This child was mauled by a stray dog in the middle of the second wave of covid. The child had injuries all around the face most prominently along the right lower eyelid, nose and a huge gash on the left cheek.
The child was quickly taken up for primary suturing of facial wounds. During the wound exploration, we noted that the right MCL was ripped out off it’s bony attachment possibly along with the lacrimal sac. A very large hematoma was also noted in the same area which was cleared. There was severe facial oedema during surgery so we chose to only do primary suturing of the eyelid and facial wounds at the time and to plan further management later.
Post operatively on late review, the facial wounds had healed well but the child developed tearing (epiphora) on the right side and the child also had chronic dacryocystitis on the same side. The marked Telcanthus confirmed the MCL detachment noted intraoperatively.
The CT scan images revealing a soft tissue swelling around right medial canthus including the lacrimal sac abscess (indicated by the red arrow)
A second surgery was performed. A DCR was done using the pre-existing sub-ciliary scar continuing on to the upper lid. (See photo below to to see the marked U shaped incision). MCL was identified, scar tissue excised and MCL reattached to correct position. Distal canalicululi was stenosed and scarred. A DCR with bicanalicular silicone intubation was done. Mitomycin C was instilled locally to reduce fibroblastic activity and scarring.
The outcome was extremely good as seen in the first picture. The child’s eyelid shape was restored, tearing and chronic dacryocystitis resolved. All this was done using aesthetically placed incisions recruiting the old scars from the initial injury. This has been an extremely satisfying surgery.
Stay dogs can be an important cause of trauma in India. It is especially more common in small kids who are about the size of a grown up dog or smaller. It is advisable to keep kids away from exposure to stray dogs on the streets which can get suddenly violent if they perceive the kid as a threat. Dogs are great and cute creatures but can be dangerous to kids in certain circumstances.
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DR. RAGHURAJ HEGDE 