Summary:

Bear attacks are very rare, but when a human is attacked, the face is often involved. This presentation reviews bear attacks on humans across all eight bear species, with brown bears attacking most frequently. Attacks most often involve a defensive female bear with cubs, a lone male victim, encountered by surprise in summer daylight. Clinically, the craniomaxillofacial region dominates injury patterns across Indian and Japanese surgical series (90–100% of patients) — bears appear to target the upper face specifically to disable a threat — with the eyes, nose, ears, lips, and scalp most often avulsed, and fractures concentrated in the midface and mandible. These crush, polymicrobial wounds carry high infection risk and often result in significant facial disfigurement. Many of these victims need epithetics of the nose or ear, but this presentation will focus on one clinical case of a mandible reconstruction using a fibular free flap with an chin epithesis.