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Background: Dog bite injuries to the face in children are often more common than in adults. The small size of the infant and child put their face at a level that is closer to a dog than that of adult. This combined with their natural lack of fear of dogs nor an understanding of how they may behave in certain circumstances put them at risk for such injuries.

Having repaired many facial dog bite injuries in children as well as having written on the topic, what is clear is that the vast majority of them will need  to undergo subsequent scar revisions. The only question is how many scar revisions will be needed and what the long-term scar outcomes will be.

Case Study: This very young child of 2 years old sustained a severe dog bite injury to the face in what can be a classic pattern of such injuries. The bite injury was to the lower lip and chin and it can be seen by the pattern of the lower lip avulsion and tooth mark pattern that the child was pulling back as the dog lunged forward to bite. This caused the entire lower lip to be avulsed from its attachments to the chin as well as sustaining puncture marks and teeth tearing through tissue lines.

A primary repair of the lip, chin and facial lacerations was done and a subsequent scar revision perfumed years later. A fifteen year followup showed a very acceptable result with scars that had minimal visibility.

For the child who has sustained a severe facial soft tissue injury, the extent of the tissue damage can be devastating and the prognosis for a normal appearance grim. But with good surgical technique of soft tissue repair and subsequent scar revision, the outcome can be far better than one could anticipate when viewing the original injury. Hopefully this case will provide some optimism to those young children and their parents who have been so affected.

Highlights:

1) Dogbites in infants and children often involve the face  around the mouth and lips areas.

2) Primary and secondary repairs of the orofacial dogbite injury, while never completely restoring the tissues to normal, can create very acceptable long-term appearances.

3) The need for scar revisions of a facial dog bite injury are common and the only question is how many such revisions will be needed.

Dr. Barry Eppley

Indianapolis, Indiana

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