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Human bites of the face present to the surgeon sometimes with a dilemma as to the method and timing of surgery. Often patients present with soft tissue defects as a result of the injury sustained. Reconstruction therefore becomes absolutely necessary to avoid psychosocial complications.
The aim of this paper is to review human bites of the face, wh...
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... patients with fresh or infected wounds were given antibiotics with Metronidazole and anti tetanus prophy- laxis. Procedures performed were as shown in Fig- ure 2 and included v-excision and closure of the lips in 20 lips (37.0 %), midline forehead flap cover in 4 (7.4 %) patients and composite auricular graft in 3(5.6 %) patients. Nasolabial flaps were used to reconstruct the nose in 3 (5.6 %) patients while chondrocutaneous flap was used in one ear, post auricular flaps in 3, skin grafts in one and direct suturing in 3 (5.6 %) patients while one (1.9 %) patient with eyelid injury had a lid switch. ...
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Citations
... 15 Seven articles were prospective studies 2,9,[16][17][18][19][20] and 19 retrospective studies. 4,11,12,14,[21][22][23][24][25][26][27][28][29][30][31][32][33][34][35] Three of these articles relate to surgical humanitarian reconstruction missions due to animal attacks on the maxillofacial region. [36][37][38] All of these three articles are studies conducted on the African continent. ...
... The items included are from every inhabited continent except Central America. Thirteen studies were from Africa, 13,17,19,20,22,23,[36][37][38][39][40][41][42] 17 6,21,26,29,71 , and five from South America. 9,[72][73][74][75] Dog bites are the most commons animal attacks on the face and this can be seen in this study as 29 included articles are associated only with dogs and one with dogs and cats. ...
... 25 Some studies referred to studies with general animals, 21,28,34 while some were more specific to mammalians 11,16,22,29 (including dogs and cats), wild mammals, 40 and wild animals. 41 Ten articles reported treatment of human facial bites, 6,15,17,[19][20][21]23,37,39,62 six of them from Africa. 17,19,20,23,37,39 Less common, peculiar animal bites were also reported, including bears, 56 camels, 45,49,51 crocodiles, 42 hyenas, 36,38 leopards, 50,53,68 rats 63 and wolves. ...
Objectives: Animal and human bites to the face occurs commonly. If they are not fatal, these injuries can lead to highly detrimental effects. The aim of this paper is to review literature on this topic and to update knowledge on the subject. Methods: A comprehensive review by PubMed, Web of Science and Google Scholar was performed using the terms “face bite” and “face attack” for surgical management of wounds. No language restrictions or animal species were applied. Articles from the last 42 years have been included. Results: A total of 71 articles from 29 different countries worldwide were included. Despite animals’ anatomy and geographic differences, multiple steps of surgical management are essential to prevent wound infection, in addition to unaesthetic and functional issues. Late attendance can be very harmful. Conclusions: Besides several important steps, copious lavage with saline and later with an antiseptic is considered the be the most effective surgical maneuver. Primary suture and later reconstruction considerations were listed. Tetanus and rabies must be screened. If in doubt, prophylaxis is strongly recommended.
... Additional ve full articles that met all inclusion criteria were identi ed from independent searches. A total of 35 articles 11,12,[21][22][23][24][25][26][27][28][29][30]13,[31][32][33][34][35][36][37][38][39][40]14,[41][42][43][44][15][16][17][18][19][20] met all inclusion criteria and were included in the qualitative analysis. Two articles 43,44 were excluded from the meta-analysis because they did not report on any one geopolitical zone, and therefore could not be combined with other studies. ...
Purpose: This study aimed to provide a nationwide survey of maxillofacial injuries pattern, distribution, etiology, and treatment based on Nigeria’s geopolitical zones.
Methods: This systematic review and meta-analysis included all cross-sectional, cohort, case-control and randomized controlled studies published between 2004 and 2019 (16 years). Comparisons were made between different age groups, gender, site of maxillofacial injury, associated injuries, and treatment across geopolitical zones in Nigeria: southwest(SW), southsouth(SS), southeast(SE), northwest(NW), north central(NC) and northeast(NE). Proportion meta-analysis using the generic inverse variance method, risk ratio effect measure, and random effects model was conducted.
Results: A total of 35 studies including 4,472 patients from four geopolitical zones across Nigeria (SW, SS, SE and NW) were included in this review. Age range was 0.3 to 90 years. Highest male to female ratio reported was 30:1. Road traffic crash (RTC) was the major risk factor for maxillofacial injuries (3.10, 95% CI, 2.34 – 4.10), and motorcycle crash was second (0.44; 95% CI, 0.29 – 0.66). Other aetiologic factors were assault (0.28; 95% CI, 0.19 – 0.40), fall (0.06; 95% CI, 0.03 – 0.11), sports injuries (0.03; 95% CI, 0.02 – 0.05) and others (0.04; 95% CI, 0.02 – 0.09).
Conclusions and relevance: RTC, motorcycle crash and assault constituted the most important factors for maxillofacial injuries in Nigeria. The result of this study highlights the importance of improved road safety measures and maintenance of law and order.
... Studies report acute reconstruction using nasolabial or melolabial flap and paramedian forehead flap for nasal defects following human bite injuries. [13][14][15][16][17] However, only few number of cases were reported in such studies. We performed delayed reconstruction of nasal defects to allow the infection to heal and scars to become supple. ...
Background Human bite wounds in emergency department need evaluation in regard of reconstruction. These are due to occlusive bite injuries over face. Most commonly, human bites over face involve ear and nose, and may lead to avulsion injury. Defects over nose can be reconstructed immediately after debridement or delayed till the wound heals and scar becomes supple. Thorough wash and lavage with broad- spectrum antibiotic cover has utmost importance in preventing cartilage infection.
Methods We report 20 cases of human bite injuries over nose who presented to us in emergency department between 2018 and 2020. At the time of presentation the wound was assessed for closure. If not possible, patient was planned for delayed reconstruction after 3 months. In case delayed reconstruction was planned, the skin and nasal mucosa were approximated at first presentation. The patients underwent paramedian forehead flap after recreation of defect with conchal cartilage graft. Second stage of flap detachment and insetting was done after 3 weeks. After three weeks of second stage, third stage of flap thinning was done. Patients were followed for 3-6 months and subjective satisfaction was noted.
Results Nineteen patients underwent delayed staged reconstruction with paramedian forehead flap and one underwent primary wound closure. The flap survival was 100%. The patient satisfaction was excellent in most cases.
Conclusion We recommend delayed reconstruction for human bite nasal injuries. For reconstruction, paramedian forehead flap with conchal cartilage graft, if required, provides excellent reconstructive option with good contour and color match and minimal donor site scar.
... Most facial bite wounds are usually to the lips, the lower lip being the commonest site affected as reported in various studies [7][8][9]. The nose is rarely affected. ...
... Human bite injuries carry the risk of being infected with bacteria from the oral cavity [2,6,7]. Prophylactic antibiotic cover is therefore advocated. ...
... The potential complications occur primarily due to bacterial infections that are more severe than those caused by animal bites. This is primarily due to the aerobic and anaerobic human oral flora [2,6]. It should also be noted that there is a risk of tetanus and viral infection (hepatitis B, hepatitis C, herpes simplex, and HIV) [4]. ...
... The lips were the most frequently damaged body part in this study. This may occur due to several factors, including the prominence of the lips in black African patients [1,4,6]. Bacterial germs usually found in facial wounds caused by human bites most often come from the bacterial flora of the mouth cavity of the person being bitten or biting [1,2,6]. ...
... This may occur due to several factors, including the prominence of the lips in black African patients [1,4,6]. Bacterial germs usually found in facial wounds caused by human bites most often come from the bacterial flora of the mouth cavity of the person being bitten or biting [1,2,6]. In this study, there was only one case of postoperative infection. ...
Introduction: The treatment of facial wounds by human bites is difficult, especially in under-developed countries. We aimed to distinguish the epidemiological and clinical aspects to describe the therapeutic methods and evaluate their effectiveness. Materials and methods: This was a descriptive and retrospective study over a period of 6 years. Patients who consulted regarding a human bite wound and were surgically treated were included. Results: Eighteen patients with a hospital prevalence of 0.008% were enrolled. The ratio of men to women was 2 (12 men for every 6 women). The average age was 32.77 years (range, 23–45 years). The lesions were labial in 11 cases (61.11%). The wounds were type III in eight cases (44.44%) and type II in nine cases (50%). Surgical treatment was primary in 12 cases (66.67%) and delayed in 6 cases (33.33%). The evolution was favorable in 16 cases (88.89%). Discussion: The wounds on the face created by human bite can be effectively treated via primary repair while reserving systematic secondary closure to an initially necrotic wound.
... This becomes obvious especially when presentation to the hospital is delayed. 14 In an elaborate multicenter study by Talan and colleagues in 2003, bite wound cultured several microbes including fungi. Streptococci especially Streptococci anginosus, which topped the list of isolates, has been implicated in serious brain and visceral abscesses when compared to other S viridians. ...
... 18 These were not features in our study rather all the assailants knew all their victims and the bites were aimed at deforming or as a form of defense. None of the victims in our study asked for legal redress in a competent court of law as compared to Olatan et al, 14 where 4 patients of 54 patients sought the face of the law necessitating pictorial evidence from the attending doctors. This highlights the importance of proper documentation. ...
... It has been proposed in earlier work that HIV status of victims and assailants be known. 14 As our institutional protocol, surgical wound care for bite injuries includes debridement with copious irrigation with 0.9% saline solution and/or povidone-iodine solution, removal of tissue tags and granulation tissues, and antibiotic cover. Amoxicillin-clavulanic acid tablets 625 mg every 8 hours and metronidazole tablets 400 mg every 8 hours are our first-line choice of antibiotics for 1 week, then followed by immediate or primary surgical repair. ...
Study Design
A retrospective study of 26 cases of human bite injuries at the Government Dental and Maxillofacial Hospital (now Maxillofacial unit, Rivers State University Teaching Hospital), Port Harcourt, within September 2011 and August 2016.
Objective
To analyze the pattern, presentation, management, and complications of human bite injuries in the orofacial region.
Methods
Information was extracted from hospital records of all victims of human bites to the face between the study period. Facial bites resulting from animals were excluded. Data such as age, gender, time lag between the injury and time of presentation in the hospital, nature and the circumstances of the injuries, site of injuries, and treatment outcomes and complications were collected and analyzed.
Results
A total of 26 patients within the ages of 18 and 60 years were seen during the period of study. They were all related to fights, which were all resolved out of court. There was a preponderance of females, and the lower lip was the most affected site ( p < .05). In all, 14 patients presented within 24 hours of injury and all but 2 (7.6%) patients presented within 7 days of injury. No wound was overtly infected. Treatments of injuries were varied from simple wedge excision and primary closure to complex multistaged procedures and were uneventful with acceptable surgical outcomes.
Conclusion
Human bite wounds reported in this study were all due to social conflicts without legal redress. Although human bite wounds are considered to be dirty or contaminated but with proper wound debridement, antimicrobial cover and primary or immediate surgical closure results in very favorable aesthetic outcomes in all cases.
... Sim- ilar high incidences of human bite has also been report- ed from Tanzania 13 , the US and UK 14,15 and Papua New Guinea 16 . The average age as well as the peak age range of victims in this study was similar to those reported in other studies 13,15,[17][18][19][20] . Contrary to report by Freeman et al 10 , in our study the average ages of male and female victims were the same. ...
... Our finding of more female victims and biters than males is not statistically significant (p=0.25 and 0.39 respective- ly) but agrees with a report from Zimbabwe 22 and has some similarity with other studies 10,19,20 . It is however in disagreement with other studies which reported more male involvement 16,18 or equal sex incidence in victims and biters 23 . ...
... As in other studies 17,20,24 , the reasons for assault-related human bite injuries varied widely in our study and include jealousy, household or workplace disputes and matrimo- nial disputes. These factors appear amplified by social tension and competition that follow over-crowding and harsh economic conditions. ...
Background
Human bite is a growing public health concern. It may be seen in both victims and aggressors following assault. Effects of human bite are both social and medical.
Objectives
This study aims to determine the prevalence and characteristics of assault-related human bite injuries in Enugu, Nigeria.
Methods
In this prospective study, an objective structured questionnaire was administered to assault victims attending the Forensic unit of ESUT Teaching Hospital between November 2013 and October 2014. Obtained data was analyzed.
Results
Out of 219 patients presenting with clinical injuries, 29 (13.2%) sustained human bite wounds. Average age was 32.2±11.30 years and 34.3±12.4 years for victims and biters respectively. Females were more involved than males. Severe injuries resulted more in bites involving females than males. Contusion (47.6%) and laceration (31.0%) were the commonest. Upper limbs were mostly affected (44.7%) followed by the face (29.0%). Romance-related injuries affected breasts and thighs. Most incidents (62.1%) occurred within home/living quarters. Most biters were known to their victims.
Conclusion
Human bite is a common outcome of assault and so should be anticipated in cases of assault. Patterns of location of bites seem related to nature of crime.
... In the surviving patients, challenging surgical repairs may be required as the injuries are complex, involving frequently soft tissues as well as bones. The quite exclusive involvement of women in human bites as both the victim and the perpetrator is also reported in some African series [21,22]. ...
Introduction: Interpersonal violence (IPV) has emerged as a worldwide health problem affecting predominantly the face. Patients and methods: This study reports the characteristics of violence, victims and injuries in IPV-related facial injuries patients, in a 10-year survey, in a tertiary hospital of Burkina Faso. Results: Patients' age ranged from 11 to 75 years (mean 31 years) and 58.2% of the patients were aged between 20 and 39 years. There were 74 males and females 24 giving a male-To-female ratio of 3.1:1. The circumstances of injuries were brawls (80.6%) consisting mostly in facial blows, and hold-ups (19.4%). Fractures involving predominantly the mandible or the zygomatic complex were the most common injury, accounting for 53.2%. Soft tissues injuries accounted for 37.2% and dental trauma for 9.2%. In 27.5% of the patients, extra facial injuries were encountered, dominated by cerebral trauma and limb fractures. Conclusion: In this study, IPV-related facial injuries are mostly mandibular or zygomatic fractures in young and males adults involved in brawls. These findings command strategies for prevention of violence in this specific group.
... [6] Bites on the face also present as a surgical challenge, especially if there is partial or total loss of important structure(s) of the face like the ears, the eyelids, the nose, the lips. [7] The cosmetic effects of such losses are enormous and may affect the social and even sometimes economic life of the patient involved. [7] Bite wound to the maxillofacial region should be properly managed to prevent infection, rabies, tetanus, and undue scarring. ...
... [7] The cosmetic effects of such losses are enormous and may affect the social and even sometimes economic life of the patient involved. [7] Bite wound to the maxillofacial region should be properly managed to prevent infection, rabies, tetanus, and undue scarring. [8] The treatment of these bite wounds can be quite challenging to the maxillofacial surgeon because these wounds may be infected by the oral microorganisms which if extensive may impair the patient both functionally and aesthetically. ...
... In previous studies by Olaitan et al., 32 cases was seen in 10 years. [7] This obvious discrepancy could be due to the location of study and documentation. ...
... In a report by Ioannides and Fossion, only one case out of 16 intraoral reconstructions with NLF had a trauma etiology (3). Other single case reports for philtral and lower lip reconstructions after bite injuries have also been mentioned (4,5). The authors' experiences in the management of gunshot injuries of the face in a trauma center are presented. ...
Introduction:
The nasolabial flap (NLF) has many advantages in oromaxillary reconstruction, but the majority of cases are reconstructions after pathologic resections. Its usage in trauma surgery, especially in the management of gunshot wounds, is rarely mentioned.
Case presentation:
Three cases involving gunshot injuries to the face are presented: one for reconstruction of the nasal ala, another for bone graft coverage in mandibular reconstruction, and the third for the repair of premaxillary hard and soft tissue avulsive defects.
Conclusions:
The NLF is a thin, pliable flap and is useful for intraoral and facial reconstruction of trauma patients with small to moderate soft tissue loss.
