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Endgames Case Report

A human bite

BMJ 2012; 345 doi: (Published 17 July 2012) Cite this as: BMJ 2012;345:e4798
  1. David A Pettitt, final year medical student1,
  2. Adeyinka Molajo, clinical fellow in plastic and reconstructive surgery2,
  3. Paul McArthur, professor of plastic and reconstructive surgery2
  1. 1University of Liverpool, Liverpool L69 3BX, UK
  2. 2Whiston Hospital, Mersey Regional Plastic Surgery Unit, Liverpool, UK
  1. Correspondence to: D A Pettitt dapettitt{at}

A 26 year old man presented to the emergency department with a painful right ear after having been bitten three hours earlier during an altercation. He also reported receiving a blow to his right eye during the incident. He was normally fit and well and not taking any regular drugs. On examination, he was alert, orientated, and afebrile. His right ear and the immediate surrounding tissue were erythematous and swollen. Soft tissue from the helix was missing superiorly, and about a third of the skin covering the posterior surface of the auricle was absent. His right eye was purple and swollen, with conjunctival haemorrhage present. He had normal visual acuity and a score of 15 out of 15 on the Glasgow coma scale.


  • 1 What are your most immediate concerns?

  • 2 How would you treat this patient?

  • 3 Which immunisations should be considered for this patient?

  • 4 What other risks are associated with such injuries?

  • 5 What is the most appropriate management for this patient?


1 What are your most immediate concerns?

Short answer

The most immediate concern is the presence of a life threatening injury or fracture sustained through the head trauma. Human (and animal) bite wounds are also particularly susceptible to infection because of the multiple organisms found in saliva.

Long answer

The most immediate concern is the presence of a life threatening head injury and the next is the risk of infection. This patient sustained a traumatic insult to his right eye with periorbital bruising present on examination. The general principles of trauma management therefore apply. This should begin with an ABCDE (airway, breathing, circulation, disability, exposure) approach (according to Advanced Trauma Life Support guidelines) to rule out any life threatening injuries. The bruised eye should then be clinically assessed during the secondary survey, and …

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