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PHILADELPHIA, Jan. 19 -- The pattern of facial trauma may help identify women abused by a spouse or significant other, researchers said.

Facial injuries from an assault by an intimate partner were more likely than expected to be periorbital fractures or intracranial injury, Oneida A. Arosarena, M.D., of Temple University here, and colleagues reported in the January/February issue of Archives of Facial Plastic Surgery.

In the retrospective study, women assaulted by an unknown or unidentified attacker were more likely to have mandible fractures (P=0.004).

The combination of these injuries with delayed presentation after the injury, multiple injuries in different stages of healing, or inconsistencies in the stated cause should trigger questions, Dr. Arosarena's group said.

Facial plastic surgeons and other providers who treat maxillofacial injuries are in "a unique position" to identify these victims and initiate appropriate medical and social intervention, depending on the victims' needs and choices, the researchers said.

Violence by an intimate partner accounts for 34% to 73% of facial injuries in women, they noted. Injuries sustained in these assaults are frequently to the head and neck (88% to 94.4%).

To assist physicians in distinguishing these cases from other causes of trauma, the researchers reviewed medical and dental records of 326 adult female facial trauma patients treated by otolaryngologists and oral or maxillofacial surgeons at an academic medical center in Kentucky.

Motor vehicle crashes accounted for the largest proportion of cases (42.6%), followed by falls (21.5%).

Assault was the third most common cause of facial trauma (13.8%). Among these women, 42.2% were documented victims of intimate partner or family violence; nearly all the rest could not or did not identify their assailant.

As expected from prior studies, few of the assault cases were reported to the police or a social worker (15.6%), the researchers said.

Although instances of domestic violence were more likely to have been reported than other assaults (26.1% versus 7.7%), this still meant that only one patient in four at-risk for ongoing violence at home was "appropriately referred for specialized protective services as required by state law and hospital policy."

Differences in injury types among victims of intimate partner violence compared with the overall incidence among women in the study included:

• Three times higher incidence of orbital blowout fracture (9% versus about 3%)
• Higher incidence of mandible fracture (4% versus 2%)
• More frequent zygomatic complex fracture (4% versus 3%)
• Lower incidence of nasal fracture (6% versus more than 8%)
• Lower rates of alveolar ridge fracture (7% versus 6%)
• Higher risk of intracranial injury (more than 2% versus less than 1%)
• Substantially lower incidence of facial laceration (1% versus 4%)

Women with facial trauma after an attack by an assailant she was unable or unwilling to identify were about twice as likely to have a mandible fracture (16% versus 7%) or zygomatic complex fracture (11% versus 6%) than were other assault victims.

"Recognition of fracture patterns, as well as patients' manners of presentation," the researchers said, "can assist physicians in identifying intimate partner violence and can be effective in the development of protocols and programs aimed at comprehensive treatment and follow-up with these patients."

However, early recognition and intervention is key, Dr. Arosarena's group said. These abused women often face ongoing or escalating abuse after leaving the hospital or physician's office.

Furthermore, a surveillance study in Kentucky showed that less than half of these facial trauma patients are compliant with or allowed to complete medical treatment, "which creates a narrow window for intervention," the researchers noted.

The researchers reported no conflicts of interest.

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