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Intentional injury persists as a major challenge to trauma centers, exerting its greatest impact on socioeconomically marginalized populations. Beyond the substantial burden of disease with respect to economic cost and human suffering, the intentional nature of the injury renders it a major risk factor for reinjury. Most of these injuries tend to derive from impulsive actions, often against a background of recent substance use, alcoholism, severe stress, or psychosocial-behavioral difficulties. In many instances, the traumatic stressor sets the stage for subsequent psychosocial sequelae that can be as disabling as any physical handicap, negatively affecting recovery and quality of life. All too often, restitution of the overt physical injury is considered the endpoint of facial injury care. Even when an underlying problem is suspected, the process of screening and referral for needed treatment or intervention is haphazard and highly fragmented. Current care of facial injury patients is notable for a general lack of involvement of other health care professionals, such as psychologists, substance abuse counselors, and social workers. Drawing on the research experiences and specialty insights of a multidisciplinary team of contributors, this issue of the Oral and Maxillofacial Surgery Clinics of North America provides a rationale and framework for comprehensive care of patients presenting with orofacial injury. To make a positive impact on the orofacial injury problem, care of injured patients needs to be expanded beyond a patient's immediate surgical needs to involve consideration of the underlying causes of injury and potential nonphysical sequelae. The continuing inability to synthesize essential patient needs into a collaborative and interdisciplinary response has tremendous consequences for injured patients. An increased awareness of the psychosocial antecedents and consequences of orofacial injury is an important first step toward providing the comprehensive care needed by many patients with facial injury and we offer this issue as a stimulus.
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