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 Table of Contents  
CASE REPORT
Year : 2016  |  Volume : 5  |  Issue : 1  |  Page : 27-29

Unusual case of maxillofacial injury secondary to camel aggression and attack during phlebotomy: Report of two cases


1 Department of Surgery/Dental and Maxillofacial Surgery, College of Health Sciences, Usmanu Danfodiyo University/Usmanu Danfodiyo University Teaching Hospital, Sokoto, Nigeria
2 Department of Dental and Maxillofacial surgery, Sir Yahaya Memorial Hospital, Birnin Kebbi, Kebbi State, Nigeria
3 Department of Dental and Maxillofacial Surgery, Usmanu Danfodiyo University Teaching Hospital, Sokoto, Nigeria

Date of Web Publication8-Dec-2016

Correspondence Address:
Dr. Ramat Oyebunmi Braimah
Department of Dental and Maxillofacial Surgery, Usmanu Danfodiyo University Teaching Hospital, Sokoto
Nigeria
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/1597-1112.192848

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  Abstract 

The camel is a very docile animal used extensively in the Northern region of Nigeria for farming, transport, and others. It is rarely implicated in the literature as an etiological factor for facial fracture. Hence, the aim of this report is to highlight the unusual presentation of mandibular, zygomatic, and orbital blowout fractures caused by camel aggression and discuss the various challenges involved in its management. The camel though docile should be carefully handled, especially during phlebotomy and rutting period to avoid any mishap.

Keywords: Camel, facial fracture, phlebotomy, rut


How to cite this article:
Taiwo AO, Awwal N, Braimah RO, Ibikunle AA. Unusual case of maxillofacial injury secondary to camel aggression and attack during phlebotomy: Report of two cases. Afr J Trauma 2016;5:27-9

How to cite this URL:
Taiwo AO, Awwal N, Braimah RO, Ibikunle AA. Unusual case of maxillofacial injury secondary to camel aggression and attack during phlebotomy: Report of two cases. Afr J Trauma [serial online] 2016 [cited 2021 Apr 21];5:27-9. Available from: https://www.afrjtrauma.com/text.asp?2016/5/1/27/192848


  Introduction Top


A camel is an even-toed ungulate animal within the genus Camelus, bearing distinctive fatty deposits known as "humps" on its back. The camel is a very docile animal used extensively in the Northern part of Nigeria for farming, transport, and others. It is rarely implicated in the literature as an etiological factor for maxillofacial injuries. Dog bites have been reported as the most common animal bite wound seen in any part of the body.[1] Injuries from animals such as bear, horses, pigs, and donkeys have also been reported.[2],[3] Specifically, camel bite injuries are relatively scarce; few cases have been reported in the literature.[4],[5],[6],[7] Therefore, the aim of this report is to highlight the rare presentation of mandibular fracture caused by camel aggression and discuss the various challenges involved in its management.


  Case Reports Top


Case 1

A 30-year-old male farmer presented with a day history of facial bleeding and swelling as a result of being flung by an adult male camel during phlebotomy. Following resuscitation and arrest of the bleeding, clinical examination showed some areas of laceration, punctured wound, and tenderness along the lower border of the mandible with swelling [Figure 1]a. Posterior-anterior view of the skull revealed bilateral parasymphyseal fracture (Between canine and first premolar bilaterally) of the mandible [Figure 1]b.
Figure 1: (a) Clinical photograph of Case 1 patient with soft tissue injuries. (b) Posterior-anterior view of the jaws showing bilateral anterior mandibular fracture. (c) Clinical photograph showing maxillomandibular fixation using direct wiring

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Tetanus vaccine (intramuscular tetanus toxoid 0.5 ml stat) and broad spectrum antibiotic (intravenous [IV] cefuroxime 1 g 12 hourly for 7 days and IV metronidazole 500 mg 8 hourly for 7 days) were given to the patient. After thorough surgical debridement of wound, decision was taken to close the wound primarily under local anesthesia. Intraoral layer closure of the wound was done with 3-0 chromic catgut sutures. After adequate approximation of deep structures, skin closure was achieved using 4-0 nylon suture and a gauze dressing put in place. The mandibular fracture was subsequently managed by closed reduction with maxillomandibular fixation (MMF) using direct dental wiring [Figure 1]c. He was admitted and placed on anti-inflammatory (IV dexamethasone 8 mg stat then 4 mg 8 hourly for 3 days). He had wound infection because of irregular antibiotic administration. The infection however resolved when antibiotic administration became regular.

Case 2

A 26-year-old male farmer was referred from a medical center in the rural Northwest zone of Nigeria with 2 days history of facial injuries following an adult male camel attack. There was no loss of consciousness; he however bled from the face and the right nostrils. Following preliminary evaluation, a diagnosis of extensive soft tissue laceration, right zygomatic complex fracture, and right orbital blow out fracture with fractured infraorbital rim was made [Figure 2]a and b]. Patient however declined further investigations and management due to financial reasons.
Figure 2: (a) Clinical photograph (posterior-anterior view) of case two patient with soft tissue injuries. (b) Clinical photograph (right-side view) of Case 2 patient with soft tissue injuries

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  Discussion Top


The Arabian camel (Camelus dromedarius) is single-hump species and reaches up to about 2 m shoulder height, body length of 3 m, and weighs 600 kg to 1200 when fully grown. They are used extensively in rural Northern Nigeria for agriculture and transport. These animals pull ploughs, assist in irrigation of farmlands, and transport agricultural produce.[6] Camels also provide milk, meat, hair for textiles or goods such as felted pouches. It has rarely been implicated in maxillofacial injuries as few cases have been reported.[4],[6] The reported cases are males and in their second and third decades of life. The high incidence of cases in this decade of life coincides with period of increased participation in farming and animal husbandry.[6]

There are two major types of animal attacks reported in the literature which are defensive or predatory.[3],[8] The camel is a known docile herbivorous mammal, we then postulated that the attack to its owner was defensive as it might have perceived the iatrogenic bleeding by the owner as a hostile act in Case 1. The local belief is that bleeding the camel will make the animal very healthy and by extension makes the animal works better. Similarly, the behavior of camels can be unpredictable, especially during the rutting period.[5] This is the period of mating were the male camel extrudes from his mouth an organ called a dulla, a large, inflatable sac when in rut to assert dominance and attract females.[5] It resembles a long, swollen, pink tongue hanging out of the side of its mouth.[5] Although this camel behaviour was not asked from the patient in the second case, we opined that the male camel may be in this rut period; hence its aggression. The laceration and facial bone fracture sustained could be as a result of been flung to the wall with considerable force by the big powerful camel in the two cases. This mechanism of injury by camel has been reported by Abu-Zidan et al.[5] were the camel picks the individual and flung them.

There is still controversy regarding the management of facial injuries as a result of animal bite. Most reports agree on immediate and thorough wound irrigation, no consensus yet on the timing of subsequent wound debridement, secondary repair, or routine antibiotics.[9] Spontaneous healing has been suggested by some authors and primary wound closure when feasible.[9] In our report, proper assessment, thorough wound cleansing with normal saline and debridement was done with primary closure. Primary closure/reconstruction may be necessary in relatively clean facial wounds or wounds that have been thoroughly debrided and irrigated to eliminate foreign bodies such as sand, stone, and grass to decrease likelihood of infection; and achieve aesthetic. Concern for adverse outcome in facial wounds is minimal as a result of excellent blood supply in contrast to other part of the body where more conservative option of delayed primary closure/reconstruction is preferred. It has been reported that camel bite wound are associated with higher risk of infection even more than dogs, cats, and human bites.[4] In this report, the risk of tetanus and infection are high and the history of vaccination is unknown; hence, tetanus prophylaxis and broad antibiotic cover were mandatory. The wound was complicated by abscess formation because the patient could not procure medications and drug administration was irregular. This is due to the out of pocket method of health care financing in underdeveloped or developing countries.

Because of financial limitation, MMF was employed, although the gold standard of using miniplates and screws would have been exploited. In spite of this constraint, satisfactory outcome was obtained. Satisfactory outcome of MMF have been reported by Taiwo et al.[10] especially in resource limited setting. The second patient declined treatment because of financial reasons, this further re-emphasize the disadvantages of out of pocket method of health care financing.


  Conclusion Top


The behavior of camels can be unpredictable, especially in the rut period. The mechanism of injury in camels is also peculiar as it bites and flung patients with its heavy weight. Care should be taken when handling camels especially during the rutting season. Furthermore, there should be universal health care coverage for all citizens by all inclusive health care insurance schemes.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Acknowledgment

The authors are grateful to Dr. Kolawole O, the departmental chair, Dental and Maxillofacial Surgery Unit, Sir Yahya Memorial hospital, Birnin Kebbi, Kebbi State, Nigeria, for the general support provided.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

 
  References Top

1.
Garcia VF. Animal bites and Pasturella infections. Pediatr Rev 1997;18:127-30.  Back to cited text no. 1
    
2.
Fourie L, Cartilidge D. Fracture of the maxilla following dog bite to the face. Injury 1995;26:61-2.  Back to cited text no. 2
    
3.
Frank RC, Mahabir RC, Magi E, Lindsay RL, de Haas W. Bear maulings treated in Calgary, Alberta: Their management and sequelae. Can J Plast Surg 2006;14:158-62.  Back to cited text no. 3
    
4.
Ogunbodede EO, Arotiba JT. Camel bite injuries of the orofacial region: Report of a case. J Oral Maxillofac Surg 1997;55:1174-6.  Back to cited text no. 4
    
5.
Abu-Zidan FM, Eid HO, Hefny AF, Bashir MO, Branicki F. Camel bite injuries in United Arab Emirates: A 6 year prospective study. Injury 2012;43:1617-20.  Back to cited text no. 5
    
6.
Ugboko VI, Olasoji HO, Ajike SO, Amole AO, Ogundipe OT. Facial injuries caused by animals in Northern Nigeria. Br J Oral Maxillofac Surg 2002;40:433-7.  Back to cited text no. 6
    
7.
Skonieczny B, Skonieczny W. Phlegmon of the foot as a camel bite complication. Pol Przegl Chir 2015;86:486-9.  Back to cited text no. 7
    
8.
Ram R. Maxillofacial injuries due to bear mauling. J Maxillofac Oral Surg 2011;10:85-9.  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.
Taiwo AO, Soyele OO, Godwin NU, Ibikunle AA. Facial fracture management in Northwest Nigeria. J Surg Tech Case Rep 2013;5:65-71.  Back to cited text no. 10
    


    Figures

  [Figure 1], [Figure 2]



 

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