Treatment of extensive oromandibular defects following wide resection of head and neck cancer is challenging. In this report, we describe our basic considerations for extensive oromandibular reconstruction with free osteocutaneous flaps.
　　Preoperative evaluation：Surgeons must evaluate the cancer region by face-to-face examination. The location, size, and extent of the tumor should be assessed and the suspected surgical margin should be taken in consideration. Furthermore, remaining teeth following cancer resection should be evaluated for postoperative functional recovery.
　　Surgical planning：In general, a mandibular reconstruction plate or free vascularized osteocutaneous flap can be used. The method of oromandibular reconstruction should be determined by careful preoperative evaluation. Furthermore, the patient background, including preexisting comorbidities, social activities, and postoperative treatment plans, including radiotherapy and chemotherapy, should be taken into consideration. In addition, 3-dimensional surgical models are useful for preoperative surgical planning.
　　Surgical procedures：There are three representative osteocutaneous flap donor sites：the scapula, ilium, and fibula. Reconstructive surgeons must be familiar with these three flap surgeries. Of these, the vascularized fibula graft has several advantages such as having a long bone source, long vascular pedicle, and thin pliable skin paddle. Thus, the fibular graft can usually be the first choice for mandibular bone reconstruction.
　　In head and neck reconstruction, several plastic surgery techniques, including flap elevation, flap suturing, vascular anastomosis, bone graft, etc., are necessary for successful treatment. Moreover, surgical success and total recovery of postoperative function are required. Although head and neck reconstruction is challenging, surgery can be successful by improving basic knowledge and surgical techniques.

　　Intraoperative repositioning assessment during facial fracture operations is important for achieving satisfactory facial symmetry. A navigation system that has been developed in neurosurgery has recently been applied to otolaryngology, orthopedic and maxillofacial surgery. We employed a navigation system (Stealth Station TREON, TRIA and S7 system, Medtronic) during facial fracture operations, and found it useful for performing accurate reduction and confirming symmetry.
　　We applied a navigation system for 45 patients with facial bone fractures. There were 25 cases of zygomatic bone fracture, 3 cases of naso-orbital-ethmoidal bone fracture, 2 cases of maxillary bone fracture, 3 cases of orbital floor fracture, 5 cases of nasal bone fracture, 2 cases of malunited zygomatic bone fracture, and 5 cases of malunited nasal bone fracture.
　　Accurate reduction and symmetry were confirmed during the operation for all patients. Good symmetry was confirmed on postoperative CT. Navigation was useful for performing accurate reduction of the fractures and confirming the symmetry of the face.
　　This system may be useful for facial fracture surgery, especially for the treatment of untreated facial fractures requiring osteotomy, comminuted facial fractures with third bone fragments, and the evaluation of bone grafts.

　　During the past 30 years, over 100 cases of craniosynostosis and related syndromes have been treated by our unit. We have had more mild and subtle form cases not commonly diagnosed in the recent decade. We present six previously unclassified cases. The cranial form was mildly small with bi-coronal and pterional constriction in all cases, and fused coronal suture was confirmed intraoperatively. However, a concave line (constriction band) was posterior to (not on) the fused suture, and the increased intracranial pressure (ICP) was monitored. Osteotomy was performed on the abnormal constriction band and the concave line was removed. The lateral end of the sphenoid ridge was widely removed for release, and cranial expansion is performed by distraction or suturectomy. In three of these cases, bone re-generation was rapid in the bi-temporal area despite the wide bone defect, and further broader ostectomy was needed. Clinical symptoms, such as delay in speech and hyperactivity, were improved and single photon emission computed tomography (SPECT) image confirmed improved vasculature in the released temporal area after surgery.

　　For surgical treatment of medial wall orbital fractures, numerous approaches are selected such as subciliary, medial canthal, transconjunctival, transcaruncular, or transnasal approaches. Our choice of surgical approach for the treatment of medial wall orbital fractures is transconjunctival with the transcaruncular endoscopic approach assisted by simultaneous image-guided surgery. In this study, postoperative outcomes of patients who were treated by our method were compared with those who were treated by the conventional transnasal endoscopic approach.
　　Ten patients with medial wall orbital fractures who underwent surgery at our hospital between April 2009 and March 2017 were included in this study. Five patients were treated by our method (transconjunctival group) and the other five patients were treated by the transnasal endoscopic approach (transnasal group) . Postoperative ocular function and the orbital volume were compared between the two groups. The orbital volume was evaluated using the orbital volume ratio.
　　There were no significant differences in postoperative ocular movement between the two groups. The postoperative orbital volume ratio in the transconjunctival group significantly improved compared with that in the transnasal group (101.0% VS. 107.8%；p<0.05) . There were no postoperative complications related to our surgical approach.
　　By inserting the endoscope through a small conjunctival incision, the operator and other medical staff can share a wide and detailed surgical view of orbital fractures. With the assistance of the image-guided surgery, reduction and fixation of orbital fractures, especially around the orbital apex, were safely performed. Our method enables safe and precise reduction and fixation in the treatment of medial orbital wall fractures.

　　Lion attacks are rare in Japan. We report a case of lion attack with multiple facial fractures and facial nerve injury. We collaborated with the emergency and critical care center, and in the second term, we performed open reduction and internal fixation (ORIF) and facial nerve reconstruction. A 28-year-old man was attacked by a lion while washing it by hand. He sustained open mandible fracture, zygomatic fracture, and transverse fracture of the cervical vertebrae, and on his left side, canaliculus laceration, facial nerve injury, and parotid gland injury. On the same day, he was hospitalized in the intensive care unit and underwent emergency operation, during which canaliculus reconstruction and parotid suturing were performed. On the 10th day after injury, he underwent ORIF for his mandible and zygomatic fractures, and facial nerve reconstruction. The patient has made good progress. In the report, we discuss the difference between lion attacks and bear attacks, which are common as animal-induced trauma in Japan.