Alcohol and interpersonal violence may increase the severity of facial fracture

The association between alcohol and interpersonal violence has been established in studies from a number of countries. We aimed to determine whether alcohol was a contributing factor in the incidence or severity of facial trauma. For 15 months we prospectively studied patients with facial fractures who presented for oral and maxillofacial review. Severity of injury was assessed using the maxillofacial injury severity score (MFISS). Of the 255 patients with facial trauma who presented to our tertiary referral centre, 202 had fractures of the facial skeleton. Most presentations were secondary to interpersonal violence (n=105, 52%), and 91 (87%) of these involved alcohol. Overall, alcohol was involved in 53% of cases (n=107). The relative risk of requiring surgical intervention when alcohol was involved was 1.61 (CI=1.12-2.32). Alcohol significantly increased the severity of facial fracture for both MFISS: alcohol (n=107) mean (SD) 11.43 (7.63); no alcohol (n=95) mean (SD) 6.87 (6.22) (p<0.05). Interpersonal violence also increased the severity of facial fracture: interpersonal violence (n=105) mean (SD) 11.06 (6.68), no interpersonal violence (n=97) mean (SD) 7.37 (7.59) (p<0.05). Patients whose facial fractures are the result of interpersonal violence have more severe injuries and are more likely to require surgery if alcohol is involved. This results in a heavier surgical workload, and is an economic and social burden to the community. Primary prevention strategies will have an important role in reducing such injuries.