RESUMEN
In all 50 states, the District of Columbia, and the Commonwealth of Puerto Rico, pediatricians, dental professionals, and other physicians are mandated to report suspected cases of abuse and neglect to social service or law enforcement agencies. The purpose of this clinical report is to review the oral aspects of abuse and dental neglect in children and the role of pediatricians, dental professionals, and other physicians in evaluating such conditions. This clinical report addresses recommendations on the evaluation of bite marks, as well as perioral and intraoral injuries, infections, and diseases that may raise suspicion for child abuse or neglect. Some physicians may have received less education pertaining to oral health, dental injury, and oral disease. These physicians may not detect the mouth and gum findings possibly related to abuse or neglect as readily as abuse injuries involving other areas of the body. Therefore, pediatricians, dental professionals, and other physicians are encouraged to collaborate to increase the prevention, detection, and treatment of these conditions in children.
Asunto(s)
Maltrato a los Niños , Humanos , Maltrato a los Niños/diagnóstico , Maltrato a los Niños/prevención & control , Niño , Notificación Obligatoria , Traumatismos de los Dientes/diagnóstico , Traumatismos de los Dientes/terapia , Traumatismos de los Dientes/etiología , Salud Bucal , Rol del Médico , Mordeduras Humanas/diagnóstico , Enfermedades de la Boca/diagnóstico , Enfermedades de la Boca/etiología , PreescolarRESUMEN
Infections are an important source of morbidity in pediatric hands that come from frequent exposure to mouths and other dangers while exploring the world. Although Staphylococcus aureus is still the most common organism in pediatric hand infections, it is less common than in adults because pediatric patients are more likely to develop mixed aerobic/anaerobic infections or group A Streptococcus pyogenes infection. Pediatric patients with open physes potentially may sustain Seymour fractures of the distal phalanges that may become infected and sources for osteomyelitis if not recognized early.
Asunto(s)
Mano/microbiología , Animales , Antibacterianos/uso terapéutico , Artritis Infecciosa/diagnóstico , Artritis Infecciosa/terapia , Mordeduras y Picaduras/diagnóstico , Mordeduras y Picaduras/terapia , Mordeduras Humanas/diagnóstico , Mordeduras Humanas/terapia , Niño , Desbridamiento , Mano/cirugía , Humanos , Osteomielitis/diagnóstico , Osteomielitis/terapia , Paroniquia/diagnóstico , Paroniquia/terapia , Infecciones de los Tejidos Blandos/diagnóstico , Infecciones de los Tejidos Blandos/terapia , Tenosinovitis/diagnóstico , Tenosinovitis/terapiaRESUMEN
Cerebral thrombophlebitis is a rare but severe disease whose underestimated frequency is increasingly recognized among children and, unlike adults, management is controversial. We report the case of a 12-year old child bitten by a friend at the level of the scalp, in the frontotemporal region of the head. This bite evolved due to the occurrence of a swelling evoking a frontotemporoparietal cellulitis complicated by cerebral thrombophlebitis, diagnosed based on the clinical feature and imaging. The patient was admitted in our hospital in a state of conscience disorder. Anticoagulant and etiological treatments enabled good clinical evolution.
Asunto(s)
Mordeduras Humanas/complicaciones , Celulitis (Flemón)/etiología , Trombosis Intracraneal/etiología , Tromboflebitis/etiología , Corticoesteroides/administración & dosificación , Analgésicos/administración & dosificación , Mordeduras Humanas/diagnóstico , Mordeduras Humanas/terapia , Celulitis (Flemón)/diagnóstico , Celulitis (Flemón)/terapia , Niño , Trastornos de la Conciencia/diagnóstico , Trastornos de la Conciencia/etiología , Trastornos de la Conciencia/terapia , Enoxaparina/uso terapéutico , Humanos , Trombosis Intracraneal/diagnóstico , Trombosis Intracraneal/terapia , Masculino , Oxígeno/uso terapéutico , Cuero Cabelludo/irrigación sanguínea , Cuero Cabelludo/patología , Tromboflebitis/diagnóstico , Tromboflebitis/terapiaRESUMEN
Antimicrobial therapy is not straightforward with the 4 infectious conditions reviewed here. Combination therapy at the start must usually be tailored once an organism is known.
Asunto(s)
Mano/microbiología , Infecciones/tratamiento farmacológico , Infecciones/microbiología , Antibacterianos/uso terapéutico , Antivirales/uso terapéutico , Mordeduras Humanas/diagnóstico , Mordeduras Humanas/diagnóstico por imagen , Mordeduras Humanas/fisiopatología , Eikenella/patogenicidad , Violeta de Genciana/análisis , Infecciones por Bacterias Gramnegativas/diagnóstico , Infecciones por Bacterias Gramnegativas/tratamiento farmacológico , Infecciones por Bacterias Gramnegativas/microbiología , Herpesvirus Humano 1/efectos de los fármacos , Herpesvirus Humano 1/patogenicidad , Humanos , Fenazinas/análisis , Examen Físico/métodos , Tenosinovitis/diagnóstico , Tenosinovitis/tratamiento farmacológico , Tenosinovitis/microbiologíaRESUMEN
In the United States, nearly 56% of households owned a pet in 2011 according to the 2012 U.S. Pet Ownership & Demographics Sourcebook by the American Veterinary Medical Association. The survey also reports that approximately 70 million dogs and 74 million cats lived in households in the United States during the same year. (1)Human and animal bites are a frequent cause of primary care and emergency department visits for children. It is estimated that 250,000 human bites, 400,000 cat bites, and 4.5 million dog bites occur in the United States each year in both adults and children. (2) In the United States, approximately 10% of all human bites will become infected in a child with a bite wound. The infection rate of dog bites in children is 20%. Cat bite infection rates in children vary but can be up to 50%. Each type of bite wound has a predisposition for sex and/or age. Infected bite wounds manifest with swelling, erythema, and tenderness with or without drainage of the affected site and can lead to serious complications. Most animal bite wounds are polymicrobial in nature. Pasteurella species (spp.) is the most common organism isolated from both cat and dog bites. The microbiology of human bites consists of both aerobic and anaerobic bacteria.Basic medical management of bite wounds includes thorough cleansing and debridement. Irrigation, closure, and need to obtain culture depend on the type of bite wound, the appearance of the wound, the and timing of medical evaluation after the initial injury. Amoxicillin-clavulanate is the antibiotic of choice for prophylaxis and empirical therapy for children who are not allergic to penicillin. With most animal bites being preventable injuries, healthcare providers caring for children have an important role discussing pet safety with the child and the family.
Asunto(s)
Mordeduras y Picaduras , Animales , Mordeduras y Picaduras/complicaciones , Mordeduras y Picaduras/diagnóstico , Mordeduras y Picaduras/epidemiología , Mordeduras y Picaduras/terapia , Mordeduras Humanas/complicaciones , Mordeduras Humanas/diagnóstico , Mordeduras Humanas/epidemiología , Mordeduras Humanas/terapia , Gatos , Niño , Perros , Humanos , Estados Unidos/epidemiologíaRESUMEN
Skin injury is the most common form of child physical abuse. Although the pattern and visual appearance of skin injury and the treatment needed for the injury is similar in children and adults, characteristics of infant and childhood skin may complicate the diagnosis of injury. A good understanding of normal developmental presentation of accidental injury from infancy to adulthood, locations for injury that should trigger consideration of abuse, and cutaneous mimics of abuse across the lifespan are critical to the identification of suspected abuse. Adults and older children can provide a history directly to providers, though it should be noted that abused adults and children may not always disclose the true cause of their injuries. In infants and very young children, a history from the patient is lacking due to the verbal abilities of the child, and a parent or other caregiver may provide a false or misleading history that can complicate the diagnosis and treatment. The approach to taking the history, when abuse is suspected, is a critical part of the evaluation, and best practice will vary depending on whether your patient is a child or an adult.
Asunto(s)
Mordeduras Humanas/diagnóstico , Quemaduras/etiología , Maltrato a los Niños/diagnóstico , Contusiones/etiología , Piel/lesiones , Adolescente , Adulto , Factores de Edad , Quemaduras/diagnóstico , Niño , Maltrato a los Niños/legislación & jurisprudencia , Preescolar , Contusiones/diagnóstico , Humanos , Lactante , Recién Nacido , Notificación Obligatoria , Anamnesis , Examen FísicoRESUMEN
In all 50 states, health care providers (including dentists) are mandated to report suspected cases of abuse and neglect to social service or law enforcement agencies. The purpose of this report is to review the oral and dental aspects of physical and sexual abuse and dental neglect in children and the role of pediatric care providers and dental providers in evaluating such conditions. This report addresses the evaluation of bite marks as well as perioral and intraoral injuries, infections, and diseases that may raise suspicion for child abuse or neglect. Oral health issues can also be associated with bullying and are commonly seen in human trafficking victims. Some medical providers may receive less education pertaining to oral health and dental injury and disease and may not detect the mouth and gum findings that are related to abuse or neglect as readily as they detect those involving other areas of the body. Therefore, pediatric care providers and dental providers are encouraged to collaborate to increase the prevention, detection, and treatment of these conditions in children.
Asunto(s)
Maltrato a los Niños/diagnóstico , Boca/lesiones , Traumatismos de los Dientes/etiología , Mordeduras Humanas/diagnóstico , Niño , Humanos , Guías de Práctica Clínica como AsuntoRESUMEN
Bite marks are rarely seen in forensic medical examinations. In most cases one can easily differentiate whether a bite mark is of human or animal origin due to the arched shape and crushed character of human bite marks. From a forensic point of view it is more interesting whether a dental imprint has been caused by an adult or a child, because children are often abused for a defensive statement. Two cases of bite injuries in children are presented. In the first case, a two-month-old infant was presented by pediatricians. The second case deals with a one-year-old boy who had allegedly been bitten several times by a two-year-old girl in a nursery school. A comparison could be performed between the bite mark impressions on the victim's skin (based on photographic documentation) and dental imprints of single teeth measuring the tooth width on the one hand and the intercanine distance on the other hand with the help of modeling wax plates. This procedure showed good correlations between the bite marks on the victim and the dental status of the biter. Especially for taking bite impressions on children, modeling wax plates are a simple, fast and cheap alternative to dental impression-taking.
Asunto(s)
Mordeduras Humanas/diagnóstico , Maltrato a los Niños/legislación & jurisprudencia , Odontología Forense/legislación & jurisprudencia , Diagnóstico Diferencial , Testimonio de Experto/legislación & jurisprudencia , Femenino , Humanos , Lactante , Masculino , Modelos Dentales , Fotograbar , Adulto JovenRESUMEN
Human bite wounds to the hand are relatively common injuries and are associated with high infection rates. Given the unique anatomy of the hand, the bite mechanism and the organisms found in human saliva, even the smallest wound can result in an aggressive infection. Failure to recognise and treat human bite wounds appropriately, can therefore have negative outcomes for patients. This article outlines the diagnostic features of, and complications associated with, bite wounds and discusses the recommended treatment options.
Asunto(s)
Antibacterianos/uso terapéutico , Mordeduras Humanas/diagnóstico , Mordeduras Humanas/enfermería , Traumatismos de la Mano/diagnóstico , Traumatismos de la Mano/enfermería , Infecciones/tratamiento farmacológico , Adulto , Mordeduras Humanas/microbiología , Femenino , Traumatismos de la Mano/microbiología , Humanos , Factores de RiesgoAsunto(s)
Mordeduras Humanas/terapia , Conocimientos, Actitudes y Práctica en Salud , Laceraciones/diagnóstico , Laceraciones/terapia , Enfermedades Cutáneas Bacterianas/diagnóstico , Enfermedades Cutáneas Bacterianas/terapia , Adulto , Antibacterianos/uso terapéutico , Mordeduras Humanas/diagnóstico , Terapia Combinada , Desbridamiento/métodos , Diagnóstico Diferencial , Humanos , Masculino , Piel/efectos de los fármacos , Piel/lesiones , Resultado del TratamientoRESUMEN
Subcutaneous facial emphysema is a well-known consequence of oral and maxillofacial traumatic injury. In some rare cases, the subcutaneous air collection could spread through the retropharyngeal and paralatero-cervical spaces, reaching the mediastinum. This clinical entity is known as pneumomediastinum and represents a severe and, sometimes, life-threatening condition. Other reported causes of pneumomediastinum are esophageal and tracheal traumatic or iatrogenic rupture. Finally, the so-called spontaneous pneumomediastinum is caused by a sudden increase in alveolar pressure and is usually seen in young men. We present two cases of pneumomediastinum as a consequence of unusual traumatic damage of orofacial tissues, followed by repeated sneezing and Valsalva maneuver.
Asunto(s)
Traumatismos en Atletas/complicaciones , Traumatismos en Atletas/diagnóstico , Mordeduras Humanas/complicaciones , Mordeduras Humanas/diagnóstico , Mejilla/lesiones , Fracturas Maxilares/complicaciones , Fracturas Maxilares/diagnóstico , Enfisema Mediastínico/etiología , Fútbol/lesiones , Enfisema Subcutáneo/complicaciones , Enfisema Subcutáneo/etiología , Heridas no Penetrantes/complicaciones , Heridas no Penetrantes/diagnóstico , Adulto , Traumatismos en Atletas/cirugía , Placas Óseas , Estudios de Seguimiento , Fijación Interna de Fracturas , Humanos , Masculino , Fracturas Maxilares/cirugía , Enfisema Mediastínico/cirugía , Estornudo , Enfisema Subcutáneo/cirugía , Tomografía Computarizada por Rayos X , Maniobra de Valsalva , Heridas no Penetrantes/cirugía , Adulto JovenRESUMEN
Se estima que las mordeduras de animales representan aproximadamente el 1% de las consultas pediátricas urgentes. El miedo popular, sobre todo a la temida rabia, sumado a la presencia de una aparatosa herida, hace que la consulta genere una importante preocupación en los padres. Sin embargo, cuando se trata de una mordedura de serpiente, no es raro que los padres estén tranquilos y sea el pediatra el que muestre preocupación. Se presenta una revisión sobre el tema con el objetivo principal de recomendar una actitud general para tratar las mordeduras en niños. Se realizan además una serie de apreciaciones sobre algunos casos en particular, como por ejemplo las mordeduras de serpiente, siempre valorando las posibilidades reales en territorio español, sin considerar animales tropicales o exóticos. También se aborda en un apartado especial el riesgo de transmisión de la rabia en nuestro medio (AU)
It is estimated that animal bites account for about 1% of pediatric emergency department visits. The popular fear, especially the dreaded rabies, coupled with the presence of a large wound, usually causes fear in parents. However, when the bite comes from a snake, it is not uncommon that parents feel relaxed, whereas the one who is concerned is the pediatrician. A review of the subject is presented with the aim of recommending a general attitude to treat animal bites in children. Several comments about some particular cases are also described, such as snake bites, always considering the real possibilities in the Spanish territory, regardless tropical or exotic animals. The risk of rabies transmission in our country is also covered in this document (AU)
Asunto(s)
Adolescente , Niño , Preescolar , Femenino , Humanos , Lactante , Masculino , Mordeduras de Serpientes/epidemiología , Mordeduras y Picaduras/epidemiología , Mordeduras y Picaduras/prevención & control , Mordeduras Humanas/epidemiología , Atención Primaria de Salud/métodos , Atención Primaria de Salud/tendencias , Profilaxis Antibiótica/instrumentación , Profilaxis Antibiótica/métodos , Mordeduras de Serpientes/diagnóstico , Mordeduras de Serpientes/terapia , Mordeduras y Picaduras/diagnóstico , Mordeduras y Picaduras/terapia , Mordeduras Humanas/diagnóstico , Mordeduras Humanas/terapia , Atención Primaria de Salud/estadística & datos numéricos , Atención Primaria de Salud/normas , Atención Primaria de SaludAsunto(s)
Odontología Forense/métodos , Determinación de la Edad por los Dientes , Mordeduras Humanas/diagnóstico , California , Crimen , ADN/análisis , Registros Odontológicos , Dentición , Víctimas de Desastres , Antropología Forense/métodos , Control de Formularios y Registros , Humanos , Radiografía Dental , Sociedades Odontológicas/organización & administración , Estados UnidosRESUMEN
BACKGROUND: 30,000 to 50,000 injuries are caused by bites in Germany every year. Dog and cat bites are common, human bites relatively rare. 25% of the victims are under age 6, and 34% are aged 6 to 17. METHODS: This review is based on pertinent literature retrieved by a selective search and on the authors' clinical and scientific experience. RESULTS: In small children, most bite wounds are on the head and neck; in older children and adolescents, most are on the limbs. Bite injuries range from trivial ones needing no medical intervention to major soft-tissue defects with the loss of functionally important structures. A bite can transmit unusual pathogens from the saliva into the wound. The risk of infection after a bite is 10-20%, and about 30-60% of the infections are of mixed aerobic-anaerobic origin. Prophylactic antibiotics are recommended only for wounds that are considered at high risk of infection in view of their type and location, the species of the biting animal, and the characteristics of the patient. CONCLUSION: Structured surgical management of bite wounds is the most important factor in the prevention of infection. High-risk wounds must be differentiated from trivial ones. Interdisciplinary management is advisable for wounds on the hands and face.
Asunto(s)
Mordeduras y Picaduras/diagnóstico , Mordeduras y Picaduras/terapia , Infecciones/diagnóstico , Infecciones/terapia , Heridas Penetrantes/diagnóstico , Heridas Penetrantes/terapia , Animales , Mordeduras y Picaduras/epidemiología , Mordeduras Humanas/diagnóstico , Mordeduras Humanas/epidemiología , Mordeduras Humanas/terapia , Causalidad , Cricetinae , Perros , Medicina Basada en la Evidencia , Alemania , Cobayas , Humanos , Infecciones/epidemiología , Ratones , Conejos , Ratas , Factores de Riesgo , Heridas Penetrantes/epidemiologíaRESUMEN
The identification of a bite injury and its differentiation between human and animal origin demand a high level of special knowledge from the examining physician. The evaluation of bite injuries in terms of their hazard potential, risk profile and origin is usually done by a forensic specialist based on medical record documentation after immediate medical treatment. Therefore, as a first responder, a detailed documentation of the entire injury pattern is essential. If necessary, samples for further DNA analysis should be taken.The present article is intended to give a brief introduction to various aspects of bite injuries as well as to point out possibilities and limitations of the assessment of such cases.
Asunto(s)
Mordeduras y Picaduras/diagnóstico , Perros , Testimonio de Experto/legislación & jurisprudencia , Animales , Mordeduras y Picaduras/clasificación , Mordeduras y Picaduras/epidemiología , Mordeduras y Picaduras/terapia , Mordeduras Humanas/clasificación , Mordeduras Humanas/diagnóstico , Mordeduras Humanas/epidemiología , Mordeduras Humanas/terapia , Conducta Cooperativa , Estudios Transversales , Dermatoglifia del ADN , Diagnóstico Diferencial , Humanos , Comunicación Interdisciplinaria , Registros Médicos Orientados a Problemas , Modelos de Riesgos ProporcionalesRESUMEN
INTRODUCTION: Traumatic lip injuries present major challenges in terms of reconstructive options and the outcome of surgical management. The aetiology of lip injuries includes human bite as interpersonal violence. Bite wounds are always considered to be complex injuries contaminated with unique polymicrobial inoculum. A classification of facial bite injuries has been included and the surgical management of these lesions has also been discussed. We report a rare bite injury on the lower lip that resembled an ulcerative process. CASE PRESENTATION: A 30-year-old African man presented with a severe tissue defect on his lower lip to a Dental and Oral Department in Tanzania. He explained that 12 days ago he had been involved in a fight and someone had bitten his lower lip. An orofacial examination confirmed a serious loss of lip tissue that resembled a chronic ulcerative process. Accurate assessment of the lesion was made by a thorough evaluation of some parameters such as size, depth, presence of granulation tissue, fibrin coverage, wound edges, exudates and/or necrosis. A surgical debridement under local anaesthesia was carried out. Afterwards a layered suture was performed. Eventually the healing was complete and satisfactory. CONCLUSIONS: A severe bite avulsive wound on the lower lip, despite the elapsed time before treatment, may have an excellent prognosis after a simple surgical procedure.