Systematic Review of the Patterns of Orofacial Injuries in Physically Abused Children and Adolescents

Abstract

Objective: To examine the evidence base for patterns of oro-facial injuries in physical abuse cases of children and adolescents aged 0-17 years. Data sources: Systematic searches of Ovid Medline, Ovid Embase, Cochrane Central and grey literature, dating from the oldest entry to August 2017. Review methods: Search criteria included English language peer reviewed articles and theses on physical abuse cases affecting the age group of 0-17 years. Exclusion criteria were: Case reports and <10 case series; studies involving bite mark injuries elsewhere on the body, sexual, ritualistic or emotional abuse and neglect, exposure to domestic violence; reviews; book chapters and conference proceedings. The following data was extracted: quality and design of study, oro-facial manifestations, new/old injuries, fatalities, coexistent injuries, co-morbidities and radiologic investigations. Each study was subjected to two independent reviews and a third, if reviewers disagreed. Results: The authors identified 51 articles, 26 of which satisfied the inclusion criteria. The oro-facial signs were superficial injuries of face, ears, neck, lips and oral mucosa, burns, torn fraenii and fractured teeth and jaws. A minority of studies stood out due to their well-developed design; expert opinion inclusion; new/old/occult injury investigations and facial bruising/ intraoral injuries as sentinel markers. Overall, the review demonstrated weak study quality and representativeness as well as lacunae in uniform reporting. Conclusions: The available literature does not endorse any pathognomonic signature patterns of child physical abuse to the exposed oro-facial region.

Comparison of Maxillofacial Trauma Patterns in the Urban Versus Suburban Environment: A Pilot Study

“…The etiologies of injury are known to vary in frequency based on these specific subpopulations. 7 –15…”

“…The etiologies of injury are known to vary in frequency based on these specific subpopulations. [7][8][9][10][11][12][13][14][15] In recent years, the importance of socioeconomic status has been reported across several domains of life, including happiness, education, and health care. 16,17 Traditionally, low socioeconomic status is associated with underserved and urban populations, while suburban areas generally grade higher on this scale.…”

Processes of Multiprofessional Child Protection Decision Making in Hospital Settings: Systematic Narrative Review

“…Hospitals are long-standing, well-established systems in which care is provided by a range of professional teams some colocated within the same building and to varying extents working under unitary management (Patel et al, 2002; Vinokur-Kaplan, 1995). Child protection cases where there is a suspicious serious injury, suspected sexual abuse, or serious neglect are often investigated in hospital, involving a number of relevant professions, such as medicine, nursing, allied health professions, social work, and law enforcement (Moon et al, 2018; Sarkar et al, 2021; Scoglio et al, 2019; Wiseman et al, 2019). Early studies from the 1990s on social workers’ activity in hospitals, which traditionally apply physician-centered model of care (Ambrose-Miller & Ashcroft, 2016), identified confusion around roles, functions, and responsibilities; power or status differences between professions; and a tendency to safeguard professional “turf” as barriers to effective multiprofessional working (Abramson & Mizrahi, 1996; Cowles & Lefcowitz, 1995).…”

Just the facts: Pediatric Dental and Oral Injuries

“…A recent systematic review of pediatric oral and dental injuries related to abuse did not find evidence of a pathognomonic pattern, although oral injuries should prompt further evaluation for additional injuries. 3 Injuries to the lips may be the most common oral injury in abuse, 5 and bruising to the face and neck, in particular the left ear (from a right handed strike), may increase the likelihood of the injury being non-accidental. 3 Labial frenulum tears have traditionally been identified as a potential sign of non-accidental injury from forcing of a bottle or pacifier; however, an isolated tear does not seem to be more common in abused children.…”

“…3 Injuries to the lips may be the most common oral injury in abuse, 5 and bruising to the face and neck, in particular the left ear (from a right handed strike), may increase the likelihood of the injury being non-accidental. 3 Labial frenulum tears have traditionally been identified as a potential sign of non-accidental injury from forcing of a bottle or pacifier; however, an isolated tear does not seem to be more common in abused children. 4 It is important to know pediatric milestones (e.g., when children can roll or walk) to help judge the likelihood of the described injury mechanism.…”