Pediatric Facial Fractures From Dog Bites

Purpose: To report a series of pediatric facial fractures associated with dog bites. Methods: Retrospective review of all dog bite injuries to the face with facial fractures in children from January 1, 2003, to October 31, 2011, at Children's Hospital Colorado (Aurora, Colorado). Patient demographics, location and number of fractures, clinical course, surgical repair, and complications were recorded and analyzed using Excel statistical software. Results: Seventeen of 1,201 (1.4%) children with dog bite injuries to the face also sustained facial fractures. The average age of patients was 3.9 +/- 3.2 years and 53% were female. Thirty-five percent of patients presented with multiple facial fractures. The most common fracture involved the nasal bone (29%), while the remainder sustained fractures of the zygomatic arch, orbital rim, orbital floor, skull, mandible, maxilla, and/or sinuses. Of the 17 patients, 41% also sustained eyelid lacerations, 24% had injuries to the facial nerve, and 18% had canalicular lacerations. Fourteen of the 17 patients required surgical repair under general anesthesia. Conclusions: Although uncommon, facial fractures associated with dog bites are a significant source of morbidity, often requiring complex surgical repair. Severe injuries to the face from dog bites should be evaluated for possible fractures in addition to soft tissue injuries.