Dog Bite to Face/Nose

SeungJu Jackie Oh MD
, Michael Alperovich MD


22-year-old male patient with past medical history of skin cancer presenting with dog bite to face (his own dog) was transferred from outside hospital. No other associated injuries and facial x-rays were completed prior to transfer and were negative for any facial fractures.


Forehead: Abrasions over right forehead

Orbits: Small superficial laceration over right upper lateral eyelid. No periorbital ecchymosis, telecanthus, orbital tenderness, step-offs, or vertical dystopia.

Ophthalmology: No subconjunctival hemorrhage, no globe laceration/abrasion/rupture, no enophthalmos or exophthalmos; PERRLA; EOMI with no evidence of entrapment; vision and visual fields grossly intact

Nose: 4 cm diagonal laceration involving the upper and lower lateral cartilage (i.e. scroll area). Nasal bones were stable. No septal hematoma, no septal deviation.

Maxilla/Mandible: unremarkable

Sensation in involved areas was intact.

Facial motor exam: Normal and symmetric

Figure 1: Zoomed out clinical image of all injuries- abrasion over right forehead, small superficial laceration over right upper lateral eyelid, and 4 cm diagonal laceration involving the upper and lower lateral nasal cartilage (i.e. scroll area).

Figure 2: Abrasions over right forehead, along with small superficial laceration over right upper lateral eyelid.

Figure 3: 4 cm diagonal laceration involving the upper and lower lateral nasal cartilage (i.e. scroll area).


Dog bite with complex laceration of nose, superficial linear laceration over right upper eyelid, and abrasions on right forehead.

Differential Diagnoses:

R/O fractures, levator muscle or lacrimal duct injuries.

Workup Required:

CT head and CTFB negative for acute traumatic injuries. Complete cranial nerve exam unremarkable. Denies changes in vision, breathing, malocclusion, and no loose/ fractured teeth noted on exam. Patient prepared for ED wound washout and closure.


Complex repair of lacerations under nerve block in the ED.

Expertise Needed:

Plastic Surgeon.


Patient was placed in a supine position. Combination of local field block over right upper eyelid and nasal dorsum, and right infra-orbital nerve block (palpated intra-orbital foramen at mid-pupillary line and injected intra-orally) given with 5cc total of 2% lidocaine. Wound was thoroughly irrigated with normal saline. Then proceeded with approximation of upper and lower lateral cartilage to re-define scroll area with 5-0 Monocryl (buried simple interrupted). Remainder of skin (both nose and right upper eyelid) closed with 6.0 Prolene in simple interrupted fashion. Bacitracin was applied to wound. Patient tolerated the procedure well.

Figure 4: S/p bedside repair of linear right eyelid and complex nose lacerations

Follow Up:

Seen in clinic 1 week with well-healing wound. Prolene sutures removed. Was recommended to continue 1 additional week of twice daily bacitracin. Start scar massage 6 weeks following injury, 2-3 times daily x2 minutes each time. Discussed possible scar revision should he be concerned about scar later. Patient education provided and advised waiting 6 months to 1 year to allow scar maturation. Follow-up PRS clinic 1 month.

Figure 5: 3-months following complex repair with smooth contour. Scars may require surgical revision.

Figure 6: Well-healed upper eyelid laceration repair.

Print Friendly, PDF & Email


Laceration Repair: A Practical Approach
Soft Tissue Trauma Over Nose
Soft Tissue Trauma to the Nose: Management and Special Considerations

Related Articles