No full-text available
To read the full-text of this research,
you can request a copy directly from the authors.
Trends in maxillofacial injuries in women, 2000–2004
Abstract
Recent government statistics have suggested that there is a reduction in violent crime, but recorded crime figures have shown a 10% increase. Attendance figures at accident and emergency departments show that 75% of assaults that required medical treatment were not recorded by the police, and that 55% of assaults that led to facial injuries were alcohol-related. Drinking alcohol is a risk factor for violent behaviour. A poorly-studied area is alcohol-related violent crimes sustained by women. A restrospective study was made of all female patients referred to a busy regional maxillfacial unit between May and October 2000–2004. A total of 251 female patients with facial injuries was seen at the unit, and records obtained for 219. Accidents were the commonest cause of attendance, and violent crime the second. Interpersonal violence was the most common mode of injury in alcohol-related incidents. Domestic violence did not increase significantly over the study period, and did not seem to be alcohol-related. The incidence of violent crime, and in particular interpersonal violence away from the home, is increasing. Women are at considerable risk of becoming victims of violence.
... [17][18][19] The use of seatbelts in cars, wearing helmets while driving motorcycles, the strict control of speed limits and compliance with the laws related to drunk driving, combined with better road con- were more common than those of the middle third, as reported in several previous studies. 1,10,12,15,23 Assault was the third most common cause of maxillofacial fractures in the present study, and the incidence was similar to that reported by Hashemi et al. 11 and Zhou et al. 2 (Table 5). Consistent with the literature, these incidents more commonly involved women aged between 19 and 64 years (p < .001). ...
... [24][25][26] Many authors have pointed out that female patients often fail to declare the actual cause of trauma out of fear, embarrassment or low self-esteem, so the incidence of these injuries is likely to be under-estimated. 3,23,25 In line with the literature, women were typically assaulted with fists or with a combination of fists and kicks. As also found by Gerber et al., 23 assault was the most common cause of alcohol and/or drug abuse-related injuries (44% of all causes in this group). ...
... 3,23,25 In line with the literature, women were typically assaulted with fists or with a combination of fists and kicks. As also found by Gerber et al., 23 assault was the most common cause of alcohol and/or drug abuse-related injuries (44% of all causes in this group). Alcohol and/ or drug abuse was also significantly associated with assaults, confirming the results of other studies. ...
Background/aims:
Approximately 20% of patients with maxillofacial trauma are women, but few articles have analysed this. The aim of this multicentric, prospective, epidemiological study was to analyse the characteristics of maxillofacial fractures in the female population managed in 14 maxillofacial surgery departments on five continents over a 1-year period.
Methods:
The following data were collected: age (0-18, 19-64, or ≥65 years), cause and mechanism of the maxillofacial fracture, alcohol and/or drug abuse at the time of trauma, fracture site, Facial Injury Severity Scale score, associated injury, day of trauma, timing and type of treatment, and length of hospitalization.
Results:
Between 30 September 2019 and 4 October 2020, 562 of 2387 patients hospitalized with maxillofacial trauma were females (24%; M: F ratio, 3.2:1) aged between 1 and 96 years (median age, 37 years). Most fractures occurred in patients aged 20-39 years. The main causes were falls (43% [median age, 60.5 years]), which were more common in Australian, European and American units (p < .001). They were followed by road traffic accidents (35% [median age, 29.5 years]). Assaults (15% [median age, 31.5 years]) were statistically associated with alcohol and/or drug abuse (p < .001). Of all patients, 39% underwent open reduction and internal fixation, 36% did not receive surgical treatment, and 25% underwent closed reduction.
Conclusion:
Falls were the main cause of maxillofacial injury in the female population in countries with ageing populations, while road traffic accidents were the main cause in African and some Asian centres, especially in patients ≤65 years. Assaults remain a significant cause of trauma, primarily in patients aged 19-64 years, and they are related to alcohol use.
... Thus, most reported epidemiological data and characteristics of maxillofacial injuries are associated with males. This trend has led to a lack of specific information on female maxillofacial trauma, which is generally studied with specific reference to violence-related injuries (Zachariades et al., 1990; Huang et al., 1998; Greene et al., 1999; Le et al., 2001; Gerber et al., 2009; Arosarena et al., 2009). In our study, the incidence of facial fractures in females was similar to that reported by various authors (Hogg et al., 2000; Kieser et al., 2002; Fasola et al., 2003a; Ansari, 2004; Erol et al., 2004) and appeared to be quite constant throughout the years examined (Table 7). ...
... Only in the 17e60 age group were MVAs a more frequent cause of facial trauma than falls. However, the percentage of falls is likely to have been overestimated, because some women referred to the emergency department might not have reported assault or domestic violence as the true cause of their injury, claiming instead that they had fallen (Perciaccante et al., 1999; Gerber et al., 2009). Falls from standing height or less caused fractures of the lower facial third in 60.7% of cases. ...
... Among our cases, assault injuries were concentrated in the 17e 60 age group, and 37.5% of victims were foreigners. In 88% of the cases, the aggressor was known to the victim (husband or boyfriend), and this undoubtedly raises the issue of domestic and intimate partner violence (Le et al., 2001; Gerber et al., 2009; Arosarena et al., 2009). When a man assaults a woman, he uses mainly his hands (89%), with feet and elbows used less frequently. ...
Epidemiological characteristics of maxillofacial injuries are typically reported for male patients, as males represent 70% of the studied population. This retrospective study analysed the aetiology and patterns of maxillofacial fractures in female patients only.
A total of 367 female patients, examined between 2001 and 2008, were divided into three age groups (<16, 17-60, and >60 years). Data were collected on aetiology, fracture site, associated lesions, type of treatment, and length of hospital stay.
The typical female patient presented a mean age of 43 and 25% were over 60 years of age. Falls were the most frequent cause of maxillofacial trauma (43%), followed by motor vehicle accidents (MVAs) (38.7%), assaults (9.3%), sports accidents (6.3%), and other causes (2.7%). The middle third of the face was most frequently affected (53.9%). Associated fractures, mostly orthopaedic and secondary to MVAs, occurred in 23.2% of cases. The over-60 age group had the greatest number of non-operated fractures (27.9%) and the longest mean hospital stay (5.7 days).
This study considered only the female population, thereby highlighting epidemiological characteristics of maxillofacial trauma not apparent in the existing literature. Clear distinctions between genders are important for better comparison of data in the future.
... So zygomatic bone injuries should be properly diagnosed and adequately treated. A literature search showed ZMC fractures to account for approximately [15][16][17][18][19][20][21][22][23].5% of maxillofacial fractures. 1,2 The etiology of zygomatic complex fractures primarily includes road traffic accidents, violent assaults, falls and sports injuries. ...
... In our study, the male to female ratio was 7.75:1, which corroborates with the worldwide data. 16 It is interesting to note that the cultural and socioeconomic characteristics of the studied population may influence the rates of facial fractures in women. In countries such as Greenland, Finland, and Austria, where women participate directly in social activities and consequently are more susceptible to traffic accidents and urban violence. ...
Background: The incidence of maxillofacial injuries is on the rise due to motor vehicle accidents and increased incidence of violence in recent times. Zygomatic bone is closely associated with the maxilla, frontal, and temporal bones which are usually involved when a zygomatic bone fracture occurs. Objective: The aim of this retrospective study was to determine clinical presentations, the pattern of fractures, their management (open reduction and internal fixation), outcome and complications in a tertiary level hospital. Materials and Methods: This retrospective analysis of all operative cases (open reduction and internal fixation) of zygomatic complex fractures was carried out in the Maxillofacial Surgery Department, Enam Medical College & Hospital, Savar, Dhaka during the period of January 2018 to December 2021. Data were obtained from clinical notes and surgical records of the patients using standardized data collection form specifically designed to examine the variables and features of zygomatic complex fractures. Results: Seventy patients were allocated to surgical intervention. Two-point internal fixation was done in more than half (57.1%) of the cases. Six (8.6%) patients developed postoperative complications like paraesthesia, ectropion, scar, facial asymmetry. Twenty-five (35.7%) patients were found having limited mouth opening preoperatively and postoperative improvement occurred in 24 patients. All the patients had facial asymmetry preoperatively and postoperative improvement occurred in most cases. Only one patient had facial asymmetry in one year follow up. Conclusion: There is no consensus on standard treatment of zygomatic complex fractures, as made evident by the survey. Significant variability in fracture type warrants an individualized approach to management. A thorough review on zygomatic complex fracture management is provided. J Enam Med Col 2022; 12(2): 102−108
... Facial fractures may result in long-term mental and physical health issues for patients. 13 Functional impairments such as deficits in mastication, speech, swallowing, and vision may follow. 14 Management of facial fractures also places a strain on the healthcare system as patients who require surgery often need long-term follow-up and may require revision surgery. ...
... 19 It can be difficult to identify victims of IPV, as patients who have been assaulted may not report an assault, rather reporting an accident, injury or fall. 9,13,18,20 Patients rarely volunteer a history of IPV, and physicians often fail to inquire appropriately. A survey of Canadian surgical residents found that most underestimated the prevalence of IPV in their practice. ...
Background:
Assault is the most common mechanism of injury in patients presenting with facial trauma in Australia. For women, there is a propensity for maxillofacial injuries to stem from intimate partner violence (IPV). Those with a low socioeconomic status have higher rates of IPV. This study examines variations in the proportion of surgical procedures that are due to facial trauma for Australian women and men by employment status and residential socioeconomic status.
Methods:
A single centre retrospective study was conducted (2008-2018). The proportion of operative patients presenting with facial fractures was examined. Multivariable logistic regression adjusting for year and age, was performed for women and men.
Results:
Facial fractures comprised 1.51% (1602) of all surgeries, patients had a mean age of 32, and 81.3% were male. Unemployed patients were more likely to require surgery for a facial fracture (OR 2.36 (2.09-2.68), P <0.001), and there were no significant variations by index of economic resources (IER). Unemployed males had higher rates of facial fractures (OR 2.09 (1.82-2.39), P <0.001). Unemployed and disadvantaged IER females had higher rates of facial fractures (OR 5.02 (3.73-6.75), P <0.001 and OR 2.31(1.63-3.29), P <0.001).
Conclusions:
This study found disparities in rates of surgery for facial fractures; unemployment increased the rates for men and women, whereas disadvantaged IER increased rates for women. Studies have demonstrated higher rates of IPV for unemployed and low socioeconomic status women. Further research ascertaining the aetiology of these disparities is important both for primary prevention initiatives and to enable treating clinicians to better understand and address the role of IPV and alcohol consumption in these injuries.
... 3,4 Several studies have attempted to identify demographic patterns associated with maxillofacial trauma, [5][6][7][8][9] with some focusing on vulnerable populations such as women and victims of domestic or interpersonal violence. [10][11][12][13][14][15][16][17][18] However, fewer studies have focused on maxillofacial trauma patterns in low socioeconomic status, urban populations. 2,3,[19][20][21] Many studies that address maxillofacial trauma and socioeconomic status were conducted outside of the U.S. 3,4,19,[21][22][23] Additionally, assault-related maxillofacial trauma is often underreported because of its association with illegal activities. ...
... Most facial fractures in women are a result of MVAs or falls rather than assault, regardless of the country. 10,13,[15][16][17] However in 1 study, 69% of women with facial fractures were domestic violence victims, with some women being victims of chronic physical abuse. 22 The majority of facial fractures in women involve the nasal bone and mandible, followed by the ZMC, orbit, and zygoma. ...
Objectives
We aimed to determine whether certain maxillofacial fracture patterns and injury mechanisms were more prevalent in an urban environment. In addition, we aimed to determine if maxillofacial trauma incidence correlated with income.
Methods
Data was collected from Einstein Healthcare Network and Temple University Health System. These data were compared to the 2016 National Trauma Data Bank© (NTDB©) using chi-square analysis. Multivariate analysis was used to identify correlations between demographic variables and fracture patterns. Sociodemographic data was further characterized utilizing neighborhood mapping.
Results
A total of 252 patients from our urban campuses and 14 447 patients from the NTDB© were identified with facial fractures. Maxillofacial trauma patients in the urban population were more likely to be minorities and less likely to be Caucasian compared to the NTDB© (P < .001). Patients in the urban setting were more likely to sustain mandibular and orbital fractures, and less likely to sustain maxillary fractures and multiple fractures (P < .001). Urban maxillofacial trauma patients were more likely to sustain assault and sporting injuries, and less likely to sustain injuries from motor vehicle accidents and self-harm (P < .001).
Conclusions
Maxillofacial trauma patterns and injury mechanisms were shown to be significantly different in an urban environment as compared to national data.
... The literature reports a tendency toward equal frequencies of facial trauma between males and females, which has been attributed to the greater participation of women in the job market, including high-risk occupations. 18 In a retrospective study at an urgent care unit in the United Kingdom, Gerber et al. 19 found that the majority of the 219 cases of facial trauma among females occurred due to accidents and women over 20 years of age were at greater risk of domestic violence. The results of the present study are in agreement with these findings. ...
... 29 Soft tissue injuries were the most common type of facial trauma in the present investigation, accounting for 67.6% of cases, which is similar to findings reported in previous studies. 11,19 The effects of such injuries include pain, numbness of the lips, chin and nose, difficulty opening one's mouth, visible gap between dental crowns and deep lacerations over bones. 1,9,11,12 Due to the physical and psychological impacts as well as the high healthcare costs related to facial trauma, the recognition of associations with gender and age underscores the need for specific measures aimed at addressing this problem. ...
Introdução
O trauma facial pode ser considerado uma das agressões mais expressivas devido às consequências emocionais, à possibilidade de deformidade e também ao impacto econômico que os mesmos causam em um sistema de saúde.
Objetivo
Este estudo retrospectivo verificou a ocorrência de traumas faciais em mulheres, atendidas em um hospital de emergência de um município do Nordeste do Brasil, no período de dois anos.
Material e método
esse estudo transversal avaliou n = 247 prontuários. Os dados foram cole- tados por meio de um formulário contendo: a faixa etária, o agente etiológico e a localização do trauma.
Resultados
Verificou-se uma maior prevalência de mulheres adultas (48,6%). A etiologia mais frequente foi a queda da própria altura (38,5%), prevalecendo lesões em tecido mole (67,6%). Quando associadas à etiologia da lesão com a faixa etária, constatou-se uma diferença esta- tisticamente significativa, apontado a relação entre crianças e idosos com a queda da própria altura e adultas com eventos violentos.
Conclusão
As mulheres adultas foram as mais afetadas, havendo predomínio das lesões em te- cido mole e em região que corresponde à mandíbula, maxila, zigomático e ossos nasais. A queda da própria altura foi a etiologia mais prevalente e associada às crianças e idosas.
... The relation between alcohol and facial injury is well documented and studies have reported between 18% and 47% of injuries being related to alcohol. 1,7,8 In the west or Ireland this was 23%. In the study we included the association with alcohol in injuries in men, delay in presentation, Saturdays being the most popular day of presentation, and injuries occurring in or just outside a public house. ...
... Two-thirds of assault-related facial injuries occurred on the Friday. Half of all the women injured had facial fractures, which is similar to other studies, 8 but it is a concern as it may be related to unreported domestic violence. However, there is no reported overwhelming delay in presentation for assaults. ...
The pattern, presentation, and volume of facial injury in the west of Ireland are subjectively different from those in the United Kingdom. We know of no prospective regional study of facial injury in Ireland to date, and nationally there is no system in place to collect data on injury. The epidemiology of facial trauma has important implications for the development of health services, the education and training of clinicians, workforce planning, prevention of injury, and promotion of health. Over 1 week we did a multicentre prospective data collection study involving all emergency departments in the west of Ireland. All patients who attended with facial injuries were included (n=325), and those with injuries solely of the scalp and neck were excluded. The proforma recorded a patient's characteristics, details of injury and presentation, treatment and follow-up. It also included relation with sport, alcohol, assault, and animals. Eighty-two fractures were suspected, of which 46% were nasal. Accidents caused 75% of injuries and sport caused 27%. Fractures were sustained by 63% (n=5) of those wearing helmets while playing hurling, but by only 22% of those who were not. Helmets did, however, reduce the total number of injuries. Injuries were associated with alcohol (23%), assault (14%), falls (38%), and motor vehicle crashes (11%). Because of the differences in aetiology, different avenues and methods are required to prevent injury. Staff in emergency departments will need training in this area, given the large proportion of facial trauma in the region.
... In South Australia, the three most vulnerable groups for facial trauma in females include young women related to assault, elderly women with falls, and indigenous women with disproportionately higher rates. An Irish study of 1190 female facial fractures reported peaks at 20-39 years and 70-89 years with the midface commonly afflicted [10], whereas Gerber's British study reported peaks at 20-29 years and a third over 60 years caused mainly by accidents, assaults, and then falls [11]. The aetiology of facial fractures has changed over the decades and influenced heavily by sociocultural values and laws pertaining to the country. ...
Purpose
Facial trauma in women is complex with physical, psychosocial, and cultural influences impacting clinical presentations. Although multifactorial, assaults and falls are principally reported as the main causes.
Methods
A retrospective review was conducted from January 2012 to January 2017 at the Women and Children’s Hospital and Royal Adelaide Hospital, Adelaide. All maxillofacial fractures in women that attended or were referred to the unit were included in this study. The primary objective was to analyse epidemiological trends of facial fractures and clinical outcomes in the South Australian female population.
Results
There is a bimodal distribution of facial fractures at 25–35 years and 65 + years. Indigenous females were 19.5 years younger than non-indigenous females (30.5 vs 49.9, P < 0.001). Approximately half the cohort had a fall-related facial fracture, followed by assault (26.2%), and sports (10.3%). There was a higher proportion of non-alcohol-related trauma from assaults than alcohol-related assaults (72.5% vs 27.5%, P < 0.001). Over half (58.0%) of the cohort had a midface fracture. The elderly had increased odds of 1.9 fold for facial fractures in winter, largely from falls, compared to younger women. Associated injuries were present in almost half the elderly women with 2.6 times the risk compared to younger women. Younger women had higher incidences of surgical intervention (52.6% vs 14.3%, P < 0.05).
Conclusions
Young women disproportionately experience larger incidences of non-alcohol-related assaults requiring operative intervention of the mandible, whereas elderly women principally suffer fall-related facial fractures with higher rates of associated injuries.
... However, our results also showed that the proportion of females was high after the age of 70. Gerber et al. speculated that even though women in their 20 s or 30 s likely have a high risk of fracture due to violence, many of those incidents are related to domestic trouble and not report to the authorities [13]. The present results showing that the proportion of elderly women was high, many of whom were injured in a fall, is likely because of the super-aging society in Japan. ...
Objective
The causes of maxillofacial fractures and their characteristics differ throughout the world. The aim of the present study was to survey and evaluate the characteristics of maxillofacial fractures in cases treated at our institution.
Methods
The records of patients with maxillofacial fractures treated during a 16-year period were examined. The survey items included sex, age, number of affected patients by year and month, cause of injury, consultation route, time between injury and initial examination, fracture site, and treatment strategy.
Results
There were 246 males and 100 females, for a male-female ratio of approximately 2.5:1, and average age was 37.4 years (range 0–93 years). By year, the number of cases was highest in 2017 and lowest in 2012, while by month, May showed the highest and January the lowest numbers. The most common cause of injury was a fall. When cause was examined in accordance with age, the number related to assault was high among young people and that related to a fall was high among elderly, with the overall rate because of a fall high since 2013. Injuries related to assault were increased in April and May, while those related sports activities were high in August. The most common fracture site was the condyle, with open reduction and internal fixation the treatment strategy most often chosen.
Conclusions
Maxillofacial fractures treated in our department were primarily related to patient activity, with higher rates noted during the warm weather season and decrease following a large earthquake.
... Previous studies have suggested that over half of facial injuries due to assault involved alcohol consumption [13]. Our data suggests about 15% of cases due to assault involved alcohol. ...
Facial fractures are the third most common type of fracture, with the nose most frequently involved. In the United Kingdom, their incidence is rising among young males particularly, and recent reports suggest that nasal injuries in females are becoming more common, which is attributed to “ladette” culture. The aim of this study was to investigate if there is any correlation in Wales with the rise in female facial fractures reported in England. A retrospective analysis of National Health Service Wales Informatics Service data (NHS WIS) shows that facial fractures were more likely to occur in males, in their teens or twenties, most commonly caused by assault and linked to alcohol consumption in this demographic. The most common cause of facial fracture in Wales was due to an accident which differs from England. The overall number of facial fractures in both males and females did not change significantly. It may be that the binge drinking culture is not as prevalent in Wales as it is in England. The reasons for this may be mutifactorial, reflecting geographical, cultural and socio-economic factors. Our findings do not correlate with the literature regarding the epidemiology of facial fractures. We suggest that binge drinking and “ladette culture” is not seen as commonly in Wales from the point of view of the ill effects of alcohol consumption.
... Violent crime, such as domestic violence and interrelationship violence, is listed as the second most common cause of injury after accidents. 2 Research has shown that aggression in domestic violence often occurs in the form of blunt trauma and slapping, 3 and the face is the area most predisposed to injury. Among all facial injuries, dental traumas are common, especially to the incisors, because of their anatomical location. ...
Dental injuries, especially of the incisors, caused by punches in violent criminal attacks could be seen in daily forensic casework involving the identification of injuries to a living body. Sometimes, when there is neither circumstantial evidence nor information about the surrounding circumstances, it is difficult to discern the cause of these injuries and the manner in which they were inflicted. As an example of clinical forensic medicine, we present the case of a 58-year-old woman whose teeth were injured when fighting with her son-in-law over household affairs with no witnesses present. The two parties had conflicting stories about the cause of the woman’s injury. The woman claimed that her teeth were lost while she was being beaten by her son-in-law, and the man argued that the damage to his mother-in-law’s teeth was self-inflicted when she bit his fingers. The police attending the crime called for a forensic examination. Forensic practitioners analysed the mechanism of the tooth loss using multi-slice spiral computed tomography (MSCT) and imaging reconstruction technology. Local alveolar bone (medial alveolar) fracture and a small area of alveolar bone loss were found on MSCT. Thus, forensic medical experts speculated that the woman’s lower central and lateral incisors were lost as a result of a violent attack and were not self-inflicted. Finally, forensic practitioners helped police in avoiding a miscarriage of justice and wrongful conviction.
... The group of people alive showed a corresponding distribution. Gerber et al. reported the involvement of alcohol in victims of crimes to be higher as in patients with any other form of injuries [35]. There are mainly two important mechanisms in victims influenced by alcohol: first, an active one when disputes are triggered and provoked (disinhibiting effect of alcohol), and, second, a passive one when a victim is vulnerable and defenceless because of being drunk. ...
Injuries caused by blunt force are seen frequently in daily forensic casework. Sometimes, especially when there is less information about the surrounding circumstances, it might become difficult to figure out the cause and background of injuries: accident, criminal violence or self-infliction? In the study presented, face injuries caused by blunt force in 694 cases were analyzed comparing the injury patterns in accidents to those in crimes. It turned out injuries of the ear and retroauricular region clearly indicate a crime. Also, soft tissue injuries of nose, upper jaw, and lower jaw point towards a criminal violence, whereas tooth injuries occur with a similar frequency in both crimes and accidents.
... An analysis of the incidence of assault-related injuries among females and males in this study inferred that 53.61 % of assault-related injuries was sustained by women when compared to 46.39 % of injuries sustained by male patients which was statistically highly significant (p < 0.001) and in agreement with the previous studies in literature [15,27,28]. The location of our unit being present in a densely populated urban area with greater reported incidence of interpersonal violence, we encountered more female patients with injuries resultant from assault than male patients [15]. ...
Background
Maxillofacial fractures occur in a significant proportion worldwide and can occur as an isolated injury or in combination with other severe injuries including cranial, spinal, and upper and lower body injuries requiring prompt diagnosis with possible emergency interventions. The epidemiology of facial fractures varies with regard to injury type, severity, and cause and depends on the population studied. Hence, understanding of these factors can aid in establishing clinical and research priorities for effective treatment and prevention of these injuries. Materials and methodsIn this present retrospective study, we provide a comprehensive overview regarding cranio-maxillofacial trauma on 3611 patients to assist the clinician in assessment and management of this unique highly specialized area of traumatology. A preformed pro forma was used to analyze the medical records of patients treated for facial trauma in The Department of Oral and Maxillofacial Surgery, Meenakshi Ammal Dental College and Hospital, Chennai. The distribution according to age, gender, etiology, type of injury, time interval between accident and treatment, loss of consciousness, facial bones involved, pattern of fracture lines, treatment offered, and postoperative complications were recorded and evaluated. ResultsWe inferred male patients sustained more injuries mostly in the third decade of age. Road traffic accidents were the most common cause of injury. Mandible was the most commonly fractured bone in the facial skeleton. Soft tissue injuries occurred more in road traffic accidents and upper lip was the commonest site of injury. Conclusion
Our study provides insights into the epidemiology of facial injuries and associated factors and can be useful not only in developing prevention strategies but also for grading the existing legal regulations and also for framing a more effective treatment protocol.
... For example, female patients in the emergency department may not always report an assault or domestic violence as the true cause of their injury. They could report a fall injury instead (Perciaccante et al., 1999; Gerber et al., 2009; Ferreira et al., 2014). The escalation in IPV-related maxillofacial fractures involves more young males. ...
Aim:
The aim of this work is to analyze the risk factors in interpersonal violence and to describe the epidemiology, patterns and management of maxillofacial fractures in high volume trauma center of the northern Italy.
Material:
This retrospective study recorded patients hospitalized with maxillofacial fractures, at the division of maxillofacial surgery, Città della Scienza e della Salute University Hospital, Torino, Italy, since January 2001.
Methods:
Only patients who presented with "violence" in the database field for "cause of injury" and with "interpersonal violence" as a subtype of etiology were considered. Statistical analysis was determined using the χ(2) or Fisher's exact test.
Results:
2567 patients were admitted. 711 patients (27.7%) had undergone interpersonal violence that has increased from 20% to 35% in the study period. The male-to-female ratio was 11:1; the mean age was 32.7. 247 patients were foreigners (34.7%). 107 patients were enrolled in that study, referred alcohol or drugs abuse. IPV episodes account for 953 maxillofacial fractures localized in 55.3% of the cases in the midface, 43.1% in the lower third. Particularly the trauma involved the orbital region and the maxillo-orbito-zygomatic region. 4.4% of patients had combined trauma.
Conclusion:
IPV maxillofacial fractures in Europe such as in Italy are becoming one of the first cause of injuries. This study shows that young males and foreigners are involved in violence mostly during the weekend. These fractures occur due to fists frequently involving the maxillo-zygomatic-orbital complex.
... The majority of patients are in their third decade of life [2].The predominance of male population is a relatively consistent finding in most studies. In our study, the male to female ratio was 21.2:1 which corroborates with the worldwide data [3]. Maxillofacial fractures are commonly caused by RTA, assaults, sports, industrial accidents and warfare [4,5]. ...
Introduction: The incidence of maxillofacial injuries is on the rise due to motor vehicle accidents and increased incidence of violence in recent times. The aim of this retrospective study was to determine the incidence, aetiology, the pattern of fractures, their management with open reduction and internal fixation (ORIF) and complications, if any.Methods: A retrospective analysis of 621 fractures in 361 patients managed by ORIF over a four year period was carried out.Result: The average age of patients was 24.3 years with a male to female ratio of 21.2:1. Panfacial fractures comprised 4.7%, frontal bone fractures 8.9%, orbital fractures 0.7%, naso-orbito-ethmoid complex (NOE) fractures 0.7%, zygomatic complex fractures 23.5%, fracture maxilla 11.5% and mandibular fractures 52.2% of all facial fractures. All the cases were successfully managed by ORIF under general anaesthesia (GA). Complications were noticed in 6.8% of cases in the form of reactive implants in 3.6%, deranged occlusion in 1% and infection at operated site in 1% cases which were managed satisfactorily.Conclusion: The findings of this study reveal sharp annual increase in the number of cases of maxillofacial trauma. Road traffic accidents (RTA) were the commonest cause and the age group most affected was between 20–25 years. ORIF of these fractures was chosen for its obvious advantages of direct anatomical reduction, early return to function and minimal complications.
... Listed as the third most common cause of traumatic dental injury, inter-relationship violence follows only domestic accidents and sporting activities (6,7). However, at the time of diagnosis, the real cause of the injuries may remain occult. ...
The purpose of this study was to investigate the prevalence and types of traumatic dental injuries in situations of domestic violence. A coross-sectional study was conducted and data were collected from the police occurrence records to domestic physical aggression between 2001 and 2005. Of the 1,844 subjects who underwent medical evaluation, 15 had information pertaining to traumatic dental injuries. From the medical records, the forensic medical reports completed by the forensic medical experts who examined the victims after the aggression were reviewed and data of individuals with dental injuries (e.g., fractures, luxation and avulsion) were collected. In the selected sample, there was a predominance of individuals with injuries to the head and neck region (38.7%), and the frequency of traumatic dental injuries among all injuries to the head and neck region was 2.0%. The most frequently injured teeth were the maxillary incisors (31.8%), followed by the mandibular incisors (27.3%) and the maxillary canines (9.1%). In 31.8% of the injured teeth, the forensic experts did not specify the nomenclature. Of the dental trauma cases, 59.1% were fractures, 27.2% were luxations and 13.7% were avulsions. In conclusion, domestic violence was an important etiologic factor of traumatic dental injury. The aggression in all cases occurred in the form of punches and slaps. Fracture was the most common type of traumatic dental injury, and the most frequently injured teeth were the incisors.
... Drinking alcohol is not only a risk factor for violent behavior, but may increase the risk of assault, especially for females.[18] In a study of females seen at a busy regional maxillofacial unit between 2000 and 2004, the most common mode of injury in alcoholrelated incidents was interpersonal violence.[19] Collectively, these studies implicate interpersonal violence as the " pathway " that links substance use and orofacial injuries. ...
Substance use is a major contributing factor to the interpersonal violence that accounts for a significant proportion of facial injuries among adults and adolescents; thus, violence is the main "pathway" through which substance use and injuries are linked. Beyond causality, substance use continues to influence recovery from the injury through its impact on the healing process (eg, patient noncompliance, suppression of T-cell counts, susceptibility to bacterial colonization, and protein production). Further exacerbating this issue are significant rates of injury recidivism and the lack of motivation to seek treatment for underlying substance-use problems. As a frontline care provider, the oral and maxillofacial surgeon has a responsibility to screen and refer patients for any needed specialty treatment (including substance-use treatment, violence reduction, and posttraumatic stress reduction). Recognizing and addressing these issues requires a paradigm shift that involves integration of multidisciplinary expertise.
Aims
This study aimed to evaluate national alcohol sales and their association with the number of maxillofacial fractures in Southern Finland.
Methods
Patient data of all facial fracture patients admitted to tertiary trauma centers (Helsinki University Hospital, Helsinki, Finland) from January 2014 to October 2020 were reviewed retrospectively. Information on alcohol sales in Finland was obtained from the Finnish Institute for Health and Welfare.
Results
The annual number of facial fractures increased, as did the number of facial fractures caused by interpersonal violence. Unexpectedly, we found a mostly inverse association between alcohol sales and facial fractures, although three months were associated positively: April, June, and November.
Conclusion
We conclude that although the significance of alcohol use in the etymology of facial fractures has been unmistakably proven neither population-level alcohol use nor interpersonal violence as an injury mechanism explains the increase in facial fractures. However, there are some associations between the seasonality of alcohol consumption and facial fractures, suggesting the same predisposing factors in both. Further, certain groups of users, exceeding a threshold of alcohol use, appear to be responsible for the traumatic presentations in emergency units. Elucidating the associations between alcohol use and facial fractures requires an assessment of patient-specific factors, rather than population-level alcohol use, for a detailed understanding and justification of alcohol policy.
Domestic violence continues to be a global public health issue, and facial injuries in these cases are common with a reported incidence of up to 94%. Our aims were to identify patients with facial injuries caused by domestic violence, and to find out how confident members of the oral and maxillofacial surgical (OMFS) team were at assessing them. In this 18-month retrospective study of patients seen at King's College Hospital we identified 18 and obtained details on sex, age, nature of maxillofacial injury, mechanism of injury, time to presentation, and alleged assailant, from their electronic records. Most of the patients were female and the mean (range) age was 28 (16-44) years. In 10 cases, the alleged assailant was the patient's current partner. A total of 15 patients presented on the same day as their injury, and only 3 the following day. Punching was the most common mechanism (n=13) followed by use of a weapon. We also circulated a questionnaire among the OMFS team to gain an insight into their attitudes regarding screening for domestic violence. Most OMFS clinicians were only "somewhat confident" at recognising and asking about domestic violence, and few were "very" or "extremely confident". Targeted training for frontline staff in OMFS teams is likely to increase their confidence to identify and manage these patients, and to refer them appropriately.
IntroductionDiversities exists in incidence, etiology and epidemiology of facial fractures among male and female individuals due to various reasons. Many of the epidemiological studies published during the millennium have shown male predilection. This study was carried to evaluate the etiology, patterns and distribution of facial fractures among different age groups in women. Materials and Methods
This Retrospective epidemiological study dealt with a total of 302 women with 422 fractures in maxillofacial region during a period of June 1st 2005 to May 31st 2015 at Mamata Dental College and Hospital, Khammam, Telangana, India. ResultsMean age of incidence was 31.58 years, mandibular fractures were highest (44.07 %) followed by zygomaticomaxillary complex injuries (ZMC) (20.37 %). Road traffic accidents (RTA) injuries (53.7 %) were highest, followed by assault (23.9 %) and other causes. Highest number (33.8 %) of fractures were sustained in the 3rd decade and least (0.7 %) in the 8th decade of life. Among soft tissue injuries most commonly seen were lacerations (51 %). Conclusion
Results of this study suggest that there is an increase in the number of maxillofacial injuries in women, representing changes in the society, exposing women to similar conditions like men and increased number of working women. This study helps to identify trauma burden, assess the awareness of current preventive measures, women protection laws, for instituting new guidelines for prevention and planning health care services for women.
Aim:
To examine the relationship between social and material deprivation and mandibular fractures.
Method:
Three hundred and forty three consecutive patients who underwent mandibular fracture fixation were selected for the study. After exclusions, 290 were divided into age groups and ranked according to their Index of Multiple Deprivation (IMD) score. Rankings were determined using postcodes, and divided into quintiles for statistical analysis.
Results:
Ages ranged from 7 to 82 with 146 (50%) patients aged between 20 and 29. Males accounted for 85% of cases. The most common site of fracture was the angle (n = 195) and assault was shown to be the most common mechanism of injury (63.3%). A strong relationship was demonstrated between fractures of the mandible and worsening deprivation, with the most striking relationship seen with fractures sustained as a consequence of assault. Females were less likely than males to sustain a fracture of the mandible as a consequence of assault; however, when assault was the mechanism of injury they were also likely to be from a deprived background.
Conclusion:
This study has demonstrated that a strong relationship exists between deprivation and the incidence of mandibular fractures in our catchment area. Fractures that resulted from interpersonal violence were shown to have a particularly strong correlation with deprivation.
The purpose of this study was to evaluate and compare the demographic characteristics of maxillofacial fractures between women and men in China.
The sample was composed of all patients who sustained maxillofacial fractures during a 10-year period (2000 through 2009). Incidences, age distributions, etiologies, fracture patterns, associated injuries, and occupation distributions were recorded and analyzed. Data analysis included the χ(2) test, the Fisher exact test, and the t test. A P value less than .05 was considered significant.
There were 1,131 patients (881 male and 250 female) who sustained maxillofacial fractures, with a male-to-female ratio of 3.5:1. Male patients sustained injuries most frequently during the autumn (P = .048), whereas female patients sustained more maxillofacial injuries during the summer (P = .006). Men sustained motorcycle (P = .023) and assault-related accidents (P = .036) more frequently than women, whereas women were more frequently injured in bicycle-related accidents (P < .001) or falling while at ground level (P = .001) than men. Women presented more frequently with condylar fracture than men (P = .028), whereas men were more prone to symphysis fractures than women (P = .037). For drivers, only men were involved (P = .001). Male workers sustained maxillofacial fractures more frequently than female workers (P < .001). Female children, students, and company staff were more prone to maxillofacial fractures than their male counterparts (P = .010, P = .004, and P = .044 respectively).
The demographic characteristics of maxillofacial fractures in female patients considerably differ from those in male patients.
Copyright © 2015 American Association of Oral and Maxillofacial Surgeons. Published by Elsevier Inc. All rights reserved.
Purpose:
This study was designed to assess the changes in the etiology, incidence, and pattern of maxillofacial fractures during 2 different study periods in our department.
Patients and methods:
In this retrospective study, patients treated for maxillofacial fractures at our department from January 2000 to December 2009 were included. Data regarding patient's age, sex, etiology of fracture, time of injury, site of fracture, and pattern of fracture were collected and grouped chronologically into two 5-year periods: 2000 to 2004 (period 1) and 2005 to 2009 (period 2); the results of the study during these periods were analyzed and compared.
Results:
A total of 1131 patients sustained maxillofacial fractures: 422 in the first period and 709 in the second period. During the second period, the male-female ratio increased from 3.35:1 to 3.63:1. Road traffic accidents remained the major etiologic factor, which increased remarkably from 49.3% to 54.6% (P = 0.085), whereas assault-related injuries decreased significantly from 16.8% to 12.4% (P = 0.039). The proportion of patients with mandibular fractures decreased from 59.6% to 55.3% (P = 0.037), whereas the proportion of patients with midfacial fractures increased from 40.4% to 44.7% (P = 0.037).
Conclusions:
The changing pattern of maxillofacial fractures in our center is correlated to the socioeconomic status, population mobility, and etiologic factors. Strict enforcement of traffic laws and regulations is still a focal factor in attaining appreciable reduction in maxillofacial fractures associated with road traffic accidents.
A large number of papers related to oral and maxillofacial surgery are published in many specialist journals. With the ever-increasing use of the internet it is easy to download them as part of a journal subscription on a fee per paper basis, or in some cases for free. Online access to the British Journal of Oral and Maxillofacial Surgery (BJOMS) is free to British Association (BAOMS) members with a $30 fee per paper download for non-members. Many colleagues use the online version of the journal, and this provides valuable information about downloading trends. Other data on articles that have been cited in subsequent publications are also readily available, and they form the basis for the calculation of a journal's impact factor. We evaluated the top 50 downloaded papers from the BJOMS website in 2010 to ascertain which articles were being read online. We also obtained data on the number of citations for papers published in 2009-2010 to see whether these papers were similar to the articles being downloaded. In 2010 there were over 360000 downloaded articles. The most popular papers were leading articles, reviews, and full length articles; only one short communication featured in the top 50 downloads. The papers most cited in subsequent publications were full length articles and leading articles or reviews, which represent 80% of the total citations of the 50 papers. Ten papers were in both the top 50 downloaded and most cited lists. We discuss the implications of this study for the journal and our readers.
It is often difficult for emergency department staff to follow up the primary closure of simple facial lacerations. This is important to allow closure of the feedback loop. Consecutive patients who were sutured by a single operator using the same technique were asked to send a photograph of the laceration six months and 12 months afterwards. The patients had Internet access and a digital camera, or a mobile phone with a camera. They were given a leaflet with the details of the email address or mobile number to send the picture to. A reminder telephone call was made to each patient at six months and 12 months, and the email address or mobile number to send the picture to was given again. In each telephone call patients were asked to grade the healing on a 5-point scale from 1 = very happy to 5 = very unhappy. At 13 months all patients were re-contacted and reminded again. Fifty patients were included in the study (33 males). The cause of injury was sport in 17 patients, assault in 18 and accidents in 15. At six months, 23 patients stated that they were happy and 27 were very happy with the scar. The mean score was 1.5. At 12 and 13 months, four patients were happy and 46 very happy. The mean score was 1.1. Twenty-four patients said they would use a computer/camera to send in the follow-up image, and 26 patients had a mobile phone with a camera and said they would use that. Despite the reminders, no patients sent a photograph. The results provide no evidence to support the use of photographs sent by email or text message for the follow-up of facial lacerations sutured in the emergency department.
This paper provides a summary of the 49 trauma and related papers published in British Journal of Oral and Maxillofacial Surgery during the period January 2008 to December 2009. 16/49 (32%) of these publications were full length articles, which covered areas such as epidemiology, service provision, materials and operative surgery. In addition there were other articles including short communications, technical notes, letters to the editor and interesting cases. Whilst fewer full length articles were published compared to the other sub-specialties, it was reassuring to see that the studies represent all aspects of trauma. More basic science and randomized control studies relating to trauma need to be encouraged.
Although the incidence of assault and other violent crime is increasing in the UK, the cause and overall pattern of injury, and the need for admission have not been defined in adult victims who attend hospital. In a prospective study, all 539 adult victims of assault attending a major city centre Accident & Emergency department in 1986 were therefore interviewed and examined.
Facial injury was extremely common: 83% of all fractures, 66% of all lacerations and 53% of all haematomas were facial. The upper limb was the next most common site of injury (14% of all injuries). Twenty-six per cent of victims sustained at least one fracture and nasal fractures were the most fiequently observed skeletal injuries (27%) followed by-zygomatic fractures (22%) and mandibular body (12%), angle (12%) and condyle (9%) fractures. Seventeen per cent of victims required hospital admission.
Overall, the type of injury observed correlated with the alleged weapon used ( P=<0.001) though 20% of victims who reported attacks with sharp weapons sustained only haematomas or fractures. Injury most often resulted from punching (72% of assaults) or kicking (42% of assaults). Only 6% of victims reported injury with knives but 11% were injured by broken drinking glasses. Those who were kicked were most likely to need hospital admission.
470 victimes d'agressions examinees dans des services d'urgence ont ete interrogees sur l'absorption d'alcool dans les 12 h precedentes et leur alcoolemie est dosee. Les lesions sont classees en 5 categories d'apres leur gravite et leur multiplicite. Les resultats montrent que les lesions les moins graves sont plus souvent notees chez les non-buveurs, et les plus graves et les plus nombreuses chez les sujets ayant absorbe plus d'alcool
Police crime statistics and crime survey data are known to be poor indicators of levels of violence in society. Longitudinal investigations of assault injury have not been carried out in accident and emergency departments hitherto, but may provide an accurate perspective of trends in violence. The attendance of assault patients at a city centre accident and emergency department was compared with 'wounding against the person' recorded by the police between 1973 and 1990. Woundings recorded by the police increased consistently throughout the study period whereas the number of assault patients did not increase between 1977 and 1987. From 1975 to 1990, police statistics showed a 9-fold and accident and emergency data a 6-fold increase. Both data sets showed substantial overall increases in violence after 1987, and a decrease in 1979. Further epidemiological studies of violence are necessary.
To determine the age and sex distribution, timing, causes, geographical location, and nature of facial injuries in the UK and to determine the association of these factors with alcohol consumption by the patient or any other involved person.
A 12-section proforma was completed on all patients with facial injuries covering their age and sex, time and day of injury and presentation, the cause and type of injury and where it occurred, the treatment the patient received, any other injuries, and alcohol consumption by the patient and any other involved person. The total attendances for the study week and the catchment population for each A&E department were recorded.
163 of the A&E departments in the UK served by 137 of the UK's oral and maxillofacial departments.
All patients who presented with facial injuries to these 163 A&E departments in England, Scotland, Wales and Northern Ireland over the study week from 09.00 hours on Friday 12 September 1997 to 08.59 hours on Friday 19th September 1997.
6114 patients with facial injuries presented over the week, out of a total of 152,692 A&E attendances. The male:female ratio was 68:32. This rose to 79:21 in assault cases. The mean age of all patients was 25.3 years, of males 23.2 years, and of females 29.8 years. Forty per cent of the facial injuries were caused by falls. A large proportion of these happened to the under-5 age group in the home. Eleven per cent of all falls were associated with alcohol consumption. Twenty-four per cent of the facial injuries were caused by assault. The commonest sites for assault were the street followed by public drinking establishments. More women than men were assaulted at home. Fifty-five per cent of assaults were related to alcohol consumption. Eight per cent of assaults were with bottles or glasses. Five per cent of the facial injuries occurred in road traffic accidents (RTAs). Fifteen per cent of RTA victims had consumed alcohol. The 15-25 age group suffered the greatest number of facial injuries caused by assault and RTAs and had the highest number associated with alcohol consumption. At least 22% of all the facial injuries in all age groups were related to alcohol consumption within 4 hours of the injury. In the over 15 age groups, alcohol consumption was associated with 90% of facial injuries occurring in bars, 45% on the street, and 25% in the home. Assault, RTA and alcohol consumption conveyed an increased risk of serious facial injury.
Campaigns should be instituted to educate young people about the link between excessive alcohol consumption, assault, road traffic accidents and serious facial injury.
Prevention of violence-related injury has become an important public health issue but national, regional and local data are lacking. The aims of this study were to determine trends, seasonality and rates of violence-related injury according to Accident and Emergency (A&E) recorded data in England and Wales over a 5 year period, 1995-2000.
A stratified sample of 58 major A&E departments in England and Wales were recruited for the study. Electronic data on age, gender and date of attendance of all those reporting violence-related injury over a 5 year period, May 1995 to April 2000, were retrieved. Injury rates (number of injured per 100 resident population) were computed and ordinary least-squares regression analysis was used to evaluate linear and non-linear trends in these time series data.
A total of 353442 (258719 males: 73 per cent) violence-related attendances were identified. Overall annual violence-related attendance did not change significantly (p > 0.05) but attendance of females aged 11-17 years increased steadily and significantly (p < 0.05) over the 5 year period. Health-region, gender- and age-specific increases in violence-related attendance slowed (p < 0.05). Compared with spring there were significantly lower levels of violence in autumn and winter for both males and females (p < 0.05). Violence affecting males aged 18-30 years was not subject to seasonality. Males, those aged 18-30 years and those living in the northern and western regions in England and Wales were at highest risk of violence-related injury.
This national study from the perspective of health services suggests that violence did not increase over the period 1995-2000. Slowing of age-, gender- and health-region-specific increases in violence-related injury suggests that violence is coming under control. The reasons for significant trends in individual urban centres deserve further study, and could provide important new directions for violence prevention.
Violence and injuries caused by violence appear to be increasing.
A prospective study of violent injuries treated in our unit.
Over a 5-month period, 148 (21%) of 704 acute admission patients aged 14 years or more and 11 children had injuries due to violence. The head, neck and hands were the commonest sites of injury. Of the 148 patients, 144 (91%) underwent surgery for their injuries.
Injuries due to violence have a significant effect on the resources of our NHS hospital and probably of all NHS hospitals with acute surgical services.
Every branch of healthcare has its own particular experience of violence, from direct physical or verbal aggression aimed at members of staff, to dealing with the victims of a crime perpetrated elsewhere. Since the first edition of this book was published in 1994, there have been huge developments in understanding and managing violence in the healthcare setting. Violence prevention is now not just the concern of the frontline healthcare team, but also of architects, service managers, psychologists, governments, health and safety managers, human resources managers, and members of the emergency services. This fully revised and updated new edition will equip all members of these teams with the information required to understand the range of factors involved, and enable them not just to develop strategies to tackle the issues but also to deal with violence when it arises in both hospital and community settings. Coverage includes the causes and nature of violence, including domestic violence, the effects on, and care of, the victims, as well as describing opportunities to limit the potential for violence through good design. This book is essential reading for all those working in, or in association with, health services and related agencies. It is also an essential resource for anyone seeking to understand, prevent or survive violence. From reviews of the 1st edition: ‘this short and affordable guide to the recognition, avoidance and aftermath of violence will prepare you for the event’ John Bignall, The Lancet 1994. 344:180 ‘Many health care staff will look for a practical guide to coping and will find this book an excellent place to start … Those spurred into action could usefully rely on this book to aid the process of effective management and staff support’ Arden Tomison, Fromeside Clinic, Bristol, British Journal of Psychiatry , August 1995 ‘There are no obvious gaps in an eminently readable and well-unified text.’ Patrick Hoyte, MDU Nurse, February 1995 ‘… the book effectively addresses a pressing problem for health care workers: how to cope with aggressive behavior’ Ellen H Taliaferro, University of Texas Southwestern Medical School, Annals of Emergency Medicine, October 1995 ‘It would be important reading for those undertaking further study of the prevention and management of violence and aggression ...’ John Rawlinson, Lecturer in Mental Health Nursing, Professional Nurse, July 1996
Objective - To determine the age and sex distribution, timing, causes, geographical location, and nature of facial injuries in the UK and to determine the association of these factors with alcohol consumption by the patient or any other involved person. Design - A 12-section proforma was completed on all patients with facial injuries covering their age and sex, time and day of injury and presentation, the cause and type of injury and where it occurred, the treatment the patient received, any other injuries, and alcohol consumption by the patient and any other involved person. The total attendances for the study week and the catchment population for each A&E department were recorded. Setting - 163 of the A&E departments in the UK served by 137 of the UK's oral and maxillofacial departments. Subjects - All patients who presented with facial injuries to these 163 A&E departments in England, Scotland, Wales and Northern Ireland over the study week from 09.00 hours on Friday 12 September 1997 to 08.59 hours on Friday 19th September 1997. Results - 6114 patients with facial injuries presented over the week, out of a total of 152 692 A&E attendances. The male:female ratio was 68:32. This rose to 79:21 in assault cases. The mean age of all patients was 25.3 years, of males 23.2 years, and of females 29.8 years. Forty per cent of the facial injuries were caused by falls. A large proportion of these happened to the under-5 age group in the home. Eleven per cent of all falls were associated with alcohol consumption. Twenty-four per cent of the facial injuries were caused by assault. The commonest sites for assault were the street followed by public drinking establishments. More women than men were assaulted at home. Fifty-five per cent of assaults were related to alcohol consumption. Eight per cent of assaults were with bottles or glasses. Five per cent of the facial injuries occurred in road traffic accidents (RTAs). Fifteen per cent of RTA victims had consumed alcohol. The 15–25 age group suffered the greatest number of facial injuries caused by assault and RTAs and had the highest number associated with alcohol consumption. At least 22% of all the facial injuries in all age groups were related to alcohol consumption within 4 hours of the injury. In the over 15 age groups, alcohol consumption was associated with 90%) of facial injuries occurring in bars, 45% on the street, and 25% in the home. Assault, RTA and alcohol consumption conveyed an increased risk of serious facial injury. Conclusions - Campaigns should be instituted to educate young people about the link between excessive alcohol consumption, assault, road traffic accidents and serious facial injury.
During the first six months of 1986, 294 consecutive victims of assault were examined to determine the patterns of injury. Forty-three victims were women aged 15-46 years (mean: 25 years). In comparison with the hospital catchment population, the unemployed were over-represented and the greater than 40 age range under-represented. Facial injury, especially bruising, was extremely common, affecting 88% of women and 84% of men. Some 56% of women had sustained a fracture compared to only 26% of men but facial lacerations were uncommon in female victims. Assailants were known to 75% of female victims, but only 25% of men, and females were four times more likely to be assaulted at home. 33% of women reported previous assault in comparison with 44% of men. Oral and maxillofacial staff should understand the likely social implications and be able to organise management of assault victims of which women form an important subgroup. Management may involve social workers and psychiatrists as well as other members of the family.
A hypothesis that facial wounds are the most common soft tissue injuries resulting from assault has been tested by examining the records of 225 consecutive victims of assault (169 males, median age 22 years; 56 females, median age 24 years) attending the Accident and Emergency Department of the Bristol Royal Infirmary during 1984/85. Demographic factors including age and sex of patients and time, day and month of attendance were recorded. Results supported the hypothesis but significantly more men (72%) than women (57%) had facial injuries (chi 2 = 12.2, p = less than 0.01). Chest, abdominal and limb injuries were proportionately more frequent in women (p = less than 0.001). Middle third wounds were the commonest facial injuries (affecting 59% of patients) followed by upper third (25%) and lower third (16%). Left-sided facial injury was more common than right-sided (chi 2 = 14.6; p = less than 0.01). Young adult males most commonly attended, but very few elderly patients. "Risk" of assault appeared highest at weekends, between 10 pm and 2 am and between July and October. The involvement of plastic and oral surgeons in the treatment of assault victims is likely to be considerable.
Few data exist regarding the relationship between the location of injuries and the presence of domestic violence. This study of 127 people at an inner-city hospital emergency department found that most patients had head, neck and facial injuries. Although only 23 percent of patients with such injuries were victims of domestic violence, 94.4 percent of victims of domestic violence had head, neck and facial injuries. The study results indicate that head, neck and facial injuries could be markers of domestic violence.
To compare the characteristics of female victims of assault with those of male victims and to see if there is a difference between female victims of domestic assault and females assaulted by strangers or acquaintances.
A two month prospective study (June and July 1995) of all assault victims attending a Scottish accident and emergency (A&E) department.
A large district general A&E department (the Royal Alexandra Hospital in Paisley) seeing 60,000 new patients per year with a catchment population of 200,000.
46 female victims of violence attended the A&E department (20% of the total of 235). In comparison with men, women were more likely to be assaulted in their homes (48% v 10%; P < 0.001), but were less likely to be assaulted with sharp weapons (7% v 28%; P = 0.003) and to require admission to hospital (P = 0.005). Nineteen women (41%) were victims of domestic assault. The victims of domestic assault were more likely to have been drinking (11% v 31%; P = 0.007) and to have a history of previous assault (63% v 22%; P = 0.002). This group also had a higher mean deprivation score and rate of unemployment, although the differences were not statistically significant.
A&E staff should be aware of risk factors associated with domestic assault to aid recognition of victims. Using the current British Association for Accident and Emergency Medicine guidelines on domestic violence and closer liaison with police, social services, and general practitioners will help prevent further attacks.
The maxillofacial region is by far the most frequently selected target in assaults on adults. There is a causal link between alcohol intoxication and injury. Therefore, oral and maxillofacial surgery is, in effect, the lead speciality for those injured in violence and has a responsibility to orchestrate holistic care that takes into account mental health needs. Recent years have also seen a determined effort by oral and maxillofacial surgeons to get involved in wider issues of prevention, exemplified by the national UK BAOMS Facial Injuries Awareness Week. Multi-agency prevention, not just with mental health professionals in the case of individual patients, but also with emergency medicine, public health, local government, the police and the voluntary sector is key to success. Given the potential complexity of collaborations like this, it is important to understand what works in multi-agency prevention. This paper reviews successful interventions: their rationale and how oral and maxillofacial surgeons can contribute to local injury prevention.
The impact of violent injuries on an NHS plastic surgery unit.
- Thornton D.J.A.
- Timmons M.J.
- Majundera S.
- Kranidhiotis N.M.