Purpose: Treatment strategies for mandibular fractures vary among institutions and often depend on the surgeon’s experience. The purpose of this study was to evaluate treatment preferences for mandibular fractures among members of the Japanese Society of Maxillofacial Traumatology and to assess changes in clinical decision-making following expert-led educational intervention using a real-time voting system.
Methods: Ninety participants attended the educational seminar and were included in this survey-based study. Three clinical cases were presented: （1） bilateral condylar process fractures in a young adult, （2） condylar head fracture in an elderly patient, and （3） mandibular fracture in a pediatric patient. For each case, three treatment options were provided. Participants first voted for their preferred treatment strategy. Subsequently, three experts in maxillofacial trauma presented their respective treatment approaches supported by personal clinical cases and rationale. After the presentations, participants voted again on the same cases. Finally, participants were asked whether they had changed their initial answer （Yes/No）.
Results: Changes in treatment selection were observed in all three cases after the expert presentations. In the young adult case, preference shifted from “ORIF for all fractures” to “ORIF limited to the basal fracture.” In the elderly case, selection of intermaxillary fixation decreased, while preference for functional conservative management （pumping therapy） increased. In the pediatric case, the proportion selecting titanium plate fixation increased, whereas preference for resorbable plates decreased. Overall, 59 participants （65.6%） reported changing their initial answer after the seminar.
Conclusion: Considerable variability exists in treatment strategies for mandibular fractures among society members. Expert-led educational intervention influenced clinical decision-making in approximately two-thirds of participants. This interactive seminar format may serve as an effective educational tool to visualize differences in treatment strategies and promote knowledge sharing in maxillofacial trauma management.

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Maxillofacial fractures arise from diverse etiologies and are frequently encountered in clinical practice. This retrospective study reviewed 631 patients treated for maxillofacial fractures at our institution over 15 years, divided into three 5-year periods for comparison. The cohort comprised 453 males and 178 females （ratio 5：2）, with ages ranging from 4 to 98 years （mean 51.0）. Referrals included 476 in-hospital cases （400 from the emergency department）, 141 from external facilities, and 14 walk-ins. Major injury causes were ground-level falls （n＝277）, traffic accidents （n＝141）, falls from height （n＝84）, sports injuries （n＝58）, assaults （n＝36）, and occupational injuries （n＝25）. Fracture sites were midfacial （n＝348）, mandibular （n＝226）, and combined fractures （n＝57）. Treatments consisted of open reduction and internal fixation （n＝175）, closed reduction （n＝43）, and conservative management （n＝413）. Over time, there was an increasing trend in patient age, fall-related injuries, emergency department referrals, and midfacial fractures, likely reflecting population aging and improved emergency care systems. Conversely, traffic-related injuries and the need for open reduction decreased, potentially due to enhanced traffic safety and advances in imaging.

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With the rapidly aging population in Japan, the incidence of oral and maxillofacial trauma in older people is increasing. In patients aged ≥90 years, multiple comorbidities, reduced physiological reserve, and age-related bone fragility often complicate the selection of an optimal treatment strategy. We encountered three cases of severe maxillofacial trauma in super-elderly patients aged 92, 96, and 102 years. One patient sustained a high-energy injury, while the other two were injured due to falling down and presented with complex fractures including Le Fort fracture, zygomaticomaxillary complex fractures, and mandibular condylar fractures. Open reduction and internal fixation were performed in close collaboration with other medical departments, 4-9 days post-injury. All patients had favorable post-operative outcomes, without complications, during follow-up. These cases suggest that, even in super-elderly patients, appropriate surgical management, combined with careful evaluation of systemic conditions, attention to local factors, and multidisciplinary coordination, can achieve good functional recovery. Maintaining pre-injury activities of daily living should be a key therapeutic goal when treating severe maxillofacial trauma in this cohort.

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Mandibular fractures following extraction of impacted mandibular third molars are rare but represent a serious complication associated with functional impairment. We report two cases of mandibular fractures occurring after extraction. Case 1 involved a 49-year-old male. A left mandibular fracture developed during eating 10 days after bilateral maxillary and mandibular impacted third molar extractions. Open reduction and internal fixation was performed 122 days post-extraction. Case 2 involved a 69-year-old male. A left mandibular fracture occurred during eating 11 days after extraction of a left mandibular third molar. Due to malocclusion, open reduction and internal fixation was performed 18 days post-extraction. Both cases involved middle-aged to elderly males with a clenching habit.
Occlusal force measurements exceeded the average in both cases, with Case 1 showing a particularly high value of approximately 2.7 times the mean. Contributing factors to the fractures included excessive occlusal forces, a clenching habit, and loss of the tension band due to mandibular crest reduction involving the external oblique line. To prevent post-extraction fractures, it is crucial to minimize external oblique line reduction and to instruct patients to consume soft foods for at least three weeks post-operatively.

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