|Year : 2014 | Volume
| Issue : 2 | Page : 115-119
An analysis of cutlass injuries to the face from assault in southern Nigeria
Arthur Nwashindi1, Edwin Maduakonam Dim2, Otasowie Daniel Osunde3, Nkem Mercy Nwashindi4, Felix Uduma Uduma5
1 Department of Dental Surgery, Maxillofacial Unit, University of Uyo Teaching Hospital, Uyo, Nigeria
2 Department of Orthopaedics, University of Uyo Teaching Hospital, Uyo, Nigeria
3 Department of Dental Surgery, Maxillofacial Unit, University of Calabar Teaching Hospital, Calabar, Nigeria
4 Department of Nursing Services, University of Uyo Teaching Hospital, Uyo, Nigeria
5 Department of Radiology, University of Uyo Teaching Hospital, Uyo, Nigeria
|Date of Web Publication||17-Nov-2014|
Department of Dental Surgery, Maxillofacial Unit, University of Uyo Teaching Hospital, Uyo, PMB 1136, Uyo, Akwa Ibom State
Source of Support: None, Conflict of Interest: None
Background: Violence in families has attracted increasing attention, especially because of indications that it may be more common than has previously been supposed. Assault has attracted increasing attention, especially due to the fact that it may be more common than has previously been thought, and a high incidence has been reported among family members. Objective: The objective of this study was to develop a database of facial injuries arising from cutlass as the major tool of attack at a Nigerian teaching hospital and to determine the patterns of trauma in these cases . Materials and Methods: We conducted a prospective study of 106 consecutive patients with facial injuries from the assault with cutlass using a preformed questionnaire. The patients were seen at the Maxillofacial Unit of Dental Department, University of Uyo Teaching Hospital and treated for various degrees of facial injuries between February 2012 and March 2014. Results: Victims within age range 21-30 years were 21.71%. Majority (67.92%) of the incidence took place in the rural areas and 23% in the urban area with more of the assaults occurring in the evening. Majority of the victims (52.83%) and offenders (41.51%) were married. This association was statistically significant (χ2 = 8.97; df = 3; P = 0.03). There was a similar significant association between the gender of the victims and the offenders (χ2 = 10.84; df = 1; P = 0.001). Conclusion: Most assault took place in the evenings and tends to occur in the victim's residence. The offenders and victims were predominantly men, and the injuries were mainly located around the eye and ears. Victims related to the offenders had, however, a higher proportion of injuries to the body.
Keywords: Assault, cutlass, facial injuries
|How to cite this article:|
Nwashindi A, Dim EM, Osunde OD, Nwashindi NM, Uduma FU. An analysis of cutlass injuries to the face from assault in southern Nigeria
. Niger J Exp Clin Biosci 2014;2:115-9
|How to cite this URL:|
Nwashindi A, Dim EM, Osunde OD, Nwashindi NM, Uduma FU. An analysis of cutlass injuries to the face from assault in southern Nigeria
. Niger J Exp Clin Biosci [serial online] 2014 [cited 2022 Aug 14];2:115-9. Available from: https://www.njecbonline.org/text.asp?2014/2/2/115/144852
| Introduction|| |
Studies of facial injuries have shown that the etiology varies from one country to another and even within the same country depending on the prevailing socioeconomic, cultural, and environmental factors. , Reports from developed countries show that assaults have replaced road traffic accidents as the major cause of maxillofacial injuries. ,, In Nigeria and other parts of Africa, although road traffic crash still plays a dominant role in the etiology of facial injuries, assaults, and interpersonal violence continue to contribute to injuries to the maxillofacial region. ,, Apart from interpersonal altercations, other mechanisms of assaults include nonaccidental injuries, battery, and civilian gunshot injuries resulting from either armed robbery attacks or cultism, especially among students of higher institutions. 
Assault has attracted increasing attention, especially due to the fact that it may be more common than has previously been thought, and a high incidence has been reported among family members.  During the last decades, the incidence of facial injuries seems to have increased  with studies showing that the assault was a common cause.  Most assault victims seeking medical care have injuries to the face, head, and neck, in most cases bruises  and most of the victims tend to be men aged between 15 and 35 years.  Other studies, however, have shown that females are the major victims of assault. The nature of injury appears to be different in females and in the study by Zachariades et al.,  67% of females were assaulted by an intimate acquaintance, and 70% of the attacks were unarmed. Risk factors include poverty, age (between 17 and 28 years), substance abuse by either partner and marital status (i.e., divorced, separated or single). ,
Although several published works on maxillofacial injuries from Nigeria mentioned assaults as one of the causative factors, ,, none specifically focused on facial injuries arising from cutlass as the sole weapon of assault. The aim of the present study was to develop a database of facial injuries arising from cutlass at a Nigerian teaching hospital and to determine the patterns of trauma in these cases.
| Materials and methods|| |
We conducted a prospective study of 106 consecutive patients with facial injuries from the assault with cutlass. The patients were seen at the Maxillofacial Unit of Dental Department of the University of Uyo Teaching Hospital and treated for various degrees of facial injuries between February 2012 and March 2014. Information was obtained from victims on presentation to the clinic using a preformed questionnaire. All cases met inclusion criteria of facial injury resulting directly from cutlass assault. Those injured from other sources of assault apart from cutlass were excluded. Demographic data, including age, sex, and race, were collected. Information on health status, including history of alcohol and drug use was assessed. Circumstances surrounding the actual assault were analyzed, such as whether the assailant was known to the patient, whether the assault occurred in the context of domestic abuse, robbery or other crime. Injury data included fractures and their site, associated soft injury to the face, time and scene of assault, occupation, and location of the assault.
One-way analysis of variance was performed to determine the significance of changes between groups. These were analyzed using statistical package Statistical Package for the Social Sciences (SPSS) version 16. A P < 0.05 was regarded as statistically significant for all analyses.
| Results|| |
The age distribution and the distribution of location, time, and the scene of the incidence are shown in [Table 1] and [Table 2], respectively. The victims fell largely within the 21-30 years age group. The least age groups affected were 0-10 years. Majority (67%) of the incidence took place in the rural areas and 23% in urban areas [Table 2]. More of the assault was in the evening with 41 (38.63%) cases. The crimes took place mostly in the evenings and more often in victims' residence (35.85%) and least at workplace with 0.94% occurrence [Table 2].
Injuries affecting the eyes and the parotid regions (ear) were more prevalent (25 and 22 respectively) [Table 3]. Majority of the injuries were skin avulsion (62.26%) followed distantly by skin laceration (21.70%) [Table 3]. [Table 4] shows marital status characteristics of both the victims and offenders. It shows that the majority of the victims (52.83%) and offenders (41.51%) were married. This association was statistically significant (χ2 = 8.97; df = 3; P = 0.03). There was a similar significant association between the gender of the victims and the offenders (χ2 = 10.84; df = 1; P = 0.001) as shown in [Table 5]. More of the assaults were from males targeted against males. In [Table 6], assault resulting from spouse/cohabiting was 35.85% (38) followed by brother/sister relationship (29.25%). The least was between friends (1.89%). This shows that most of the attacks came from family members or family relations. About half of the victims (58.49%) were unemployed and civil servants were the least affected (3.77%) [Table 7]. Bulk of the assaults (>90%) were domestic in nature and majority (73.58%) of the assaults was not provoked by anything, while 21.70% was believed to be due to alcohol influence [Table 8].
|Table 4: Marital status of study group (check sig of marital status to victims and offenders)|
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| Discussion|| |
As found in other studies, ,, the age groups mostly involved were in the twenties. It is probable that younger people were involved in assaults at places of public entertainment. Similarly, it is also assumed that older people stayed at home and were subject to violence in homes. The number of children as victims in this study was low. The reason for this low figure could be that children are not really object of attack in assault.
Most victims of assault were men aged 15-35 years and this concurs with the results of previous studies. , The findings that more of the assault took place in the rural area while it is in agreement with the report of a previous study,  contrasts the results of another study where it was more prevalent in the urban areas.  In the present study, assault was observed to occur in the evenings which supports the findings from earlier.  The assaults were mostly related to provocative arguments. Fractures of the zygomatic-complex, the nose, and mandibular fractures were the most common facial fractures in assault cases. 
Gender affected the pattern of facial trauma from cutlass assault. In the present study, males constituted the majority of both the victims and offenders. This is in agreement with previous studies where victims and offenders were predominantly men. , Most males are usually injured in altercations after consuming alcohol or in violent drug-related activities.  Although there has been a wide opinion that the proportion of injured women from assault has increased, Starkhammar and Olofsson found no support in their study for the commonly held opinion that abuse of women has increased.  The pattern of injury from the study appears to be different in females who are much less involved both as the victims and offenders.
The peculiarity noted in this study is that the majority of the victims and offenders of assault-induced injuries were related in one way or the other and most especially among spouses and co-habitors. The proportion of relatives as victims was mostly female spouses. This is in agreement with Zachariades et al., who also reported that females were assaulted by an intimate acquaintance but in a much higher proportion of 67%. 
In Nigeria, the unemployment rate among college and university graduates has increased from 4% during the early 1970s to 45% currently.  Furthermore, the per capita income of the average Nigerian has decreased by 75% during the past 20-25 years.  Thus, the prevailing poor socioeconomic crises in the present day Nigeria may also have contributed to the high incidence of assault-related injuries observed in this study. Most of the victims and offenders were either unemployed or had very low level of income. This was buttressed by the findings that the majority of the victims were artisans, students and retired workers. The ensuing assaults may be a result of "bottled-up" anger and frustrations due to deprivations and several unmet needs. Unemployment, especially among able-bodied men and women who are often involved in assaults-related injuries, may increase the tendency toward aggressive behavior, stress, crime, and other social vices.
Studies of injuries due to violence have shown that most victims had minor injuries.  Majority of the victims had skin avulsion followed by lacerations with only 4% of fractures. This is in agreement with Linkφping  who reported that 91% of people abused had skin injuries, and 4% had fracture. Injuries to the eye and parotid regions were the most common in this study. This is in contrast to other studies where zygomatic-maxillary fractures  or nasal fractures  were the most common. Some authors claimed that fractures of the zygoma and orbital floor were more common.  This is in contrast to the present study where fractures of the zygoma was the third most common.
From the study, only 21.7% of the offenders were under the influence of alcohol and thus leaving a greater percentage of the cases uninfluenced by alcohol. This is in contrast to the previous study were the offenders were drunk.  Assaults often occurred in places where alcohol was consumed, and it is most likely that drinking habits influenced the way in which people associated. These places were often places of public entertainment where also other negative factors, like a girl's refusal to dance, could lead to an assault. In this study, majority of the assault did not occur in public places but victims' residence and so the influence of alcohol could not have been the major source of provocation. Drugs were noted in only a few cases, indicating that individuals under the influence of drugs are not inclined to commit violent crimes.
| Conclusion|| |
In many of the cases we described, the maxillofacial surgeon may be the first person to identify the assault. It is important for the surgeon to recognize multiple facial injuries as a symptom of domestic abuse and to be attentive to the risk factors of substance abuse, low socioeconomic status, and the mechanisms of injury to make the diagnosis of assault with cutlass and help the patient break the cycle of abuse and injury because the psychological dimension of the trauma can be harmful to the patient. Injury patterns were found to be gender-specific with a higher proportion of soft tissue avulsion. Demographics differed significantly between males and females, with the males being more affected than females. The findings in this study show the need to be made more aware of the importance of documenting these cases. The victim has the right to be treated with a possible understanding, respect, and support in a stressful and delicate situation.
| References|| |
Olasoji HO, Tahir A, Arotiba GT. Changing picture of facial fractures in northern Nigeria. Br J Oral Maxillofac Surg 2002;40:140-3.
Khan AA. A retrospective study of injuries to the maxillofacial skeleton in Harare, Zimbabwe. Br J Oral Maxillofac Surg 1988;26:435-9.
Magennis P, Shepherd J, Hutchison I, Brown A. Trends in facial injuries: Increasing violence more than compensate for decreasing road trauma. Br Med J 1998;316:325-32.
King RE, Scianna JM, Petruzzelli GJ. Mandible fracture patterns: A suburban trauma center experience. Am J Otolaryngol 2004;25:301-7.
Boffano P, Kommers SC, Karagozoglu KH, Forouzanfar T. Aetiology of maxillofacial fractures: A review of published studies during the last 30 years. Br J Oral Maxillofac Surg 2014.
Osunde OD, Amole IO, Ver-or N, Akhiwu BI, Adebola RA, Iyogun CA, et al.
Pediatric maxillofacial injuries at a Nigerian teaching hospital: A three-year review. Niger J Clin Pract 2013;16:149-54.
Bamjee Y, Lownie JF, Cleaton-Jones PE, Lownie MA. Maxillofacial injuries in a group of South Africans under 18 years of age. Br J Oral Maxillofac Surg 1996;34:298-302.
Obimakinde OS, Okoje VN, Fasola AO. Pattern of assault-induced oral and maxillofacial injuries in Ado-Ekiti, Nigeria. Niger J Surg 2012;18:88-91.
Shepherd JP, Gayford JJ, Leslie IJ, Scully C. Female victims of assault. A study of hospital attenders. J Craniomaxillofac Surg 1988;16:233-7.
Olafsson SH. Fractures of the facial skeleton in Reykjavik, Iceland, 1970-1979. (I) Mandibular fracture in 238 hospitalized patients, 1970-79. Int J Oral Surg 1984;13:495-505.
Timoney N, Saiveau M, Pinsolle J, Shepherd J. A comparative study of maxillo-facial trauma in Bristol and Bordeaux. J Craniomaxillofac Surg 1990;18:154-7.
Larsen OD, Nielsen A. Mandibular fractures. I. An analysis of their etiology and location in 286 patients. Scand J Plast Reconstr Surg 1976;10:213-8.
Zachariades N, Koumoura F, Konsolaki-Agouridaki E. Facial trauma in women resulting from violence by men. J Oral Maxillofac Surg 1990;48:1250-3.
Zawitz M. Highlights from 20 Years of Surveying Crime Victims: The National Crime Victimization Survey, 973-92. Washington, DC: US Department of Justice, Bureau of Justice Statistics; 1993.
US Department of Justice. Violence against Women: Estimates from the Redesigned Survey. Washington, DC: US Department of Justice, Bureau of Justice Statistics; 1995. [Report NCJ-154348].
Beck RA, Blakeslee DB. The changing picture of facial fractures 5-Year review. Arch Otolaryngol Head Neck Surg 1989;115:826-9.
Adi M, Ogden GR, Chisholm DM. An analysis of mandibular fractures in Dundee, Scotland (1977 to 1985). Br J Oral Maxillofac Surg 1990;28:194-9.
Allan BP, Daly CG. Fractures of the mandible. A 35-year retrospective study. Int J Oral Maxillofac Surg 1990;19:268-71.
Eriksson L, Willmar K. Jaw fractures in Malmö 1952-62 and 1975-85. Swed Dent J 1987;11:31-6.
Afzelius LE, Rosén C. Facial fractures. A review of 368 cases. Int J Oral Surg 1980;9:25-32.
Balle V, Christensen PH, Greisen O, Jørgensen PS. Treatment of zygomatic fractures: A follow-up study of 105 patients. Clin Otolaryngol Allied Sci 1982;7:411-6.
Greene D, Raven R, Carvalho G, Maas CS. Epidemiology of facial injury in blunt assault. Determinants of incidence and outcome in 802 patients. Arch Otolaryngol Head Neck Surg 1997;123:923-8.
Hussain K, Wijetunge DB, Grubnic S, Jackson IT. A comprehensive analysis of craniofacial trauma. J Trauma 1994;36:34-47.
Fothergill NJ, Hashemi K. A prospective study of assault victims attending a suburban A&E department. Arch Emerg Med 1990;7:172-7.
Starkhammar H, Olofsson J. Facial fractures: A review of 922 cases with special reference to incidence and aetiology. Clin Otolaryngol Allied Sci 1982;7:405-9.
Denaner RM, Fitchett VH. Motorcycle trauma. J Trauma 1975;15:678-81.
Brook IM, Wood N. Aetiology and incidence of facial fractures in adults. Int J Oral Surg 1983;12:293-8.
Gussack GS, Luterman A, Powell RW, Rodgers K, Ramenofsky ML. Pediatric maxillofacial trauma: Unique features in diagnosis and treatment. Laryngoscope 1987;97:925-30.
Khalil AF, Shaladi OA. Fractures of the facial bones in the eastern region of Libya. Br J Oral Surg 1981;19:300-4.
[Table 1], [Table 2], [Table 3], [Table 4], [Table 5], [Table 6], [Table 7], [Table 8]