Dog Bite Injuries in the Head and Neck Region: A 20-Year ReviewFunding None.
30 November 2017
20 April 2018
22 June 2018 (online)
Dog bite–related wounds seem to have become a common problem, especially when they relate to the head and neck region. According to Overall and Love, up to 18 per 1,000 people sustain a dog bite every year, of whom 3 need medical attention. Approximately 1 to 2% of bite injuries require hospitalization of the victims. Most of the lacerations are found in the upper lip and the nose regions and they are classified according to severity and concomitant damage to other organs. Bite wounds are considered “dirty” wounds and are prone to infection. When dealing with bite wounds, there is always an indication for antibiotic treatment. Broad-spectrum antibiotics like amoxicillin-clavulanate and/or moxifloxacin cover most of the pathogenic flora and should be administered in every bite wound case at risk of infection. This article would like to present a medical record review: a retrospective analysis of all bite wounds sustained in the head and neck region, treated at the University Hospital of Leuven over the past 20 years. Furthermore, it provides an overview of the current literature and its standings on the treatment of dog bite injuries in the maxillofacial region. We assessed both surgical and medical treatment options, as well as primary management, which includes infection prevention strategies, closure management, and additional vaccination requirements. Secondary management or scar revision methods will be mentioned. After conducting a UZ Leuven database search using keywords such as “dog,” “dog bite,” “face,” “head,” “lip,” and others, 223 patients were included. Age at the time of injury, location of the injury, treatment method used, and whether secondary infection was present or not were documented. All patients have been divided in age groups. We concluded that 21.52% was 5 years old or younger. Almost half of our patients (49.33%) were 18 years old or younger. Of all patients, 79 were hospitalized (35.43%). Primary closure was the treatment of choice. In 141 patients, the wounds were closed primarily (63.23%), resulting in only 2.24% reported secondary infections. Only one fatality was reported in our center over the course of 20 years (0.45%), a 6-year-old girl who had been attacked by her father's Rottweilers. Most patients who sustained dog bite injuries in the head and neck region seem to be children, specifically toddlers. Due to their height, it is possible they are more prone to dog bite injuries in the head and neck region. It is essential to optimize management of these injuries due to the impact they have on patients. This article provides the epidemiological data and clinical outcome of the approach at our center.
No patients were involved in setting the research question or the outcome measures, nor were they involved in developing plans for design or implementation of the study. All clinical images of patients were anonymized.
Compliance with Ethical Statements
The protocol was approved by the Ethics Committee of our institution (University Hospitals of Leuven; file number S60452) and was conducted according to the principles expressed in the Declaration of Helsinki.
- 1 Overall KL, Love M. Dog bites to humans--demography, epidemiology, injury, and risk. J Am Vet Med Assoc 2001; 218 (12) 1923-1934
- 2 Statbel. Belgische gezinnen spenderen 1,3 miljard euro aan huisdieren in 2014. Statistics Belgium. Available at: http://statbel.fgov.be/nl/statistieken/organisatie/statbel/informatie/statbel/in_de_kijker_archief/In_de_kijker_2016/20160825_honden_en_katten_in_2014.jsp . Published 2016. Accessed April 29, 2017
- 3 Szczypa K, Hryniewicz W. Epidemiology, microbiology and diagnostics of dog and cat bites related infections [in Polish]. Pol Merkuriusz Lek 2015; 39 (232) 199-204
- 4 Foster MD, Hudson JW. Contemporary update on the treatment of dog bite: injuries to the oral and maxillofacial region. J Oral Maxillofac Surg 2015; 73 (05) 935-942
- 5 Mannion CJJ, Graham A, Shepherd K, Greenberg D. Dog bites and maxillofacial surgery: what can we do?. Br J Oral Maxillofac Surg 2015; 53 (06) 522-525
- 6 Schultz RC, McMaster WC. The treatment of dog bite injuries, especially those of the face. Plast Reconstr Surg 1972; 49 (05) 494-500
- 7 Chen HH, Neumeier AT, Davies BW, Durairaj VD. Analysis of pediatric facial dog bites. Craniomaxillofac Trauma Reconstr 2013; 6 (04) 225-232
- 8 Palmer J, Rees M. Dog bites of the face: a 15 year review. Br J Plast Surg 1983; 36 (03) 315-318
- 9 Javaid M, Feldberg L, Gipson M. Primary repair of dog bites to the face: 40 cases. J R Soc Med 1998; 91 (08) 414-416
- 10 Kizer KW. Epidemiologic and clinical aspects of animal bite injuries. JACEP 1979; 8 (04) 134-141
- 11 Lackmann GM, Draf W, Isselstein G, Töllner U. Surgical treatment of facial dog bite injuries in children. J Craniomaxillofac Surg 1992; 20 (02) 81-86
- 12 Andersson L, Kahnberg K-E, Pogrel MA. Oral and Maxillofacial Surgery. Hoboken, NJ: Wiley-Blackwell; 2012
- 13 Gwinnutt CL, Driscoll PA. Advanced trauma life support. Eur J Anaesthesiol 1996; 13 (02) 95-101
- 14 Reyes VRV, Ávila MGF, Balandrano AGP. Treatment of craniofacial region wounds. Rev Odontol Mex 2013; 17 (04) 243-250
- 15 Lin W, Patil PM. Facial dog attack injuries. Indian J Surg 2015; 77 (01) 55-58
- 16 De Munnynck K, Van de Voorde W. Forensic approach of fatal dog attacks: a case report and literature review. Int J Legal Med 2002; 116 (05) 295-300
- 17 Looke DDC. Bites (mammalian). Systematic review 914. BMJ Clin Evid 2015. Available at: http://clinicalevidence.bmj.com/x/systematic-review/0914/overview.html . Accessed May 10, 2018
- 18 Ribadeau-Dumas F, Cliquet F, Gautret P, Robardet E, Le Pen C, Bourhy H. Travel-associated rabies in pets and residual rabies risk, Western Europe. Emerg Infect Dis 2016; 22 (07) 1268-1271
- 19 World Health Organization. WHO expert consultation on rabies. Second report. World Health Organ Tech Rep Ser 2013; 982 (982) 1-139
- 20 World Health Organization. Weekly epidemiological record - Relevé épidémiologique hebdomadaire. World Health Organ Tech Rep Ser 2010; 85 (32) 309-320
- 21 World Medical Association. World Medical Association Declaration of Helsinki: ethical principles for medical research involving human subjects. JAMA 2013; 310 (20) 2191-2194