The treatment goal of maxillofacial bone fracture is to recover the preinjury occlusion and facial appearance. In order to obtain good results, it is important to reduce the deviated bone fragments to the anatomically proper positions and to reestablish the preinjury occlusion by intermaxillary fixation.
In conservative treatment, bone fragments are indirectly reduced and fixed by reestablishing the proper occlusal relationship with intermaxillary fixation.
In surgical treatment, the key to successful surgical treatment is to rebuild the buttresses and rigidly fix these parts.
Sufficient knowledge of the biomechanics of the jawbone and the characteristics of each fixation material and fixation system are necessary for osteosynthesis of bone fragments.
There are various osteosynthesis methods and materials, but in recent years, titanium plates and screws are mainly used.
In the surgery for maxillary fracture, it is important first to restore the occlusal relationship with the mandible, and then to rebuild and rigidly fix the buttresses.
In the surgery for mandibular fracture, a plate is placed based on the Champy theory or AO concept according to the fracture mode such as the fracture site, number of fracture lines, and state of bone fragments.

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Soft tissue injuries are a common type of oral-maxillofacial trauma and may occur in isolation or associated with fractures. Although isolated soft tissue injuries （ISTI） are common, relevant studies are rare. The aim of this study was to investigate the distributions, patterns, and treatment modalities of ISTIs. Records of patients over a 27-year period who were treated for oral-maxillofacial injuries were reviewed.
Of the 1,329 patients with oral-maxillofacial injuries, 388 （29.2％） sustained ISTIs. The male to female ratio was 1.49：1. The age distribution showed bimodal peaks in populations aged under 10 and 70–79 years. The ratio of patients aged＞60 years increased from 19.2％ to 30.6％. Simple falls （34.0％） were the main cause of ISTIs, followed by self-inflicted bites （22.2％）. The tongue （31.6％） was the most common intraoral site, while the lower lip （30.7％） was the most common extraoral site. A total of 215 patients received conservative treatment and 173 underwent surgery. A total of 31 patients （8.0％） were using antithrombotic agents. In 90 patients 60 years or older, 28 （31.1％） were using antithrombotic agents. The portion of elderly patients with ISTIs related to antithrombotic agents tended to increase.
The results of this analysis of 388 patients with oral-maxillofacial ISTIs over a 27-year period showed that ISTIs have unique features that differ from hard tissue injuries.

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Patients with mental retardation tend to suffer more oral and maxillofacial injuries than healthy subjects because of their mental and physical peculiarities. We performed clinical observation of 47 mentally retarded patients with oral and maxillofacial injuries in the Division of Dentistry, Chiba Prefectural Sawara Hospital during the five-year period of 2012 to 2017. The male to female ratio was 1.5：1. By age distribution, the age group of 30–39 years showed the highest incidence of injuries （10 cases, 31.9％）. The most common systemic disease was epilepsy （27 cases, 57.4％）, followed by autism （13 cases, 27.7％）. The most common cause was fall （27 cases, 57.4％）. A unique characteristic was that many patients were self-injured: biting of mouth soft tissue （18 cases, 38.2％）. The frequency of traumas was higher in May （7 cases, 14.9％）, June （7 cases, 14.9％） and December （8 cases, 17％）. Injury in only teeth was present in 31 cases （66％）, followed by 8 cases （17％） with only soft tissue injuries and 7 cases （14.9％） presenting tooth and soft tissue injuries. Most patients were treated appropriately, however, surgical procedures such as tooth extraction and observation of progress were chosen for some patients because they were non-cooperative. The results of our analysis showed that, for appropriate treatment of mentally retarded patients with oral and maxillofacial injuries, it is important to consider the differences in physiology and psychological features between mentally retarded and healthy patients.

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We report a case of an iatrogenic foreign body inserted into the maxilla and maxillary sinus during dental treatment. A 73-year-old woman was referred to our hospital for evaluation and treatment of the primary complaint of an uncomfortable feeling in her left maxillary gingiva. X-ray and CT images showed a foreign body like a metal needle from the apical area of the left maxillary second molar to the left maxillary sinus. We removed the foreign body under local anesthesia through an alveolar part after extraction of the maxillary second molar. The foreign body was a fragment of a peeso reamer. Unfortunately, the patient had not been informed by the previous dentist of the aberrant insertion of the foreign body. In case of aberrant insertion, it is important to explain the fact to the patient immediately and to remove the foreign body using minimally invasive methods.

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A 67-year-old woman was referred to our clinic after being involved in a traffic accident. Computed tomography revealed multiple maxillofacial compound fractures. Clinical parameters showed hemorrhagic shock and anemia, leading to disseminated intravascular coagulation （DIC）. After open reduction of the maxillofacial fractures, her general condition improved, and she was dis-charged 39 days after the surgery.

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Recently, the frequency of maxillofacial injuries has increased and the causes have diversified. Blast injuries due to explosions can be life-threatening. We report a case of blast injury requiring emergency surgery for a mandibular fracture with active bleeding. A 59-year-old woman presented with an injury to the right face with hemorrhage, caused by a gas canister explosion at her home. She was transferred to the Emergency and Critical Care Center of our hospital. Her vital signs were normal and she was alert with a Glasgow Coma Scale score of 15; however, a penetrating wound of the right buccal region and active bleeding in the oral cavity were found. Contrast computed tomography revealed a right mandibular fracture and extravasation around the fracture region. There was a risk of airway obstruction from active oral cavity bleeding; therefore, we performed urgent open reduction and internal fixation for hemostasis. She received an intraoperative blood transfusion and hemostasis was achieved with good reduction and fixation. Fortunately, she had no other injuries and her clinical course was good. It is crucial to understand the unique mechanisms underlying a blast injury, and to perform appropriate clinical evaluation and treatment because of the possibility of head and neck injury, damaged neck vessels, and airway obstruction.

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While domestic violence is recognized as a social problem in Japan, efforts to reduce its incidence have been mostly unsuccessful. Injuries resulting from domestic violence are most often to the face. Additionally, such injuries are so severe as to require surgery, and can result in very severe sequelae such as disfigurement and visual impairment. This report describes a case of domestic violence in which a woman suffered multiple facial fractures from her husband.
The patient was a 35-year-old woman brought to the hospital by ambulance after an argument with her husband at a family party led to her being beaten in August 201X. A computed tomography （CT） scan showed multiple fractures in the mandible and the nasal and orbital bones. Based on this diagnosis, open reduction and internal fixation surgery were performed for the mandibular fracture under general anesthesia. Moreover, because the patient was traumatized, she was discharged from the hospital after a cross-disciplinary team was assembled to provide ongoing support for the patient and her family.
When treating victims of domestic violence, in addition to the obvious need to treat the physical injuries, it is essential to provide mental health support before and after treatment for the victims and their families.

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