The 26-month-old patient was brought to Viet Duc Friendship Hospital in a state of panic, bleeding profusely with a series of dog bite wounds in the head, face and neck area.
The most worrying thing is a deep wound stretching from the temple area through the cheeks down to the right neck area, located close to the carotid artery. This is a particularly dangerous anatomical area, because just a slightly deeper bite can damage the carotid artery, causing acute bleeding that threatens life or leaves serious neurological sequelae.
Not only dangerous due to the risk of major blood vessel damage, the wound is also located on the pathway of the VII facial nerve branches and the parotid salivary tube system.
According to Assoc. Prof. Dr. Nguyen Hong Ha, Head of the Department of Maxillofacial Surgery - Plastic Surgery and Aesthetics, Viet Duc Friendship Hospital, if damage to the VII nerve and saliva tube is not detected and handled from the beginning, the consequences can be very serious.
“Disconnection or damage to the VII cranial nerve can cause children to have facial paralysis, distorted mouth, and unable to close their eyes, thereby leading to the risk of corneal ulcers and long-term effects on the function, aesthetics, and psychology of children. Meanwhile, if the salivary gland is damaged and not restored, saliva can escape to the skin, causing prolonged saliva leakage, damaging tissues and making wounds difficult to heal,” Assoc. Prof. Dr. Nguyen Hong Ha said.
Another particularly serious injury lies in the upper jaw area, lower eyelids and left cheekbones. The baby suffered from cleft lip of the upper jaw, widespread soft tissue crushed, forming a passage from the oral cavity to the eye socket.
Notably, the child's two upper jaw teeth were broken and pushed deep into the eye socket, located close to the eyeball, directly threatening vision. In addition to the above injuries, the patient also suffered widespread scalp peeling, bruised lips and under chin area, causing significant blood loss.
Immediately after receiving the patient, Viet Duc Friendship Hospital immediately activated the multi-specialized emergency system.
Because the patient was only 26 months old, in a state of panic and could not cooperate with a full examination, accurately assessing the extent of soft tissue, nerve and salivary glands damage was difficult. Therefore, doctors continued to check and evaluate in detail right in the operating room after the patient was given full-body anesthesia.
With the support of microscopy glasses, the team of the Department of Maxillofacial Surgery and Plastic Surgery performed meticulous dissection from the root to the branches of the facial nerve to accurately determine the location of the lesions, and at the same time restore the parotid salivary tube system.
Doctors also safely removed two teeth pushed into the eye socket, preserving the eyeball intact; and at the same time cleaned the lesions, corrected the fractured bone area and reshaped complex lesions in the cheek and left eyelid.
Another major challenge in surgery is the risk of infection. Animal bite wounds often contain many types of bacteria, including anaerobic bacteria, which are especially dangerous when the wound is in the head and face.
Thanks to in-depth expertise in plastic surgery and microsurgery, the team treated all lesions in one surgery, creating optimal conditions for the child to recover. After surgery and treatment, the patient's condition stabilized and the child was discharged from the hospital.
According to doctors' assessment, if the recovery process progresses smoothly, the possibility of functional recovery in the head and face areas of children can reach about 90–95%, thereby significantly reducing the risk of leaving serious functional and aesthetic sequelae in the future.
