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 Table of Contents  
ORIGINAL ARTICLE
Year : 2017  |  Volume : 20  |  Issue : 1  |  Page : 20-24

Menace of human lip bite in South-South Nigeria


1 Department of Dentistry, University of Jos, Jos, Nigeria
2 Department of Dental and Maxillofacial Surgery, Jos University Teaching Hospital, Jos, Nigeria
3 Department of Paediatrics, Jos University Teaching Hospital, Jos, Nigeria

Date of Web Publication11-Jan-2017

Correspondence Address:
Arthur Nwashindi
Department of Dental Surgery, Maxillofacial Unit, University of Uyo Teaching Hospital, Uyo, PMB 1136, Uyo, Akwa Ibom
Nigeria
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DOI: 10.4103/1119-0388.198104

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  Abstract 

Background: In general, human bite injuries in the maxillofacial region can be self-inflicted or originating from another person's teeth. Lip injuries have the potential for infection and gross disfigurement. Bites on the face also present as a surgical challenge, especially if there is partial or total loss of important structure(s) of the face like the ears, the eyelids, the nose, the lips. Materials and Methods: This was a prospective study of patients with human bites to the lip. One hundred and two patients with human bites on the lip who presented at the Maxillofacial Unit of University of Uyo Teaching Hospital were involved in the study. Information obtained on the patients includes age, gender, time of presentation after the injuries, nature and circumstances of injuries and treatment offered to the patients were noted. Results: A total of 102 patients were seen in the study. The victims and offenders were mainly males, while male to female ratio among the offenders was 1:2. Upper lip was more affected than lower lip, while more patients lost one-third of the lip. The majority of the patients (46%) presented within 24 h of attack. The majority of them were treated with prophylactic antibiotic and primary repair. Conclusion: Human bites of the face are still common in our society. According to Lackmans' classification, the majority of injuries were Class 111. The injury cuts across all age groups, more in lower lip. Minimal debridement and primary closure are effective when patients present early.

Keywords: Bite, infection, injuries, Lackmann, lip


How to cite this article:
Nwashindi A, Akhiwu B, Agbara R, Idowu E, Akhiwu H, Afolabi A. Menace of human lip bite in South-South Nigeria. Trop J Med Res 2017;20:20-4

How to cite this URL:
Nwashindi A, Akhiwu B, Agbara R, Idowu E, Akhiwu H, Afolabi A. Menace of human lip bite in South-South Nigeria. Trop J Med Res [serial online] 2017 [cited 2017 Aug 21];20:20-4. Available from: http://www.tjmrjournal.org/text.asp?2017/20/1/20/198104


  Introduction Top


Human bite is considered to be one inflicted on one person by another.[1] In any type of bite, it is important to determine the time that has elapsed since injury. Literature data suggest that human bite injuries in the maxillofacial region are quite common.[2],[3]

Generally, human bite injuries in the maxillofacial region can be self-inflicted or originating from another person's teeth. Human teeth may cause lacerations, punctures, and soft tissue avulsions. Self-inflicted bite injuries are most common on tongue, labial, or buccal mucosa.[4] They are serious injuries that not only have the potential for infection but also may result in gross disfigurement. Human bites are as serious as animal bites because they lead to more serious infectious complications and also compromise functional, esthetics, and also have social and psychological effects.[5]

Many of the patients who sustained human bites to the face present with healed wound resulting in disfiguring scars and deformed facial appendages which required reconstruction. Human saliva is considered to be a virulent inoculum with bacterial loads at the order of 108 per mm, which significantly increase in cases of periodontal disease and oral sepsis.[6] Bites on the face also present as a surgical challenge, especially if there is partial or total loss of important structure(s) of the face like the ears, the eyelids, the nose, the lips.[7] The cosmetic effects of such losses are enormous and may affect the social and even sometimes economic life of the patient involved.[7]

Bite wound to the maxillofacial region should be properly managed to prevent infection, rabies, tetanus, and undue scarring.[8] The treatment of these bite wounds can be quite challenging to the maxillofacial surgeon because these wounds may be infected by the oral microorganisms which if extensive may impair the patient both functionally and aesthetically.[9]

The menace of a human bite includes infection, rabies, tetanus, undue scarring, and transmission of HIV or hepatitis B virus infection. Human bites typically transfer a larger number of bacteria to the bite victim than dog or cat bites, primarily because the human mouth carries a higher population of resident bacteria.[10]

The purpose of this study, therefore, is to perform a general analysis of cases of human bite wounds in the lip requiring management.


  Materials and Methods Top


This was a prospective study of patients with human bites to the lip. The period of the study was about 4 years (between February 2012 and October 2015). One hundred and two patients with human bites on the lip who presented at the Maxillofacial Unit of University of Uyo Teaching Hospital were involved in the study. Inclusion criteria were bites on the lip only. Bite injuries on other parts of the face and self-inflicted human bites were excluded. Information about was gotten from the victims.

On presentation, general assessment of the wound for size and depth, lacerations, avulsion, and signs of infection was noted. Information obtained on the patients includes age, gender, time of presentation after the injuries, nature and circumstances of injuries and treatment offered to the patients were noted. Prevalence of injuries according to anatomic location and classification of severity of the wounds was analyzed based on Lackmann's classification. All patients were treated according to the same surgical protocol. All cases were treated as outpatients, the procedures were carried out under local anesthesia.

Data were recorded and analyzed using SPSS Version 16, Chicago, USA. Spss Inc. software. The value of P < 0.05 was regarded as statistically significant for all analyses.


  Results Top


A total of 102 patients were seen in the study .The age range of victims in this study was 0-80 years [Table 1]. The extremes of age in the study group was the least affected. The age range 31-40 (29.10 % ) was the highest number of victims as shown in [Table 2]. The victims and offenders were mainly males [Table 3]. Fifty-three percent (53%) of the victims and 68% of the offenders were male. The male-to-female ratio among the victims was 1:1, while male to female ratio among the offenders was 1:2. Indicating that the assailants were mainly females as shown in [Table 3]. Upper lip was more affected than lower lip, while more patient lost one-third of the lip (46.08) as shown in [Table 4] and [Table 5]. Avulsive injury (71%) was the most prevalent followed by penetrative injury (21%). Thirty-six percent (36%) of the bite occurred between friends , followed by colleaques and business associates. [Table 6] and [Table 7] respectively]. [Table 8] shows that Seventy-eight percent of the human bites occured during fights, with least only 6% occurring without identifiable source of provocation. As shown in [Table 9], majority of the patients(46%) presented within 24 hours of attack .Majority of them were treated with prophylactic antibiotic and primary repair [Table 10].
Table 1: Lackmann's classification of facial bite injuries


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Table 2: Age distribution of victims


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Table 3: Gender distribution of victims and offenders


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Table 4: Injury according to Lackmann's classification


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Table 5: Site and degree of lip loss


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Table 6: Nature of lip injury


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Table 7: Relationship between victims and offenders


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Table 8: Context of provocation


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Table 9: Average time of presentation


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Table 10: Distribution of treatment modalities


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None of the patients in the observed sample were hospitalized. All were treated as outpatients. There were no complications reported following completed surgical treatment. No cases of tetanus were reported.


  Discussion Top


One hundred and two cases were seen within the period of study. The number of cases of human bites seen is something of concern. In previous studies by Olaitan et al., 32 cases was seen in 10 years.[7] This obvious discrepancy could be due to the location of study and documentation.

In this study, distribution of the lip bite injuries varies with different age groups. Most frequently, these injuries were seen in 31-40 age group. Datubo-Brown also reported that most of his patients were adult females in their third decades.[11] This is in contrast to the study by Konstantinović and Puzović[4] who recorded that age group of 21-30 years were more involved. Young individuals are socially more active, who may indulge in conflict situations that result in fighting.

The finding that a greater number of human bites occurred among men than women is similar to those of other reports.[12],[13] In this study, the victims and assailants were mainly males. This is in contrast with previous studies where women were reported to be a larger number of the victims.[14],[15] Most of the bites from those previous studies were inflicted mostly by women as assailants. Furthermore, women form the greater number of patients in those previous reports.[14],[15] However, in agreement with our study, Olaitan et al., reported more male victims than females (1.6:1) while there were more female assailants than male.[7] This was also the view of Konstantinović and Puzović; with bites more in male than female.[4]

These results are also consistent with the study by Harrison;[3] who reported that gender ratio in injured patients was 3:1 with more of the male gender being involved. This is due to the higher physical activity of men in aggressive behavior, which further increases the risk of bite injuries. Konstantinović and Puzović; in their study stated that the most frequently injured facial structure were lips.[4]

Although all the facial structures were included in their study, in this current study only lip bite was included, and it was noted that the lower lip was more involved. This finding is consistent with the previous study where the lower lip was the site more commonly involved.[5] This could be explained by the position of the lower lip in the face, which makes it one of the most prominent parts of the face and therefore easily grabbed by the teeth.[16]

Human bite injuries seen were of the I, IIA, 11B and IIIA class according to Lackmann's classification, which means that soft tissues of the face were affected. This can be explained by the fact that human bite does not generate enough force which would lead to bone, vessels or nerves injuries. In this study, various types and degrees of injuries were recorded. Human teeth can lead to various types of the soft tissues injuries, like lacerations, abrasions and avulsion, which may be accompanied by tissue loss.

In the current study, victims were friends of the offenders. This is in contrast to other studies where it was reported that majority of the assailants were spouses and co-habiting.[11],[15] The physical conflict was the major cause of provocation in this study. This was in agreement with a previous study which reported that most of the human bite injuries occur during physical conflict followed by a sexual assault.[6] Human bite injuries caused by other person are often due to assaults. They occur in physical conflicts and sexual assaults, most frequently affecting prominent facial parts.[2],[17]

The majority of the patients presented within 24 h. This contributed to minimal infection and complication in most of the cases seen in this study. This could also be explained with a primary treatment after injury, adequate surgical protocol, and antibiotic prophylaxis. In other published reports, delayed treatment of infected human bite wounds leads to complications and infections.[18],[19]

The current practice emphasizes that thorough irrigation of contaminated bite wounds would considerably decrease the bacterial load, remove particulate matter and reduce the infection rate. At presentation, normal saline was used to irrigate the wound. For the obviously infected wounds, antiseptics were used before normal saline. Initial debridement is necessary because human bite injuries carry the risk of being infected with the bacteria flora of the oral cavity and these infections are polymicrobial in nature. This often lead surgeons to consider initial debridement and delayed closure because of the fear of wound infections.[7],[20] In 66 cases, primary repair was done. The majority of these patients fall within the early presentations with no or minimal infection In avulsive wounds subcutaneous suturing may be required to get a primary closure even with the presence of a severe tissue defect.[21] The secondary repair was carried out in patients that presented late with healing already taking place or with a severe defect.


  Conclusions Top


Human bites of the face are still common in our society. According to Lackmans' classification, the majority of injuries were Class 111. The injury cuts across all age groups, more in the lower lip. Minimal debridement and primary closure are effective when patients present early.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

 
  References Top

1.
Tomasetti BJ, Walker L, Gormley MB, Berger J, Gold BD. Human bites of the face. J Oral Surg 1979;37:565-8.  Back to cited text no. 1
    
2.
Stierman KL, Lloyd KM, De Luca-Pytell DM, Phillips LG, Calhoun KH. Treatment and outcome of human bites in the head and neck. Otolaryngol Head Neck Surg 2003;128:795-801.  Back to cited text no. 2
    
3.
Harrison M. A 4-year review of human bite injuries presenting to emergency medicine and proposed evidence-based guidelines. Injury 2009;40:826-30.  Back to cited text no. 3
    
4.
Konstantinović SV, Puzović ZD. Maxillofacial bite injuries treatment - 20 years experience. Cent Eur J Med 2014;9:461-7.  Back to cited text no. 4
    
5.
Shubi FM, Hamza OJ, Kalyanyama BM, Simon EN. Human bite injuries in the oro-facial region at the Muhimbili National Hospital, Tanzania. BMC Oral Health 2008;8:12.  Back to cited text no. 5
    
6.
Stefanopoulos PK, Tarantzopoulou AD. Facial bite wounds: Management update. Int J Oral Maxillofac Surg 2005;34:464-72.  Back to cited text no. 6
    
7.
Olaitan PB, Uduezue AO, Ugwueze GC, Ogbonnaya IS, Achebe UJ. Management of human bites of the face in Enugu, Nigeria. Afr Health Sci 2007;7:50-4.  Back to cited text no. 7
    
8.
Schultz RC, McMaster WC. The treatment of dog bite injuries, especially those of the face. Plast Reconstr Surg 1972;49:494-500.  Back to cited text no. 8
    
9.
Wolff KD. Management of animal bite injuries of the face: Experience with 94 patients. J Oral Maxillofac Surg 1998;56:838-43.  Back to cited text no. 9
    
10.
Smith PF, Meadowcroft AM, May DB. Treating mammalian bite wounds. J Clin Pharm Ther 2000;25:85-99.  Back to cited text no. 10
    
11.
Datubo-Brown D. Human bite of face with tissue losses. Ann Plast Surg 1988;21:322-8.  Back to cited text no. 11
    
12.
Marr JS, Beck AM, Lugo JA Jr. An epidemiologic study of the human bite. Public Health Rep 1979;94:514-21.  Back to cited text no. 12
    
13.
MacBean CE, Taylor DM, Ashby K. Animal and human bite injuries in Victoria, 1998-2004. Med J Aust 2007;186:38-40.  Back to cited text no. 13
    
14.
Donkor P, Bankas DO. A study of primary closure of human bite injuries to the face. J Oral Maxillofac Surg 1997;55:479-81.  Back to cited text no. 14
    
15.
Obukwe ON. A study of human bite injuries to the face. Cent Afr J Med 2002;48:68-71.  Back to cited text no. 15
    
16.
Adeyemo WL, Taiwo OA, Adeyemi MO, Adewole RA, Gbotolorun OM. Pattern of presentation and management of lip injuries in a Nigerian hospital. Niger J Clin Pract 2012;15:436-41.  Back to cited text no. 16
  Medknow Journal  
17.
Griego RD, Rosen T, Orengo IF, Wolf JE. Dog, cat, and human bites: A review. J Am Acad Dermatol 1995;33:1019-29.  Back to cited text no. 17
    
18.
Baurmash HD, Monto M. Delayed healing human bite wounds of the orofacial area managed with immediate primary closure: Treatment rationale. J Oral Maxillofac Surg 2005;63:1391-7.  Back to cited text no. 18
    
19.
Koech KJ, Chindia ML. Presentation and management of human lip bites at a Kenyan center: A case series. J Oral Maxillofac Surg 2010;68:2701-5.  Back to cited text no. 19
    
20.
Merriam CV, Fernandez HT, Citron DM, Tyrrell KL, Warren YA, Goldstein EJ. Bacteriology of human bite wound infections. Anaerobe 2003;9:83-6.  Back to cited text no. 20
    
21.
Stremitzer S, Wild T, Hoelzenbein T. How precise is the evaluation of chronic wounds by health care professionals? Int Wound J 2007;4:156-61.  Back to cited text no. 21
    



 
 
    Tables

  [Table 1], [Table 2], [Table 3], [Table 4], [Table 5], [Table 6], [Table 7], [Table 8], [Table 9], [Table 10]



 

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