The face of domestic violence

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Domestic violence is believed to be vastly under-reported, and emergency and other physicians have long been urged to be on the alert for patients with unexplained injuries. The right questions can help identify victims -- the majority of them women -- and secure referrals to community service agencies.

Now doctors have a new clue. Rather than trying to read injured patients’ faces for signs of fear or shame, physicians can read their facial injuries.

Women who had been assaulted by intimate partners generally sustained different patterns of facial injuries than women who were injured in car crashes, falls or assaults by strangers, according to a study published today in Archives of Facial Plastic Surgery.

Women who were assaulted by a husband or boyfriend had higher than expected numbers of orbital blow-out fractures (breaks or cracks in the bones surrounding the eye) and traumatic brain injuries.

Previous studies of facial injuries in men and women from car accidents and assaults had found that mandible and nasal fractures -- broken jaws and noses -- were the most frequent injuries, followed by zygomatic complex fractures, or cracks in the cheekbones and the bones that adjoin them.

Researchers had expected to find similar results in women who were victims of domestic violence. They looked at medical records of women age 18 years and older who went to the University of Kentucky Medical Center to be treated for trauma to the face.

The most common cause of facial injury was car accidents, followed by falls, then assaults. Of 45 assault victims identified, 19 were documented victims of domestic violence.

Women who were in motor vehicle crash or had suffered falls had higher than expected numbers of fractures to the alveolar ridge fractures (the horseshoe of bone directly beneath the teeth) and facial cuts. Women who were assaulted by a stranger were more likely to have broken jaw bones and zygomatic complex fractures.

In addition to distinctive patterns of injury, domestic violence victims also differed in presentation: They were more likely to delay seeking care for their injuries.

‘For more than a decade, we have known that when healthcare providers assess patients for domestic violence and refer those who need help to local domestic violence programs, it can save victims’ lives,’ said Esta Soler, president of the San Francisco-based Family Violence Prevention Fund. ‘But not nearly enough doctors, nurses and other providers are doing this. This study makes it even easier for surgeons and other providers to recognize when patients are victims of violence -- and creates an even more urgent mandate for them to intervene.’

-- Mary Engel