Dr. Joel Aronowitz - Real Patients Real Stories – Graphic Dog Bite to Face Trauma Surgery & Postop Facial Defect Anatomy
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| Dr. Joel Aronowitz |
Dr. Joel Aronowitz: “So, this is a terrible dog attack tonight and we have lacerations in the labella of the down to the periosteum. Turn your head a little bit away from me. The clamp is on the superficial temporal vein and then we can see the pre-auricular area here down to the parotid and the facial nerve is going to be at this layer but the facial nerve fortunately is intact. Go ahead and smile for me. And you can see the zygomatic branch is working just fine. But raise your eyebrow. But the frontal branch is not. The frontal branch is either been lacerated or badly contused. And then on this side we have lacerations of the upper eyelid. Raise your eye lid for me. But the levator is intact. And the laceration in the cheek and lower lid area. The lower lid and an avulsion of the area just above the lobula of the ear. So we have some work to do and then we'll take a look at what everything looks like Okay, well done. Let's see how you look. There's your many lacerations on the lid, the nasoglabella and the cheek. And then we have the one on your hand. The ones on your leg were already repaired. And Bridget you did such a good job. Turn your head away from me a little bit. Yeah, that looks good. Very nice. Here we are now. How long has it been since the dog attack? August, September, October. Yeah, a month and a half only. And you had a very severe dog bite to both sides of your face with multiple cuts on the left upper lid and multiple cuts on the right side of your face. This is all torn completely from your face and this part was torn down. And now we're looking at how your scars look and some of the problems from the injury. So I want to first show people what the facial nerve problem is, okay? And thank you for cooperating with us so we can teach others. So the facial nerve comes out of the stylo-masculine frame and deep down here just below the ear and it spreads across the face and one branch goes here and one branch goes to the eye and one branch goes to the smile and one branch goes to the sneer pulling the lip down and one branch goes to the neck. So if you raise your eyebrow for me, that's one branch. And now squint really hard, closure eye really hard, this muscle going around that closes. Now relax and smile real big and we have the zygomaticus muscle and then sneer like, show me your teeth. So the depressor of the lower lip here, that's one branch and then the last branch is this one in the neck like that and you can see his platysma here. So that all looks good but on this side where he had an injury up here to the facial nerve as it goes up into the forehead, raise your eyebrow, you can see on this side the frontalis muscle like a blind that lifts up like this, it works just fine but on this side it doesn't. The reason is because that nerve has been, was crushed in the dog bite unfortunately. Here is the scar and here is the scar from the injury out on the cheek and that's healing up very nicely and over here we can see where the scar is where this was all torn up and it's actually healing beautifully. It's lucky you're a handsome man to start with. Now we're just talking about why does the, when he looks in the mirror he says I look scary sometimes and I made a joke that it's because of his bun but it's not because of your bun is it? It's because when we look at you we're expecting to see the same opening of the eye on both sides, we call this the orbital fissure. So we should be about the same on both sides and we shouldn't see too much of the white, the sclera of the eye and here the upper lid had several cuts which you can't even see now, the scars have healed beautifully but the scar tissue is pushing down a little bit so this eye he has a little pushing down of the lid called ptosis where the eyelid is drooping a little too much over the pupil of the, over the iris of the eye and over here he doesn't so the upper lid on this side is in the correct spot and the upper lid on this side is a little too low and then over here the lower lid is too low, looks up a little bit more and we see too much white here on the lower and here we see the right amount of sclera or white so when we see too much white of the eye that looks scary and that's why that looks a little bit scary to you and maybe and is why you look asymmetric and over time as that scar tissue softens and may require a little steroid injection, may require some other things that a oculoplastic surgeon may want, we may need him to help us with or her to help us with later on but right now at only this brief time after the injury what we're going to do is just give his own body time for that scar tissue to mature and for these things to take care of after all this? Yeah, yeah.
Good, well that's good to not hold any grudges in your heart, I think that's good advice. I tested myself but I failed, the other day a pit bull passed by me and I was drinking coffee and my friend he took off and I said I want to test myself but as soon as the dog got too close to me I jumped and he attacked me. Oh really? Yeah but he attacked me because he sensed fear. Yeah, so maybe it's a little too soon to test yourself, a little too soon. But not with pit bull. Yeah, start with chihuahuas and maybe start with cats and we're good.
But thank you for sharing your story and letting us show people what that looks like because I think it's helpful to kind of analyze the anatomy. I mean like every doctor I show him this, the ophthalmologist, he said this is a great job. I mean like my Dr. Zaki he was questioning how we were able to do this this precise and he said it took like a lot of hours I think it was like six hours. It took a long time yeah, it took a long time and pretty fast though. But you're very welcome, you're very welcome. This time next year you're going to be a new man. Thank you so much. Okay, so we'll see you later from Aronowitz land.”
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