Intracranial Injuries from Dog Bites in Children

Steen, Talora; Ravin, Karen; Timmons, Shelly D.; Kershenovich, Amir

doi:10.1159/000431179

Cited by 13 publications

(26 citation statements)

References 24 publications

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“…Skull fractures can often occur bilaterally or coexist with facial fractures due to the mechanism of a forceful bite gripping the head from two opposing sides. 32 Cranial fractures were more common in infants, where the skull-toface ratio is much higher, which could contribute to an increased likelihood of sustaining injury to the scalp.…”

Section: Discussionmentioning

confidence: 99%

“…There is a pattern of late diagnosis with depressed skull fractures, often remaining unrecognized until complications such as abscess or meningitis appear. 25,32 Lacerations over the skull may be particularly deceptive, as underlying puncture fractures may not be obvious due to displacement of the scalp. Furthermore, both normal consciousness and absence of neurologic deficits do not appear to rule out penetration of the cranium.…”

Section: Discussionmentioning

confidence: 99%

“…Furthermore, both normal consciousness and absence of neurologic deficits do not appear to rule out penetration of the cranium. 32 It is possible that CT is underutilized in cases that present as punctures to the scalp through relatively small skin wounds. 35 All scalp lacerations must be thoroughly examined to exclude the possibility of a skull fracture.…”

Section: Discussionmentioning

confidence: 99%

See 2 more Smart Citations

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

Saadi

Oberman²,

Lighthall

2018

Craniomaxillofacial Trauma & Reconstruction

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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.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

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

Saadi

Oberman²,

Lighthall

2018

Craniomaxillofacial Trauma & Reconstruction

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“…6 Steen et al recently published a report on a series of 10 children with intracranial injury from dog bites, of which 50% required surgical intervention. 22 The native oral flora of canines includes multiple aerobic and anaerobic bacteria such as Streptococcus, Staphylococcus, Corynebacterium, Pasteurella, and Bacteroides spp. 8,20 Infections after dog bite generally occur from those bacteria found in the mouth of the canine or on the skin of the victim.…”

Section: Discussionmentioning

confidence: 99%

Neurosurgical sequelae of domestic dog attacks in children

Kumar¹,

Deleyiannis²,

Wilkinson

et al. 2017

PED

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OBJECTIVE The authors' goals in this study were to describe a series of dog attacks on children that required neurosurgical consultation and to better understand the pattern of injuries inflicted, the circumstances that place children at risk for attack, and the dog breeds involved. In addition, the authors review the surgical and medical management of these patients. METHODS The authors performed a retrospective review of all children requiring neurosurgical consultation for dog bite at a regional Level 1 pediatric trauma center over a 15-year period. RESULTS A total of 124 children with dog bites to the head, face, and neck were evaluated in the emergency department. Of these, 17 children (13.7%) incurred injuries requiring neurosurgical consultation. Fifty-three percent of victims were female. The mean age at the time of attack was 30 months. Twelve (71%) of the attacks were perpetrated by the family pet, and 13 (76%) occurred at the patient's home. Breeds involved in the attacks included German Shepherd, Pit Bull, American Bulldog, large mixed breed, Labrador Retriever, and Akita, with German Shepherds and Akitas being the most frequently involved. Neurosurgical injuries included nondepressed skull fracture in 5, depressed skull fracture in 10, intracranial hemorrhage in 5, cerebral contusions in 4, dural laceration in 4, pneumocephalus in 5, clinically evident CSF leak in 3, spinal fracture with complete spinal cord injury in 1, stroke in 2, vascular injury in 2, and cranial nerve injury (hypoglossal and facial nerve) in 1. Prophylactic antibiotics were administered in 16 patients (94%). Only 1 patient had a confirmed infection involving the site of injury. Neurosurgical intervention was required in 10 patients (59%) and ranged in severity from debridement and closure of a complex scalp wound to decompressive craniectomy. Neurological deficits, all of which were considered catastrophic, developed in 3 patients (18%). CONCLUSIONS Dog attacks on children requiring neurosurgical consultation commonly involve the family pet, which is usually a large-breed dog with no history of prior aggression. Neurosurgical injuries often involve the cranial vault, with depressed skull fractures being the most common injury pattern. Most patients do not suffer a neurological deficit, although catastrophic neurological injury may occur. Prophylactic antibiotics are commonly used and surgical intervention is required in the majority of cases.

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“… 2 , 3 Given the thinness of cranial bones in children and high pressures associated with dog bites (200–450 psi), crush injuries and puncture wounds from canine teeth can occur despite minimal skin defects. 3 , 4 Delayed diagnosis of injuries is not uncommon, resulting in significant morbidity. 3 , 4 CT imaging should be considered early, and MR angiography should be obtained in cases of penetrating trauma.…”

Section: Discussionmentioning

confidence: 99%