Knife inflicted penetrating injuries of the maxillofacial region: A descriptive, record-based study M. Meer a , A. Siddiqi b, *, J.A. Morkel b , P. Janse van Rensburg d , S. Zafar c a Griffith University, School of Dentistry and Oral Health, Australia b Department of Maxillo-Facial and Oral Surgery, UWC, South Africa c Department of Paediatric Dentistry, UWC, South Africa d Department of Radiology, Faculty of Health Sciences, University of Stellenbosch, South Africa Violence is a complex phenomenon; its causes are multi- dimensional and its consequences have ramifications far beyond the immediate perpetrators and victims. Violence is proportionally much more common in South Africa, especially all forms of interpersonal violence. The 1999 South African non-natural mortality survey has shown around 50% of the non-natural mortalities countrywide. 4 According to the National Victims of Crime Survey, each year South Africans face nearly a 25% chance of becoming a victim of crime. 21 A study by the World Health Organisation stated that the murder rate in South Africa is far higher than in any other country in the world. 21 According to the South African Police’s release of crime statistics for 2006–2007, the murder rates have increased to 2.4%. 3 Homicide (40.5%) was the leading manner of death, followed by traffic accidents and suicide. 2 Homicide mortality rates are particularly high in Cape Town, 67.7 (over 100,000), as compared to industrialised nations (USA baseline rate of 9). 22 Penetrating knife blade injuries to the face are quite rare, mainly as a result of attempts to protect the face by the hands in self-defence. 25 The most recent and respected maxillofacial literature confirms the low incidence of knife injuries in the facial complex. Shinohara et al. 25 presented two cases, and Cohen and Boyes-Varley, 6 in a sample of 37 penetrating injuries, found only 4 caused by a knife blade. The largest study is that of 11 patients reported by Grobbelaar and Knottenbelt. 10 However, larger patient samples are clearly necessary for statistical significance. Generally, the penetrating material is stiff enough to pass through different anatomical structures during a particular violent attack. Removal of such an object from the maxillofacial region is potentially life-threatening and requires careful evaluation. Surgical dogma dictates that the evaluation of all penetrating Injury, Int. J. Care Injured 41 (2010) 77–81 ARTICLE INFO Article history: Accepted 5 May 2009 Keywords: Knife in situ Penetrating injuries Maxillofacial region Selective angiography ABSTRACT Penetrating knife injuries of the face are more common in South Africa than the rest of the world. These injuries can be life-threatening, especially where the major blood vessels of the face are involved. The approach to treatment should be multidisciplinary, beginning with the trauma unit to provide airway maintenance and haemodynamic stabilisation. An interventional radiologist may be consulted for angiography. The aim of the present study was to retrospectively analyse all cases of knife-inflicted penetrating injuries to the maxillofacial region with the knife in situ and subsequently develop a management protocol to be used by maxillofacial surgery registrars when presented with such cases. Materials and methods It was a retrospective, cross-sectional and record-based study, analysing all penetrating knife injuries reported at various hospitals for a period of 11 years. In this study, 24 cases of knife injuries were analysed. Results Twenty-one patients (87.5%) in this series were male and three (12.5%) were female. Of these 24 patients, 13 (54.2%) were coloured and 11 (45.8%) were black. There were no white or Indian patients. Post-surgical recovery of all patients was rapid and uneventful, and there were no fatalities. Conclusion Patients with knife injuries to the face with no definite signs of vascular injury can thus be safely and accurately managed on the basis of physical examination and plain-film radiography. An angiogram is mandatory if the patient presents with excessive bleeding, an expanding haematoma or if the knife blade is in the region of any large vessels. ß 2009 Elsevier Ltd. All rights reserved. * Corresponding author at: Department of Maxillo-Facial and Oral Surgery, Faculty of Dentistry, University of the Western Cape, Private Bag X1, Tygerberg 7505, South Africa. Tel.: +27 21 93334493; fax: +27 21 931 2287. E-mail address: siddiqidr@gmail.com (A. Siddiqi). Contents lists available at ScienceDirect Injury journal homepage: www.elsevier.com/locate/injury 0020–1383/$ – see front matter ß 2009 Elsevier Ltd. All rights reserved. doi:10.1016/j.injury.2009.05.003