Incidence Pattern of Bear-Inflicted Injuries to the Maxillofacial Region-Soft and Hard Tissue Injuries, Their Management, and Sequelae.

PURPOSE: The aims of the study were to elucidate the incidence pattern of bear-inflicted facial injuries and to document soft and hard tissue injuries, their management, and complications. MATERIALS AND METHODS: A prospective study was performed of 21 bear-associated injuries sustained to the facial region. Most patients were young to middle age and most were male. Most attacks occurred during the daytime, and the highest incidence occurred during the months of April to October. Wounds were assessed for soft and hard tissue injuries, including tissue loss, and corresponding management in the craniofacial region for 18 months. A standardized surgical treatment was used for patient management, which included thorough debridement of wounds and routine primary repair of soft tissue. Bony defect reconstruction was performed by open reduction and internal fixation. Regional or distant flaps were used for the reconstruction of soft tissue defects. RESULTS: Mauled patients were treated for injuries varying from lacerations and puncture wounds to fractures and avulsive tissues. On average, most patients underwent a single operation for reconstruction of bony fractures and soft tissue repair and spent 3 to 7 days in the hospital; however, some patients underwent more than 1 operation and stayed in the hospital for more than 4 to 6 weeks. Facial fractures were mainly seen in the midfacial region (71%), followed by mandibular fractures (24%). Overall, the results were satisfactory, except for a few instances of scar formation, facial nerve palsy, and ectropion. The mortality rate was 5% (1 patient) from the severe injury caused by bear mauling. CONCLUSIONS: Extensive bear-bite injuries of the facial skeleton can be treated with immediate primary wound repair after meticulous wound debridement and according to commonly used criteria of esthetic reconstructive facial surgery.

Assessment of Fixation of Mandibular Interforaminal Fractures by Using a Single Second-Generation Headless Compression Screw: A Pilot Study.

The aim of this article is to evaluate the efficacy of a single second-generation headless compression screw along with a lower arch bar in the fixation of interforaminal mandible fractures. A total of seven patients were included in the study. An open approach was used either intraorally or extraorally. A second-generation 3.0 HCS (headless compression screw), 24 to 32 mm in length, diameter at the head of 3.5 mm, smooth shaft with 2.0 mm and at the leading edge 3.0 mm (Synthes, Paoli, PA) was used for the fixation along with a lower arch bar. Postoperative clinical and radiographic follow-up was performed at 3 weeks, 3 months, 6 months, and 1 year. A single, cannulated HCS was found to be effective in fixation of interforaminal mandible fractures except in one case where a miniplate had to be applied subapically. Clinical and radiographic follow-up revealed accurate reduction and fixation in all cases and no postoperative occlusal disturbances. A single, second-generation HCS along with a lower arch bar provides good results when used for the fixation of interforaminal mandible fractures. Headless compression screw fixation of interforaminal mandible fracture is a simple, quick, economic, and efficient method of rigid fixation with minimum complications.