ABSTRACT
A 6-month-old baby boy presented with a mark on his cheek as shown in Image 107a. His father gave a history of the baby sleeping with his cheek on top of his pacifier/dummy (shown) all night, which resulted in this mark. https://s3-euw1-ap-pe-df-pch-content-public-p.s3.eu-west-1.amazonaws.com/9780429170423/e1d751c1-a9c7-4bb9-9d59-53742c84031a/content/fig107a.jpg"/>
What is your diagnosis?
Is the injury consistent with the provided history?244 https://s3-euw1-ap-pe-df-pch-content-public-p.s3.eu-west-1.amazonaws.com/9780429170423/e1d751c1-a9c7-4bb9-9d59-53742c84031a/content/fig107b.jpg"/>
Image 107a shows a patterned bruise on the child’s right cheek. It shows a circular mark made by two opposing concave arcs, consistent with a bite mark. The intercanine distance was more than 3.5 cm in this infant, suggesting a human adult-sized bite. The diagnosis is a bite mark.
The injury is not consistent with the provided history. Sleeping with his cheek on his pacifier will not result in bruising of the skin. Furthermore, the diameter of the patterned bruise is not consistent with the measurement of the pacifier. Children with bite marks need to be fully evaluated for associated injuries. A complete skin exam in this infant showed a similar mark on his left forearm (Image 107b). After the mark was noted, his father stated that a few days prior he was playing with the baby and the baby grabbed the father’s hair. The father stated he ‘had to bite’ the baby’s arm to release his hair. Unlike the injury to the cheek, the injury to the forearm is consistent with the history provided and is consistent with an adult-sized bite mark. However, it is still considered an abusive injury. Bite marks should be carefully documented with photos and measurements. 1 An intercanine distance of 3.5 cm in this child suggests a human adult-sized bite. In children where the bite marks appear fresh, it should be swabbed with a pre-moistened sterile cotton-tipped applicator for forensic analysis of potential genetic markers found in saliva. 2 If available it is also recommended to consult a forensic odontologist for further analysis of the bite mark. The perpetrator may be identified from the dental characteristics of the bite. It is also important to recognize that bites, especially those with a thrust mark or a suction mark may be a sign of sexual abuse. A suck mark appears as a bruise or area of haemorrhage in the centre of the bite mark and occurs when the skin is drawn into the mouth in a forceful manner and held. A thrust mark occurs when the tongue is pushed against the lingual aspect of the teeth with the skin located between the two. 2
