Journal of Indian Society of Pedodontics and Preventive Dentistry
Journal of Indian Society of Pedodontics and Preventive Dentistry
                                                   Official journal of the Indian Society of Pedodontics and Preventive Dentistry                           
Year : 2013  |  Volume : 31  |  Issue : 3  |  Page : 188--190

Kite string: An unusual mode of maxillofacial injury


Virendra Singh1, Puneet Puri1, Aviral Agrawal1, Pradeep Kumar1, Ruchi Singhal2,  
1 Department of Oral and Maxillofacial Surgery, Post Graduate Institute of Dental Sciences, Pt. B. D. Sharma University of Health Sciences, Rohtak, Haryana, India
2 Department of Pedodontics, Post Graduate Institute of Dental Sciences, Pt. B. D. Sharma University of Health Sciences, Rohtak, Haryana, India

Correspondence Address:
Aviral Agrawal
Department of Oral and Maxillofacial Surgery, Government Dental College, Pt. B. D. Sharma University of Health Sciences, Rohtak, Haryana
India

Abstract

Kite flying is a popular sport among children. Most of the injuries sustained during kite flying are due to falls, cuts, head injuries, or fractures. Injury with innocent-looking kite string in the maxillofacial region is rare. A 4½-year-old male patient with a clean cut, deep incised wound exposing the fat and muscle was treated with primary closure. Kite flying is associated with injuries ranging from simple cuts to grave lacerations or head trauma. The severity of lacerations depends on the abrasive material that is often placed on the string of the kite to increase its ability to cut. Injuries related to kite flying are preventable. Preventive measures include choosing a safe location and the need for increasing awareness about the possible effects of such a sport.



How to cite this article:
Singh V, Puri P, Agrawal A, Kumar P, Singhal R. Kite string: An unusual mode of maxillofacial injury.J Indian Soc Pedod Prev Dent 2013;31:188-190


How to cite this URL:
Singh V, Puri P, Agrawal A, Kumar P, Singhal R. Kite string: An unusual mode of maxillofacial injury. J Indian Soc Pedod Prev Dent [serial online] 2013 [cited 2019 Oct 17 ];31:188-190
Available from: http://www.jisppd.com/text.asp?2013/31/3/188/117976


Full Text

 Introduction



Kite flying is a popular sport in children in many cultures around the world. In India, Pakistan, and Bangladesh, people celebrate the arrival of spring by holding a kite festival. These kite festivals include a game of kite fighting, in which participants attempt to use their kite to cut the string of a rival kite.

Kites are associated with various types of injuries, including accidents that occur during the preparation of the threads, electrical injuries from high-tension currents, falls that occur during the game, or injuries caused to bystanders during kite flying, especially those riding motorcycles or bicycles. [1],[2]

Injuries related to kite flying commonly range from mild injuries to severe disability and death, and may manifest with varied clinical presentations with chemical, metallic strings.

Previously, kite flyers mainly used kite string which was made with three to nine layers of variously treated cotton thread. In the early 1980s, elastic kite string and nylon cord were introduced. In the recent past, kite fighters started using metallic, chemical, and glass powder coated string (manja) to make the competition of kite fighting more challenging. Use of such strings has turned the simple traditional fun of kite flying deadlier, and now, it has become the potential cause of severe injuries, disabilities, and deaths each year. [3]

Kite flying is very common in India and we feel that trauma caused by the kite thread is grossly underreported. The present case is being reported to highlight the magnitude of injuries caused by innocent-looking thread.

 Case Report



A 4½-year-old male boy was brought to emergency with the chief complaint of deep cut on right cheek region. Patient's parents narrated that the child was sitting in front of his father on motorbike while going to their relative's home when a kite string flowing across the road entangled in the lip and cheek of the child.

On clinical examination, there was a clean cut, deep incised wound, approximately 7 cm in length, exposing the fat and muscle. It was extending from lower labial mucosa traversing across the corner of mouth toward the angle of mandible, with multiple linear abrasions extending up to the neck [Figure 1]. There was no facial paresis. Patient's medical history, general and hematological examination revealed no significant finding.{Figure 1}

The soft tissue repair was performed under general anesthesia. Patient was laid down on OT table and orotracheal intubation was done. The surgical area was scrubbed and draped in the usual standard procedure. The wound was debrided and irrigated with copious amount of normal saline followed by betadine. Layer-wise suturing was done with 4-0 round body vicryl followed by subcuticular suturing with 4-0 reverse cutting prolene [Figure 2]. Lower labial mucosa was sutured with 3-0 round body vicryl. Antiseptic dressing was given. {Figure 2}

Patient was kept at regular follow-up and the wound healed uneventfully [Figure 3]. {Figure 3}

 Discussion



Kite flying might look like blossom floating in the wind, but it is one of the dangerous sports in the world. Among all age groups, this is a popular sport in children and young people, [4] and thus, more injuries are observed in younger age groups. A study done in India shows that kite flying is associated with various modes of injuries in children. [4]

Kite flying is associated with wide range of injuries ranging from simple cuts (29%) to grave lacerations and neck injuries or head trauma. [5] Palmer aspect of the hand is the commonest site of injury to a kite flyer or even to those who try to catch the kite string.

The severity of injury depends on the abrasive material which is often placed on the string of the kite to increase its ability to cut other kite strings. [3],[4] Typically, the thread is coated with a combination of ground glass and a water-soluble paper glue called manja. Contact between manja and human skin can lacerate the skin, deep fascia, and injure internal cervical structures, such as the carotid arteries, jugular veins, larynx, and trachea. Neto et al. [6] reported two patients who sustained neck injuries due to a kite string in 1998 in Belo Horizonte, Brazil. In one case, there was laceration of internal jugular vein, while the trachea was lacerated in the second case. Within a 2-month period, 49 patients with manja-related injuries were admitted to the hospital in Brazil.

In news published from China, five people suffered throat injuries and one of them had a cut artery and a vein. Broken threads which had become caught across the bridge on which these people were going were thought to be the cause of this incident. [7]

Motorcyclists, cyclists, and pedestrians, including both adults and elderly people may sustain injuries when they come across strings of a flying kite or a wandering kite because of inattention to their surroundings. [2] The killer thread "manja", if white in color, may prove to be more dangerous as that is not easily visualized by motorists. Injuries sustained by the two-wheeler riders are severe compared to that of pedestrians, as the severity of injury depends upon both the speed of two-wheelers and the moving kite. In a news article published in India, a person in Mumbai sustained a rupture of the voice box [8] and another person died in Chennai due to kite string injury of the neck. [9] Both victims were riding motorbikes. In the present case, the child sitting in front of his father on a bike also sustained injury to cheek because of kite string. In another case reported by Singla et al., the victim was on motorbike and sustained injury to his neck and shoulder due to kite string. [10]

 Conclusion



Injuries related to kite flying are preventable. Proper preventive measures include choosing a safe location (such as an open beach or field) and keeping a safe distance from telephone lines, electricity cables, trees, people, and animals. Also, there is need for increasing awareness about the possible effects of such a sport and offering social counseling to the families, which can help to reduce the incidence of injuries.

References

1Kyriacou DN, Zigman A, Sapien R, Stanitsas A. Eleven-year-old male with high-voltage electrical injury and premature ventricular contractions. J Emerg Med 1996;14:591-7.
2Wankhede AG, Sariya DR. An electrocution by metal kite line. Forensic Sci Int 2006;163:141-3.
3Wankhede AG, Sariya DR. "Manja" - A dangerous thread. J Forensic Leg Med 2008;15:189-92.
4Tiwari VK, Sharma D. Kite-flying: A unique but dangerous mode of electrical injury in children. Burns 1999;25:537-9.
5Mehmood N, Khwaja ZH, Ramazan S, Quddus A. Kite-flying associated injuries in Rawalpindi. Ann Pak Inst Med Sci 2010;6:116-9.
6de Rezende Neto JB, Ferreira GC, de Silva Filho AL, Fontes MO, Bomfim F, Abrantes WL. Kiting injuries: Report of two cases and discussion. J Trauma 2000;48:310-1.
7Cut throat kites. Available from: http://www.google.com/ Shanghai star. [Last accessed on 2002 May 23].
8Youth hurt in kite-string mishap out of danger, expressindia.com/Express news service, January 18, 2008.
9Boy dies after throat slit by kite string. Article from: United Press International, article date: December 31, 2001.
10Singla SL, Marwah S, Kamal H. Kite string injury- A trap for the unwary. Inj Extra 2009;40:277-8.