Bite Trauma Research Articles

A Safe and Effective Way for Reduction of Temporomandibular Joint Dislocation

Anterior dislocation of the temporomandibular joint (TMJ) is a common problem which demands immediate reduction to relieve the discomfort. The most popular technique is to put the operator's thumbs over the molar teeth of the patient and push the dislocated jaw downward and backward. This maneuver takes a lot of effort and usually needs sedation. Failure to reduction is not uncommon. Furthermore, the physician has to take the risk of being bitten and disease transmission. A novel method for reduction of the dislocated TMJ via extraoral route is presented, based on the observation that once the mandible is dislocated anteriorly, the coronoid process and anterior border of the ramus can be palpated easily over the cheek. By applying steady pressure over this prominent part, the anteriorly dislocated mandible can be reduced easily. From May 2000 to July 2005, there were 7 anterior mandible dislocations treated successfully by this method in Chang Gung Memorial Hospital. None of the patients need any adjuvant medication for sedation or relaxation. This technique is simple and effective, and the physicians are spared from the risk of bite trauma and unexpected disease transmission.

Thoracic bite trauma in dogs: a comparison of clinical and radiological parameters with surgical results

Canine bite wounds may cause severe underlying tissue trauma even with no clinically evident puncture wounds. In order to assess the ability of pre-operative diagnostic parameters to predict the extent of internal damage inflicted by a thoracic bite wound, the clinical, radiological and surgical data of 45 dogs that sustained thoracic bite trauma were recorded. Clinical, radiographic and surgical parameters from 45 dogs of various breeds with thoracic bite trauma, were analysed (P<0.05). All dogs were treated according to a previously described protocol and had exploratory surgery including a thoracotomy. Mainly small-breed dogs were traumatised. Clinical and radiological data were suggestive of internal trauma but not reliable as accurate indicators for internal lesions. Only radiological evidence of lung contusion was significantly associated with the presence of surgically confirmed lung contusion (P=0.006). Dogs with postoperative wound complications had a significantly higher risk of dying than those without complications (P=0.04). This study concludes that according to protocol an optimal management of thoracic bite wounds in small dogs includes surgical exploration of the wound and the thoracic cavity in the presence of flail or pseudo-flail chest, fractured ribs, radiological evidence of lung contusion, pneumothorax or any combination of these.

Osteology of Tyrannosaurus Rex: Insights from a nearly complete Skeleton and High-Resolution Computed Tomographic Analysis of the Skull

ABSTRACT A detailed osteological description of Tyrannosaurus rex Osborn, 1905 is presented, based primarily on the most complete specimen yet collected of this taxon (FMNH PR2081, popularly known as “Sue”) but also including observations from other specimens. Skull morphology of FMNH PR2081 is largely congruent with that described for previous specimens, but new details are added. Palatal morphology of FMNH PR2081 differs slightly from that of previously-described specimens—the internal choanae are slightly larger relative to skull size, and the anterior expansion of the fused vomers is elongate. Posteriorly, the vomers pass medially for nearly the entire length of the pterygoids. High-resolution x-ray computed tomographic (CT) analysis of the skull reveals internal details not previously observed. Complex recess systems can be traced in the jugal, lacrymal, ectopterygoid, quadrate, exoccipital, supraoccipital, prootic, and basioccipital. The exoccipital recess was perforated by a small foramen on the posterodorsal surface of the paroccipital process, and may have communicated with pneumatic chambers in the atlas-axis complex. The maxillary antra were bound medially by a thin bony wall; traces of these walls in earlier CT studies of tyrannosaurid skulls may have led to the impression that these animals had bony maxillonasal turbintes. A digital endocast was constructed from these images, confirming many previous observations based on natural endocasts, but also yielding new details, such as the presence of a large and presumably pneumatic sinus in the prootic adjacent to the pathway for the maxillary-mandibular branches of the trigeminal nerve. The olfactory bulbs were very large. The postcranium is also largely congruent with previously published descriptions. The precaudal vertebral column was heavily pneumatized, with pneumatopores penetrating the centra and neural arches of all presacral vertebrae, the cervical ribs, and the anteriormost four sacral centra. Unusual structures are tentatively identified as a proatlas arch and a rib on the last presacral vertebrae, structures previously thought absent from tyrannosaurids. The “missing chevron” partially responsible for claims that FMNH PR2081 is female was actually present. The gastralia are extensively fused anteriorly, and the morphology of the anteriormost gastral segments closely resembles the only published account of a tyrannosaurid sternum. This raises several possibilities, including the complete absence of a bony sternum in tyrannosaurids. The appendicular skeleton is congruent with those of other tyrannosaurids. A slender rodlike bone may represent a partial furcula, but this is not certain. The scapulocoracoids would probably not have met at the midline, but would nonetheless have closely approached each other in articulation. Several abnormalities in the skeleton have attracted popular attention. There is no defensible evidence for bite trauma on the skull, but the rib cage does show evidence for healed fractures. Lesions on the right scapulocoracoid and humerus coincide with fractured ribs on the right cervical-dorsal transition and may indicate a single trauma to the right side of the body. The left fibula is pathological, but may not have been fractured. Two fused tail vertebrae may preserve natural molds of the tail muscles.

Primary cutaneous blastomycosis: Report of a case acquired by direct inoculation of a bullous pemphigoid lesion

methoprim-sulfamethoxazole, methyldopa, hydrochlorothiazide, terfenadine, and prednisone. Examination revealed a 1.0 X 0.5 em, erythematous, slightly crusted nodule at the site of a previous vesicle (Fig. 1). A biopsy specimen revealed epidermal hyperplasia and a mixed granulomatous infiltrate with microabscesses and epithelioid histiocytes in the dermis (Fig. 2, A). A periodic acid-Schiff stain showed large broad-based budding yeast forms consistent with blastomycosis (Fig. 2, B). A repeat biopsy specimen for culture failed to grow the organisms. However, a fluorescent antibody test of the original biopsy specimen revealed 2+ staining for Blastomyces dermatitidis, confirming the diagnosis of blastomycosis. Enzymelinked immunosorbent assay for blastomycosis revealed a serum titer of I:8. A chest radiograph was normal. There was no history of a dog bite or previous trauma to the area other than the opening of a blister with a needle. The patient's lesion resolved with 4 weeks of ketoconazole therapy (400 mg daily). No signs suggestive of disseminated blastomycosis developed. A repeat chest radiograph was normal, From the Universityof Texas Medical Branch. Reprint requests:Stephen K. Tyring, MD, PhD, Department of Dermatology, University of Texas Medical Brunch, Route G-83, Galveston, TX 77555-0783. JAM ACAD DERMATOL 1994;31 :277-8. Copyright @ 1994 by the American Academy of Dermatology, Inc. 0190-9622$3.00 + 0 16/54/54352 CASE REPORT