Dog-Bite–Related Craniofacial Fractures among Pediatric Patients: A Case Series and Review of Literature

Abstract

Dog bites in the pediatric population commonly cause injuries to the head and can be associated with fractures, often leading to prolonged hospital stays, multiple surgical interventions, and long-term complications. Our goal was to evaluate our experience with dog-bite–related craniofacial fractures, understand frequency and demographics of these fractures, identify common fracture patterns, and provide recommendations based on management and complications encountered. The institution's electronic medical record was reviewed. A review of the English literature for the past 20 years was also conducted. A retrospective chart review was conducted using ICD-9 codes to include all patients with head and neck dog bites and craniofacial fractures. Fractures resulting from canine bites to the face and scalp were rare, occurring in our study in less than 1% of total facial dog bites (1,069 cases) and 1.5% of pediatric facial dog bites (462 cases). Ages ranged from 5 months to 9 years at the time of presentation. A total of seven patients, all pediatric, were documented. All seven patients required operative intervention for their wounds, and five patients required at least two operative interventions. Midface and skull fractures were the most commonly encountered fracture sites. Dog bite injuries to the face in young children, especially when severe, should raise suspicion for fracture of underlying bone. Management of these injuries should include a multidisciplinary approach and focus on repair of soft tissue and skeletal deformities. Furthermore, it is prudent to follow up patients who require operative management after injury to monitor for long-term complications, given the significant proportion of complications and operative takebacks in this study.

Pediatric patients with dog bites presenting to US children’s hospitals

“…While the majority of dog bite episodes in our study had open wounds without more substantial traumatic injury, a smaller percentage sustained fractures, including of the craniofacial region and long bones, genitourinary trauma, and intracranial hemorrhage. Prior work from one single-center study has suggested that a low proportion of pediatric patients with dog bites (1.5%) sustained traumatic fractures to the scalp and face (Saadi et al 2018 ). An analysis of 182 patients with craniofacial injuries, of which 19 had fractures, suggested that younger age and female patient sex were at higher risk of these conditions (Khan et al 2020 ).…”

“…Our outcome of interest was clinically significant dog bites, characterized by indicators of higher morbidity based on the care provided or injuries sustained. We defined this as any of the following: hospital admission, operating room charge or use of sedation medications, fractures, and dislocations (Khan et al 2020 ; Saadi et al 2018 ), intracranial injury and skull fractures (Steen et al 2015 ), injuries to the eyeball (Hurst et al 2020 ), skin/soft tissue infection (Drumright et al 2020 ), and in-hospital mortality.…”

“…Additional work is required to identify risk factors for the most serious dog bites as these factors can identify targets for public health interventions. Reports from single-center studies, for example, have noted a trend toward younger age and severe injuries with the most substantial complications, such as infection, craniofacial injury, or death (Khan et al 2020 ; Saadi et al 2018 ). A better understanding of clinically significant outcomes, such as those requiring hospitalization or with complex surgical outcomes, would facilitate future efforts at prevention.…”

Mechanisms of Soft Tissue Injury

“…13,15 A disproportionate number of bite injuries in the pediatric population is in the head and neck with these accounting for 80% of bite injuries. [16][17][18] The mortality from dog bites is fortunately very low but tends to occur in young children. The breed of dog most often associated with bites is Pit Bulls, which account for 47.5% of adult dog bites, 48.2% of pediatric dog bites, and 28.6% of fatal dog bites.…”

Manejo de lesão extensa face decorrente de mordedura canina em paciente pediátrico: Relato de caso clínico

“…Esse tipo de ferimento resulta em traumatismos faciais complexos, podendo ter um envolvimento funcional e estético, assim como sucedendo em infecções polimicrobianas, tornando-se um desafio para os cirurgiões maxilofaciais (Piccart et al, 2018;Cohen-Manheim et al, 2018). Dada a altura de uma criança pequena e a cabeça maior em tamanho, assim como a falta Research, Society and Development, v. 10, n. 9, e546101918374, 2021 (CC BY 4.0) | ISSN 2525-3409 | DOI: http://dx.doi.org/10.33448/rsd-v10i9.18374 de força dificuldade de força para defesa a prevalência de lesões por mordedura canina vai variar inversamente com a idade (Heitz, Louzada, Couci, Rodrigues & Fritscher, 2018;Saadi, Oberman & Lighthall, 2018;Foster & Hudson, 2015).…”