title: Mandible fracture severity may be increased by alcohol and interpersonal violence.
abstract: BACKGROUND
  Alcohol as a cofactor in interpersonal violence (IPV) has been established by studies from a number of countries. This study aimed to determine if alcohol was a cofactor in the incidence or severity of mandible fracture.
  
  
  METHODS
  A prospective study of mandible fracture patients presenting for oral maxillofacial review over 16 months was completed. Injury severity was assessed utilizing the Mandible Injury Severity Score (MISS).
  
  
  RESULTS
  A total of 252 facial trauma cases presented to our tertiary referral centre, 83 with fractures of the mandible. The majority of presentations were secondary to IPV (n = 54, 65.06%), 49 (90.74%) of these cases involved alcohol. Overall, alcohol was involved in 63.85% of cases (n = 53). The relative risk of requiring surgical intervention with alcohol involvement was 2.68 (CI = 1.11-9.47). Alcohol significantly increased facial fracture severity for MISS: alcohol (n = 53) 13.07 ± 5.01, no alcohol (n = 30) 11.03 ± 4.87 (p < 0.05). IPV also increased facial fracture severity for MISS: IPV (n = 54) 13.09 ± 4.90, non-IPV (n = 29) 11.00 ± 4.81 (p < 0.05). The angle of the mandible was most commonly fractured (40.5% of cases).
  
  
  CONCLUSIONS
  Mandible fracture patients, whose injury is a result of IPV, have more severe fractures and a higher likelihood of requiring surgery if alcohol is involved. This correlates to a higher surgical workload, economic and social burden to the community. Primary alcohol and IPV prevention strategies will play an important role in reducing mandible fracture.
authors.affiliation: Academic Department of Surgery, The Canberra Hospital, Australian Capital Territory, Australia. connor.omeara@anu.edu.au
authors.forename: C
authors.initials: C
authors.lastname: O'Meara
authors.forename: R
authors.initials: R
authors.lastname: Witherspoon
authors.forename: N
authors.initials: N
authors.lastname: Hapangama
authors.forename: D M
authors.initials: DM
authors.lastname: Hyam
mesh_terms: D000058:Accidental Falls / Q000706:statistics & numerical data; D000063:Accidents, Traffic / Q000706:statistics & numerical data; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000428:Alcohol Drinking / Q000453:epidemiology*; D001265:Athletic Injuries / Q000145:classification / Q000453:epidemiology; D020958:Australian Capital Territory / Q000453:epidemiology; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D015994:Incidence; D007223:Infant; D015601:Injury Severity Score; D008297:Male; D008337:Mandibular Fractures / Q000145:classification / Q000453:epidemiology* / Q000601:surgery; D008875:Middle Aged; D011446:Prospective Studies; D018570:Risk Assessment; D014754:Violence / Q000706:statistics & numerical data*; D055815:Young Adult