|Year : 2016 | Volume
| Issue : 1 | Page : 32-35
Etiology of injuries due to assault in the head and neck region: Socioeconomic factors and biological pattern
Ikechukwu Udo Madukwe1, Akhiwu Wilson Oberaifo2
1 Department of Oral Surgery and Pathology, Faculty of Dentistry, College of Medical Sciences, University of Benin, Benin City, Edo State, Nigeria
2 Department of Pathology, Forensic Unit, Police Hospital, Benin City, Edo State, Nigeria
|Date of Web Publication||18-Jan-2016|
Ikechukwu Udo Madukwe
Department of Oral Surgery and Pathology, Faculty of Dentistry, College of Medical Sciences, University of Benin, Benin City, Edo State
Source of Support: None, Conflict of Interest: None
Background: The emergency department of any given tertiary hospital setting provides an opportunity to deal with the outcomes of violence. The head and neck region is the most affected, especially in assault cases.
Materials and Methods: A retrospective medical forensic auditing of a non-confidential cumulative record of assault cases from December 1, 2001 to December 1 st 2002 was carried out at the Nigerian Police Hospital, Benin City, Nigeria.
Result: There was a total of 1051 victims of which females were 52% and males 48% respectively. Almost 90% of the victims were of low socio-economic background. The most affected age-range was 21-30 years and the most commonly used assault weapon was a blunt object 23.5% head and neck region was affected 56.9% of the time.
Conclusion: We concluded that this study might sensitize the general practitioners, the oral surgeons, and the maxillofacial surgeons in collaborative management and research on head and neck assault.
Keywords: Etiology, injury, assault
|How to cite this article:|
Madukwe IU, Oberaifo AW. Etiology of injuries due to assault in the head and neck region: Socioeconomic factors and biological pattern. Saudi J Oral Sci 2016;3:32-5
|How to cite this URL:|
Madukwe IU, Oberaifo AW. Etiology of injuries due to assault in the head and neck region: Socioeconomic factors and biological pattern. Saudi J Oral Sci [serial online] 2016 [cited 2020 Aug 9];3:32-5. Available from: http://www.saudijos.org/text.asp?2016/3/1/32/174334
| Introduction|| |
The emergency department of a tertiary hospital provides an opportunity to manage the outcomes of a violence. , The head and neck region is the most affected, ,, especially in assault cases. ,, Previous studies by Madukwe et al.  had shown that violence especially human bite in this area is common. In this study on domestic assault, the human bite and its anatomic distribution, by age of victim and type of crime involved, revealed that bite marks occur primarily in sex-related crimes, child abuse, and cases involving other types of physical altercation. Legal options are rare in our community. Orofacial injuries and bite mark evidence have been admitted in a vast number of court cases throughout the United States, as well as other countries of the world. This is made possible because of the variation in human dentition making it feasible and possible to identify the perpetrators of the crime. Quantitative measures of the importance of evidence such as the "likelihood" ratio have become increasingly popular in the courtroom.  Assault can be common assault, actual bodily harm, and grievous bodily harm with intent.  Common weapons are blunt and sharp objects, fist blows, kicks, slaps, guns, and teeth.  Benin City location as a linkage city to other oil-rich cities makes it prone to violence, with a sparse record of victims and assailants. This sparse record may be due to the victim's perception that the assailant is not identifiable, victim's habituation to violence, reluctance to have their conduct scrutinized, social cost, and fear of reprisal.  This under recording  and severity  not help in identifying potentially vulnerable groups  for protection. This underscores the need for medical/dental trainees, trainers, and practitioners to understand the characteristics of these violence-related injuries and their anatomic distributions, mechanism, chronobiology,  and demography.  Lura and Rambousek found that the percentage of craniofacial injuries was dominant.  This study, therefore, aimed to characterize the etiology of injuries due to assault in the head and neck region in a large Nigerian City. Cultural and racial idiosyncrasy do affect assault types. 
| Materials and Methods|| |
A retrospective medical forensic auditing of a non-confidential cumulative record of assault cases was carried out from 1 December 2001 to 1 December 2002 at the Nigeria Police Hospital, Benin City, Nigeria. This included two yuletide periods when assault rate was normally high. This hospital record contained data on weapons and category of assault on the head and neck region documented by the police consultant pathologist. Data included age, gender, and occupation of the victim; time lapse before presentation to hospital and types of assault; weapons used; and clinical findings. Locations of assault outside Benin City were excluded.
| Results|| |
The number of assault victims was 1,051. Among them, 52% were females and 48% males [Table 1]. Low socioeconomic status of victims was 89.63% (942) [Table 2] and high socioeconomic status was 10.37% (109) [Table 3]. The various age ranges of victims were 11-20 years (25.21%), 21-30 years (39.10%), and 31-40 years (19.31%) and over 40 years 16.38% [Table 4]. Time lapse before presentation of the assault victims to the clinic was 1-2 days (78%), 3-4 days (9.6%), and more than 4 days presentation was 12.4% [Table 5]. Assault mechanism were blunt objects 27.5%, sharp objects 18.7%, gunshot 3%, others 22% [Table 6]. Anatomic distribution of assault site revealed head/neck 56.98%, upper limb 22.8%, trunk 9.62%, and lower limb 3.5% [Table 7].
| Discussion|| |
Assault is usually a product of degenerated disagreement on the population studied. The head and neck region was the most exposed and was easily the most vulnerable part of the body. ,,,,,,,,,,,,,,,,,,,,,, The result from the police crime records in the accident and emergency data demonstrated that females were more affected. Ninety percent (90%) of the victims were of low socioeconomic class [Table 2]. This is in tandem with Pfeiffer's view that socioeconomic inequality leads to declining social cohesion, heightened individual competition, fear of interpersonal violence, and intensified conflict. Conflict between spouses in poor families finds expression in assault.  The age groups represent the restless and the most active period of a life span and coincidentally falls between the primary group of 21-30 years (39.10%) were the most affected, followed by those belonging to the age groups 11-20 years (25.21%) and 31-40 years (19.3%) [Table 4]. These age groups represent restless and most active period within a life span and coincidentally falls between the primary, secondary, and university age years. It is, therefore, worthwhile for policy makers to develop a campaign geared toward educating parents on the risk around home and schools for these young children. The time lapse before victims' presentation to clinic was 1-2 days for 7.8% and 3-4 days for 9.6% [Table 5] which was encouraging but most victims in the population believed that the assailant would be unidentifiable. This is compounded by victim's habituation to violence, reluctance to have their conduct scrutinized, social cost, and fear of reprisals. 
Etiology of injuries linked to blunt objects (27.5%) as most used, fist boxes (24.8%), kicks (2.8%), and sharps (2.6%). Injuries to the head and neck region can be life-threatening causing airway obstruction provoking severe hemorrhage. Facial injury may cause permanent derangement of function such as vision, smell, taste, mastication, and swallowing. The trigeminal and facial nerves may be damaged, resulting in alterations in the victim's facial appearance that may cause psychological morbidity.  More so, when the anatomic distribution of injuries of victims revealed head and neck as the most affected 56.98% in our study subjects.
| Conclusion|| |
We concluded that this study could sensitize and empower the general practitioners, the oral surgeons, and the maxillofacial surgeons for greater involvement in collaborative management and research on head and neck assault with a view at proffering preventive solutions through public campaign in primary, secondary, and university educational levels. These assaults are preventable. 
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
Borrios DC, Grady D. Domestic violence. Risk factors and outcomes. West J Med 1991;155:133-5.
Kyriacom DN, McCabe F, Anglin D, Lapesarde K, Winer MR. Emergency department-based study of risk factor for acute injury from domestic violence against women. Ann Emerg Med 1998;31:502-6.
Garbin CA, Guimarães e Queiroz AP, Rovida TA, Garbin AJ. Occurrence of traumatic dental injury in cases of domestic violence. Braz Dent J 2012;23:72-6.
Francisco SS, Filmo FJ, Pinheiro ET, Murrer RD, de Jesus Soares A. Prevalence of traumatic dental injuries and associated factors among Brazilian school children. Oral Health Prev Dent 2013;11:31-8.
Hardwick L, James R. Domestic abuse - An under-reported problem in general dental practice? Dent Update 2013;40:550-2, 554.
Patton JH, Kralovich KA, Cuschieri J, Gaspavvi M. Clearing the cervical spine in victims of blunt assault to the head and neck: What is necessary? Am Surg 2000;66:326-31.
Nanni A, Lazar J, Berg C, Berge M, Tomashek K, Cabral H, et al
. Physical injuries reported on hospital visiting for assault during the pregnancy-associated period. Nurs Res 2008;57:144-9.
Oberoi SS, Aggarwal KK, Bhullar DS, Aggawal AD, Walic DS, Singh SP. Profile of assault cases in pastiala. J Punjab Acad Forensic Med Toxicol 2012;12:17.
Madukwe IU, Obuekwe ON, Ojo MA. Pattern of human bite of the oro-facial region and the indigenous mode of resolution of the resultant conflict: University of Benin Teaching Hospital experience. Nig Dent J 2007;15:52-5.
De Valck E. Bite analysis, Part I. Methods and overview. Med Tijdschr Tondheelkd 1995;102:221-3.
Bache J. The laws of violence. J Accid Emerg Med 2000;17:396-9.
Erin C, Nicolas R, Angela C, Khic HP, Emily K. Assault-related injury among young people aged 15-34 years that occurred in public places: Deaths and hospital-related injury: Victorian Injury Surveillance Unit. Hazard Edition. No. 73. Winter 2011.
Clakson CM, Cretney AL, Davis GC, Shepher J. Assault: The relationship between sinuousness, criminalization and punishment. Cim LR 1994;4-21.
Shepherd JP, Sivarajasingam V, Rivare FP. Using injury data for violence prevention. Government proposal is an important step towards safer communities. BMJ 2000;321:1481-2.
Surtherland I, Sivara Jasingam V, Shepherd J. Recording of community violence by medical and police services. Inj Prev 2002;8:246-7.
Sitar J. Chronobiology of human aggression. Cas Lek Cesk 1997;136:174-80.
Taylor D, Eddey D, Cameroon P. Demography of assault in a provincial Victorian population. Aust N Z J Public Health 1997;21:53-8.
Pridmore S, Ragan K, Blizzard L. Victims of violence in Fiji. Aust N Z J Psychiatry 1995;29:660-70.
Lukas J, Rambousek P. Injuries of the upper and middle thirds of the face. Analysis of the cause of injury. Cas Lek Cesk 2001;140:47-50.
Shepherd JP, Shapland M, Pearce NX, Scully C. Pattern, severity and aetiology of injuries in victims of assault. J R Soc Med 1990;83:75-8.
Wong JY, Choi AW, Fong DY, Wong JK, Lam CL, Kam CW. Pattern, aetiology and risk factors of intimate partner violence-related injuries to head, neck and face in Chinese women. BMC Women Health 2014;14:6.
Brink O. When violence strikes the head, neck, and face. J Trauma 2009;67:147-51.
Pfeiffer J. African independent churches in Mozambique: Healing the afflictions of inequality. Med Anthropol Q 2002;16:176-99.
[Table 1], [Table 2], [Table 3], [Table 4], [Table 5], [Table 6], [Table 7]