If doctors suspect a patient has been abused, they generally check for telltale signs, such as multiple injuries in various stages of healing. But new research suggests they may be missing an important clue: fractures around the eye or upper face.

A study published today in the Archives of Facial Plastic Surgery found that such injuries are more common in female victims of intimate partner violence (IPV) — defined as physical, sexual or emotional violence between partners or former partners — than among women who were assaulted during, say, a robbery, or hurt in a car accident, who are more likely to suffer broken jaws. 

(Intimate partner violence is sometimes referred to as domestic violence, but that term encompasses violence perpetrated between any members of a household, not specifically those who are current or former sexual partners.)

Study co-author Oneida Arosarena, an associate professor of otolaryngology at Temple University School of Medicine, says researchers were surprised by the findings, which they reached after reviewing the medical and dental records of 326 women treated for facial wounds from a variety of sources. "We expected the injuries to be distributed the way they are for other facial traumas, such as motor vehicle accidents, and they weren’t," Arosarena tells ScientificAmerican.com.

But David Greene, an otolaryngologist in Naples, Fla. (and adjunt faculty member at the Cleveland Clinic) who has studied intimate partner violence, says the pattern makes sense.

"The jaw is the type of place where if you fall down, it's predominant," he says. "The trajectory of someone taller than you and striking down at you will be to the upper face. If someone is hitting down on you with a cell phone or vase, it's going to hit you around the eye or nose.

"There's a lot of hitting in the face because a woman's face is the most meaningful area — a hand slap, bruises are typical of that," Greene adds. "If someone is robbing you, they're not going to slap you in the face; the goal of the assailant in robbery is to knock you out once or twice and get out, which is a different type of thing" than the repetitive nature of intimate violence injuries. Robbers are also more likely than batterers to know how to perform upper cuts, he says, which strike at the junction of the neck, ear and jaw and can cause an immediate knockout.

Each year, an estimated 4.8 million women in the U.S. and 2.9 million men are the victims of intimate partner-related physical assaults and rapes, according to the Centers for Disease Control and Prevention (CDC). Worldwide, four times as many women as men are victims of intimate partner violence, today's study says.

Image © iStockhoto/Amanda Rohde