Bear attacks constitute only 0.1% of all animal attacks in India. Odisha, one of the eastern coastal states of India, represents prime habitat for sloth bear. Jaws and claws can impart forces up to 1800 psi causing devitalization, crushing, cutting, avulsion and puncture injuries resulting in significant functional and aesthetic disfigurement making its management challenging. The aim of the study is to review 30 cases of complex maxillofacial injuries in patients with bear mauling attacks and to discuss the various challenges for management of maxillofacial defects in these patients and to provide a treatment guideline for their management.

This is a retrospective, monocentric case series study to review 30 cases of complex maxillofacial injuries in patients with bear mauling attacks, reported to a tertiary care center in Odisha between 2010 and 2023. Various covariates included were demographic characteristics, injury characteristics, treatment modalities and complications. Descriptive statistics were computed for each study variable.

The sample was composed of 30 patients with 22 males (73.34%) and 8 females (26.66%). The age of the patients ranged between 0–60 years (73.34%) and more than 60 years (26.6%). All patients reported with maxillofacial injury (100%) along with involvement of other body parts. The mortality rate in this case series was 3.34%. Management of maxillofacial defects were done with primary closure, local flaps, and vascularized free flaps.

Bear attacks can cause gross maxillofacial deformities, systemic dysfunction, risk of airway obstruction and high risk of tetanus and rabies. Management of patients with bear mauling maxillofacial injuries carries a lot of challenges and risks. Timely comprehensive management is important for providing better quality of life to the patients, restoration of function and esthetics, and a balanced psychological condition.