Grievous Temporal and Occipital Injury Caused by a Bear Attack

Bear attacks are reported from nearly every part of the world. The chance of a human encountering a bear increases as the remote bear territory diminishes. The sloth bear is one of the three species of bears found in India, which inhabits the forests of India and its neighboring countries. Here we describe a teenager who came to us with a critical injury involving the face, temporal and occipital bones inflicted by a sloth bear attack. He underwent a temporal exploration, facial nerve decompression, pinna reconstruction, and occipital bone repair to save him from fatality. 1. Introduction Bear attacks on humans are rare and are even more rarely reported in medical literature. Each year people have numerous accidental interactions with bears. A very small fraction of this results in human injury. The chance of a human encountering a bear increases as the remote bear territory diminishes. A search of scientific literature reveals very few articles detailing case reports or an in-depth analysis of injuries due to bear mauling. Here we discuss the presentation and subsequent management of an 18-year-old young man who came to us in a state of shock with a history of an assault by a sloth bear which led to an avulsion of his temporal and occipital bones associated with a facial nerve paralysis. 2. Case Report An 18-year old teenager, a shepherd by occupation, presented to the emergency room in a state of shock with laceration of the ear and head, bleeding from the ear and the back of the head. A history by the relatives of the boy revealed that he had been mauled by a sloth bear in the forests of his native village where he had gone shepherding with his brother-in-law. To elaborate the account, which in itself is interesting, the two boys unexpectedly ran into a sloth bear in the forest, which attacked the brother-in-law. Seeing this, our boy ran to his rescue and in turn incurred the wrath of the bear on himself. While being mauled himself, the boy showed great presence of mind when, just as the bear was about to take a bite at his face, he hurled a rock piece from nearby into the bear’s mouth and kicked it in its belly. The bear was frightened and ran way. The boy started bleeding profusely from his right ear and the back of his head and following that he collapsed into unconsciousness. He was taken to the village health center where he was given first aid but no fluid replacement or wound inspection was done. The boy was referred to our department after a 3-hour journey. There was no history of vomiting or nasal bleed. On examination, we found the patient