Management of a late presentation of bear mauling with a complex maxillofacial defect in a tertiary care hospital - A case report

Rationale: Bear mauling is the most common wild animal-inflicted injury in India. Ideally, these injuries should be managed early with fracture fixation, wound debridement, and appropriate coverage. Delay may lead to devascularization and a more severe deformity, which needs complex and multi-staged procedures for optimal outcome. Patient Concerns: Facial deformity in bear mauling is upsetting to the patient. Apart from facial aesthetics, the victim has difficulties in speech, eating, and respiration when the midface is involved. Diagnosis and Treatment: Patients require proper assessment of the soft tissue and bony defects by clinical assessment and imaging before planning any reconstruction. Outcome: The complex defect was managed in stages by both microsurgical and nonmicrosurgical methods including debridement, fracture fixation, local flaps, free flap, and prosthesis. Take-away Lessons: Systematic approach in categorizing each component of the problem, finding the best possible solution for each of them, and inter-departmental collaboration are important.