Blast-induced injury is caused by exposure to the blast generated by an explosion. In addition to trauma mechanisms experienced by non-military clinicians when taking care of the civilian population, the mechanism of penetrating objects and the mechanism of pressure injury accompanied by shock waves （composed of a lead shock wave followed by supersonic flow） damage the body in a complex manner, resulting in various injuries. In addition to treating patients in accordance with the guidelines for acute-stage trauma care, treatment should be performed in consideration of the risk stratification and pathology of pressure injuries accompanied by shock waves, including an understanding of the conditions at the time of injury. Such injuries are different from non-military, civilian trauma, and it is necessary to understand the characteristics before surgical or cerebrovascular treatment.
Global activity is expected to resume after the pandemic, including large international events such as the 2025 Osaka World Exposition. Accordingly, it is necessary to ensure safety and prepare for emergency treatment in the event of terrorism and unexpected disasters. Even in Japan, medical professionals and related parties involved in emergency care should have a certain level of knowledge about the pathology, diagnosis, and treatment of blast-induced injuries.
This article outlines the mechanism of blast injury, its characteristics including pathophysiology, and diagnosis and treatment, including initial care for blast victims.

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We investigated 158 patients under the age of 12 who visited the Division of Dentistry and Oral-Maxillofacial Surgery, Chiba University Hospital between January 2010 and December 2020 with the chief complaint of trauma-associated oral and maxillofacial lesions, and compared the results with those of the investigation obtained 10 years ago.
The number of first-visit patients decreased compared to that of 10 years ago. Regarding the timing of being injured, the number of injuries was higher during the morning and afternoon hours, but lower during the night hours. Treatment for pediatric oral trauma varies since we need to consider aspects such as young age, jawbone growth and development. Therefore, an accurate diagnosis and proper treatment at the patient’s initial visit is important.

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Each year approximately 200 patients who have attempted suicide are transported to the Advanced Critical Care Center of the Tokyo Metropolitan Bokutoh Hospital. About 20% of these patients suffer from high-energy trauma caused, for example, by jumping off a building resulting in multiple traumas. We report herein a clinical review of 27 cases of oral and maxillofacial fractures who had been injured in suicide attempts, among 574 cases treated in our department over 16 years from January 2006 to December 2021.
Of the 27 cases, 16 had a history of psychiatric treatment, 3 were diagnosed with mental illness after hospitalization, and 8 were due to short-circuit reactions. The psychiatric liaison team intervened in these patients from the early stages of their treatment at the hospital, enabling early stabilization of the mental status of patients with short-circuit reactions to suicide attempts, and treatment with mental rest and sedation in patients with mental illness.
Fracture sites were as follows: mandible alone in 16 cases, maxilla and mandible in 4 cases, mandible and zygoma in 1 case, maxilla and zygoma in 1 case, and maxilla, mandible and zygoma in 5 cases. All patients underwent surgical repair and fixation under general anesthesia, while surgical repair and fixation was performed for condylar process fracture in 3 of 12 cases. Comminuted fractures were the most common type of fracture, both for the maxilla and mandible, and for these patients we often had difficulties in reconstructing the occlusion.
In the case of high-energy trauma, airway clearance and hemostasis were often the initial treatment, and intraoral bleeding was often a cause of intubation difficulties. In addition, patients who had attempted suicide show severe body movements due to impaired consciousness and restlessness on the day of transport, and the risk of aspiration of agitated teeth and fractured fragments is increased. Therefore, it is considered important to work closely with the emergency department.

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Traumatic optic neuropathy is a relatively rare complication of midface trauma, with 20％ of cases associated with optic nerve canal fractures. We report a case of concurrent midfacial and optic nerve canal fracture. The patient was a 60-year-old man who suffered systemic pan-traumatic injuries caused by falling from a stepladder. On examination, the patient was conscious, vital signs were stable, and there were no abnormal neurological findings. A computed tomography （CT） scan revealed a left naso-orbito-ethmoidal Type I fracture, left zygomatic and maxillary complex fractures, anterior and middle skull base fractures, together with an optic nerve canal fracture. Since there was no loss of vision, the anterior and middle skull base fractures and optic nerve canal fracture were first treated conservatively. However, traumatic optic neuropathy due to optic nerve canal fracture developed on the 5th day; therefore, endoscopic optic nerve decompression was immediately performed with navigation and endoscope assistance on the 7th day. In addition, steroid pulse therapy was administered for 3 days starting the day after the surgery. On the 15th day, open reduction and internal fixation of the midfacial fractures was performed. Currently, 18 months since the surgery, his vision has been restored and the midfacial trauma treatment is progressing well. In cases of maxillofacial trauma with suspected optic canal fracture, prompt and appropriate examination, diagnosis, and treatment of traumatic optic neuropathy is desirable.

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Dog-bite injuries to the oral and maxillofacial region are not common. Especially in children, these injuries often involve the facial area. Dog-bite injuries should be treated early to prevent infection and for esthetic restoration. We report the case of a 7-year-old boy who suffered facial trauma caused by a pet dog. A large area of his left side cheek and lower lip were bitten. We treated the injuries, and the postoperative course has been uneventful with good progress.

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Oral and oropharyngeal trauma due to falling while holding a toothbrush in the mouth is often experienced by children; however, it is less common in adults. In the case of oral and oropharyngeal trauma by toothbrush, even if the local findings are minor, there may be serious complications such as damage to major blood vessels or the central nervous system, deep cervical or mediastinal emphysema, or mediastinal abscess. Therefore, such cases require careful and thorough examination and diagnosis, including imaging studies. Herein, we present a case of a 72-year-old woman who had an intraoral impalement injury with a toothbrush that reached the parapharyngeal space caused by a fall.
She had a history of rheumatoid arthritis and eosinophilic granulomatosis with polyangiitis and was taking warfarin potassium. On initial examination, there was no evidence of persistent bleeding. The CT scan showed that the tip of the toothbrush had reached the parapharyngeal space, and emphysema had extended around the carotid sheath. On the same day, due to concerns about the possibility of hematoma increase over time in the cervical interspaces, the patient was admitted to the hospital and managed with no food or liquids, warfarin was withdrawn, and transvenous antibacterial agents were administered. Furthermore, we punctured the already-closed wound on the anterior pharyngeal arch to facilitate drainage. The inflammatory findings were reduced without serious complications, and the patient was discharged 6 days post-hospitalization.

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Most oblique mandibular fractures occur in the bone body especially the midline area, and osteosynthesis has been widely applied to such cases using the lag screw method. However, to the best of our knowledge, there have been no reports on applying the lag screw method because oblique fractures of the mandibular ramus are rare.
Furthermore, if the displacement of bone fragments is large or multiple fractures are found in the mandible, open reduction and internal fixation can be used in pediatric jaw fractures.
We report herein a case of oblique fracture of the pediatric mandibular ramus treated by open reduction and internal fixation using the lag screw method.
The patient was a 14-year-old boy whose face was beaten by an upper-grade student. Two fracture lines in the right paramedian and left mandibular ramus were found.
We performed open reduction and internal fixation of the mandible under general anesthesia. The oblique fracture of the mandibular ramus was osteosynthesized by two lag screws reaching the medial and lateral cortical bone from the anterior margin of the mandibular ramus after reduction and fixation of the paramedian fracture. We achieved early morphological and functional recovery of the pediatric oblique mandibular ramus fracture by open reduction and internal fixation using the lag screw method.

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