In daily clinical practice, quite a few cases with maxillofacial trauma are encountered, where not only lower-face fractures but also middle-face fractures are found. As a result, various functional disorders are encountered, among which we often find cases accompanied by nasal bone fracture or orbital fracture. In some cases with orbital fracture, limitation of supraduction due to inferior rectus muscle injury or diplopia is observed. In cases of orbital fracture with bone defect, where the abovementioned clinical symptoms are severe, bone grafting is required in cooperation with ophthalmologists, otorhinolaryngologists or plastic surgeons. However, in cases with fewer symptoms, high priority should be put on conservative treatment. Between May 2010 and April 2014, we experienced cases of reducing orbital fracture accompanied by maxillary fracture with the antral balloon technique. This paper introduces the technique and discusses its treatment results, with a review of the literature.

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Cases of nerve injury of the maxillofacial area are on the rise, many of which are inferior alveolar nerve injury and lingual nerve injury. These nerve injuries used to be treated conservatively. However, cases with severe damage require early diagnosis of the condition and nerve repair operation.
With this background, we have established a specialized outpatient department at Tokyo Dental College Oral and Maxillofacial Surgery, using a conventional sensory test and sensory nerve action potential（SNAP）for cases with inferior alveolar nerve injury and lingual nerve injury. Here, we report the application of SNAP for cases with inferior alveolar nerve and the lingual nerve damage.
A nerve-stimulating electrode（TUN209-012A Sasaki type, UNIQUE MEDICAL, Tokyo, Japan）and a recording electrode were used. The recording electrode was a coaxial needle electrode（NM-330T, NIHON KODEN, Tokyo, Japan）. The SNAP derivation device was an electromyogram and evoked-potential testing device（MEB-9404 Neuropack S1, NIHON KODEN, Tokyo, Japan）.
Conduction velocity, amplitude and waveform shape of SNAP were evaluated, and nerve injury was diagnosed. Case of conservative therapy was restored conduction velocity and amplitude at an early stage. Selected surgical therapy were SNAP could not be measured. In each of the cases, nerve function was recovered. We consider that SNAP can be used to perform an accurate diagnosis and appropriate treatment.

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A fall due to syncope tends to show a slight trauma on the head or face, and serious cases are rare. We report a case of panfacial fractures that occurred after a fall due to reflex syncope. The patient was a 60-year-old man. He did not have a history of syncope, and after various examinations, we eliminated cardiogenic syncope and a transient ischemic attack as possible causes. Because syncope occurred after evacuation, we diagnosed the cause of the fall as reflex syncope. A midface examination revealed a Le Fort pattern of fractures: fractures of the maxillary frontal process, inferior orbital rim, zygomaticofrontal suture, maxillary sinus, and piriform aperture lateral margin were found. Moreover, a comminuted mandibular symphyseal fracture and bilateral condylar head fractures were also found. We performed open reduction and internal fixation surgery for all fractures except the bilateral condylar head fractures. For the fracture of the maxillary frontal process, we performed a butterfly incision from the proximal end of the left eyebrow to the midline of the glabella region. For the inferior orbital rim fracture, we performed a subciliary incision, and for the zygomaticofrontal suture fracture, we performed a supraorbital lateral eyebrow incision. For the inferior maxillary fracture, we performed an upper gingivobuccal sulcus incision, and for the comminuted mandibular symphyseal fracture, we performed a laceration approach. All fractures that underwent open reduction and internal fixation healed in proper union. The scar from the glabella incision healed neatly. The butterfly incision in the glabella region was a useful approach for the fracture of the maxillary frontal process. We considered that the situation syncope in the standing position caused a defenseless fall and severe blow to the patient’s face.

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The main causes of facial injuries are traffic accidents, falls, and blows. However, the use of professional rotating cutting instruments such as angle grinders is increasing in line with the popularity of do-it-yourself. There have been some reports on injuries caused by such tools. Sufficient protection is necessary because injuries with rotating cutting instruments are sometimes critical. Here, we report a case of a facial injury caused by using an angle grinder.
A 61-year-old man was referred to our hospital in May 200X. The patient had been injured by being hit by a propeller of paraglider using an angle grinder. The wound involved from the left side of the nose root to the left side of the buccal and from the right side of the buccal to the chin. The left parotid duct was ruptured and the wound reached the sinus wall and alveolar bone.
The patient was diagnosed with facial soft tissue injury, rupture of the left side of the parotid duct, and fracture of teeth roots, and underwent wound suture, repair of the parotid duct, and teeth extraction. Bone fracture of the left side of the sinus wall was observed but there were no signs of shift of occlusion. Parotid duct contrast radiography revealed good repair. However, scar contracture of the left side of the buccal wound was observed, so cicatrization was conducted 4 months after the operation.
Facial injuries caused by rotating cutting instruments result in diverse wounds. When repairing facial injuries, not only functional recovery but also cosmetic recovery after operation is important.

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A 78-year-old man was referred to our hospital with mandibular trismus. Physical examination showed severe trismus and stiffness of the masseter and temporal muscles. The patient had no noticeable history of trauma. The clinical diagnosis was TMD. On the next day, the symptoms intensified. Tetanus was diagnosed on the basis of clinical course and symptoms such as trismus, facial grimacing, and stiffness of the masseter and neck muscles. The patient was immediately admitted to the intensive care unit. He was given antitetanic human immunoglobulin, tetanus antitoxin, antibiotics, dantroren, and midazolam. The patient recovered with tracheotomy and tracheal intubation. Opisthotonus, airway obstruction, and circulatory disturbance did not occur. Tetanus is a fatal infectious disease if early treatment is not appropriately performed. When examining patients with trismus, we should consider the possibility of tetanus and observe them carefully.

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