This article reviews the basic concept for the diagnosis and treatment of mandibular condylar fractures. In the diagnosis and primary treatment, CT images and occlusal reduction with intermaxillary elastics are important. TMJ irrigation for traumatic arthritis induced by condylar fracture may contribute to the remission of TMJ pain during mandibular motion exercise, resulting in early recovery of mandibular function. The criteria for indication of open reduction and internal fixation （ORIF） for condylar fractures are described from the viewpoint of recovery of original occlusion and acceptable mandibular function within at least 3 to 6 months. In the past, several approaches for ORIF and their clinical usefulness were reported, and the supremacy of the high perimandibular approach was suggested on the basis of the difficulty of securing sufficient surgical space for ORIF and risk of facial nerve disturbance. Additionally, the surgical points and applicable limitations of the single high perimandibular approach are described, with the presentation of cases.

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In recent years, cases of isolated oral and maxillofacial trauma have decreased, but those with severe multiple trauma have increased, highlighting the importance of team-based medical care. Our hospital’s trauma team （since 2000） plays a vital role in treating severe multiple traumas, involving specialists such as emergency physicians, intensive care doctors, trauma and plastic surgeons, and dental experts. Some cases require specialized care at other facilities, underscoring the role of regional trauma care systems. Demand for oral and maxillofacial surgeons is substantial due to their importance in saving lives and addressing functional and cosmetic concerns. To improve patient outcomes, we emphasize training of trauma surgeons and oral and maxillofacial specialists, fostering collaboration, optimizing our in-house trauma teams, establishing regional trauma centers, and creating comprehensive regional trauma care systems.

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Due to the physiological changes associated with aging and jawbone changes, including tooth loss in the maxillofacial region, differences in trauma are expected between elderly and nonelderly individuals. This study compared mandibular fractures due to falls between these groups.
We retrospectively evaluated 155 patients with mandibular fractures due to falls who visited our department, and categorized them into the elderly （above 65 years old） group and the nonelderly （below 65 years old） group.
There were 81 nonelderly and 74 elderly patients. The male : female ratio was 2.5：1 and 1.1：1 in the nonelderly and elderly groups, respectively, with a small gender difference in the latter. The risk factors identified for falls were pre-existing diseases （nonelderly, 36％; elderly, 88％）, alcohol consumption （nonelderly, 37％; elderly, 8％）, and loss of consciousness （nonelderly, 51％; elderly, 20％）. The most common fracture site was the condylar process in the nonelderly （58％） and elderly （71％）. Condylar process fractures were more common in the nonelderly patients because more than half of the injuries were caused by loss of consciousness or alcohol consumption, and in the elderly patients because of loss of buffering of external forces by the tooth due to tooth loss. Analysis using the Eichner index revealed that 1） the body of the bone in group A and the articular process in groups B and C were the common fracture sites; 2） common fracture site in the articular process was the basal part in group A and the superior neck in group C; and 3） the common fracture aspect of the articular process was fissure in group A and dislocation in group C. The Eichner index suggested an association between occlusal support and fracture pattern.
Mandibular fractures in elderly patients due to falls exhibited differences in fracture status due to the general and local physical changes unique to this population group. Evaluation using the Eichner index revealed an association between loss of occlusal support and mandibular fracture pattern.

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A retrospective investigation of the clinical records of five patients （1 male, 4 females） with maxillofacial injuries associated with suicide attempts was conducted. Mean age was 31.4 years and four （80.0％） patients had depression as an underlying psychiatric disorder. The means of the suicide attempt was jumping from a building in all cases. The two patients （40.0％） under 18 years of age had family problems, the two （40.0％） middle-aged/older patients had health problems, and the one younger adult patient （20.0％） had school problems. Four （80.0％） were examined by a member of our department on the day of or one day after incurring injury. Psychiatric intervention was performed for three patients （60.0％） on the first day after the suicide attempt. All patients were treated by our department within two weeks of sustaining injury. The total number of treatments was greater in patients with more complicated injuries and the longest hospital stay was 118 days, with an average of 62.8 days. The clinical diagnosis in oral surgery was skin laceration associated with trauma in all cases, and mandible fracture alone in 2 cases （40％）, and maxillary fracture and mandible fracture overlapping in 2 cases （40％）. Complicated injuries in the lower extremities were noted in all, while head injuries were seen in one （20.0％）. The Injury Severity Score （ISS） was 15 or more in 4 patients （80.0％）, with a mean of 23. The most common site of injury was the anterior maxillary teeth （8 teeth total）. No suicidal ideation in any of the patients was noted following treatment.
It is important for patients who attempt suicide to receive early treatment intervention and psychosocial support by a specialized team, including psychiatry experts, to prevent recurrence and suicidal ideation. Maxillofacial trauma related to the suicide attempt was found to be associated with concomitant injuries to the whole body, including the head and teeth, due to the impact. Treatment intervention performed by our department tended to be later than that by other departments.

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Recently, orthodontic anchor mini-screws have been widely used in orthodontic treatment. Fractures of the implants, soft-tissue infections, and injuries of the roots of adjacent teeth are reported as complications of implantation. We report a case of fracture of an orthodontic anchor mini-screw during implantation in the palate.
An orthodontic anchor mini-screw was implanted for the patient at a dental clinic. During the procedure, the mini-screw fractured and remained under the mucosa, so she was referred to our hospital to remove the remaining mini-screw. The fractured mini-screw was impacted under the palatal mucosa. Computed tomography revealed a fractured screw in the midline of the palate. We removed the screw under general anesthesia using an ultrasonic bone cutting device.
Anchor screw fracture is considered to be caused by excessive torque at the time of implantation. To avoid this problem, it is essential to form the guide hole in advance and then to implant the anchor screw using a torque screwdriver.

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Mandibular fracture is one of the complications of mandibular impacted wisdom tooth extraction. However, it is very rare, occurring with a frequency of 0.0033 to 0.0049％.
We report a case of mandibular fracture after extraction of an impacted mandibular wisdom tooth. The patient was a 56-year-old male. Under local anesthesia, an impacted right mandibular wisdom tooth was extracted at our department. The day after surgery, dysesthesia occurred in the area innervated by the inferior alveolar nerve. He noticed an unusual sound in his right mandible when he ate a snack on the 5th day after wisdom tooth extraction, and had pain and mild swelling in the affected area on the 11th day. On the 33rd day, trismus, malocclusion, and drainage from the extraction socket were observed, so a panoramic radiograph was taken, which revealed a fracture of the mandible. On the 54th day, open reduction with internal fixation of the mandibular fracture was performed under general anesthesia.
At present, 5 months have passed since the open reduction surgery; the malocclusion and paresthesia have improved and a good course has been obtained.

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In daily clinical practice of oral surgery, knowledge of psychiatric disorders and appropriate treatment are indispensable. Schizophrenia, bipolar disorder, autism spectrum disorder, and depression are known to be the four major mental disorders, and cause social problems. Oral and maxillofacial surgeons are commonly required to treat patients with these diseases. A 21-year-old female patient had asthma, bipolar disorder, attention-deficit/hyperactivity disorder （ADHD）, dissociative disorder, dissociative amnesia, and suicide attempt. The patient attempted to insert a 1.3mm diameter, 50.0mm long piercing needle into her tongue on her own. However, she could not remove the needle and decided on overnight observation. The next day, the patient was admitted to our department with fever and tongue pain, and was urgently hospitalized for anti-inflammatory treatment and removal of the needle. Computed tomography showed the needle intruding from the back of the tongue to the lower part of the mandible, and so extraoral removal of the foreign body was performed under general anesthesia. Drainage was performed due to pus from the wound. During hospitalization, the patient developed mental problems, such as a marked tendency toward somnolence and emotional incontinence, but was discharged from the hospital 4 days after surgery because of good wound healing. We report this case in which a needle used for body piercing by a patient with multiple psychiatric disorders strayed into the tongue, with a review of the literature.

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Higher brain dysfunction manifests as a wide variety of symptoms, and it is difficult to accurately detect the symptoms in such patients.
We performed open reduction and fixation of a mandibular fracture in a patient who had higher brain dysfunction due to a traumatic brain injury. A titanium mini-plate for fracture fixation after surgery and rigid secondary surgery became necessary.
The patient was a 4X-year-old man who was referred to our department for a right mandibular angle fracture due to a fall. On the third day after the injury, the patient underwent arch bar placement and open reduction and fixation using a mini-plate. Postoperatively, he tried to remove the arch bar and yelled repeatedly. The wound healed through an uneventful postoperative course, and he was discharged on postoperative day 7. He revisited our department for fever and swelling in the wound area on postoperative day 23. As breakage of the mini-plate was noted, we performed open reduction and fixation with 2 plates after the inflammation had resolved. Postoperative agitation was not noted. As of 1 year after surgery, no refractures had occurred, and the postoperative course was uneventful.

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We experienced a case in which a carbide bur fractured during extraction of a third molar, migrated into the soft tissue on the mandibular lingual side, and was complicated by emphysema. A 35-year-old woman underwent dental extraction under local anesthesia at her referring dental clinic based on a diagnosis of horizontally impacted right mandibular third molar. A carbide bur fractured during crown sectioning and was replaced with a new carbide bur to continue the tooth extraction. Although removal of the fractured carbide bur was attempted thereafter, it had migrated to the soft tissue on the lingual side, making its removal challenging. Therefore, the patient was referred to our department 3 days later. Intraoral examination revealed an extraction socket in the area of the right third molar. Redness of the surrounding mucosa, mild swelling, and tenderness were noted, but there were no signs of infection. Panoramic radiography revealed an opaque structure in the right mandible that appeared to be the broken piece of the carbide bur （9mm×1mm）. Plain computed tomography （CT） showed a radiopaque structure in the soft tissue on the right lingual side. Additionally, gaseous images were observed in the upper right temporal space and upper mediastinum. As a treatment policy, it was decided to first prevent infection, confirm the disappearance of emphysema, and then remove the foreign body. The patient was given SBT/ABPC, 3g/day. On day 6, resolution of emphysema was confirmed based on the disappearance of crepitus and CT assessment. The patient underwent foreign body removal under general anesthesia 58 days after the initial diagnosis.
We experienced a case in which a carbide bur fractured during extraction of a third molar, migrated into the soft tissue on the mandibular lingual side, and was complicated by emphysema.

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Toothbrush trauma is reported to be more common in children, and it has been pointed out that such trauma can lead to fatal complications even when the local findings are minor. We report the case of an elderly patient with a deep injury from the oral cavity to the posterior neck area caused by a toothbrush. The patient, a 90-year-old woman, fell with a toothbrush in her mouth and sustained an injury, and was brought to our emergency room. The tip of the toothbrush reached the lower mastoid process and was removed under general anesthesia. Two weeks after surgery, a finding of suspected abscess formation was observed in the parapharyngeal space. Three weeks after surgery, the clinical findings improved and the patient was discharged.
Even if the local findings are not so severe, it is important to follow the patient carefully under inpatient care based on a comprehensive evaluation of imaging and blood sampling.

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