Sep. 19, 2001 Denver, CO -- It is estimated that at some time in their life, an animal or person will bite half of all people in the United States. Of these, only 20 percent will require medical attention, with most bites being minor in nature. Some victims may avoid medical treatment because of embarrassment, resolution of injury, or fear of legal ramifications. Most bites occur during fights, but sports accidents and sexual activity are other sources of injury. Human bites are seasonal, increasing during the spring and summer and on weekends.
Human bite injuries require both medical and surgical management. These bites are less common than dog or cat bites, consisting of two to 23 percent of all bite wounds. Fifteen to 20 percent of human bites are in the head and neck. Other common sites include the hands, arms, and shoulders in men, and the breasts, genitalia, legs, and arms in women.
Treatment options for human bites have long been a subject of controversy. Early reports from the 1920s and 1930s describe severe infections after human bites. Historical treatments include radical wound excision, wound edge electrocautery, nitric acid cleansing, and radiotherapy. Later studies advocated treating human bites of sites other than the hand with the same wound management principles as lacerations and abrasions. One finding suggested the generous vascularity of the face might account for decreased wound infections compared with other body sites. This research was the first to include prophylactic antibiotic use for bite wounds. Further authors advocated antibiotic treatment and primary repair or secondary reconstruction for bites to the face.
There have been few recent studies on the treatment and outcome of human bites in the head and neck region. Now, a group of Texas medical researchers have reported on their experience in treating human bites at their medical center. The authors of the study, "Treatment and Outcome of Human Bites in the Head and Neck," are Karen Stierman, MD, Danielle DeLuca-Pytell, MD, Linda G. Phillips, MD, Karen Calhoun, MD, and Kristen Lloyd, all from the University of Texas Medical Branch, Galveston, TX. Their findings were presented on September 12, 2001, at the American Academy of Otolaryngology--Head and Neck Surgery Foundation Annual Meeting/OTO EXPO, being held September 9-12, 2001, at the Colorado Convention Center, Denver, CO.
Methodology: A retrospective chart review was carried out in a tertiary referral medical center examining all head and neck human bites (adult and pediatric) presented in the past 10 years. Patients were located by a search for the ICD-9 code of open wound of the head and neck and the results were cross-referenced with the code for assault. These patients were treated by otolaryngology, plastic surgery, or oral and maxillofacial surgery (OMFS) services.
Forty human bite cases occurred over the past ten-year period (1990-2000). Follow-up ranged from one day to approximately 4.5 years (average 139 days). The average victim was 29 years old. African Americans were most commonly involved (53 percent), followed by Caucasians (30 percent) and Latin Americans (17 percent). Males made up the majority of patients (93 percent). Twenty-five bites (63 percent) occurred among patients who were inmates in the Texas Department of Criminal Justice at the time of injury. Bites were classified as avulsion (tearing or ripping), laceration or abrasion injury. Avulsion injury was most frequent (79 percent). The ear was the most common site involved in the head and neck (67 percent). Twenty-eight of the 40 patients (67 percent) presented with exposed cartilage, most commonly in those patients with auricular avulsion injuries.
Medical treatment included tetanus vaccination, wound care, and antibiotic treatment. All patients received a tetanus booster if their tetanus vaccine was not known to be up to date. When ear cartilage was exposed and the wound was treated in a delayed fashion, Sulfamylon(r) or Silvadene(r) dressings were most commonly used. Once the wound was closed, the most common topical antimicrobial treatment was Bacitracin(r). Ticarcillin/Clavulanate acid (Timentin(r)) was the most commonly used antibiotic (in 15 of 40 cases), and penicillin and ampicillin/sulbactam (Unasyn(r)) were also frequently used. Surgical treatment was primary closure (within 24 hours of injury) in 15/40 patients (37.5 percent), delayed closure in 17 patients (42.5 percent
Results and Conclusions: Forty head or neck human bites were reviewed with an average follow-up of 139 days. Young males involved in an altercation were the most common victims. The most common injury was auricular avulsion. Most patients sought medical treatment within five hours of the injury. The majority of patients who did not become infected received at least 48 hours of intravenous antibiotics, with Ticarcillin/clavulanate acid (Timentin(r)) being most common. Ten out of 40 (25 percent) bite injuries resulted in wound infection, with six (15 percent) occurring after surgical closure. Fifteen of 40 patients (37.5 percent) had their wounds closed primarily (within 24 hours of injury). Six of the 15 primary closures (40 percent) developed post-operative infections. None of the 17 patients treated with delayed closure became infected post-operatively. Correlation between post-operative infection and primary closure was statistically significant.
Human bites to the head and neck are best treated with at least 48 hours of intravenous antibiotics and delayed surgical closure (greater than 24 hours post-injury) to prevent infection.
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