A Bear of a Case: Multidisciplinary Reconstruction Following a Grizzly Bear Mauling

Abstract

Grizzly bear attacks are rare but often result in devastating craniofacial injuries requiring staged, multidisciplinary reconstruction. A 61-year-old male sustained extensive facial trauma, including complete lower lip avulsion and anterior mandibular loss, after a grizzly bear attack. He underwent early stabilization followed by virtual surgical planning-guided fibula free flap reconstruction with immediate dental implants, and a radial forearm free flap incorporating palmaris tendon to restore oral competence. The patient's postoperative course was uncomplicated and he was decannulated and discharged. At 6 months, he underwent vestibuloplasty and delayed dental prosthesis placement. Due to insufficient lip height, a custom magnetic lower lip prosthesis was fabricated to improve function and appearance. This case demonstrates a successful multidisciplinary approach to complex facial trauma, combining microvascular reconstruction, immediate dental rehabilitation, and prosthetic innovation to achieve functional and aesthetic recovery following a rare animal mauling.

Keywords: ear, nose, and throat; epidemiology; otolaryngology; public environmental & occupational health; surgery.

FIGURE 1

Current and historical geographic distribution of grizzly bears in North America. The yellow area represents the occupied grizzly bear range as of 2021, while the green area reflects the species' historical range. Notably, the current U.S. population is concentrated in Montana and the Greater Yellowstone and Northern Continental Divide ecosystems. Lisa Landenburger, USGS—Interagency Grizzly Bear Study Team. Public domain. Sources: IUCN, M. Proctor, Interagency Grizzly Bear Study Team.

FIGURE 2

(A) Preoperative 3‐D reconstruction of the area of missing mandible after the initial trauma. (B) Computer‐assisted design plans, with planned placement of 5 dental implants. (C) Intraoperative image of the mandible reconstruction, with white arrow pointing to the dental implants. (D) Final operative outcome after reconstruction of the lower lip using a radial forearm free flap with use of palmaris tendon.

FIGURE 3

(A) Preoperative image prior to completion of complex vestibuloplasty, with well‐healed radial forearm used to reconstruct lower lip. (B) Planned incisions to slip the radial forearm free flap, which enable us to reconstruct the alveolus. (C) Exposure of the five dental implants with excellent osseointegration. (D) Final outcome after the vestibuloplasty, with transcutaneous sutures utilized to secure down the soft tissue of the new reconstructed alveolus. Significant reduction in the height of the lip after this surgery was appreciated.

FIGURE 4

(A) Frontal view of the patient displaying integration of the prosthetic and implant‐supported dental restoration, with significant reduction in the height of the lower lip after recreating the alveolus. (B) Postoperative image demonstrating the patient's lower lip prosthesis in situ, with natural beard growth blending into the prosthetic contour. (C) Final cosmetic outcome.