Monday, January 26, 2009

Maxillofacial Injuries and Violence Against Women – an Article Review

The referenced article below has recently been published in Archives of Facial Plastic Surgery.  It takes a look at the ugly side of facial fractures.  They stated their objective as

To determine if patterns of facial injuries differed between those of female assault victims with maxillofacial injuries and those of female patients with maxillofacial injuries from other causes.

To accomplish their objective, they reviewed the records for adult (over 18 yrs) women who received treatment for facial trauma between January 1998 and December 2004 at the University of Kentucky Medical Center and the Kentucky Medical Services Foundation.  There were 481 (234 + 247) such women identified.  Of these 481 patients, 140 (67 + 73) had to be excluded due to missing or incomplete medical records.  There were 14 (3 + 11) others excluded due to duplication of records, etc.  This left them with 326 (164  + 162) cases to review. 

The records were then combed for information that included

… demographic data (patient age and ethnicity), date of injury, date of earliest presentation for medical attention, diagnosis codes, and treatments.

Patients were grouped as to whether their injuries were caused by IPV (ie, assault perpetrated by a current or former spouse, partner, or dating relationship), family violence (ie, assault perpetrated by a parent, sibling, or other blood relative), fall, work-related injury, assault by a known assailant not domiciled with the victim (ie, assault perpetrated by a friend, neighbor, or acquaintance), assault by an unknown assailant, motor vehicle crash, self-inflicted gunshot wound, sporting accident, other accident, or unknown/undocumented cause.

Most recorded injuries were grouped as bruising, lacerations, nasal fractures, mandible fractures, zygomatic complex fractures, orbital blow-out fractures, and intracranial injuries.

For the target population, additional information extracted included whether assault victims did or were able to identify their assailant(s) and whether there was documentation of notification to the police or a social worker when the patient presented for care. The method of injury (ie, gunshot, stabbing, punching, kicking, hitting, biting, burning, bludgeoning, pushing, throwing) was also recorded when available.

 

They found that the most common cause of facial trauma in the adult female patients was motor vehicle crashes (42.9%), followed by falls (21.5%), assault (13.8%), undisclosed or undocumented mechanisms of injury (10.7%), sporting injuries (including all-terrain vehicle accidents,7.7%), other accidental causes (2.4%), self-inflicted gunshot wounds (0.6%), and work-related accidents (0.6%).  

Of the 45 assault victims, 19 (42.2%) were documented victims of IPV or family violence.  Of these 19, most were IPV cases (18 [94.7%]).  Of the other 26 assault victims, most (92.3%) could not or did not identify their assailant.

Several causes of injury were found to correlate with pattern of injury

  • Assault was associated with mandible fractures, zygomatic complex fractures, orbital blow-out fractures, and intracranial injuries.
  • Specifically, higher than expected numbers of zygomatic complex fractures, orbital blow-out fractures, and intracranial injuries were found in IPV victims.
  • Victims assaulted by unknown or unidentified assailants were more likely to have mandible fractures than were other assault victims.
  • In contrast, higher than expected counts of mandible fractures, alveolar ridge fractures, intracranial injuries, and facial lacerations were found in motor vehicle crash victims.
  • Nasal fractures, which were the most common injuries, correlated with family violence, falls, work-related injuries, assault by a known assailant (not IPV), sporting accidents, other accidents, and unknown/undocumented cause of injury.
  • Patients with falls as the cause of injury were more likely than expected to have nasal fractures, alveolar ridge fractures, and facial lacerations.
  • Alveolar ridge fractures also correlated with unknown/unspecified cause of injury.

Sadly,  25-33% of American adult women are affected by intimate partner violence abuse by a spouse or significant other.   Of these victims, 88% to 94% will seek medical help for head and neck injuries.  More than half (56%) of these women will have facial fractures.

Because of these numbers, facial plastic surgeons and other health care providers who treat maxillofacial injuries need to be able to identify these victims.  These women should then be referred to local domestic violence service programs where they can get help with safety planning, information and referrals, support services and advocacy.

 


For more information on Domestic Violence

National Domestic Violence Hotline:  1-800-799-SAFE (7233) or TTY 1-800-787-3224.

Domestic Violence Safety Tips and Facts

 

Source Article
Maxillofacial Injuries and Violence Against Women; Arch Facial Plast Surg. 2009;11[1]:48-52; Oneida A. Arosarena, MD; Travis A. Fritsch, MS; Yichung Hsueh, MD; Behrad Aynehchi, MD; Richard Haug, DDS

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