We report a case of bear trauma resulting in jaw fracture, which was treated using the hybrid maxillomandibular fixation （MMF） intermaxillary fixation system.
The patient, a 50-year-old man, was attacked by a bear during the night in mid-November. He was transported to our hospital via emergency （medical） services after being examined at another general hospital. At the initial examination, there was a laceration from the left forehead to the lower lip and failure of eyelid closure on the left side with difficulty in opening and occlusion. The imaging findings revealed left zygomatic, left zygomatic arch, left maxillary, and left mandibular condylar fractures. The zygomatic arch fracture with a large displacement was treated using plastic surgery, and the jaw fracture was treated using the hybrid MMF intermaxillary fixation in our department. After release of the inter-arch fixation, occlusal guidance was performed using intermaxillary elastics. The patient’s progress was good, and he was discharged after 31 days.
The hybrid MMF is a device that reduces invasion of the teeth and periodontal tissues by directly placing screws into the jawbone to obtain a fixed anchor. The use of this device was thought to be critical in this case.

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In recent years, dental laser therapy has become increasingly popular and applicable. On the other hand, there is an increasing number of reports of subcutaneous and mediastinal emphysema caused by dental laser therapy. This paper reports a case of mediastinal emphysema caused by CO₂ laser irradiation into the periodontal pocket. The patient was an 80-year-old man. In a dental clinic, for the purpose of curettage in 11 periodontal pockets, the tip of the device was directly inserted and CO₂ laser was continuously irradiated for 5 minutes, and his face and neck swelled significantly. He was referred to our hospital and was immediately admitted with a diagnosis of mediastinal emphysema. CT examination revealed a wide range of aerobic images from his bilateral face to the neck and mediastinum. He was given an antibacterial drug to prevent infection and was discharged on the 5th day because CT showed a decrease in emphysema. He continued to take antibiotics thereafter, and CT confirmed the disappearance of emphysema on the 18th day. It is important to consider the risk of severe emphysema from CO₂ laser irradiation and learn the proper use of laser equipment and proper response to mediastinal emphysema.

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Oral penetrating traumas with a toothbrush are often encountered in clinical oral surgery. Most cases are minor injuries, but some require surgery or hospitalization due to complications. We report an overview of three cases of oral penetrating injuries caused by toothbrushes. The first case was a 4-year-old girl whose toothbrush had penetrated her palatoglossus muscle, leading into her parapharyngeal space. The second case was a 2-year-old boy who was transported by ambulance with a toothbrush stuck in the buccal mucosa. In the third case, the buccal fat pad of a 1-year 6-months-old boy was incarcerated after penetration of the buccal mucosa with a toothbrush. After admission, he needed a reduction of the buccal fat pad under general anesthesia. The clinical symptoms of an oropharyngeal penetrating injury vary depending on the condition of the toothbrush that caused the injury, the site of the injury, and the degree of injury. Even if the wound is small, it can cause severe damage to deep tissues. Therefore, it is necessary to make an accurate initial diagnosis, predict the subsequent risks, and decide on appropriate treatment. Additionally, literature reviews have shown several characteristics of these injuries and the risk of serious complications.

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