Assault and facial soft tissue injuries

doi:10.1016/0007-1226(87)90157-3

British Journal of Plastic Surgery

Volume 40, Issue 6, November 1987, Pages 614-619

https://doi.org/10.1016/0007-1226(87)90157-3 Get rights and content

Summary

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 1984/1985. 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 (χ² = 12.2, p = <0.01). Chest, abdominal and limb injuries were proportionately more frequent in women (p = <0.001). Middle third wounds were the commonest facial injuried (affecting 59% of patients) followed by upper third (25%) and lower third (16%). Left-sided facial injury was more common than right-sided (χ² = 14.6; p = <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.

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Cited by (46)

Identifying Injury Patterns Associated With Physical Elder Abuse: Analysis of Legally Adjudicated Cases
2020, Annals of Emergency Medicine
Citation Excerpt :
We found that physical elder abuse victims were more likely to have injuries on the left side of the face. This supports existing literature examining younger adult assault victims, which has found that left-sided facial injuries are more frequent after assault than right-sided ones, likely because most assailants are right-handed.70-72 Neck injuries were also found much more commonly in abuse, as may be expected because the neck is typically protected during a fall by the shoulders or face.
Elder abuse is common and has serious health consequences but is underrecognized by health care providers. An important reason for this is difficulty in distinguishing between elder abuse and unintentional trauma. Our goal was to identify injury patterns associated with physical elder abuse in comparison with those of patients presenting to the emergency department (ED) with unintentional falls.
We partnered with a large, urban district attorney’s office and examined medical, police, and legal records from successfully prosecuted cases of physical abuse of victims aged 60 years or older from 2001 to 2014.
We prospectively enrolled patients who presented to a large, urban, academic ED after an unintentional fall. We matched 78 cases of elder abuse with visible injuries to 78 unintentional falls. Physical abuse victims were significantly more likely than unintentional fallers to have bruising (78% versus 54%) and injuries on the maxillofacial, dental, and neck area (67% versus 28%). Abuse victims were less likely to have fractures (8% versus 22%) or lower extremity injuries (9% versus 41%). Abuse victims were more likely to have maxillofacial, dental, or neck injuries combined with no upper and lower extremity injuries (50% versus 8%). Examining precise injury locations yielded additional differences, with physical elder abuse victims more likely to have injuries to the left cheek or zygoma (22% versus 3%) or on the neck (15% versus 0%) or ear (6% versus 0%).
Specific, clinically identifiable differences may exist between unintentional injuries and those from physical elder abuse. This includes specific injury patterns that infrequently occur unintentionally.
Analysis of the pattern of maxillofacial injuries in Saudi Arabia: A systematic review
2020, Saudi Dental Journal
Citation Excerpt :
These findings were in agreement with reports from other developing countries in which road traffic accident is considered to be the most common cause of facial trauma (Oji, 1999; Qudah and Bataineh, 2002; Al Ahmed et al., 2004; Nwoku, 2004; Obuekwe et al., 2005; Cheema and Amin, 2006; Chandra Shekar and Reddy, 2008; Kamulegeya et al., 2009; Mesgarzadeh et al., 2011; Chrcanovic et al., 2012) and this may be attributed to the rapid and wide economic expansion of the country economy following the oil discovery (Ansari et al., 2000). Other possible reasons could be due to high speed driving and the ignorance of traffic roles, but the current findings differ from reports published in other parts of the world in which assault was regarded as the main cause of facial injuries (Shepherd et al., 1987; Huang et al., 1998; Arosarena et al., 2009). Researchers highlighted various causes for RTAs such as over speed and improper turning (Ali Aba Hussein and El-Zobeir, 2007; World Health Organization, 2011; Barrimah et al., 2012; Farah et al., 2015).
Maxillofacial trauma (MFT) is a serious health problem and in Saudi Arabia is mainly caused by road traffic accidents (RTAs). MFT commonly associated with injuries to the face, head, and jaws and may cause soft tissue lacerations and bruises. MFT can also cause fatal blood loss and airway obstruction. The objective of this review was to determine the prevalence of MFT, identify the major causative factors in males and females in the main cities of Saudi Arabia.
We performed literature searches of all published studies describing MFT from KSA during the last 20 years.
In Saudi Arabia, males are more prone to MFT than females, although the male: female ratio of MFT varies between different cities. Specifically, Aseer has the highest male: female ratio (10:1), followed by AlHofuf (8.3:1) while AlQurayyat had the least gender ratios of MFT (2:1). Most cases of MFT are associated with RTAs, which accounted for (63%–90.3%) in Medina, (89.1%) in Aseer, (86.1% –87.1%) in Riyadh, (67%–73.1%) in Jeddah, (71%) in Khamis Mushait, (64.2%) in Makkah and (63.3%) in Al-Hofuf. The least percentage of RTA resulting into MFT was recorded in AlQurayyat (24%).
Maxillofacial trauma is a serious health problem in Saudi Arabia. RTAs remain the major cause of maxillofacial injuries especially among males, thus strict implementation of traffic rules is a must to minimize maxillofacial injuries and its physical and psychological impact.
Geriatric assault victims treated at U.S. trauma centers: Five-year analysis of the national trauma data bank
2016, Injury
While geriatric trauma patients have begun to receive increased attention, little research has investigated assault-related injuries among older adults. Our goal was to describe characteristics, treatment, and outcomes of geriatric assault victims and compare them both to geriatric victims of accidental injury and younger assault victims.
We conducted a retrospective analysis of the 2008–2012 National Trauma Data Bank. We identified cases of assault-related injury admitted to trauma centers in patients aged ≥60 using the variable “intent of injury.”
3564 victims of assault-related injury in patients aged ≥60 were identified and compared to 200,194 geriatric accident victims and 94,511 assault victims aged 18–59. Geriatric assault victims were more likely than geriatric accidental injury victims to be male (81% vs. 47%) and were younger than accidental injury victims (67 ± 7 vs. 74 ± 9 years). More geriatric assault victims tested positive for alcohol or drugs than geriatric accident victims (30% vs. 9%). Injuries for geriatric assault victims were more commonly on the face (30%) and head (27%) than for either comparison group. Traumatic brain injury (34%) and penetrating injury (32%) occurred commonly. The median injury severity score (ISS) for geriatric assault victims was 9, with 34% having severe trauma (ISS ≥ 16). Median length of stay was 3 days, 39% required ICU care, and in-hospital mortality was 8%. Injury severity was greater in geriatric than younger adult assault victims, and, even when controlling for injury severity, in-hospital mortality, length of hospitalization, and need for ICU-level care were significantly higher in older adults.
Geriatric assault victims have characteristics and injury patterns that differ significantly from geriatric accidental injury victims. These victims also have more severe injuries, higher mortality, and poorer outcomes than younger victims. Additional research is necessary to improve identification of these victims and inform treatment strategies for this unique population.
Maxillofacial fractures in women and men: A 10-year retrospective study
2015, Journal of Oral and Maxillofacial Surgery
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 χ² 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.
Assault-related maxillofacial injuries: The results from the European Maxillofacial Trauma (EURMAT) multicenter and prospective collaboration
2015, Oral Surgery, Oral Medicine, Oral Pathology and Oral Radiology
Citation Excerpt :
The observed mean age was 32.2 years (range 4-91 years; median 29; standard deviation 14). The similar gender and age predominance had also been observed in many earlier studies on maxillofacial injuries related to assaults and interpersonal violence.1-3,6,39-43 Our results confirm that assault-related fractures tend to affect a particular demographic group.
The aim of this study is to present and discuss the demographic characteristics and patterns of assault-related maxillofacial fractures as reported by a European multicenter prospective study.
Demographic and injury data were recorded for each patient who was a victim of an assault.
Assaults represented the most frequent etiology of maxillofacial trauma with an overall rate of 39% and the values ranging between 60.8% (Kiev, Ukraine) and 15.4% (Bergen, Norway). The most frequent mechanisms of assault-related maxillofacial fractures were fists in 730 cases, followed by kicks and fists. The most frequently observed fracture involved the mandible (814 fractures), followed by orbito-zygomatic-maxillary complex fractures and orbital fractures.
Our data confirmed the strong possibility that patients with maxillofacial fractures may be victims of physical aggression. The crucial role of alcohol in assault-related fractures was also confirmed by our study.
The lived experience of victims of crime
2011, International Emergency Nursing
The focus of this research study was to ascertain the impact of crime on individuals, who presented with an injury to the emergency department.
Given the high prevalence of crime in our society today, victims of crime are identified as a growing patient population seeking help in emergency departments. To maximise holistic care for these patients it is important that healthcare professionals gain insight into the experience of being a victim of crime.
The study was qualitative in nature and used a phenomenological approach. In-depth, unstructured audio taped interviews were conducted to elicit the essence of the experience of being a victim of crime.
The voices of the victims revealed four themes; “Fear, Shock and Disbelief”, “Guilt/Self-blame”, “Physical and Psychological Scars” and “Lifestyle Changes”.
The management of victims of crime in the emergency department appears to be concerned exclusively with physical injuries. Unseen is the potential psychological sequelae of the assault. Pivotal to these findings is the absence of psychological follow-up support for these victims of crime. This study affords healthcare professionals working in the emergency department, the opportunity to reflect upon current practice and highlight the value of their role in the provision of optimal care for this patient population.

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Assault and facial soft tissue injuries

Summary

International Journal of Oral Surgery

British Journal of Oral Surgery

Journal of Maxillofacial Surgery

British Journal of Oral Surgery

Lancet

British Journal of Criminology

International Journal of Oral Surgery

Home Office Research Study No. 76

Aetiology and incidence of facial fractures in adults

International Journal of Oral Surgery

The Neurologic Examination