Bull gore injury-Buccal mucosa

Introduction

Bull horn injuries are defined as injuries by the horns of a animals (bull, cow, buffalo). Bull horn injuries are commonly observed in rural areas where there is a large population of livestock and the oxen are frequently employed for ploughing the fields and various domestic works. Bull horn injuries are very frequently encountered in villages and rural areas and the incidence is very less in the urban areas^1,2.

Case Report

An elderly man was presented in the OPD with a history of injury in the buccal cavity on the left side. He sustained the injury while he was feeding the bull. He was shifted immediately to the hospital with immobilization of oral cavity.

On examination the oral cavity revealed a “v” shaped laceration measuring of 15 cms x 3 cms at largest point with 2 cms depth over the left buccal mucosa (Fug, 1). Under short GA, the wound was explored. The buccal pad of fat was protruding through the laceration (Fig. 2). Luckily there was no injury to the papilla and parotid duct. The wound was cleaned nicely and suturing was done in two layers after replacing the buccal pad of fat.

Liquid diet was prescribed for 1 week, in order to prevent the mobility. Mouth gargling was prescribed 2nd hourly. Inj Ceftraixone and Metrogyl were given for 3 days, along with oral Seratiopeptidase. Patient recovered well.

Discussion

Knowledge of the mechanism of injury by bull horns is important to appreciate the complexity of these wounds. As the bull charges and accelerates toward its subject, it initially lowers its head by neck flexion right before engaging; it then extends its neck powerfully, driving one or both horns into the subject. The mass of the animal combined with its acceleration result in tremendous amounts of force being applied at the point of entry of the sharp horn. The bull follows through with its neck extension while engaged with the subject with its horn(s). As the subject is raised violently off the ground, the bull’s head stereotypically tosses its head in a circular movement. The horn thereby acts as a fixed vertical axis, while the powerful head movement turns the victim, with all his weight on it, about the horn(s), causing further shearing^7,8. This combined motion results in massive deep tissue damage.

The largest series of bull gor injuries published to date have been obtained from Spain and Latin America, but these injuries occur during bull fighting events and are mostly provoked injuries with a probably higher intensity are much different from the injuries in the Indian rural scenario.

The horns of bull are long, curved with smooth tapering ends that produce lacerations and can also penetrate the body cavities.^2,4 The patterns of injuries sustained by the victim vary depending on the height of the victim, the height of the bull, and position of the animal and the victim at the time of the attack by the bull. The common site of injury in bull-horn cases is the chest, abdomen and perineal region.^2,4

The anatomy of the perineal region is complex and visualization and access to various structures in the region is difficult.⁶ Perineal injuries are associated with delayed complications like anovaginal fistula, urethrorectal fistula, loss of sphincter function due to injury to the anal canal.³ Hence, the repair of injury in the area needs a complete knowledge about the anatomy of the region and expert surgical skills. Usually these injuries are associated with injury to the abdominal and urological structures. In females the anatomy of the perineum is further complicated by the presence of the uterus, vagina and the various supporting ligament.⁵

In the abdomen, the horn first enters the skin and subcutaneous tissues and later muscles, and further if the violence is more, the peritoneum is punctured with the involvement of viscera with tear. A distinctive feature of domestic bull horn injuries is that prolapse of the bowel through the abdominal wall, but rarely it is associated with damage to or perforation of the intestine itself.

Summary

A bull gore injury causing laceration of buccal mucosa is reported.