An Uncommon Presentation of Camel Bite Injury to the Head with Frontal Calvarial Bone Loss

Copyright: © 2014 Balan JR et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. An Uncommon Presentation of Camel Bite Injury to the Head with Frontal Calvarial Bone Loss Jyoshid R Balan*1, Jerry R John2, and Ramesh Kumar Sharma2 1Sushruta Institute of Plastic Surgery, Elite Mission hospital, Thrissur, Kerala – 680007, India 2Post Graduate Institute of Medical Education and Research, Chandigarh, India


Introduction
Camel with calm look on their face can be extremely dangerous causing bite injury which may be sometimes life threatening. Among the animal bite injuries it represents a minimal proportion. It has been reported that camels become aggressive especially during mating seasons. There are reported cases of camel bite especially from the gulf countries.
Running head: Camel bite injury with calvarial bone loss.

Case report
Our patient 40 year old gentle man a camel care giver by profession presented to our emergency department with bleeding wound over the right side of face. On examination we noticed avulsion of right side scalp with fore head, nose and cheek ( Figure 1). There was loss of part of frontal bone with loss of dura from the frontal cortex ( Figure 1). Emergency surgery was performed in the form of wound debridement, dural reconstruction with tensor fascia lata, nose closure in layers and skin closure ( Figure 2). The post-operative period was well tolerated. There was no functional defecit over a follow up period of three months. There was bony deformity over right frontal region which requires further reconstruction ( Figure 3). The patient was not for any bony reconstruction since he had a good functional recovery.

Abstract
Animal bite injuries are common worldwide, camel bite being uncommon and unusual one. Here we present a case report of camel bite over right frontal region amounting to loss of part of frontal bone with avulsion of forehead and nose and right side cheek.

Discussion
Even in the modern world the incidence of animal bite injuries is not less, extending from the domestic to wild animals. Out of these animals the camel bites are very unusual and uncommon injury. The reported cases of camel bite injuries are few in number and most of them from the middle-east countries.
Suess et al. [1] has reported a severe case of camel bite injury over the head of a 3 year old child, who required urgent neurosurgical management. There was depressed skull bone fracture with brain parenchymal injury. In our case the injury was too extensive with loss of part of frontal bone exposing the dura and part of brain parenchyma which was tackled with a tensor fascia lata graft.
Abu-Zidan et al. [2] in his study showed that 15% of camel bite involves the head and neck region, upper extremity being the commonly involved region (64%). He even noted death of patient with neck bite and having brain infarct. The same author [3] in another epidemiological study of camel related injury noticed 25% of the injury happens due to bite injuries especially during the rutting season. Khatana et al. [4] in his study demonstrated a severe maxillofacial injury in the form of ramus of the mandible fracture with extensive soft tissue injury which required immediate surgical management.
Among the animal bites crocodiles and alligator top the table while taking the bite force and when the mammals are considered hippopotamus (even though a herbivore) tops the table. We never expect a calm looking camel will cause extensive injuries amounting to death.

Conclusion
The camel bite even though being unusual and uncommon may cause extensive injury to the victim requiring urgent medical attention.