DISCUSIÓN

Maxillofacial injury by bull goring: literature review and case report

Herida por asta de toro en el área maxilofacial: revisión de la literatura y presentación de un caso

Luis Antonio Sánchez Cuellar

Médico Adjunto. Servicio de Cirugía Oral y Maxilofacial. Hospital Universitario Río Hortega. Valladolid, España

The article describes the treatment of a patient who suffered serious cervicofacial trauma when gored by a bull. The epidemiology, pathogenesis, and diagnostic and therapeutic attitude to bull-goring injuries is reviewed.

As is well known, bullfighting and other festivals related with bulls are important in Spain and have economic, cultural, and artistic connotations. Bullfighting also is sometimes a focus of controversy and debate.

There are no reliable data on the incidence of accidents related with bullfighting. The number of accidents could be high, considering the following indirect data:

• Festivals celebrated in Spain in 2007: 7,762

• Number of professionals: 7,370

• Number of companies raising fighting bulls: 1,327

Of the 7,762 festivals celebrated the last year, 4,111 were popular events featuring bulls rather than professional bullfights. Professional bullfighters do not take part in these events and they usually are celebrated in third-ranked or portable bullrings, or in open and municipal spaces. The festivals are held mainly in July and August, when 4,941 took place last year.

The legislation that regulates the health facilities and medical and surgical services of bullfighting events is found in Royal Decree 1649/1997. These services may be permanent or temporary, depending on the facilities where the events are staged. The required staff is determined by the type of festival. At more important events (bullfights, novilladas [bullfights with bulls 2-4 years old] with mounted bullfighters, and fighting bull-related festivals with lancers), the service must be staffed by a general surgeon or traumatologist, a first assistant surgeon of any specialty, a second assistant physician, and an anesthesia and resuscitation specialist. Other events mandate only the presence of a general surgeon or traumatologist, a physician assistant, and a nurse.

The most frequent and serious accidents usually occur in the smaller festivals that are open to public participation. These festivals involve the participation of less experienced professionals, fans, spectators, and even bystanders to the spectacle. However, these festivals are bound by less demanding legal regulations with regard to the equipment and qualified personnel who must be on hand.

In recent years, medical care has improved due to the creation of mobile medical-surgical services. These units are well equipped and staffed with specialized personnel. They serve towns and arenas where all types of events are held and suitable permanent facilities are lacking. In these cases, medical care previously was provided by local physicians and primary care centers.

The importance of early treatment must be emphasized. In first and second-ranked bullrings, infirmaries are fully equipped for surgical interventions and patients almost always are operated on immediately. This is fundamental for the good evolution and rapid recovery of the injury victim.

A specialist in oral and maxillofacial surgery may form part of the medical-surgical staff for bullfighting spectacles as an assistant to the surgeon or traumatologist. The high incidence of cervicofacial trauma, wounds, airway control, and vascular injuries would justify the presence of a maxillofacial specialist.

Injuries in the cervicofacial area vary widely in severity, ranging from minor fractures and wounds to major trauma with serious injuries of the airways, vascular, and nervous structures. The treatment given in the place of the accident depends on the personnel and material resources available. As reflected in the present article, the priority is to ensure airway patency, rule out respiratory and cardiovascular instability, and transfer the patient to a hospital center where the proper complementary examinations can be performed. Certain circumstances (particularly vascular injuries) require immediate emergency intervention. The case reported in the article was treated perfectly and had very satisfactory results.

References

1. Real Decreto 1649/1997, de 31 octubre. BOE 12 de noviembre 1997, pág. 32998        [ Links ]

2. Ministerio del Interior. Estadísticas de la temporada taurina 2007.        [ Links ]