How Scared Should I Be of Getting Punched in the Face?

How Scared Should I Be of Getting Punched in the Face?

I've never been in a fight, but it turns out you can get hurt in them. Did you know this?
August 18, 2016, 4:55pm

In the column "How Scared Should I Be?" VICE staff writer and generalized anxiety disorder sufferer Mike Pearl seeks to quantify the scariness of everything under the sun. We hope it'll help you to more wisely allocate that most precious of natural resources: your fear.

When I write something that pisses a lot of people off (usually something about video games), a handful of people will point out that I have a punchable face. They're right. In photos, including the one at the top of this post, I look smug, judgmental, professorial, weak, and just generally like I have what Germans call "Backpfeifengesicht" or "Ted Cruz Disease."

But despite my birth defect, my punchable face has avoided contact with fists for all of my 31 years of life. And as a fearful person, I don't let myself get complacent, despite my impressive un-punched streak. Instead, I back down easily when confronted, and I strenuously avoid people who look like they might be throwing fists around indiscriminately. I realize that's no way to live my life, and I've known for a few years that I should probably confront my fear.

But just this week, I happened upon a news story about a guy who had once killed a man with a single punch. Given that just one well-placed knuckle sandwich can end it all, does it make sense for me to keep doing everything I can to avoid fisticuffs completely?

Maybe I should, according to Dr. Darragh O'Carroll, an emergency room doctor in Los Angeles, and part-time ringside physician at MMA fights. If I got punched in the face, he said, "the odds are probably that nothing serious is going to happen, but it's still possible."

My likelihood of getting punched is a bit of a mystery. I couldn't find good data on face punching, and the only crime stats I could find were on aggravated assault.

Self-reporting on fights makes them seem much likelier. No one seems to ask adults, but in 2013, the Child Trends Data Bank asked high school students if they'd been in a fight in the past year. And 24.7 percent said they had. And in a very unscientific poll, I asked ten people at the VICE office if they'd been punched in the face, and 100 percent said they had at least once. The point, in O'Carroll's opinion, is that I can't hide from getting punched forever. "At some point, there's a high likelihood," he said, laughing.

But what are the health risks of a punch to the face?

Broken Nose

When the inevitable happens, the most likely injury is a broken nose, in O'Carroll's opinion. Nose breaks can be simple fractures, or more complex breaks. Most, O'Carroll said, "will heal without any intervention." But he warned me about a potentially dangerous side effect of a broken nose called a septal hematoma. "If you stuck your finger in either nostril, you would feel—I would describe it as a big grape," he said, and that's something that would need emergency attention, or else my nasal septum could be destroyed due to lack of blood flow.

Jaw and Teeth Injuries

Obviously one concern should be my teeth, which O'Carroll said are more likely to be knocked clean out than broken. But when it comes to punching teeth, punchers should be more scared than punchees, according to O'Carroll. "There's more bacteria in a human mouth than a dog's mouth, so if those teeth got into your knuckle, you would need to get that washed out in an operating room, because the bacteria can proliferate and destroy the joint," he said.

I should be more concerned about getting punched in the jaw. "The mandible is half a ring, and rings like to break in two spots," O'Carroll explained. If my jaw only breaks in one spot, and it's non-displaced, he told me, I could get away with my jaw being wired shut, and drinking through a straw for 4 to 6 weeks. That's actually the better outcome when it comes to jaw fractures. O'Carroll said an open jaw fracture would be much worse. "That's when I look inside the mouth, and the fracture continues to where your gums and teeth have separated." Apart from the heavy-duty repairs involved, and the obvious risk of disfigurement (go ahead and google image search "open jaw fracture," I'll wait), there's also a risk of serious infection.

Brain Damage

Obviously the most likely form of brain damage is the most minor: a concussion. Intracranial hemorrhaging—that is: a bleeding brain—is less likely and much scarier. If I get an "epidural" bleed, it might seem like a concussion. "You get knocked out. You wake up. You're a little confused, but you're feeling better. In 20 or 30 minutes, you gradually get more stuporous," O'Carroll said. That would be an epidural bleed, and I need to go to the hospital or brain herniation could occur, which could be fatal. O'Carroll told me a hard punch to the temple could cause this kind of brain bleed, but that "if an intracranial hemorrhage was to happen, it's most commonly from the fall."

Eye Injuries

I gave O'Carroll a hypothetical: Assuming a fist was about to collide with his face, what would he be most worried about? "I don't want anybody messing with my eye," he said.

The "globe" of the eye itself and the orbit (the eye socket) are complicated, and they can be subject to countless different kinds of injuries. "Retinal detachment is possible," he said, but he added, "I don't see it as much as fractures."

Fascinatingly, orbital fractures don't happen the way I thought they did—from the knuckles crushing the eye socket. Instead, the eye and the other tissues, nerves, blood vessels, and muscles get compressed by the fist and explode unpredictably outward. "The pressure has to go somewhere," O'Carroll explained, and the result is often a broken bone somewhere inside the socket. And sometimes these internal orbital fractures are serious, because the muscle system that controls your eye doesn't like having splinters of skull bone mixing with it. "If a bone fragment is stuck in that muscle, and you can't turn your eye all the way inward or all the way outward, that's an indication that you need to go in for surgery," O'Carroll told me.

The Takeaway

Given the range of possible injuries, it seems like the actual danger of being punched in the face is a wild card. You can die, but no one I know has died from a face punching, or even needed surgery, and they all seem to laugh about it.

But some fears are easy to confront, so I had myself punched, Tyler Durden–style.

I work a few desks away from Mike Hresko, the editor in chief of Fightland, our sister site for fighting and MMA news. Mike, who knows Jiu Jitsu and Muay Thai, knows how the pros punch. That's a little intimidating, but it also meant he wouldn't slip and hit me in the ear or throat or something. I asked Mike to hit me like he would a guy in a bar who was getting out of hand and needed someone to make him shut up. But I also told him I needed to finish writing this, so no concussions please.

It sucked.

It wasn't exactly painful at first, more like an overall shock to the system, kinda like a minor car crash or a firecracker going off near your head. My ears rang, and I got an instant headache. I felt myself reflexively lean away from it. In the next few seconds, my brain slowly started painting a picture of the specific injury. But I was alive and feeling fine to be honest. I was also able to go back to my desk and type about it, so my brain seems to be in working order.

Getting punched is no picnic, even when the assailant is your co-worker, and he's doing you a favor. Knowing what a relatively soft, message-delivery punch feels like, the thought of someone trying to seriously injure me actually sounds a little scarier than it did before I investigated this. And for the most part, seriously injuring you is exactly what people set out to do when they punch, at least according to O'Carroll. "If someone is really pissed off at another person, they're going for the knockout," he told me.

So I'll go back to being careful.

Final Verdict: How Scared Should I Be of Getting Punched in the Face?

3/5: Sweating it

Follow Mike Pearl on Twitter.