Exploring the patterns and outcomes of accidental and assaultive facial soft tissue injuries: A one-year medicolegal study in the emergency department of Alexandria main university hospital.

BACKGROUND

Plastic surgeons must document initial facial injuries before surgery for medicolegal purposes. Distinguishing between accidental and assaultive injuries poses a challenging issue. Therefore, this study explored the features that differentiate assaultive facial soft tissue injuries from accidental injuries.

METHODS

This prospective cross-sectional study included 179 patients with facial soft tissue injuries. We recorded sex, age, occupation, marital status, residence, and history of drug abuse. Additionally, the traumatic events were analyzed, and injuries were assessed. All patients received standard medical care.

RESULTS

Males constituted 82.7 % of patients. 62.57 % of patients had accidental facial injuries, while the rest of the patients attributed their injuries to assaults. A significantly higher percentage of assaultive injuries were located on the left side of the face, with p < 0.001 (OR = 5.966, 95 % CI=3.013- 11.813). Whereas a significantly higher percentage of accidental injuries were located on the midface, with p < 0.001. A multivariate binary logistic regression analysis that identified strong predictors of assaultive facial injuries, including a history of drug abuse (OR = 44.998, 95 % CI: 3.049-661.107), injury with sharp instruments (OR = 638.601, 95 % CI: 20.296-20,093), and a cutting/piercing mechanism of injury (OR = 89,298.81, 95 % CI: 196.963-404,861). Regarding the characteristics of soft tissue facial injuries, the probability of assaultive trauma increases with the presence of injuries on the left side of the face (OR = 27.309, 95 % CI: 1.653-451.157), involvement of the mandibular zone (OR = 40.780, 95 % CI: 1.147-1449.419), neurovascular or duct injury (OR = 121.806, 95 % CI: 1.110-13,369.2), and the presence of multiple associated injuries (OR = 1.005, 95 % CI: 1.001-1.254).

CONCLUSIONS

Accidental facial injuries are more common than assaultive injuries, and males are particularly vulnerable to both traumas. This study helps differentiate between assault-related and accidental facial injuries. A history of drug abuse, injuries caused by sharp instruments, and mechanisms involving cutting or piercing are strong indicators of assaults. Clinical signs that strongly suggest assault-related injuries include injuries on the left side of the face, involvement of the mandibular area, damage to neurovascular structures or ducts, and the presence of multiple associated injuries.