Maxillofacial fractures in children often occur in the mandible. However, children are in the process of growing and developing, and their fracture patterns change depending on the anatomical factors of the mandibular bone and the social factors of the child at the time of injury. In this study, we report 33 cases of pediatric mandibular fractures in our department whose age, sex, cause of injury, fracture site, fracture pattern, and treatment were examined, in order to clarify the characteristics of each of the various age groups. The patients were divided into three age groups: infant age （0-6 years）, school age （7-12 years）, and junior high school age （13-15 years）.
There were 9 cases of infant age, 13 of school age, and 11 of junior high school age. As for the ratio of males and females, the proportion of girls decreased with increasing age. More than half of the injuries were caused by falls at infant age. At school age, traffic accidents and falls were the most common in that order, and at junior high school age, traffic accidents and sports were the most common in that order. The fracture pattern was characterized by a symphysis fracture at infant age, mandibular body fracture at school age, and angle fracture at junior high school age. The characteristic findings of pediatric mandibular fractures during the development stage were considered to be closely related to mandibular bone flexibility, mandibular sutura and tooth germ formation.

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A clinical study of 65 patients with maxillofacial fractures who visited our hospital from April 2008 to March 2013 was conducted.
The patients consisted of 53 males and 12 females, a male-to-female ratio of 4.4：1. The patients ranged in age from 2 to 90 years old. The most common age range was 20-30 years old with 18 cases （27％）, with around 10 cases （15％） in each of the 10-20, 30-40, and 40-50 ranges.
The causes of injury included 19 cases of falls （29.2％）, 18 cases of horse-related accidents （28％）, 12 cases of sports accidents （18.5％）, 6 cases of traffic accidents （9％）, 5 cases of a blow （8％）, and 3 cases of work accidents （5％）. The main fracture site was the mandible （43 cases, 66.2％）, the mid face （22 cases, 33.8％）, and multiple facial bone fracture （5 cases, 7.7％）. Fracture sites of the mandible were 20 incisor region, 11 molar region, 14 mandibular angle, and 26 condylar process. Twenty-nine patients were treated by open reduction, 23 were treated conservatively, 13 were moved to other hospitals.
The results showed that the ratio of fractures caused by horses was remarkably high compared to other regions.

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We report a clinico-statistical study of 338 patients with maxillofacial fractures who visited our department from April 2014 to March 2019 and who were divided into operation cases （ORIF group; N＝188; mean age 44 years） and non-operation cases （conservative group; N＝150; mean age 47 years）. An ambulance was used for transportation for 63.3％ and 48％ of patients in the ORIF group and conservative group, respectively. The number of patients in each age-group from the teens to the 60s was higher in the ORIF group than in the conservative group, except for those in their 70s and older. The most common causes of injury were traffic accidents （42.0％） and stumbling or fall from a height （47.3％） in the ORIF group and conservative group, respectively; however, patients in their 70s and older reported stumbling and fall from a height as the most common causes of injury in both the groups. Analysis of the fracture site revealed that the number of patients with midfacial fractures was more than those with mandibular fractures in both groups, and it was one of the characteristics of all maxillofacial fracture cases referred to our department. Stumbling or fall from a height frequently resulted in fractures of the mandibular condyle. Among the 27 patients with severe fractures such as midface overlapping fractures and panfacial fractures, 23 patients underwent surgery. This study found that surgical or conservative treatment was selected depending on the individual circumstances of the patient.

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Wild animal attacks, specifically bear attacks, commonly involve maxillofacial injuries caused by the animal’s forepaws and teeth. The resulting severe facial injuries require cosmetic reconstruction and oral function rehabilitation. We report a case of severe facial injury that necessitated bone graft and dental implantation.
A 70-year-old man was attacked by a wild bear on a mountain in 2017. The patient was referred to our hospital and underwent hemostatic treatment and wound closure with sutures. He received antibiotics for a week, and we performed debridement and zygomatic fixation with a titanium plate. His oral function, including occlusion and speech, did not fully recover despite postoperative denture placement. Bone grafting was performed 6 months after his initial visit, and dental implantation was performed 6 months after bone graft reconstruction. He received a custom-fitted denture and underwent oral function evaluation, which revealed adequate restoration of oral function.
Optimal restoration of both esthetics and good oral function are essential for facial injury treatment.

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Broken needles are one of the accidents that may occur during dental treatment. Most occur during inferior alveolar block anesthesia, but sometimes the injection needle breaks and is lost in deep soft tissue during infiltration anesthesia. We report a case in which a dental needle broke during local anesthesia and strayed into the infratemporal fossa. A 29-year-old woman was referred to our department to search for the lost needle on the day. The injection needle could not be found near the extraction socket by oral examination. In the panoramic radiograph, a linear radiopaque object was found from the posterior upper part of the left maxillary tooth extraction cavity to the posterior upper part. CT revealed that the broken injection needle was located in the infratemporal fossa along the maxillary bone. On the day of the incident, the needle was removed under general anesthesia. With reference to the three-dimensional CT image, the lower end of the needle could be found in the soft tissue over the periosteum, and was removed. The removed object was a 30G needle with a length of 21mm that had broken at the base and also had bent near the center. The patient was discharged on the 7th postoperative day and was followed up for 2 months. The postoperative course was uneventful.

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Surgical approaches can be selected to treat temporomandibular joint ankylosis when favorable effects are not achieved with conservative treatment. We report a case of bilateral temporomandibular joint ankylosis in which a combined AlKayat–Bramley and endoscopic approach was implemented. A 65-year-old man was transported to the Emergency and Critical Care Center of our hospital due to trauma in a traffic accident. Computed tomography showed bilateral condylar head fractures and a midline fracture of the mandible. Four days after the injury, we performed open reduction and internal fixation of the midline fracture of the mandible. The bilateral condylar head fractures were managed conservatively. It was difficult to perform mouth-opening training for one month after the surgery due to disturbance of consciousness and diffuse axonal injury accompanied by traumatic subarachnoid hemorrhage. At the beginning of the rehabilitation, an opening disorder occurred, and no improvement was observed even after continuing mouth-opening training after discharge from our hospital. Three years after the injury, we performed bilateral arthroplasty with a temporalis muscle flap using an endoscope for post-traumatic temporomandibular joint ankylosis. We were able to perform the surgery correctly and safely using an endoscope, particularly when we removed the condylar head, which was dislocated inside the ramus. The maximum mouth-opening distance improved from 15mm to 42mm after the surgery. Three years postoperatively, maximum interincisal opening was maintained and no recurrence with functional disturbance was found.

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Emphysema is the abnormal introduction of gas in body tissues, and emphysema in the stomatognathic region is caused by various factors such as dental treatment, head and neck surgery, and trauma. In the dental field, instruments such as handpieces and air syringes have been reported as the main causes of emphysema. The characteristic symptoms are marked swelling and crepitus on palpation. A computed tomographic scan demonstrates low-density areas in the subcutaneous tissues. To prevent infection, it is necessary to give antibiotics.
We report four cases of emphysema related to CO2 laser, trauma, sneezing, and straining, presenting in the stomatognathic region. In conclusion, all patients were given antibiotics to prevent infection, which improved the emphysema without any complications. It is important to recognize the various causes of emphysema and to treat it appropriately.

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