Abstract: The objective of this study is to characterize the pattern of craniofacial injuries. Design: cumulative study. Setting: is Police Hospital Benin City. Medical practice and research inevitably involves dealing with the consequences of violence. This include common assault, actual bodily harm, grievous bodily harm and grievous bodily harm with intent. A standardized assault register in use by the police consultant pathologist revealed that female suffered more assault. Assault victims are more from low socio-economic group and the most violent age group is 15 years to 25 years. Time lapse before presentation was 1-2 days. Injury mechanisms were more from blunt objects, with the head and neck showing peak site of assault. It is therefore recommended that with a time lapse of 1-2 days and head and neck peak involvement, the dental practitioners should be better involved in a collaborative assault research with a view to proffering preventive solutions through public campaign.
INTRODUCTION
Medical practice and research inevitably involves dealing with the consequences of violence (Brink et al., 1998). This include common assault (Rouge-Maillar et al., 2001), actual bodily harm, grievous bodily harm and grievous bodily harm with intent (Bache, 2000). Benin metropolis is violence prone, due to the fact that it is a linkage city to other oil rich cities. Both victims and assailants are managed and documented in this Police Hospital. Ever since pattern of Craniofacial injuries have not been characterized. This underscores the need for medical/dental trainee, trainers and practitioners to understand the characteristics of these violence-related injuries. These include the anatomic distribution, mechanism, chronobiology (Sitar, 1997) and demography (Taylor et al., 1997). Though cultural and racial idiosyncrasy do exit (Pridmore et al., 1995). The pattern of biodistribution of injuries due to interpersonal violence had been assessed in different settings world over (Fothergill and Hashemi, 1990) and the percentage craniofacial injuries found to be dominant (Lukas and Rambousek, 2001). This study therefore aims at characterization of victims of assault attended to and documented in an assault register in a Nigerian setting, with a view to highlight craniofacial features.
MATERIALS AND METHODS
This involved a retrospective analysis of a non-confidential cumulative data from a standardized assault register in use by the police consultant pathologist in reporting assault victims. One thousand and fifty one patients reported and were recorded for assault in the emergency department of the Police Hospital, Benin City catchment location in Nigeria for a period of one year. December 1st 2001 to December 30th 2002. This period accommodated two yuletide reasons when assault rates are high. Data included age, gender, occupation, time lapse before presentation to hospital. Category of assault, implements used and clinical findings. Other locations of assault records outside this city setting were deliberately excluded to avert spuriousness.
RESULTS
Out of the overall assault victims (1,051), 52% (551) were female and 48% (500) male (Table 1). Socio-economic status low 90% (942) (Table 2). High status 10% (109) (Table 3). Age range of assault victims were dominantly 11-20 years 25.21%, 21-30 years 39.10%, 31-40 years 19.31% and other age group 16.38% (Table 4).
| Table 1: | Percentage gender assault |
| Table 2: | x/1051 Socio-economic distribution (Low) |
| (ii) High: 109 (10%) were of higher socio-economic status | |
| Table 3: | x/1051 Socio-economic distribution (High) |
| Table 4: | Age distribution and number of assault victims |
| Table 5: | Time lapse before presentation to clinic |
Time lapse before assault victims were presented to the clinic for management was between 1-2 days 78%; 3-4 days 9.6% and other later presentation 12.4% (Table 5). Injury mechanism for assault were mainly from Blunt objects 57.7% (S/N 2-6), sharp objects 18.7%, gun shot 3% and others 22% (Table 6).
| Table 6: | Injury mechanism and number of assault sites |
| Table 7: | Anatomic distribution of injuries |
| Fig. 1: | Atomic distribution of assault site |
Anatomic distribution of assault site, head and neck 56.98%, upper limb 22.8%, trunk 9.62% and lower limb 3.5% (Table 7 and Fig. 1).
DISCUSSION
Disagreement is an obstinate reality in any given social setting in both developed and developing societies. Mismanagement may result in conflict or outright violence. African setting is endowed with well spelt out traditional norms in conflict resolution. Abuse takes many forms and occur in variety of setting Africa it is both under-recognized and under-reported (Bradley et al., 1996) culture hydrization or frank imperialistic incursion brought on its wake a mix approach to seeking redress when assaulted. In the rural communities, legal option are usually remote, as against the municipal setting. Even in the municipality, the core adherents to traditional norms, view legal options as an aberration, disdainful and utter disregard to status quo.
Female suffered more assault (52%) than men (48%). Socio-economic status of victims revealed more involvement from lower socio-economic groups, which is in tanderm with Pfeiffer’s view that socio-economic inequality leads to declining social cohesion, heightened individual competition, fear of interpersonal violence and intensified conflict between spouses in poor families that finds expression in assault (Pfeiffer, 2000). Age range of assault victims revealed between ages 21-30 year (39.10%) as most involved. This followed by ages 11-20 years (25.21%) and ages 31-40 years (19.31%). Again this is in conformity with Hatchison et al. (1998) findings. These age groups are of note, based on the fact that these age groups represent the 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 towards educating parents on the risks around home and school for these young children. Anatomic distribution of assault sites show highest involvement in the head and neck region (56.98%). Again, injuries to the head and neck can be life-threatening causing airway obstruction or provoking severe hemorrhage. The 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 victims facial appearance which may cause psychological morbidity (Bisson et al., 1997). It is therefore soothing that the time laps before victims presentation to the clinic had its peak at between 1-2 days (78%). Most dominant injury mechanism were more through blunt objects (57.7%).
CONCLUSIONS
We therefore, conclude that with the time lapse of 1-2 days (78%) and head/neck involvement of 56.98%. The knowledge generated from this study will sensitize and empower the general practitioners, the oral surgeons and the maxillofacial surgeons for greater involvement in collaborative assault management and research with a view at proffering preventive solutions through public campaign in primary, secondary and university educational levels. It is tragic that many of these assault injuries are preventable (Hutchison et al., 1998).