Women who are victims of intimate partner violence tend to have different patterns of facial injury than women who experience facial trauma from other causes, according to a report in the January/February issue of Archives of Facial Plastic Surgery, one of the JAMA/Archives journals. This information, and other key characteristics such as a delay before visiting a health care facility, could help surgeons and other physicians recognize patients who are victims of this type of abuse.
Intimate partner violence—abuse by a spouse or significant other—affects approximately 25 percent to 33 percent of women in the United States, according to background information in the article. Between 88 percent and 94 percent of intimate partner violence victims seek medical attention for injuries to the head and neck, and 56 percent of those have facial fractures. “Because intimate partner violence accounts for 34 percent to 73 percent of facial injuries in women, facial plastic surgeons and other health care providers who treat patients with maxillofacial injuries are in a unique position to identify these victims and refer them to local domestic violence service programs for safety planning, information and referrals, support services and advocacy, depending on the victims’ needs and choices,” the authors write.
Oneida A. Arosarena, M.D., of the Temple University School of Medicine, Philadelphia, and colleagues reviewed the medical and dental records of 326 women (average age 35 years) treated for facial trauma at one university medical center between 1998 and 2004. Of the 45 patients (13.8 percent) who were assault victims, 18 were documented victims of intimate partner violence, while 24 of the remaining 26 assault victims could not or did not identify their assailant. Other common causes of injury included motor vehicle crashes (139 patients, or 42.6 percent), falls (70 patients, or 21.5 percent) and unknown or undocumented causes (35 patients, or 10.7 percent).
Overall, assault was associated with mandible (jaw) fractures, zygomatic complex fractures (complicated breaks in the cheekbones), orbital blow-out fractures (cracks or breaks in bones surrounding the eye) and intracranial (brain) injury. “Specifically, higher than expected numbers of zygomatic complex fractures, orbital blow-out fractures and intracranial injuries were found in intimate partner violence victims,” the authors write. “Victims assaulted by unknown or unidentified assailants were more likely to have mandible fractures than were other assault victims.”
Results of the study indicate that about one in four women at risk for ongoing intimate partner violence was referred for protective service as required by state law and hospital policy. “Underreporting of intimate partner violence remains a hindrance to appropriate social intervention for many victims,” the authors write. “While our study was limited to facial trauma victims, it demonstrates that universal screening and examination of the patterns of presentation, including patterns of injury, can assist medical professionals in identifying these patients and initiating appropriate medical and social intervention.”
Arch Facial Plast Surg. 2009;11:48-52.