[in Japanese]

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Temporomandibular joint （TMJ） ankylosis causes fibrosis or bony changes in the structural tissues of the jaw. This results in persistent impairment of jaw-specific movement. In addition to marked trismus, there is impairment of eating and mastication, and dysarthria. Facial shape is altered, causing cosmetic problems, and patients have a lower quality of life （QOL）. While TMJ ankylosis is often caused by external factors, such as traffic accidents or falls, it can also occur secondary to conditions such as psoriatic arthritis involving the TMJ, rheumatoid arthritis of the TMJ, or ankylosing spondylitis.
It has been reported that when resecting the adhered portion, a gap arthroplasty of at least 15mm is appropriate to prevent re-ankylosis. For bone resection of the site of ankylosis, if the mouth-opening distance is insufficient, coronoidectomy on the affected side or both sides is performed.
There have been many reports of re-ankylosis of the resected site post-surgery following mobilization of the TMJ, and various inserts are used to prevent it. Going forward, it is anticipated that treatment aiming for the prevention of re-ankylosis and improved patient QOL will be achieved through widespread use of total TMJ replacement systems, new materials, and continuous mouth-opening exercise.

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In the surgical treatment of maxillofacial fractures, in order to achieve accurate reduction and stable fixation, it is necessary to have a good knowledge of appropriate fracture treatment instruments and the skills to use them at the right time. In this paper, we explain the structure, usage and clinical application of dissectors, hooks, intermaxillary fixation-related instruments, reduction instruments and osteosynthesis device-related instruments, classifying them into each category. In particular, ease of use for the surgeon contributes to improved surgical precision, so it is important for the surgeon to be familiar with the characteristics of the instruments and to choose them accordingly.

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[in Japanese]

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We report a retrospective review of 24 cases of medial orbital wall fracture. The subjects were 24 cases of medial orbital wall fracture between April 2024 and April 2016. The ages ranged from 16 to 91 years （mean age 52.1±22.5 years）, with 20 males and 4 females. All but one patient was referred from the emergency department of our hospital. The cause of injury was a punch in the face in 7 cases, followed by traffic injuries in 6 cases and fall injuries in 5 cases. The average waiting period from initial consultation to surgery was 8.4±5.4 days. Fifteen cases included concomitant injuries. Regarding the fracture site, 8 cases had a medial orbital wall fracture alone, and the rest had concomitant fractures in other areas. Regarding treatment for the medial orbital wall, conservative follow-up was performed in 11 cases, and treatment was performed in 13 cases （open reduction in 8 cases, open reduction＋endoscopic surgery in 2 cases, and endoscopic surgery alone in 3 cases）.

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High-energy trauma often results in multiple maxillofacial fractures and intracranial injuries, and may be accompanied by cerebrospinal fluid （CSF） leaks and pneumocephalus. We report a case of tension pneumocephalus that developed two months after surgery for multiple maxillofacial fractures. The patient was a 67-year-old man who was injured when he collided with a car while riding a bicycle. The patient had an anterior skull base fracture including a frontal bone fracture, and maxillofacial fractures. He showed cerebral contusion, subdural hematoma, and pneumocephalus without CSF leakage. Open reduction and internal fixation were performed after 10 days of bed rest. The postoperative course was uneventful and he was transferred to another hospital for rehabilitation. However, 2 months after the injury, he developed tension pneumocephalus. Emergency operation was performed to repair the CSF leakage and the prognosis was good. In the case of anterior skull base fractures associated with cerebral contusions, close consultation with relevant departments, appropriate treatment, and careful postoperative management and follow-up are important.

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In cases of severe oral and maxillofacial trauma, intracranial injuries can sometimes occur, often resulting in significant sequelae. Among these, oculomotor nerve palsy is characterized by impaired eye movement except for abduction, dilated pupils, and ptosis. This condition is important for oral and maxillofacial surgeons handling such trauma cases. We experienced a case of severe oral and maxillofacial trauma in an 83-year-old man, who developed residual oculomotor nerve palsy as a sequela. We report the case with a brief review of the literature. The patient sustained multiple head and maxillofacial injuries due to a fallen tree during a logging operation. Detailed imaging of the entire body revealed a fracture of the right temporal bone, a middle cranial fossa fracture, traumatic subarachnoid hemorrhage, and pneumocephalus. He was referred to our department for surgery to address the panfacial fractures and underwent open reduction and internal fixation under general anesthesia. Additionally, the patient presented with left ptosis, left dilated pupils, and impaired left eye movement. Based on these symptoms, he was diagnosed with traumatic left oculomotor nerve palsy and was monitored by both the neurosurgery and ophthalmology departments. Detailed imaging suggested that injury near the dural perforation of the cavernous sinus was suspected to be the cause of this disease. In oral and maxillofacial trauma cases, close cooperation with related departments is essential for prompt and appropriate diagnosis and treatment of such conditions.

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Most oral perforation injuries caused by toothbrushes are considered to be minor and have a favorable outcome. On the other hand, even if the local findings are minor, there is a possibility of serious damage deep inside the mouth and serious complications may occur. Therefore, when removing a perforated toothbrush, the extent of damage must be accurately assessed by imaging studies. In this report, we describe a case of penetrating injury in which a toothbrush reached the posterior region of the mandible ramus. The patient, a 76-year-old woman, was injured when she accidentally fell with a toothbrush in her mouth while brushing her teeth after breakfast. The toothbrush perforated her buccal mucosa, and she was unable to remove it by herself, so she called for emergency medical assistance and was brought to our hospital. The toothbrush was removed under local anesthesia. Concerned about postoperative complications, the patient was hospitalized and managed. The patient was discharged on the third day of hospitalization because of good progress. About one year to date, the patient is doing well with no signs of infection or functional impairment.

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The neck contains vital tissues, such as the common carotid artery, trachea, esophagus, and nerves. Cervical incisions can damage these tissues and can be fatal. We report a case of a patient with a major depressive episode with a bilateral cervical incision wound caused by a suicide attempt.
The patient was a 71-year-old man. He cut himself on both sides of the neck with a cutter knife in a suicide attempt and was admitted to the emergency department of Tokyo Metropolitan Bokutoh Hospital. On arrival at the hospital, the patient’s blood pressure was 144/101mmHg and heart rate was 139 beats/min. The wound was Zone Ⅱ, bilateral, with large amounts of blood clots and leaky hemorrhage from the surrounding area. After securing the airway by tracheal intubation, contrast-enhanced computed tomography was performed, which revealed extravascular leakage of contrast medium in the right cervical region. The patient was referred to our department at this stage. The wound was treated with hemostasis and sutured in the operating room with emergency center doctors. The wound had exposed the submandibular gland and the external jugular vein, and partially lacerated the submandibular gland. Bleeding from the facial arteriovenous vein on the right side was ligated. Blood transfusions were required in the ward postoperatively. The patient’s progress was good with no postoperative bleeding or salivary fistula.
As the patient had attempted suicide, he was transferred to the psychiatric ward five days after surgery. He was discharged 81 days after surgery, after receiving psychological support intended to prevent recurrence.
A patient with bilateral cervical incisions caused by a suicide attempt was successfully treated through multidisciplinary collaboration among the emergency center, oral and maxillofacial surgery, and psychiatry.

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