1 Introduction

The face is the most conspicuous part of the body as it is important for identification, cosmetics and expressions. Any injury affecting the face therefore requires special attention (Jose Luis Munantes Cardenas, 2011). Bite injuries are very unique form of trauma and that they constitute to high morbidity and mortality both in developing and developed countries (Chalya PL, 2011). Many victims with minor injuries from animal bites do not present for treatment, so the actual worldwide incidence is unknown (Smith PF, 2000). There is a big therapeutic challenge in trauma surgery from animal bites due to a high complication rates compared to similar soft tissue wounds caused by other reasons (Abuabara, 2006). There are no completely defined protocols for treatment of animal bites and sometimes, the initial management could be complex (Chalya PL, 2011).

Among the contributors to very serious animal bites are honey badgers or Ratel (Mellivora capensis).These are  fearless and very aggressive honey and flesh eating mammals found mainly in Africa and Asia.

They are even listed as the “most fearless animals in the world” in the Guinness Book of Records (Begg, 2011). Facial soft tissue trauma due to animal bite is not uncommon. Most of the reported cases include pets like dogs and cats. We present a rare case of 3 years old boy that underwent a multistage repair of facial soft tissue injuries he got from a Honey Badger bite.

2 Case report

A 3 years old boy was referred to our hospital (Bugando Medical Centre) from Kahama District Hospital, Shinyanga presenting with a complaint of an animal bite on his face. His Father reported the animal to be Honey Badger (Mellivora capensis). He was attacked in the morning while sleeping on the floor of their home’s veranda. He sustained injuries of his face on the right side tearing his cheek and lips. At the District Hospital, he got initial management by achieving haemostasis and wound debridement.

At our center, history was taken again and physical examination was done. He had lacerations and avulsion of right cheek, a wound at his lower lip and the upper lip was completely absent. The Nasolacrimal duct, parotid gland, Stensen duct and nasal septum were not affected. The wounds were septic (Figure 1).

He was admitted in an ENT surgery ward where he was given Tetanus and rabies prophylaxis. Culture and sensitivity of pus obtained from the wounds were done and then he was given I/V ceftriaxone for one week and daily saline wound dressing. Sepsis cleared completely almost 1 month post admission and surgery for reconstruction was planned to be in stages. 

Due to limited facilities, what was done was local wound repair and flaps. First the cheek and lower lip wounds were repaired (Figure 2). The cheek was repaired by secondary suturing where edges were undermined, the lower lip wound refreshed and wedge repair was done.

After healing of the cheek and lower lip wounds, reconstruct of missed upper lip was done using deltopectoral vascular flap. Four weeks later, the grafted part of new upper lip took and the rest of the flap was detached. Vermillion was reconstructed by grafting patients’ buccal mucosa (Figure 3, 4). 

3 Discussion

Facial injuries have the potential to cause disfigurement and loss of function; for example, blindness, difficulty in moving the jaw or excessive salivation can result. Although it is seldom life-threatening, facial trauma can also be deadly, because it can cause severe bleeding, interference with the airway or wound infections; thus a primary concern in treatment is ensuring that the airway is open and not threatened so that the patient can breathe (Avinash, 2010). In our case, the airway wasn’t compromised but the wound was so septic which necessitated a serious wound management prior to reconstruction.

Reconstruction of severe facial trauma can be challenging especially if there is no enough facilities. In good centres one can do full or near total face transplant, though this has complication especially in a child of 3 years of age. Apart from high morbidity, local wound repairs, skin-grafts and flaps if carefully done may help make patients cosmetically acceptable and have satisfactory physiological outcomes.

The duration of reconstruction is very important as it needs to be well discussed prior with the patient or for this case parents or guardians.

4 Conclusion

A good wound management that consists of thorough irrigation and careful debridement are important to diminish the risks of infection after primary closure, which should be considered for animal bite injuries to the face, and for this case post honey badger bite. Reconstruction can be very challenging but if carefully done may help make patients cosmetically acceptable and have satisfactory physiological outcomes.

References

Abuabara A., 2006, A Review of Facial  injuries due to dog bites, Medical oral patholoral bucal 11: 348-350

Avinash  D.S., 2010, Psychological issues in acquired facial trauma, Indian Journal of plastic surgery, 43(2): 200-205

https://doi.org/10.4103/0970-0358.73452

Begg K.C. (2011) honey Badger Diet. Honey badger. Rondebosch.

Chalya Pl M.M., Gilyoma Jm, Mabula Jb, Chandika Ab,Mshana Se, 2011, Bite injuries st Bugando Medical Centre,Tanzania: A five year experience, East and Central African Journal of surgery, 16(1)

Jose Luis Munantes Cardenas S.O., Luciana Asprino,Roger Wf Moreira, 2011, Pattern and Treatment of facial Trauma in Paediatrics and Adolescent Patients, The Journal of cranial facial surgery, 22(4): 1251-1255

Smith Pf M.A., May Db, 2000, Treating mmmalian bite wounds, Journal of clinical pharmacy and therapeutics, 25: 85-99