Purpose: Maxillofacial fractures have become one of the major fields of oral and maxillofacial surgery. However, the situation of maxillofacial fracture cases treated by oral surgeons in Japan remains unclear. It is considered that the causes and demographics of such fractures have been changing due to the social background, such as population aging and the decrease in the number of traffic accidents. In this study, we systematically reviewed related papers to examine the changing requirements of maxillofacial fractures.
Objects and Methods: We searched articles published by oral and maxillofacial surgery facilities in Japan between 1965 and 2017, using the keywords maxillofacial and fracture, in Ichushi-Web and CiNii. Consequently, 69 articles fit the requirements of this study. These were divided into two groups of 38 and 31 articles that were published up to 1990 and after 1991, respectively, and sex, age, injury cause, fracture site, etc. were compared between the two periods.
Results: The articles of the former and latter periods described 9,787 and 5,741 patients, respectively. The proportion of females increased from 21％ to 29％, and the proportion of patients over 60 years old increased from 4％ to 18％. Regarding the cause of injury, the rate of falls overtook that of traffic accidents.
Discussion: This systematic review helped clarify the long-term changes and current situation of maxillofacial fractures treated by oral surgeons in Japan.

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The treatment of maxillofacial fractures is performed both domestically and internationally as an important area of dental and oral surgery. However, the overall situation of maxillofacial fracture cases treated by oral surgeons in Japan is not clear. Accordingly, we studied the situation of maxillofacial fractures in patients who consulted or were treated at oral surgery facilities in Japan, by analyzing the data of a nationwide disease survey led by the Japanese Society of Oral & Maxillofacial Surgeons （JSOMS）. 　The Society has surveyed the numbers of consultation cases and inpatient surgery cases by disease every year and has published the results for the 14 years from 1998 to 2011 so far. We focused on the data of fractures in the mandible, maxilla and zygoma, and examined the conditions of consultation and inpatient surgery during the period. 　The number of respondent facilities in the JSOMS survey increased from 172 in 1998 to 213 in 2011, a 1.24-fold increase. The total number of consultation cases for mandibular, maxillary and zygomatic fractures increased from 4243 in 1998 to 5416 in 2011, a 1.28-fold increase. The rates of increase of consultation cases for the mandible, maxilla and zygoma were 1.17, 1.40 and 1.26 during the 14 years, respectively. The number of inpatient surgery cases increased 1.25, 1.11 and 1.01 times, respectively. Differences in the rate of increase between consultation and inpatient surgery suggested that patients who not only consulted but also underwent treatment at oral surgery facilities slightly increased for mandibular fracture but decreased for the other two fractures. The percentages of mandibular, maxillary and zygomatic fractures were approximately 72%, 16% and 12% in 1998 and 66%, 19% and 15% in 2011, respectively. 　To examine whether regional differences of those percentages existed among prefectures, a cluster analysis was performed in each prefecture. Consequently, no uneven distributions of the clusters among the prefectures were observed. 　This study helped clarify the overall picture of current maxillofacial fracture cases treated by oral surgeons in Japan.

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Objectives: The goal of treatment of panfacial fractures is to restore both the function and the preinjury three-dimensional facial contours by accurate buttress reconstruction. However, because most patients with panfacial fractures are medically unstable because of associated neurologic or systemic injuries, treatment of panfacial fractures may have to be delayed. Although there have been some case reports on the treatment of panfacial fractures, these fractures have not been clinically evaluated in Japan. The aim of this study was to investigate the frequency of concurrent trauma, treatment sequence of open reduction and internal fixation （ORIF）, and complications in patients with panfacial fractures.
Methods: Between April 2011 and March 2017, we examined 13 patients （11 males and 2 females; average age, 29.5±14.7 years） who were treated for panfacial fractures at the Department of Oral and Maxillofacial Surgery, Kobe City Medical Center General Hospital.
Results: In 7 patients （53.8％）, intracranial trauma occurred with the panfacial fracture. Ten patients （76.9％） were treated with the “bottom-up and outside-in” procedure and 3 patients （23.1％） with the “top-down and inside-out” procedure. In addition, 2 patients required secondary ORIF because liquorrhea treatment necessitated a delay in fracture repair. Seven patients （53.8％） had postoperative complications.
Discussion and Conclusion: Surgeons need to consider the areas of fracture, fracture complexity, severity of facial injury, and the condition of the midfacial buttresses when choosing an adequate period of surgery and treatment sequence of ORIF for individual patients. Because of the frequent co-occurrence of cranial trauma and panfacial fractures, ORIF cannot be adequately performed as a first-stage surgery in some cases. Therefore, in such cases, ORIF must be included as a second-stage surgery in the treatment sequence. Surgeons must also recognize and try to minimize or prevent the frequent postoperative complications of panfacial fractures.

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We report a case of massive hemorrhage due to multiple facial trauma that was successfully treated by embolization of the branches of the external maxillary artery. A 71-year-old man suffered maxillofacial trauma in an automobile accident. The clinical diagnosis included multiple facial fractures, massive bleeding and hemorrhagic shock. We used transcatheter arterial embolization （TAE） with operation and successfully controlled bleeding.

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We report a case of mandibular fracture that was operated on without general anesthesia. A 52-year-old man involved in a traffic accident was transferred to the emergency and critical care center of another hospital. Since tension pneumothorax, hemothorax and multiple rib fractures were observed at the primary examination, he was hospitalized in the intensive care unit （ICU）. The next day, acute renal failure with crush syndrome occurred, and dialysis was initiated. He was discharged from the ICU 24 days after hospitalization. As pain in the right mandible inhibited eating, he was referred to our hospital 37 days after the traffic accident. On initial examination, a bone gap at the right mandible angle and hypoesthesia around the right lower lip were observed. Occlusal contact was observed only in the left molars. Radiographs and a computed tomography （CT） scan showed fracture of the right mandible angle. We planned an open reduction and internal fixation surgery for the mandibular fracture under general anesthesia. However, the anesthesiologist's assessment deemed that surgery under general anesthesia was impossible. Bone fragment mobility was observed and therefore maxillomandibular fixation （MMF） using elastic bands was performed. Three days after starting MMF, the bone gap was decreased. In order to start oral intake early, we performed open reduction and internal fixation surgery for the mandibular fracture to the extent feasible under local anesthesia with intravenous sedation. After operation, MMF was restarted. He could ingest liquid food three days after operation, and had good occlusion after nine days. Solid food was reintroduced gradually, and no functional issues in the mandible were observed in the postoperative period. This good condition has been maintained for 15 months after operation. This report demonstrates that open reduction and internal fixation surgery for a mandibular fracture to the extent feasible under local anesthesia with intravenous sedation should be proactively considered instead of conservative treatment if surgery under general anesthesia is impossible, as this can result in early oral intake and reduction of patient stress.

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Osteoradionecrosis of the mandible is one of the severe complications of radiation therapy for head and neck cancer. Generally, osteoradiomyelitis or osteoradionecrosis presenting pathological fracture is categorized into advanced stage that requires mandibular resection followed by bone reconstruction. We report a case of pathological mandibular fracture caused by osteoradionecrosis and osteoradiomyelitis, which was treated with open reduction internal fixation in combination with adjuvant therapies, closed irrigation-suction system, hyperbaric oxygen treatment and free composite iliac bone grafts. The patient was a 65-year-old male who had undergone superselective intra-arterial chemotherapy concurrent with radiotherapy for oropharynx cancer 5 years before. He had suffered from alveolar bone exposure and pain in the left mandible, accompanied by swollen cheek and skin fistula. Panoramic radiography and CT images revealed diffuse bone resorption and fracture in the left mandible. Histopathological examination showed no metastasis of the oropharynx cancer or other malignancy. We adopted closed irrigation-suction therapy in the period between the debridement of necrotic bone and the open reduction internal fixation, in order to control the infection and inflammation. The postoperative course was favorable and no trouble has been observed.

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