Portal de Periódicos da CAPES

Bite Worse Than Their Bark? Pediatric Facial Nerve Injuries Secondary to Dog Bites

2023; Wolters Kluwer; Volume: 11; Issue: 10S Linguagem: Inglês

10.1097/01.gox.0000992680.37856.c7

2169-7574

Raghave Upadhyaya, Samuel H. Cole, Michael Klebuc, Amy S. Xue,

Facial Nerve Paralysis Treatment and Research

BACKGROUND: Traumatic facial injuries secondary to dog bites can have longstanding negative implications for pediatric patients. While injuries to the facial nerve (FN) because of dog bites are rare, they can be difficult to manage. Their complexity is compounded by the limited volume of literature, and lack of consensus in the management of these injuries. Herein, we review our own institutional experience to dog bite-related facial nerve injuries. METHODS: A retrospective review was conducted of all patients referred to the plastic and reconstructive surgery service between 2012 and 2022 at a single Pediatric Level 1 Trauma Center for facial nerve injuries resulting from dog bites. Data pertaining to surgical timing, perioperative findings, Sunnybrook facial nerve grading system (SB), surgical technique, and postoperative outcomes was recorded and analyzed using descriptive statistics. RESULTS: Of 939 patients with craniofacial involvement, 199 were managed operatively while 740 were managed in the acute setting. 246/740 patients underwent laceration repair, of which there were no missed FN injuries nor scar revision procedures. Of 199 surgically managed facial injuries, 15 patients underwent FN exploration with 8/15 positive for FN injury. Out of these 8 patients (mean age = 5yrs, pre-op SB = 77.5, post-op SB = 92.5), 5 underwent primary nerve repair, 1 primary nerve graft, 1 no primary repair due to lack of distal targets, and 1 no primary repair due to extent of structural and nerve injury, requiring secondary reanimation. One case of postoperative wound infection required additional intervention (6.7%). Primary nerve repair demonstrated full functional recovery in 80% of the patients. Primary nerve graft demonstrated partial recovery with residual deficit. 80% of the patients with facial nerve injury demonstrated preoperative findings. An algorithm is proposed based upon location of laceration, extent of facial nerve injury and wound condition. CONCLUSION: FN injuries secondary to dog bites present unique challenges, particularly in the pediatric population. As majority of cases occur in the very young, preoperative examination is frequently hindered by lack of cooperation and intraoperative explorations can be difficult due to both the diminutive nerve size and the traumatized field. Successful management requires a high index of suspicion combined with meticulous and judicious surgical exploration and repair.