The aim of this study was to characterize and report the epidemiological data regarding pediatric facial dog bites. For this study, a retrospective chart review was used. This study was performed at a large tertiary pediatric hospital. All children younger than 18 years who sought medical attention after a facial dog bite between January 1, 2003, and December 31, 2008, were included. Demographic and epidemiologic data were collected and analyzed. A total of 537 children were identified. The average age was 4.59 ± 3.36 years, with a slight male preponderance (52.0%). The majority of dog bites occurred in children 5 years of age or younger (68.0%). Almost all (89.8%) of the dogs were known to the children. When circumstances surrounding the bite were documented, over half (53.2%) of the cases were provoked. The most common breeds were mixed breed (23.0%), Labrador retriever (13.7%), Rottweiler (4.9%), and German shepherd (4.4%). Inpatient treatment was required in 121 (22.5%) patients with an average length of stay of 2.96 ± 2.77 days. Children 5 years or younger were more likely to be hospitalized than older children. Children 5 years old and younger are at high risk for being bitten in the face by a familiar dog and are more likely to require hospitalization than older children. Certain dog breeds are more likely to bite, and there is often a history of provocation. There is a tremendous financial and psychosocial burden associated with dog bites, and prevention strategies should focus on education with the aid of public policies and better documentation and reporting systems.
Although uncommon, facial fractures associated with dog bites are a significant source of morbidity, often requiring complex surgical repair. Severe injuries to the face from dog bites should be evaluated for possible fractures in addition to soft tissue injuries.
A 15-month-old female child presented with progressive right-sided facial swelling, nasal obstruction, and deviation of the nose to the left. Computed tomography revealed a cystic mass in the maxillary sinus with disruption of the medial orbital floor. Incisional biopsy of this mass was nondiagnostic and the mass continued to grow rapidly. The mass was removed by excisional biopsy and curettage with conservative margins via combined lateral rhinotomy and sublabial approaches. Intraoperatively, a large defect of the floor that extended to the orbital apex was noted. Histopathology revealed an odontogenic myxoma. Odontogenic myxomas are uncommon tumors that are usually seen in adults. Our case is unique because to the best of our knowledge, it is the first reported case with orbital involvement in the pediatric population.
Volume loss in the upper third of the face contributes significantly to aging. The use of lipotransfer in this area is an important adjunct to traditional surgical techniques. It can also be used as a primary rejuvenation procedure in select patients. More studies are needed to elucidate the optimal method of fat harvest, processing, and injection as well as longevity of transplanted grafts.
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