Journal of Maxillofacial and Oral Surgery

, Volume 16, Issue 3, pp 356–364 | Cite as

Animal Inflicted Maxillofacial Injuries: Treatment Modalities and Our Experience

  • Anjani Kumar Yadav
  • Mehul Rajesh Jaisani
  • Leeza Pradhan
  • Ashok Dongol
  • Arpita Singh
  • Pradeep Acharya
  • Alok Sagtani
Clinical Paper



Animal inflicted injuries to the face and neck are becoming much more common as people lavish affection on pets. Injuries caused by animal attacks to the face can cause complex injuries to soft and hard tissues, presented as perforations, lacerations, crushes, avulsion or fractures. An uncountable number of bacteria and virus can be found in such injuries, with a potential pathological effect to humans, regarding infections. Although the infection rate is low due to excellent blood supply to face, the injuries have disfiguring effect with possible psychological repercussion to the patients. The treatment of animal inflicted injuries must address the soft tissue defect, neurovascular injuries, and bone injuries as well as prevention of post treatment infection. Primary wound repair is the treatment of choice for most clinically uninfected bite wound where as delayed closure should be reserved for wounds at high risk of infection or already infected wounds and tissue defect may require local flap or micro-vascular re-implantations.

Material and Methods

In this article, we have elicited up to date considerations regarding the management of animal inflicted injuries to the face based on literature search and exemplified by multiple case reports.


For bite injuries on face, immediate primary wound repair after meticulous wound debridement and irrigation with sufficient volume added by antibiotic prophylaxis gives good cosmetic results with minimum risk of infection. Depending upon type of attack and age of victims, psychiatric or social counseling may also be required.


Animal inflicted injuries Wound debridement Primary repair Rabies prophylaxis Psychiatric consultation 


Compliance with Ethical Standrds

Conflict of interest

The authors declare that they have no conflict of interest.


  1. 1.
    Sandora TJ, Bernstein HH (2001) Neonatal jaundice, animal-induced injuries, and immunizations. Curr Opinn Pediatr 13:377–385CrossRefGoogle Scholar
  2. 2.
    Centers for Disease Control and Prevention (CDC) (2003) Nonfatal dog bite-related injuries treated in hospital emergency departments—United States, 2001. MMWR Morb Mortal Wkly Rep 52:605–610Google Scholar
  3. 3.
    Steven MR, Emam HA (2013) Management of human and animal bites. In: Fonseca RJ, Walker RV (eds) Oral and maxillofacial trauma, 4th edn. Elsevier, St. Louis, Missouri, pp 615–632CrossRefGoogle Scholar
  4. 4.
    Pinsolie J, Phan E, Coustal B et al (1993) Dog bites on the face: apropos of 200 cases. Ann Chir Plast Esthet 38:452Google Scholar
  5. 5.
    Callabam M (1988) Controversies in antibiotic choices for bite wounds. Arm Emerg Med 17:1321Google Scholar
  6. 6.
    Bhanganada K, Wilde H, Sakolsataydorn P, Oonsombat P (1993) Dog bite injuries at a Bangkok teaching hospital. Acta Trop 55:249–255CrossRefPubMedGoogle Scholar
  7. 7.
    Strady A, Rouger C, Vernet V et al (1988) Animal bites: epidemiology and infection risks. Presse Med 17:2229–2233PubMedGoogle Scholar
  8. 8.
    Agrawal K, Misbra S, Panda KN (1992) Primary reconstruction of major human bite wounds of the face. Plast Reconstr Surg 90:394–398CrossRefPubMedGoogle Scholar
  9. 9.
    Venter TH, Duminy FJ (1994) Microvascular replantation of avulsed tissue after a dog bite of the face. S Afr Med J 84:37–39PubMedGoogle Scholar
  10. 10.
    Husami TW, Cervmo AL, Permington GA et al (1992) Replantation of an amputated upper lip. Microsurgery 13:155–156CrossRefPubMedGoogle Scholar
  11. 11.
    Schubert W, Kimberley B, Guzman-Stein G et al (1988) Use of the labial artery for replantation of the lip and chin. Ann Plast Surg 20:256–260CrossRefPubMedGoogle Scholar
  12. 12.
    Rettinger G, Reichensperger-Goertzen C (1995) Facial injuries caused by dog bites. HNO 43:159–164PubMedGoogle Scholar
  13. 13.
    Fleisher GR (1999) The management of bite wounds (editorial). N Engl J Med 340:138–140CrossRefPubMedGoogle Scholar
  14. 14.
    Wilberger JE Jr, Pang D (1981) Craniocerebral injuries from dog bite in an infant. Neurosurgery 9:426–428CrossRefPubMedGoogle Scholar
  15. 15.
    Centers for Disease Control and Prevention (CDC) (1997) Dog-bite related fatalities—United States, 1995–1996. MMWR Morb Mortal Wkly Rep 46:463–467Google Scholar
  16. 16.
    Weber EJ, Callaham ML (2002) Mammalian bites. In: Marx JA, Hockberger RS, Walls RM (eds) Rosen’s emergency medicine: concepts and clinical practice, 5th edn. Mosby, St Louis, pp 774–785Google Scholar
  17. 17.
    Goldstein EJC (2005) Bites. In: Mandell GL, Bennett JE, Dolin R (eds) Mandell, Douglas, and Bennett’s principles and practice of infectious diseases, 6th edn. Elsevier Churchill Livingstone, Philadelphia, pp 3552–3556Google Scholar
  18. 18.
    Goldstein EJ (1992) Bite wounds and infection. Clin Infect Dis 14:633–640CrossRefPubMedGoogle Scholar
  19. 19.
    Centers for Disease Control (1991) Diphtheria, tetanus, and pertussis: recommendations for vaccine use and other preventive measures: recommendations of the immunization practices advisory committe (ACIP). MMWR 40(RR-10):1–28Google Scholar
  20. 20.
    Krebs JW, Strine TW, Childs JE (1993) Rabies surveillance in the United States during 1992. J Am Vet Med Assoc 203:1718–1731PubMedGoogle Scholar
  21. 21.
    Capellan O, Hollander JE (2003) Management of lacerations in the emergency department. Emerg Med Clin N Am 21:205–231CrossRefGoogle Scholar
  22. 22.
    Presutti RJ (2001) Prevention and treatment of dog bites. Am Fam Physician 63:1567–1572PubMedGoogle Scholar
  23. 23.
    Weber DJ, Rutala WA (1999) Zoonotic infections. Occup Med 14:247–284PubMedGoogle Scholar
  24. 24.
    Manning SE, Rupprecht CE, Fishbein D, Centers for Disease Control and Prevention (CDC) et al (2008) Human rabies prevention—United States, 2008. Recommendations of the advisory committee on immunization practices (ACIP). MMWR Recomm Rep 57(RR-3):1–28PubMedGoogle Scholar
  25. 25.
    Medeiros I, Saconato H (2001) Antibiotic prophylaxis for mammalian bites. Cochrane Database Syst Rev 2:CD001738Google Scholar
  26. 26.
    Brook I (2003) Microbiology and management of human and animal bite wound infections. Prim Care Clin Office Pract 30:25–39CrossRefGoogle Scholar
  27. 27.
    Goldstein EJC, Citron DM, Merriam CV, Warren YA, Tyrrell KL, Fernandez HT (2002) Comparative in vitro activity of faropenem and 11 other antimicrobial agents against 405 aerobic and anaerobic pathogens isolated from skin and soft tissue infections from animal and human bites. J Antimicrob Chemother 50:411–420CrossRefPubMedGoogle Scholar
  28. 28.
    Talan DA, Abrahamian FM, Moran GJ, Citron DM, Tan JO, Goldstein EJC (2003) Clinical presentation and bacteriologic analysis of infected human bites in patients presenting to emergency departments. Clin Infect Dis 37:1481–1489CrossRefPubMedGoogle Scholar
  29. 29.
    Moran GJ, Talan DA, Abrahamian FM (2008) Antimicrobial prophylaxis for wounds and procedures in the emergency department. Infect Dis Clin North Am 22:117–143CrossRefPubMedGoogle Scholar
  30. 30.
    Keogh S, Callaham ML (2001) Bites and injuries inflicted by domestic animals. In: Auerbach PS (ed) Wilderness Medicine, 4th edn. Mosby, St Louis, pp 961–978Google Scholar
  31. 31.
    Lieblich SE, Topazian RG (1997) Infection in the patient with maxillofacial trauma. In: Fonseca RJ, Walker RV (eds) Oral and maxillofacial trauma, 2nd edn. Philadelphia, WB Saunders, pp 1248–1273Google Scholar
  32. 32.
    Javaid M, Feldberg L, Gipson M (1998) Primary repair of dog bites to the face: 40 cases. J R Soc Med 91:414–416CrossRefPubMedPubMedCentralGoogle Scholar
  33. 33.
    Morgan JP III, Haug RH, Kosman JW (1996) Antimicrobial skin preparations for the maxillofacial region. J Oral Maxillofac Surg 54:89–94CrossRefPubMedGoogle Scholar
  34. 34.
    Brown LL, Shelton HT, Bornside GH, Cohn I Jr (1978) Evaluation of wound irrigation by pulsatile jet and conventional methods. Ann Surg 187:170–173CrossRefPubMedPubMedCentralGoogle Scholar
  35. 35.
    Trott AT (1997) Wound cleansing and irrigation. In: Trott AT (ed) Wounds and lacerations: emergency care and closure, 2nd edn. Mosby, St Louis, pp 90–101Google Scholar
  36. 36.
    Chen E, Hornig S, Shepherd SM, Hollander JE (2000) Primary closure of mammalian bites. Acad Emerg Med 7:157–161CrossRefPubMedGoogle Scholar
  37. 37.
    Morgan JP III, Haug RH, Murphy MT (1995) Management of facial dog bite injuries. J Oral Maxillofac Surg 53:435–441CrossRefPubMedGoogle Scholar
  38. 38.
    Stierman KL, Lloyd KM, De Luca-Pytell DM, Phillips LG, Calhoun KH (2003) Treatment and outcome of human bites in the head and neck. Otolaryngol Head Neck Surg 128:795–801CrossRefPubMedGoogle Scholar
  39. 39.
    Mitchell RB, Nañez G, Wagner JD, Kelly J (2003) Dog bites of the scalp, face, and neck in children. Laryngoscope 113:492–495CrossRefPubMedGoogle Scholar
  40. 40.
    Concannon MJ, Puckett CL (1998) Microsurgical replantation of an ear in a child without venous repair. Plast Reconstr Surg 102:2088–2093CrossRefPubMedGoogle Scholar
  41. 41.
    Murakami CS, Nishioka GJ (1996) Essential concepts in the design of local skin flaps. Facial Plast Surg Clin N Am 4:455–468Google Scholar
  42. 42.
    Papel I (2002) Facial plastic and reconstructive surgery, 2nd edn. Thieme Medical Publishers, New YorkGoogle Scholar
  43. 43.
    Baker SR (1994) Local cutaneous flaps. Otolaryngol Clin North 27:139Google Scholar
  44. 44.
    Summers BK, Siegle RJ (1993) Facial cutaneous reconstructive surgery: general aesthetic principles. J Am Acad Dermatol 29:669CrossRefPubMedGoogle Scholar
  45. 45.
    Arndt KA, Leboit O, Robinson J et al (1996) Cutaneous medicine and surgery. WB Saunders, PhiladelphiaGoogle Scholar
  46. 46.
    Geetha NT, Shivakumar HR, Upasi Amarnath P, Bekal Pattathan RK, Rai K (2012) Bear maul injuries in maxillofacial Region: our experience. J Maxillofac Oral Surg 11(4):420–424CrossRefPubMedGoogle Scholar
  47. 47.
    Wolff K-D (1998) Management of animal bite injuries of the face: experience with 94 patients. J Oral Maxillofac Surg 56:838–843CrossRefPubMedGoogle Scholar
  48. 48.
    Lackmann GM, Draf W, Isselstein G, Töllner U (1992) Surgical treatment of facial dog bite injuries in children. J Craniomaxillofac Surg 20:81–86CrossRefPubMedGoogle Scholar

Copyright information

© The Association of Oral and Maxillofacial Surgeons of India 2016

Authors and Affiliations

  • Anjani Kumar Yadav
    • 1
  • Mehul Rajesh Jaisani
    • 1
  • Leeza Pradhan
    • 1
  • Ashok Dongol
    • 1
  • Arpita Singh
    • 1
  • Pradeep Acharya
    • 1
  • Alok Sagtani
    • 1
  1. 1.Department of Oral and Maxillofacial Surgery, College of Dental SurgeryBPKIHSDharanNepal

Personalised recommendations