A.S. SEREGIN^1, 2, E.P. KRIVOSHCHEKOV¹, D.A. TRUNIN¹, E.B. ELSHIN³, A.S. BOZHKOVA²

¹Samara State Medical University, Samara

²Samara Regional Clinical Hospital, Samara

³Samara City Clinical Hospital № 8, Samara

  Contact details:

Elshin E.B. — Head of the Admission Department, surgeon of the Department of Purulent Surgery

Address: 169 Mirnaya St., Samara, Russian Federation, 443035, tel.: +7-927-733-33-75, e-mail: ebels@mail.ru

The purpose — to improve the results of treatment of bitten wounds of the maxillofacial area in children.

Material and methods. The research included 304 children (182 boys, 122 girls), aged from 5 months to 15 years, with bitten wounds of the maxillofacial area in 2014–2018. 270 children were hospitalized (159 boys, 111 girls), 34 were treated as out-patients. Distribution of the hospitalized patients by age was as follows: I — 5 months to 3 years (n = 67), II — 4 to 7 years (n = 99), III — 8 to 11 years (n = 81), IV — 12 to 15 years (n = 23). The basic therapy included antirabic prevention, antibiotics (generation 3 cephalosporins with aminoglycosides), desensibilizing drugs, physiotherapy (magnetic laser therapy, electrophoresis with dimexidum, phototherapy, acunpunture), primary surgical treatment (PST) and/or secondary suture. All patients attended a psychotherapist.

Results. Terms of turning to specialized maxillofacial surgery department were analyzed: 1^st day after trauma — 90% of patients, 2–3 days — 8% (after inflammatory complications), 5–6 days — 2% (from surgical departments of Republic hospitals). The most frequent localization of wounds is: periorbital area, parotid-manducatory, adoral. In children younger than 3 y. o. the bitten wounds of the maxillofacial area were combined with fractures of nose, upper and lower jaw bones. The length of wounds was from 5 mm to 10–12 cm. The highest frequency was in May, July, and August. Traumas in the street constitute 60,97%, at home — 39,03%. The treatment efficiency control was as follows: estimating the quantitative contamination, analysis of microflora, esthetic estimation of the scars. Analysis of treatment results showed that 45 (36,58%) patients had complications: of purulent-inflammation character in 42 (34,14%) children, development of marginal necrosis in 3 (2,44%) children. Analysis of microflora of purulent bites showed the following agents: Staphylococcus aureus, Staphylococcus epidermidis, Proteus vulgaris, Bacteroides. Treatment according to the proposed scheme significantly reduced contamination of the wound, starting from the 2–3 days.

In post-operative period, esthetic estimation of scars was carried out. Suture of wounds with monofilament threads gave satisfactory and good results in 82% cases. The result was unsatisfactory with braided multifilament.

Conclusion. Analysis of the results of treating bitten wounds of the maxillofacial area in children showed that general surgical methods are inapplicable. During surgical treatment of such wounds tissues should be minimally dissected; primary skin plasty with local tissues should be more broadly used. For that, patients with these traumas should be timely taken to specialized departments of maxillofacial surgery.

Key words: maxillofacial surgery, bitten wounds of the maxillofacial area in children, surgical approach, suture material, basic therapy.

(For citation: Seregin A.S., Krivoshchekov E.P., Trunin D.A.,  Elshin E.B., Bozhkova A.S. Tactics of treating children with maxillofacial injuries caused by animal bites. Practical Medicine. 2019. Vol. 17, № 5, P. 206-211)

REFERENCES

1. Parshikova S.A., Parshikov V.V., Glyavina I.A. To the question of tactics of helping children with bitten facial wounds. Vestnik eksperimental’noy i klinicheskoy khirurgii, 2013, vol. 6, no. 4, pp. 483–488 (in Russ.).
2. Seregin A.S., Khamadeeva A.M., Tarasov Yu.V. The possibility of using polymer-salt biodegradable materials in the treatment of facial bones defects in children. Dental Forum, 2008, no. 4, pp. 27–31 (in Russ.).
3. Walker T., Modayil P. Dog bite – fracture of the mandible in a 9 month old infant: a case report. Cases Journal, 2009, no. 2, p. 44.
4. Bogatov V.V. Bite wounds of the maxillofacial region: analysis of the situation in the Tver region. Stomatologiya, 2009, no. 5, pp. 34–36 (in Russ.).
5. Tarasov Yu.V., Seregin A.S. Primenenie kollagen-apatitovogo kompozita v detskoy chelyustno-litsevoy khirurgii. Sovershenstvovanie spetsializirovannoy meditsinskoy pomoshchi detyam [The use of collagen-apatite composite in pediatric maxillofacial surgery. Improvement of specialized medical care for children]. Materialy nauchno-prakticheskoy konferentsii, posvyashchennoy 95-letiyu pediatricheskoy sluzhby SOKB imeni M.I. Kalinina i 90-letiyu kafedry detskikh bolezney SamGMU, 2011. Pp. 117–119.
6. Klyukvin I.Yu. Treatment of injuries from dog and cat bites: experience, opportunities, problems. Rossiyskiy meditsinskiy zhurnal, 2005, no. 3, pp. 52–57 (in Russ.).
7. Korsak A.K., Petrovich N.I. Features of the clinic and treatment of bitten facial wounds in children. Meditsinskiy zhurnal, 2012, no. 2, pp. 73–75 (in Russ.).
8. Galegov G.A., Andronova V.L., Leont’eva N.A. et al. Etiotropic drug therapy of viral infections. Voprosy virusologii, 2004, no. 3, pp. 35–40 (in Russ.).