Maxillofacial fractures have a characteristic fracture pattern depending on the cause of injury, which eventually changes as regional characteristics and social activities change. Human injuries due to snow accidents in snowy areas, such as Ishikawa Prefecture where our hospital is located, have been reported. Here, we investigated such cases to elucidate the characteristics of trauma in the area. We reported the clinical studies of 110 cases of maxillofacial fractures treated in our department. In this study, we included 73 males and 37 females （male to female ratio, 2：1） with an age distribution of 0-93 years and a median age of 42 years. Ninety-three cases had mandibular fractures, seven cases had mid-facial fractures, and 10 cases had midfacial and mandibular fractures. Overall, 64 cases were in-hospital referrals （50 from the emergency department and 14 from other departments）, eight were from direct consultations, and 38 were referrals from other hospitals （15 from dental clinics and 23 from other medical institutions）. The causes of injury were slipping on the ground in 59 cases, traffic accidents in 21 cases, tumbles and falls in 11 cases, assault in nine cases, sports-related accidents in six cases, and work-related accidents in four cases. Treatments were open reduction and fixation in 47 cases, noninvasive reduction and fixation in 17 cases, conservative treatment in 41 cases, and other treatments in five cases. Several patients with mandibular fractures were taken to an emergency department, and open reduction and fixation was often performed. The causes of injury were falls, which match the reports from other hospitals. However, only a few cases were related to snowfall.
We report a case of traumatic maxillary artery aneurysm caused by mandibular fracture.
The patient was an 86-year-old woman. She fell down and bruised her face on the ground. She had mandibular fractures in the bilateral condyles. Two days after the injury, she developed swelling and an enlarged hemorrhagic spot on the lower left jaw. CT showed a pseudo-aneurysm at the bifurcation of the maxillary artery and inferior alveolar artery inside the left mandibular ramus fracture. Trans-catheter embolization for the traumatic aneurysm was performed prior to our fracture surgery.
The posttraumatic complications of maxillofacial fractures related to maxillofacial function and facial deformity include nonunion, malunion, malocclusion and facial asymmetry.
We report a case of malunion and malocclusion following inadequate open reduction of unilateral subcondylar fracture successfully treated by sagittal splitting ramus osteotomy （SSRO）. A female in her 70s suffered unilateral subcondylar and contralateral mandibular angle fractures after falling while walking. Both fractures were openly reduced and internally fixed at another hospital. However, the treatment was insufficient and two months later, she presented in our department with the chief complaint of significant malocclusion. Clinical examination and computed tomography revealed severe open bite on the left molars with malunion of the right subcondyle due to lateral override of the fractured proximal fragment. We performed SSRO on the right side to correct the malocclusion. Revision surgery provided satisfactory results with stable occlusion and maxillofacial function.