eMedicine Specialties > Otolaryngology and Facial Plastic Surgery > Reconstructive Surgery

Animal Bites

Author: Suzanne K Doud Galli, MD, PhD, Consulting Staff, Cosmetic Facial Surgery, Private Practice
Coauthor(s): Philip J Miller, MD, FACS, Assistant Professor, Department of Otolaryngology, Division of Facial Plastic and Reconstructive Surgery, New York University School of Medicine
Contributor Information and Disclosures

Updated: Jan 7, 2009

Introduction

Background

Animal bites are not uncommon occurrences. However, victims who are treated in emergency centers represent only a small percentage of all bite victims. Although notification is mandatory in many states, an estimated 50% of all dog bites are not reported.

Most animal bites are dog bites (80-90%). Cat bites make up approximately 10%, and bites from miscellaneous animals and rodents also contribute to these figures.

Most animal bites occur on the extremities, but the head and neck region is also often affected. Animal bites to the face are most commonly made by dogs or cats. Of all dog bites, 9-36% occur to the head and neck region. The head and neck region is injured in 6-20% of persons who sustain cat bites. Children are injured more frequently in the head and neck region than adults.

Most bites occur in the summer months in the late afternoon. Additionally, most bites occur in the victim's home or in the home of a friend or relative. Often, the animal is known to the victim (eg, a pet).

Pathophysiology

Although the risk of infection exists in any bite situation and proper wound management is required, animal bites to the head and neck require special considerations. The intimate juxtaposition of vital structures and the cosmetic issues of the head and neck region warrant special care for animal bite wounds to these areas.

Frequency

United States

Animal bites account for 1% of the emergency department visits in the United States. Up to 4.5 million people are treated for animal bites each year.

International

In studies from England and Scotland, animal bite injuries account for 3% of emergency department visits. In Switzerland, up to 23,000 people are treated for animal bites and scratches annually.

Mortality/Morbidity

Animal bites can lead to infection, and, if treated appropriately, patients can avoid this risk. Other complications include sepsis, osteomyelitis, septic arthritis, and even death. Fatalities are uncommon, but an average of 10-15 deaths occur following dog bites each year in the United States. Most of these fatalities are children who sustain bites to the head and neck region. Even a minor bite to a major vessel can lead to hemorrhage in a small child. Skull fractures resulting from dog bites have been reported.

Race

Epidemiologic data have failed to demonstrate an association between race and bites.

Sex

In general, animal bites occur with equal incidence in men and women. However, dog bites occur more frequently in men and boys, while cat bites occur more frequently in women and girls.

Age

Animal bites occur more frequently in adults. However, children have a higher percentage of head and neck bites. Additionally, bites in children are more likely to warrant medical attention.

Breed

The breed of the dog has been reported for some bites. Most bites (>50%) are inflicted by working dogs, which includes German shepherds, Doberman pinschers, collies, Great Danes, huskies, and mixed shepherd-type dogs. Sporting dogs, such as spaniels, retrievers, pointers, and setters, are implicated less frequently. Cats are not typically identified by breed.

Clinical

History

• Although the incidence of infection transmission is quite low, the risk of rabies is probably the best reason for investigating animal bite injuries. Regardless, many animal bites remain unreported because they are minor and can be self-treated.
• When evaluating a patient following an animal bite, the nature of the injury is pertinent, including whether or not the animal was known to the victim. The time of injury may have implications for treating potential wound infections or for addressing avulsed appendages.

Physical

• Following an animal bite, patients require a full physical examination to address all bite wounds.
• Adults are injured most often in the extremities. Children are injured more often in the head and neck region compared with adults.
• The degree of injury is important. Some patients can be managed with local wound care or simple suturing by emergency department staff. Others require a consultation with a specialist or a trip to the operating room to address their wounds.

Causes

Epidemiologic studies have shown that most dog and cat bites are not from stray animals. Rather, the animal is often the pet of the victim or an acquaintance of the victim. In many animal bites in children, the animal was inadvertently provoked by the child. Infant swings have been linked to dog attacks.¹

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