Multidisciplinary management of complex craniofacial animal bites in children: A case series and review of principles

Pediatric craniofacial animal bites represent a significant source of traumatic injury, characterized by distinct epidemiological and anatomical patterns. Due to their stature and proportionally larger head size, children sustain facial injuries in up to 78% of cases, with the lips, nose, and cheeks being the most vulnerable areas. These injuries range from superficial lacerations to complex avulsions and fractures, often involving critical structures such as the parotid (Stensen’s) duct, the dentoalveolar complex, and the orbital region. This article reviews the principles of management and presents a case series of three pediatric patients (aged 4, 8, and 17 years) who sustained severe wolf or dog bites to the face. Each case involved full-thickness soft tissue damage; two included Stensen’s duct transection, and one featured significant dentoalveolar avulsion and a minor zygomatic fracture. Management followed a systematic, multidisciplinary protocol emphasizing immediate rabies prophylaxis, antibiotic therapy, meticulous surgical debridement, and anatomical reconstruction—including microsurgical duct repair with stenting and layered soft tissue closure. All patients achieved excellent functional and cosmetic recovery without long-term complications over follow-up periods ranging from six months to one year. The discussion highlights the necessity of integrating acute surgical care with long-term psychological support and preventive public health strategies. This case series demonstrates that, despite their severity, coordinated multidisciplinary care can successfully restore form and function in pediatric facial bite injuries.