This paper examines the role of our hospital as a social safety net in the Kumamoto area, especially for oral and maxillofacial injuries, over the past 40 years.
We received approval as a dental facility with hospitalization equipment in 1975 and we have performed oral and maxillofacial surgery operations and dental emergency care. Since 1983, we have had a system for accepting emergency patients of dental accidents 24/7/365. The number of trauma patients needing hospitalization increased from 1980 to 1990, rising to 42 patients in 1999, but then decreasing thereafter. Possible causes of this decrease include the decrease in traffic accidents with the spread of air bags in cars, the obligation to wear a seat belt, and the severe punishment against drunk driving. Furthermore, the number of facilities performing oral and maxillofacial surgery and plastic surgery increased, so the number of trauma patients coming to our hospital decreased. We have performed surgery for mandibular bone fracture for 10–20 patients per year since 2000. The ratio of women and elderly people has increased. On the other hand, many patients with condylar process fracture have been referred to our hospital from other emergency hospitals.
It is convenient for emergency patients because our hospital has a system for accepting first aid patients 24 hours a day. As a result, cases requiring treatment for injured teeth, alveolar bone and soft tissue have increased. When treating children with injuries, comprehensive knowledge of the growth and development of children is also necessary, so our hospital’s doctor plays a useful role. After our hospital was approved as a support hospital for dental treatment in the Kumamoto area, the number of patients carried by ambulance increased. This was likely because rescue crews and local health center staff came to know about our emergency system.
We consider that our hospital should serve as a social safety net for the local community in the Kumamoto area by treating, in addition to patients with injuries, patients with inflammation, bleeding from the mouth, TMJ dislocation, and accidental ingestion.

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Our department of dentistry and oral surgery, Tokyo Dental College Ichikawa General Hospital, received 309 cases of oral and maxillofacial fracture from 2011 to 2015. Elderly patients （over 65 years old） comprised 19.9％ of those cases. Patients who had fallen comprised 72％ of cases among elderly patients, and some injuries were complicated by a condylar process bone fracture of the lower jaw. Many requests of the correspondence to customariness of the need of nursing care elderly person or obsolete temporomandibular joint dislocation were recognized separately from bone fractures in the outpatient department, too. There are 1,610 nursing facilities in that demographic division of medical services. 10％ of patients were residents of those facilities, and 85％ had medical histories that included complications such as mental illnesses, neurologic diseases, or cerebrovascular diseases. Consequently, there was a delay in dealing with temporomandibular joint dislocations.
The role of the community medicine support hospital includes providing training for local healthcare workers in areas other than those offering medical care to new patients and providing emergency care. The role of a hospital attached to a dental college with a high number of oral and maxillofacial trauma patients is significant. We provide information concerning the appropriate initial response to oral and maxillofacial trauma, and informational and training sessions focusing on temporomandibular joint dislocations for medical and nursing personnel through medical workshops. It is important for a hospital attached to a dental college to promote the prevention of oral and maxillofacial trauma and provide training to perform early and appropriate treatment.

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The surgical treatment of pediatric mandibular fractures is complicated because of the dynamic nature of a developing mandible and the presence of permanent tooth germs. Therefore, the use of circummandibular wires with an occlusal splint, which is the traditional method of closed reduction and fixation, is more applicable in pediatric mandibular fractures.
Recently, some reviewers have reported on osteosynthesis, a procedure using titanium plate fixation, in pediatric mandibular fractures having excessive deviation of bone fragments or the possibility of causing redeviation when using circummandibular wires alone. However, this procedure has some limitations such as restriction on mandibular growth, bone atrophy due to excessive stress shielding, release of metal ions, and the requirement of a second surgery for plate removal.
Besides the titanium plate system, biodegradable plate fixation is mainly used in the field of craniomaxillofacial surgery. This method has been superior in the treatment of pediatric mandibular fractures because it does not involve a second surgery for plate removal and provides sufficient mechanical strength that is maintained during bone healing.
On the basis of our clinical investigation, we emphasize the use of either a titanium plate or a biodegradable plate for osteosynthesis, with respect to mandibular growth and permanent tooth germs, and suggest that our method is a safe and acceptable treatment modality for surgically treating pediatric mandibular fractures. However, long-term follow-up and a greater number of cases are needed to confirm our results.

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A clinico-statistical study of 147 patients with maxillofacial fractures who visited our hospital from May 2009 to April 2015 was conducted. The patients consisted of 93 males and 54 females, a male-to-female ratio of 1.7:1. Forty-six percent （67 cases） of patients were aged 10 to 20 years old. The causes of injury included 68 cases （46％） of tumbles and falls, 30 cases （20％） of traffic accidents, 23 cases （16％） of a blow, and 20 cases （14％） of sports accidents. Sixty-two cases （42％） were referred to our hospital from medical hospitals, 27 cases （18％） were referred from dental clinics, and 40 cases （27％） visited our hospital directly. Regarding the period from injury to visiting our hospital, 84％ of patients attended our hospital within three days of injury. The main fracture site was the mandible （105 cases, 71％） followed by multiple facial bones （22 cases, 15％）, the zygomatic bone （13 cases, 9％）, and the maxillary bone （7 cases, 5％）. Sixty-five patients （44％） were treated by open reduction with internal maxillary fixation, 31 patients （21％） were treated by closed reduction with internal maxillary fixation, and 47 patients （32％） were treated conservatively.

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Introduction: The number of maxillofacial injuries sustained during sports is increasing in line with the growing number of people engaging in sports activities. Sports are one of the frequent causes of oral and maxillofacial trauma. To elucidate the characteristics of oral and maxillofacial injuries, we retrospectively examined cases of sports injuries in our department.
Patients and Methods: Three hundred fifty-nine patients with oral and maxillofacial injuries between April 2012 and March 2016, and 64 patients （17.8%） with these injuries occurring during sports presenting at our department.
Result: As for oral and maxillofacial injuries occurring during sports, most injuries were in male subjects, with a male to female ratio of 3.3:1, and the most frequently injured were teens （67.2%）, followed by those under ten （12.5%） and those in their twenties （12.5%）. By type of sport, injuries were most common in baseball （39.1%）, followed by basketball （18.8%）, soccer （12.5%）, and volleyball （6.3%）. Regarding type of injury, fracture was the most frequent （35.9%）, such as jaw fracture and orbital floor fracture, followed by tooth injury and soft tissue injury. Treatments were usually performed, and the patients made an uneventful recovery and regained their pre-accident maxillofacial function.
Conclusion: It appears that oral and maxillofacial injuries occur frequently in the popular sports such as baseball, soccer, basketball and volleyball. We consider it is important to recognize characteristic trauma for prompt diagnosis and treatment of these injuries. It is necessary to wear a mouthguard, faceguard, and so on to prevent some sports injuries such as fracture and tooth injuries.

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We report a case of migration of a broken carbide bur into the inferior border of the mandible during surgical extraction of a third molar.
The patient was a 36-year-old woman who was referred to our outpatient clinic for the removal of a broken piece of carbide bur at the inferior border of her mandible. Prior to this, she had been to a private clinic for the extraction of an impacted third molar, during which the carbide bur for dividing the tooth crown broke two times. The surgeon tried to remove the broken bur but could not do so completely, therefore the patient was referred to our department 6 days after the tooth extraction.
X-ray examination revealed a broken bur lodged at the inferior border of the patient’s mandible. Nevertheless, at her initial visit to our outpatient department, we found the presence of inflammation, so antibiotics were administered until the inflammation disappeared. 21 days after tooth extraction, we finally removed the piece of broken bur at the inferior border of the mandible under general anesthesia.

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A 29-year-old male suffered high-energy trauma resulting from an automobile accident and was brought to our emergency and critical care center. Despite an airway obstruction due to massive oronasal bleeding, his SPO2 increased temporarily due to continuous aspiration. However, the SPO2 decreased after aspiration was stopped because he was in and out of consciousness. We determined that use of an illicit drug before the traffic accident was the cause of the unstable consciousness. We identified his midfacial fractures including right Le Fort Ⅰ/Ⅱ, Le Fort Ⅰ, right zygomatic, nasal and right orbital fracture without a traumatic intracranial injury on a computed tomography scan. The sustained oronasal bleeding was caused by multiple complex midfacial fractures, and surgical treatment was planned. We decided to perform emergency surgery under general anesthesia because of his unstable consciousness due to the illicit drug and upper airway obstruction due to massive bleeding. The patient underwent open reduction and internal fixation for the complex maxillofacial fractures, and hemostasis was achieved. The patient did not bleed after the surgery and was extubated the next day. He was taken to a psychiatric hospital due to drug withdrawal symptoms. His clinical course was good 2 years after the surgery. This case demonstrates that consciousness can be unstable in an illicit drug-using patient with complex maxillofacial fractures; therefore, oral and maxillofacial surgeons should be careful but must intervene quickly.

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