Incidence Pattern of Bear-Inflicted Injuries to the Maxillofacial Region-Soft and Hard Tissue Injuries, Their Management, and Sequelae

Abstract

Purpose: The aims of the study were to elucidate the incidence pattern of bear-inflicted facial injuries and to document soft and hard tissue injuries, their management, and complications.

Materials and methods: A prospective study was performed of 21 bear-associated injuries sustained to the facial region. Most patients were young to middle age and most were male. Most attacks occurred during the daytime, and the highest incidence occurred during the months of April to October. Wounds were assessed for soft and hard tissue injuries, including tissue loss, and corresponding management in the craniofacial region for 18 months. A standardized surgical treatment was used for patient management, which included thorough debridement of wounds and routine primary repair of soft tissue. Bony defect reconstruction was performed by open reduction and internal fixation. Regional or distant flaps were used for the reconstruction of soft tissue defects.

Results: Mauled patients were treated for injuries varying from lacerations and puncture wounds to fractures and avulsive tissues. On average, most patients underwent a single operation for reconstruction of bony fractures and soft tissue repair and spent 3 to 7 days in the hospital; however, some patients underwent more than 1 operation and stayed in the hospital for more than 4 to 6 weeks. Facial fractures were mainly seen in the midfacial region (71%), followed by mandibular fractures (24%). Overall, the results were satisfactory, except for a few instances of scar formation, facial nerve palsy, and ectropion. The mortality rate was 5% (1 patient) from the severe injury caused by bear mauling.

Conclusions: Extensive bear-bite injuries of the facial skeleton can be treated with immediate primary wound repair after meticulous wound debridement and according to commonly used criteria of esthetic reconstructive facial surgery.