Dog bites to the head, neck, and face (HNF) disproportionately affect children, and it is unclear if specific facial regions are uniquely at risk in this population. Some have identified the periorbital region as particularly at risk(1), and others have described a “central target area” (CTA), where the nose, cheeks, and lips are most often injured(2). This study sought to answer the following question: Among individuals sustaining a dog bite injury to the HNF, are children, when compared to adults, at greater risk of injury to the periorbital region or CTA?
The investigators designed and implemented a retrospective cohort study and enrolled a study sample derived from the population of patients with HNF dog bite injuries identified in the trauma registry at Harborview Medical Center, Seattle, WA, between 2000-2015. The primary predictor variable was age category, pediatric, or adult (> 18 years). The primary outcome variable was injury location classified as isolated periorbital, isolated CTA, both (periorbital and CTA), or other HNF location (neither periorbital nor CTA). The periorbital region included eyebrow, eyelid, medial, or lateral canthus, canaliculus, orbit, and orbital contents. The CTA region included the nose, lips, zygomatic, and buccal regions. Other variables included demographics, injury circumstances, and clinical course. Descriptive and bi-variate statistics including chi-squared tests and relative risk were computed. P-value < .05 was considered statistically significant.
The sample consisted of 183 (58.5%) pediatric and 130 (41.5%) adult subjects. Isolated periorbital injuries were more common in the pediatric group (26.8%) than in adults (12.3%), relative risk (RR) 2.2 (1.3-3.7 [p = 0.003]). Injury to both periorbital and CTA regions was also more common in the pediatric group (23.5%) than in adults (11.5%), RR 2.0 (1.2-3.5 [p = 0.01]). Isolated CTA injury was the most common injury pattern overall in both children (37.7%) and adults (55.4%), but children were at significantly less risk than adults, RR 0.7 (0.5-0.9 [p = 0.002]). Children were also less likely to sustain an injury to other HNF regions, RR 0.6 (0.3-0.97 [p = 0.038]).
In conclusion, we found that pediatric subjects, when compared to adults, were twice as likely to incur a periorbital dog bite injury. No such increased risk was observed for the CTA. This may reflect unique anatomic risks in children or targeting of their eyes by attacking dogs, contributing to higher rates of HNF injury in this population. Public health and educational measures should recommend against children being placed at eye level with dogs, even if familiar or under adult supervision. Opportunities for collaboration exist between the National Facial Protection Month sponsored by the American Association of Oral and Maxillofacial Surgeons and the National Dog Bite Awareness Week led by The American Veterinary Medical Association.
1. Prendes MA, Jian-Amadi A, Chang S, Shaftel S. Ocular Trauma From Dog Bites: Characterization, Associations, and Treatment Patterns at a Regional Level I Trauma Center Over 11 Years. Opthal Plast Reconstr Surg. 2016;32:279-283
2. Palmer J, Rees M. Dog bites of the face: a fifteen year review. Br J Plast Surg 1983;36:315-8