*3.5.3 Orbital*

The majority of periocular or orbital involvement in dog bite wounds are eyelid lacerations (**Figure 1**) or eyelid marginal lacerations [19]. Experts recommend primary closure within 24 hours and prophylactic antibiotics with amoxicillin-clavulanate [19].

Ensure that there is no corneal abrasion, orbital fractures, or ruptured globe associated with the injury [19, 20]. Use a woods lamp with fluorescein, unless a suspected ruptured globe is suspected, to visualize any corneal abrasions [19, 20]. If a ruptured globe is high on the differential, obtain facial CT which would show a deflated orbit if positive for globus rupture [19, 20]. Consider an additional head CT if there are further concerns for cranial injury or the patient has altered mental status [19, 20].

### *3.5.4 Genitalia*

Copious irrigation with normal saline, debridement, and primary closure are the recommended steps in correcting dog bite lesions of the genitalia [21]. One of the biggest concerns for male genitalia wounds is the unilateral or bilateral loss of the testis. If this occurs, an ultrasound to look for torsion or hematocele formation is necessary after the attack, and an urgent urology consult is recommended [21]. Urethral injuries must also always be excluded in the cases of genitalia involvement [21]. Placement of a foley or cauterization for urine is contraindicated. Urethral endoscopy is the recommended next step after physical examination or known ureteral damage before surgical intervention [21].

#### *3.5.5 Dental*

Although not much research has been conducted on dental injuries secondary to dog attacks, it can be assumed that tooth avulsion or gingival laceration can occur [19, 22]. This is particularly relevant in cases of facial injury [19, 22]. If a patient presents with an avulsed tooth, the medium found to keep the tooth most viable is milk [23]. Current data suggest the tooth may only be viable for 30–60 minutes, thus reimplantation by the EM or dental specialist should occur as soon as possible. Gingival lacerations should always be inspected and repaired by the dental specialist.
