Surgical management of a patient with severe and complex maxillofacial injuries caused by a bear mauling in the forest: A case report from Thailand

A 60-year-old Thai male sustained severe and complex maxillofacial injuries, along with superficial neck and abdominal injuries, from being mauled by a black bear in Thailand. The accident caused massive injury to the face, including the right eye and periorbital soft tissue, right cheek, total nose, total upper lip, partial lower lip, and underlying bone structures. A computed tomography scan showed comminuted pan-facial fractures. Lifesaving procedures were performed at nearby hospitals, and then he was referred to our center one month after the injury. Our initial multi-stage surgical management strategy for treating this patient included debridement, right eyeball enucleation, coverage of the entire defect with anterolateral thigh with vastus lateralis chimeric free flap, and gastrostomy tube insertion to ensure appropriate nutrition. The next phase of treatment involved total nasal reconstruction with the two-stage folded paramedian forehead flap with cadaveric costal cartilage grafts. The outcomes of treatments provided the patient with spontaneous breathing via neonostrils and eating directly through his mouth. This case report demonstrates that satisfactory results can be achieved using a well-planned multi-stage reconstruction strategy.