Oral injuries as a result of falling with a stick in the mouth are occasionally encountered in children. We herein report a pediatric case of trauma to the buccal mucosa caused by a toothbrush, resulting in herniation of the buccal fat pad. A 3-year-old boy fell off the sofa at home with a toothbrush in his mouth. His mother discovered him bleeding orally and brought him to the emergency unit of our hospital. The bleeding had ceased, and a reddish-yellow tissue mass was observed on the right buccal mucosa. The clinical diagnosis was a stab wound of the right buccal mucosa with hematoma and herniation of the buccal fat pad. Two days after the injury, the herniated buccal fat pad was excised under general anesthesia. The postoperative course was uneventful. The size of a mucosal stab wound by a toothbrush is larger than that caused by a chopstick, and may cause traumatic herniation of the buccal fat pad. Since its spontaneous loss is unexpected, reduction or excision of the fat pad may be necessary depending on the degree of herniation.

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A clinical study of 19 patients with pediatric maxillofacial fracture who visited our hospital from January 2008 to December 2017 was conducted. The patients consisted of 14 boys and 3 girls. 　Patient age ranged from 1 to 15 years （median, 13 years）. The causes of injury included 6 cases of falls, 5 cases of sports accidents, 5 cases of tumble, 1 case of traffic accident, and 1 case of a blow. The fracture sites were the mandible （10 cases） and zygomatic bone （7 cases）. Ten patients were treated conservatively, 3 patients by open reduction with internal fixation, 2 patients by internal maxillary fixation, and 1 patient by closed reduction. The median follow-up period was 7 months （range, 1-52 months） for 19 patients, 19 months （range, 3-52 months） for patients with mandible fracture, and 6 months （range, 1-12 months） for those with zygomatic fracture. In all of the patients, a good range of movement was achieved and no growth disturbance was apparent in the follow-up period.

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Temporomandibular joint（TMJ）ankylosis is defined as a pathology causing severe limitation of joint mobility by filling of the gap between the mandibular condyle head and mandibular fossa with fibrous or osseous tissue. 　We report our clinical experience with a case of recurrent TMJ ankylosis resulting from gap arthroplasty. At the initial visit, the patient’s maximum mouth opening was 17 mm and hard trismus was felt. X-rays showed narrowing of both TMJ gaps, and fibrous adhesions and ankylosis on the left side were suspected. Therefore, we performed a gap arthroplasty. Thereafter, the patient did not perform postoperative mouth-opening exercises, and so we educated the patient before a second procedure, and the patient performed aggressive, continuous mouth-opening exercises postoperatively. One year postoperatively, the maximum mouth opening was 35 mm and there had been no recurrence.

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We performed a clinical study on the actual situation and treatment of maxillofacial fractures in pediatric patients. The 6 cases were treated at Asahikawa Hospital of the Japanese Red Cross during the 10 years from April 2007 to March 2017. The fracture sites of all 6 cases were the mandible and there were no cases of multiple injury. Four of them needed surgical repositioning and fixation with a titanium mini-plate or stainless steel wire because of remarkable displaced fracture of the mandible; the other cases were followed up without any surgical treatment. In principle, non-invasive treatment is recommended because the tooth germ or unerupted teeth will be not damaged. In the present cases, it is thought that the surgical repositioning and fixation for the pediatric patients enabled early training of mouth-opening and early recovery of oral function. None of the cases suffered complications such as damage to tooth germ or osteomyelitis of the jaw. 　In conclusion，surgical repositioning and fixation with a titanium mini-plate or stainless steel wire is useful for severe maxillofacial fractures in pediatric patients. Although there are no definite reports on the timing of removing a titanium mini-plate or stainless steel wire, in the present cases we confirmed clear bone union with CT scan at 4 months after the surgical operation, so we consider that this is a suitable timing for removing the mini-plate or wire.

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