We present a case of an 18-year-old male referred to Hospital 12 de Octubre by SAMUR, after suffering a bull horn injury to the left cervicofacial region during the running of the bulls in San Sebastián de Los Reyes in August 2005. He was immediately transferred to the operating theatre, where the correct orotracheal intubation, which had been carried out in situ by the medical staff in the bullring, was confirmed. The absence of respiratory and cardiovascular alterations was verified, as well as a stable haemodynamic situation.
Then, under general anaesthesia, a regular tracheotomy and cannulation of the corresponding central and peripheral airways were performed. Subsequently, an initial and diagnostic examination was carried out, where an incised and anfractuous wound was observed from the upper left supraclavicular region to the ipsilateral labial commissure. A fracture of the right mandibular body, comminuted fracture of the left mandibular angle, dental avulsion of the incisal sector of the upper jaw, as well as severe laceration of the lingual musculature and floor of the mouth were observed. In addition, an exposure of the left jugulo-carotid bundle was observed, which was found to be completely intact. Interdental suturing was performed at the fracture sites and adjacent soft tissue in order to provisionally restore the anatomy, and the patient was transferred to the Radiology Department for a diagnostic craniofacial CT scan in order to rule out the existence of associated central nervous system and cervical lesions. Subsequently, once in the operating theatre, direct laryngoscopy was performed to exclude the presence of laryngo-oesophageal lesions. The entire oral cavity and affected tissues are meticulously washed with a surgical brush and antiseptic solution. Tetanus vaccine and gamma globulin are administered, and systemic intravenous treatment with amoxicillin-clavulanic acid and metronidazole is started.

After correct exposure of the fracture sites at the level of the right mandibular body and left mandibular angle, favoured by the characteristics of the wound itself, reduction and osteosynthesis is performed using 2.4 Synthes® mandibular reconstruction plates, given the presence of comminution in one of them and the high potential for infection of the surgical site. The remaining root debris in the upper incisal sector was exodonticated and the corresponding bone regularisation was carried out. Suture and anatomical restoration of the cervical musculature, floor of the mouth and tongue. Microsurgical anastomosis of the right mentonian and left lingual nerves. The skin and oral mucosa are sutured. The patient was subsequently transferred to the ICU-Polytrauma Department where he remained for 36 hours, presenting no neurological or systemic complications during this time. After referral to the ward, antibiotic treatment was continued for 10 days, and the wound was treated daily with antiseptic solution, both intraoral and cutaneous. There was no evidence of infectious pathology in this area, and the patient progressed favourably, being discharged on the eleventh day.