Froind Shay, Parra Angelica Shapira, Segal Nili
Department of Otolaryngology - Head and Neck Surgery, Soroka Medical Center, Faculty of Health Science, Ben-Gurion University of the Negev, Beer-Sheva, Israel.
Int J Pediatr Otorhinolaryngol. 2013 Sep;77(9):1400-2. doi: 10.1016/j.ijporl.2013.06.032. Epub 2013 Jul 27.
Dog bite injury of the head and neck is not rare in children although intracranial injury is reported anecdotally. Among the case reports there is a significant number of patients in whom the diagnosis of penetrating cranial injury was delayed. The aim of the study was to describe a patient with a trans mastoid head injury due to a dog bite that was not diagnosed at presentation and review similar cases in the literature.
A 13-year-old girl was admitted to the emergency room with severe head, neck and breast lacerations. She was transferred to the operating room for debridement and only then was a trans mastoid fracture diagnosed. We searched for case reports in the literature describing children suffering from dog bites in whom the diagnosis of intracranial injury was delayed.
We found descriptions of five children, 4 after dog bite and one after tiger bite. Four of them were under two years of age and all had scalp lacerations that were treated at presentation. The time period to diagnosing the brain injury was one day to three weeks. The symptoms that led to the diagnosis were fever in 3 patients, meningitis in two, brain abscess in one child and four of them developed neurological signs. All of the children had surgical intervention after diagnosis.
Intracranial injury after dog bite should be suspected in any child with scalp lacerations. Adequate investigations should be performed at presentation with careful attention to this specific type of trauma.
儿童头颈部犬咬伤并不罕见，尽管颅内损伤仅有零星报道。在病例报告中，有相当数量的患者穿透性颅脑损伤诊断延迟。本研究的目的是描述一名因犬咬伤导致经乳突头部损伤的患者，该损伤在就诊时未被诊断出来，并回顾文献中的类似病例。
一名13岁女孩因严重的头部、颈部和胸部撕裂伤被送往急诊室。她被转至手术室进行清创，直到此时才诊断出经乳突骨折。我们在文献中搜索了描述犬咬伤儿童且颅内损伤诊断延迟的病例报告。
我们发现了五名儿童的描述，其中4名是犬咬伤后，1名是老虎咬伤后。他们中有4名年龄在两岁以下，所有患者就诊时均有头皮裂伤并接受了治疗。诊断脑损伤的时间为1天至3周。导致诊断的症状包括3名患者发热、2名患者患脑膜炎、1名儿童患脑脓肿，其中4名出现神经体征。所有儿童在诊断后均接受了手术干预。
任何有头皮裂伤的儿童都应怀疑有犬咬伤后的颅内损伤。就诊时应进行充分的检查，并特别关注这种特定类型的创伤。
