotomy. Sixty-five cases were collected. Twenty-two percent of patients with normal respiratory patterns showed thoracic radiographic lesions. Respiratory distress was not correlated with mortality. Twenty-eight patients were presented with superficial wounds and 13 with deep wounds. Eight patients exhibited penetrating wounds. Radiographic lesions were observed in 77% of dogs and 100% of cats. Explorative thoracotomy was performed in 28% of patients, and surgical wound exploration in 17.2%. With the exception of skin wounds, thoracic wall discontinuity was the most frequent lesion. Thoracotomy was associated with increased length of hospitalisation but was not correlated with mortality. The mortality rate was 15.4%. No studied factor correlated with mortality, and the long-term outcomes were excellent. A penetrating injury, more than three radiographic lesions, or both together seemed to be indicative of the need for a thoracotomy. In the absence of these criteria, systematic bite wound explorative surgery is recommended, with extension to thoracotomy if thoracic body wall disruption is observed.

Paired maxillary and smaller mandibular mouthguard for rugby player with malalignment

A rugby player who had frequently experienced soft tissue injuries while playing rugby and wearing a conventional custom-made mouthguard came to the hospital clinic. The patient had suffered traumatic soft tissue injuries such as lip lacerations and bite trauma. Severe crowding due to ectopic maxillary and mandibular canines was observed. In response to the patient's request for better protection, a set of maxillary and mandibular mouthguards was designed: one covering the entire maxillary dentition and the other the mandibular front teeth only. The mouthguards were to be worn simultaneously. In this paper, we describe how these mouthguards were fabricated and discuss the results. The patient has experienced no injury to the stomatognathic system, including the lips, for five seasons since he began wearing this set of mouthguards. This new pairing of mouthguards appears to offer sufficient protection against injury, despite severe malalignment. We believe that this new type of paired maxillary and mandibular mouthguards has the potential to reduce sports-related dental injuries.

Radial Artery Pseudoaneurysm in aMaineCoon Cat

To report the diagnosis and treatment of a radial artery pseudoaneurysm in a cat. Clinical report. Maine Coon cat (8-year-old neutered male). Ultrasonographic and angiographic examination of a fluctuant, nonpainful, 3 cm × 1.5 cm subcutaneous swelling on the craniomedial distal aspect of the right radius that occurred 40 days after suspected cat bite trauma was consistent with a radial artery pseudoaneurysm. After ligation of the radial artery proximal to the lesion, the pseudoaneurysm was surgically excised. The excised tissue had hemorrhage and fibrin surrounded by a thick fibrous granulating capsule of variably mature fibroblasts and focal areas of inflammatory cells (lymphocytes, plasma cells, and macrophages) consistent with a pseudoaneurysm. Surgical excision resulted in resolution of clinical signs. Ultrasonography enabled prompt, noninvasive diagnosis of pseudoaneurysm. Angiography or computed tomography may be useful to aid diagnosis and assess the collateral blood supply to the manus before surgical treatment.

看護・介護の場における「咬傷の成因と対応」

看護・介護の場における「咬傷の成因と対応」

The 2009 Sydney shark attacks: case series and literature review

There were 59 unprovoked shark attacks worldwide in 2008. Twelve of these occurred in Australia, ranking it as second only to the USA. In February 2009, two attacks occurred within 72 h in Sydney, Australia. The two patients involved survived severe limb trauma. Case 1 suffered bite trauma to the lower limb and hand and underwent staged debridement and early amputation. Case 2 presented with a hand severed at the level of the wrist that was initially replanted. However, it would succumb to progressive necrosis after 12 days. We discuss the aspects of these cases that contributed to the patients' survival and ultimately good functional outcomes. New paradigms for the management of major trauma patients have emerged over the last decade. We consider recent advances in the understanding of pre-hospital tourniquet use, rapid transit to the operating suite and damage control surgery, and examine how they impacted on the management of our patients. Very little is known about the microbiology of shark bites. Organisms from sea water, the patient's skin and the shark's mouth must all be considered when selecting appropriate antimicrobial prophylaxis. The planning of definitive surgery in severe limb trauma is dependent on the interactions of a number of factors including physical, psychological and social issues. The decision to ultimately replant or amputate the effected limb is best made in union with the patient and their family.

Utilization of a Modified Bite Guard for Preventing Traumatic Macroglossia

This clinical report describes the treatment of a patient having traumatic macroglossia due to schwannoma in the craniocervical region. Enlarged tongue or macroglossia may compromise vital functions of the patient. To avoid a chronic tongue bite trauma, a bite guard that was inspired from a habit breaker was fabricated. Tongue injury has significantly healed with the use of this appliance, and the patient was able to masticate without biting on his tongue.

Selective mutism due to a dog bite trauma in a 4-year-old girl: a case report

IntroductionA child experiencing an event of threatening or catastrophic nature may experience considerable post-traumatic psychological distress. Dog bites present an important public health problem and are a frequent cause of physical trauma in children. Physicians who manage paediatric trauma may not be vigilant of the high risk of psychological stress in children exposed to a physical injury.Case presentationA 4-year-old white girl of Greek origin, with a dog-bite related trauma was admitted to the University Hospital of Crete, Greece, for surgical repair and intravenous antibiotic therapy due to extensive lesions. Exposure to the traumatic event triggered the onset of an unusual psychological response, selective mutism and acute post-traumatic stress disorder.ConclusionThere is limited literature discussing the psychological effect of dog bites in children. Parents and physicians involved in pediatric physical trauma need to be more familiar with post-traumatic behavioral reactions. Awareness of the potential development of such reactions may result in early detection and effective management of children at risk.

Mucocelo do Lábio Inferior: Relato de Caso Atípico

An atypical case of a down lip lesion with an approximately 4cm diameter was described by these authors. The lesion, having a six months evolution, was associated with a bite trauma in a fifteen years old teenager. It was clinically diagnosticated as a mucocele and after surgical remotion, the diagnosis was confirmed within the anatomy-pathological test.