Hyena Bite Injury to the Neck Leading to Laryngotracheal Separation

Abstract

Animal-induced trauma can lead to severe injury and death, especially in medically isolated settings. Few reports of hyena attacks on humans have been reported in the literature. The goal of this report is to describe such an attack and the heroic efforts required to preserve life and function in a resource-limited environment. A 55-year-old female was attacked by a hyena in a rural region of Ethiopia. Despite delays in medical care, she was able to survive this attack and was successfully discharged after prolonged treatment efforts. Animal-induced trauma is a potential source of substantial and disfiguring injury, especially in resource-limited environments. Early transfer to tertiary care centers and creative solutions are needed to optimize outcomes in such environments.

Keywords: global surgery; hyena attack; hyena bite; laryngeal trauma; laryngotracheal separation.

Figure 1. Preoperative photograph and endoscopic images showing the extent of the anterior neck injury.

(A) Photograph depicting the injury and (B) endoscopic view of the patient’s supraglottis. A complete absence of the true vocal folds is evident (white arrow). (C) Endoscopic view of the patient’s proximal trachea. The anterior tracheal wall injury can be easily visualized. (D) Endoscopic view of the distal extent of the patient’s injury. Note the normal appearance of the distal airway. (E) Endoscopic view of the patient’s pharynx showing communication between the anterior neck defect and the proximal esophagus (white arrow).

Figure 2. Photographs documenting the second reconstructive surgery.

(A) Preoperative image showing appropriate recovery from the initial surgery. (B) Image depicting full exposure of the defect after reopening. (C) Image depicting closure of the remnant supraglottis after appropriate removal of excess tissue (white arrow). (D) Image depicting the formal maturation of the tracheostoma.

Figure 3. Photograph showing the patient’s wound after healing. Note that the area of prior fistula has largely healed with no continued drainage appreciated.