Extensive and mutilating craniofacial trauma involving defleshing and decapitation: unusual features of fatal dog attacks in the young.

Four cases of fatal dog attacks are reported in 3 children aged 6, 10, and 11 years and in an infant aged 3 weeks. The cases were all characterized by extensive and mutilative stripping of soft tissues from the face and scalp, progressing to decapitation in the infant. The attacks were highly focused, involving 2 dogs in all but 1 case, with the area of trauma localized to the craniofacial region. The injuries resembled those found after postmortem animal depredation. The involvement of more than 1 dog may account for the severity of the injuries due to "pack" behavior. Deaths were due to exsanguination, air embolism, and decapitation. Necropsy examination of the attacking dogs revealed tissues from the victims in 2 of the animals' stomachs. These cases demonstrate the vulnerability of infants and young children to fatal dog attacks, with an unusual concentration of severe injuries to the head regions. Necropsy of the canine assailant, with collaboration between pathologists and veterinarians, is an important part of such investigations as it may provide information helping to establish the identity and ownership of the animal, along with trace evidence confirming that the dog was involved in the attack.