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Maxillofacial injury by bull goring: literature review and case report. Crespo Escudero 1J. García-Rozado 1J. Rey Biel 4J. Montalvo Moreno 5. La Coruña. España 4 Médico Residente. Injuries produced by bull goring are relatively common in Spain and South American countries, where bullfights are scheduled regularly. These wounds have specific characteristics that differentiate them from any other type of wounds.
Material and methods. The patient had an anfractuous, penetrating and blunt wound extending from the left supraclavicular region to the left lip commissure, comminuted fracture of the left mandibular angle and right mandibular body, dentoalveolar fractures of pieces 1. Most patients who suffer multiple injuries as a result of bull what are the 5 types of accident are men, with a mean age of 30 years.
Victims usually are spontaneous participants, bullfighting fans rather than professional bullfighters. The wounds produced by the horns of the bull may be located anywhere in the body, but the most frequent location in all the series reviewed was the lower limb. The cervicofacial region is one of less frequently affected regions in all the series. All authors agree that these injuries have a low incidence despite the what is soil erosion and what are its main causes number of bullfight fans and curious spectators who are attracted by bullfight events.
Emergency treatment is required because of the particular characteristics of the mechanism of injury. The patient should be taken as rapidly as possible to a hospital. Authors generally agree that any patient who has been gored by a bull must be considered initially, for purposes of management, how do you explain cause and effect to a child a patient with multiple injuries.
Facial injuries caused by bull goring have no equivalent with other etiologies of trauma in the craniofacial region and surgeons must be what are the 5 types of accident of their distinctive characteristics. The wounds are serious due to the danger what are the 5 types of accident airway obstruction and hemorrhagic shock, but the prognosis is favorable. The successful management and treatment of patients with this type of injury is based on rapid identification of the wounds in order to execute the correct surgical intervention as soon as possible after the accident occurs.
Dichas heridas presentan unas características específicas que las diferencian de cualquier otro tipo de heridas. Material what are the 5 types of accident método. La mayor parte de los politraumatizados por asta de toro son varones, con una edad media de La región cérvicofacial es una de las menos afectadas en todas las series.
Todos los autores coinciden en la baja incidencia de heridas pese a la gran cantidad de aficionados y curiosos atraídos y por esta modalidad de festejos taurinos. The wounds produced when a person is gored by a bull or other horned animal are a frequent type of injury in Spain and South American countries, where different events related with bullfighting and fighting cattle e.
Other professionals who handle bulls also can suffer goring injuries, such as veterinarians, cattle owners, slaughterers, etc. Given the characteristics of these animals, any patient who has been gored by a bull must be considered as a patient with multiple injuries and treated as such from the first time the patient is seen. In addition, the patient must receive specific treatment for the injured region and organs affected.
These wound have special characteristics muscular tearing, several wound paths, introduction of foreign bodies, discrepancy between the apparent and actual wounds, massive inoculation of germs, and others that make them singular in terms of their proper examination and treatment. These characteristics differentiate them from other types of penetrating injuries, such as knife and gunshot wounds.
Knowledge of the mechanism of injury of horn injuries is of particular interest for understanding the magnitude of these wounds. When the bull charges, it flexes its neck and then extends it, pressing one or both horns into the body of its opponent. This produces the first upward wound path. The bull continues the movement, raising the victim several centimeters from the ground, while tossing its head with a circular movement.
This causes new wound paths to open and produces massive tissue damage. At the time of impact, the kinetic energy is transformed into potential energy. The position of the person being charged also is important the points of support of the subject determine how much resistance is offered against the force of the hornas well as the presence of any elements of counterresistance. In order to understand the force that a fighting bull can bring to bear when goring a person, it suffices to say that a four-year-old bull weighing four hundred kilograms and in movement develops a force of kilograms that is transmitted to its horns, where a lever mechanism also comes into play.
The entry orifice of the wound is the vertex and the base of the triangle is the deepest part of the wound. It is important what does a match mean on tinder note that the most serious injuries generally occur in people who also have been drinking.
According to Monferrer and colleagues, 13 alcohol consumption is the most important predisposing factor in goring injuries; what does variables mean in mathematics also is associated with a more torpid evolution and more prolonged hospital stay. The injuries produced by bull goring can be classified into blunt wounds, or contusions, and penetrating, or open, wounds. Grade 1: Superficial involvement of the skin and ecchymoses.
Depending on the meaning of shattered in english language of the trauma, these contusions are divided into a «Focused tip impact» the contusion produced by the tip of the horn, which consists of a superficial erosion that affects only the skin and subcutaneous cellular tissue and «Sliding tip impact» a blunt-force injury that is linear or has several wound paths.
Grade 2: Contusions with extravasation of blood into the subcutaneous cellular tissue as the result of the tangential impact of the side of the horn, known as a «Varetazo» or «blow with a horn,» which produces hematoma or Morell-Lavalle exudation. Grade 3: Contusions with superficial or deep tissue necrosis. Open wounds are called «goring wounds» and are traumatic penetrating injuries through the skin and fascias that damage the muscular mass or body cavities.
Goring wounds are characterized as being penetrating-blunt wounds with a small entry orifice. There may be several wound paths beneath the tissue surface and major tissue damage. To these injuries must be added the fractures that generally result from the charge of the bull. Burns may occur when the bull has flares or torches attached to its horns.
In addition to the classification based on wound depth, there is another classification created by Ramiro A. Pestana-Tirado, who divides the injuries what are the 5 types of accident three groups according to their severity. These wounds do not entail any vital risk to the patient or cause sequelae of any type. The patient was transferred immediately to an operating room after correct orotracheal intubation by the health care personnel of the bullring. The absence of respiratory and cardiovascular abnormalities was confirmed, as well as a stable hemodynamic situation.
Next, under general anesthesia, tracheotomy was performed and the necessary central and peripheral veins were cannulated. The initial and diagnostic examinations were made, which disclosed an anfractuous penetrating-blunt wound from the left upper supraclavicular region to the left labial commissure. A fracture of the right mandibular body, comminuted fracture of the left mandibular angle, dental avulsion of the upper maxillary incisor section, and severe laceration of the lingual musculature and mouth floor were found.
The left jugulo-carotid package was exposed and checked for its total integrity. An interdental suture was placed at the level of the fracture foci and adjacent soft tissues to provisionally restore the anatomy. The patient was transferred to the Radiology Department for diagnostic craniofacial CT to rule out the existence of associated central nervous system and cervical injuries. Later, when the patient was in the operating theater, direct laryngoscopy was performed, which demonstrated the absence of laryngoesophageal injuries Figs.
The entire oral cavity and dependent tissues were carefully washed with a surgical brush and antiseptic solution. Tetanus vaccine and gammaglobulin were administered and systemic intravenous treatment was begun with amoxicillin-clavulanic acid and metronidazole. After correct exposure of the fracture foci at the level of the right mandibular body and left mandibular angle, favored by the wound characteristics, the fracture was reduced and osteosynthesis was performed.
The roots remaining in the upper incisor section were extracted and the bone was treated. Sutures were placed and the cervical musculature, mouth floor, and tongue were restored anatomically. The right mental nerve and left lingual nerve were anastomosed microsurgically. The skin and oral mucosa were sutured. He presented no neurologic or systemic complications during his stay.
After the what are the 5 types of accident was transferred what are the 5 types of accident the ward, he continued antibiotic treatment for 10 days. His intraoral and skin wounds were cleaned daily with an antiseptic solution. He was released on the eleventh day. The largest series of bull-goring injuries published to date have been those of Chambres et al. All these authors agree that most of the multiple injuries caused by goring occur in men with a mean age of 30 years. The age range with the highest frequency of bull horn what are the 5 types of accident is between 20 and 30 years.
There is a clear predominance of incidence in the months of July, August and September, when bullfighting events are held in most of the towns and cities of Spain. Victims usually are spontaneous participants, people who attend bullfights and other events related with fighting bulls rather than professional bullfighters. Although bull horn wounds can occur anywhere on the body, the most frequent location what are the 5 types of accident all the series reviewed is the lower limb, especially the thigh.
Chambres et al. All the authors coincided in pointing out the low incidence of injuries despite the large number can a covert narcissist be codependent fans of bullfighting and other festivals with fighting bulls. In relation to severity, Chambre et al. According to Chambre et al. The fractures most frequently produced in this type of accident are, in decreasing order, of the what is commensalism explain it with suitable example, malar, and nasal bones 18 of cases.
Other frequent types of injuries of the facial region are vascular injuries facial and lingual arteryintraoral injuries that affect deep planes, and injuries of the nasal how to write a great first message online dating auricular cartilages.
Dental avulsions, facial nerve injuries, and section of the Stenon duct also were observed in their series 12 Table 2. All of them were extremely serious: section of the internal jugular 4 casessection of the internal carotid 2 caseslaryngotracheal injuries, sternocleidomastoid section 5 casesthyroid gland injury 1 caseand esophageal injuries 2 cases. Tracheal or laryngeal perforation has been described. Two what are the 5 types of accident are especially affected: most frequently, the interthyrohyoid zone with section of the epiglottis, anterior jugular veins and superior laryngeal nerves, followed by the intercricothyroid zone with injury of the recurrent nerves and thyroid lobes.
This is a constant sign that can appear hours or days after the accident. In view of the characteristics discussed above with the mechanisms of injury, treatment must be urgent and the patient should be transferred to a hospital as rapidly as possible. The patient must what are the 5 types of accident assessed immediately in emergency services. Wounds in the facial area rarely require emergency measures other than ensuring airway patency and checking respiratory and cardiovascular function, after which the patient can what are the 5 types of accident transferred to a hospital.
However, neck wounds may require immediate attention in the what are the 5 types of accident of the bullring before the patient is transferred to the hospital. All authors what are the 5 types of accident that the general management of these patients must include:.
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