In oral and maxillofacial surgery, the diagnosis and treatment of oral and maxillofacial trauma is particularly important in pregraduate dental education and postgraduate clinical practice, as well as in other oral surgery diseases or in terms of learning the basics of surgery. Mandibular fractures associated with facial trauma can have a considerable effect on oral function after injury. The treatment of mandibular fractures must focus on recovery of occlusion among the lost oral functions.
This article is based on materials obtained regarding the causes, appearance, diagnosis, treatment, etc. of mandibular fractures mainly in normal times and emergency situations, which are frequently handled by oral and maxillofacial surgeons.

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We report a case of limited systemic sclerosis discovered by dysgeusia. A 72-year-old woman was referred to our hospital with a complaint of bitter taste in her mouth. A smooth tongue and dry mouth were observed, and follow-up was performed after the patient had been prescribed a mouthwash. However, as a taste test revealed bitter-sensitivity, a taste disorder was suspected and a blood test was performed. This revealed zinc deficiency and the presence of anti-centromere antibody. After referral to the Department of Collagen Disease of a neighboring medical university, a diagnosis of limited cutaneous systemic sclerosis was established. This case suggests the need for blood tests for any underlying conditions in patients who present to dentistry departments with taste disorders.

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We report a rare case of acute cholecystitis and sepsis diagnosed during the treatment of left-sided buccal cellulitis. A 67-year-old man visited a nearby hospital because of worsening swelling and pain on the left side of his face and was admitted to a hospital for anti-inflammatory treatment. However, his symptoms did not improve, and he was referred to our hospital for treatment. We diagnosed the cause of the left buccal cellulitis as marginal periodontitis of the maxillary left first and second molars.
After receiving anti-inflammatory treatment with antimicrobial agents and undergoing tooth extraction, the patient’s clinical findings indicated resolution of the inflammation; however, blood tests did not show any improvement in C-reactive protein levels. This led to a suspicion of inflammation in other organs; hence, the patient was referred to the gastroenterology department.
Echocardiography and other tests revealed acute cholecystitis. The patient’s general condition then deteriorated rapidly, and he developed septic shock. First aid and anti-inflammatory treatment were administered, following which the patient’s general condition improved.

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Reactive lymphoid hyperplasia （RLH） is pathologically lymphoid hyperplasia and requires differentiation from malignant lymphoma. Development of RLH in the oral cavity is rare, and concomitant development with oral carcinoma has not previously been reported. We report two cases of RLH that developed with oral carcinoma. An 81-year-old Japanese woman with an upper gingival mass and a 72-year-old Japanese woman with a right tongue mass visited the Department of Oral and Maxillofacial Surgery, Gunma University Hospital. The masses were diagnosed as squamous cell carcinoma on biopsy, and RLH was found in the subepithelium adjacent to the carcinoma. RLHs included formation of a lymphoid follicle with germinal centers. No atypical lymphocytes were present in the germinal centers, most lymphocytes were CD20-positive, many tingible-body macrophages were observed, and Bcl-2 was negative. In addition, most lymphocytes were MIB-1-positive. RLHs were completely resected by biopsies. The cause of RLH development has not been determined. However, the cause of RLH development in the two patients described in this paper may have been due to a local hyperimmune reaction and induced by potentialization of cancer immunity and severe inflammation.

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Although flap reconstruction for soft tissue defects after resection of oral cancers such as tongue cancer contributes to functional recovery, malignant tumors such as squamous cell carcinoma may develop on the flap. A rare case of squamous cell carcinoma on a flap 8 years after reconstruction with a forearm flap following resection of tongue cancer is reported. The patient was a 76-year-old man. After chemotherapy for squamous cell carcinoma of the left tongue, partial tongue resection, left shoulder hyoid muscle upper neck dissection, and forearm flap reconstruction were performed under general anesthesia. Eight years after the operation, an outward-growing mass with induration was found on the reconstructed flap, and squamous cell carcinoma was diagnosed. Partial tongue resection was performed under general anesthesia. The wound was sewn to reduce the volume of the tongue and shape it. A complete denture was prepared 9 months after the operation. Three years have passed since the operation, but no recurrence has been observed, and the patient’s course has been good. There are various possible causes for flap carcinogenesis, but in this case, it was considered that the flap had become cancerous due to chronic irritation by the denture.

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Zinc plays an essential role in humans, including numerous enzymatic catalysis and protein synthesis processes. Although the relationship between dysgeusia and zinc deficiency is widely recognized, there are few reports of stomatitis related to zinc deficiency. While stomatitis has various causes, in many cases the removal of the source of pain or application of steroidal ointment often leads to complete healing within one or two weeks. In certain cases of intractable stomatitis associated with low serum zinc levels, zinc supplementation may lead to complete healing. We experienced five cases of effective zinc supplementation in intractable stomatitis. We recommend the routine screening of zinc serum levels in intractable stomatitis cases.

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Von Recklinghausen’s disease is an autosomal dominant disease characterized by café au lait spots and neurofibroma of the skin. It may be accompanied by nervous system, bone, eye, or gastrointestinal tract symptoms. In addition to neurofibroma, benign tumors, such as leiomyomas, non-epithelial tumors accompanied by gastrointestinal stromal tumor, smooth muscle sarcoma, and epithelial malignant tumors like colon cancer or esophageal cancer have been reported in the gastrointestinal tract. There are many reports of leiomyoma in the small intestine, but reports of leiomyoma in the gastrointestinal tract above the stomach are rare. We report a case of leiomyoma of the tongue in a patient with von Recklinghausen’s disease.

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We report a case of spindle cell lipoma （SCL） which developed in the right buccal mucosa. The patient was a 54-year-old woman with the chief complaint of a mass in the right buccal mucosa. At the first visit to our clinic a pedunculated and well-circumscribed mass, measuring 15×20mm, was observed in the right buccal mucosa. Magnetic resonance imaging （MRI） showed a well-circumscribed lesion with low signal in the T1 weighted images, high signal in the T2 weighted images, and slightly high signal in the STIR images. Based on the clinical and imaging findings, we diagnosed the lesion as a pedunculated benign tumor and excisional biopsy was performed under local anesthesia. The surgical specimen was pathologically and immunohistochemically diagnosed as spindle cell lipoma （SCL）. No symptoms of recurrence have been recognized for 3 years after surgery.

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We report a case of an epidermoid cyst （EC） in a submandibular lesion. The patient visited our department in March 202X, with the main complaint of swelling of the submandibular region. An indolent mass with spherical elastic hardness and mobility was observed in the submandibular region, and a 27×20mm, well-defined mass between the platysma muscle and the submandibular gland could be identified by CT and MRI. The results of fine-needle aspiration cytology were negative for malignancy. Based on this, a diagnosis of submandibular cyst was made. The excised tissue was a thin layer of squamous epithelium lining filled with stratified keratinization, no skin appendage carcinoma was observed, and EC was diagnosed. EC in the submandibular region is extremely rare: only 14 cases, including cases of self-testing, have been reported in Japan and overseas. Diagnostic imaging and differential diagnosis by fine-needle aspiration biopsy are considered to be important in the diagnosis of tumor lesions of the neck.

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