The mandibular condyles are a common site for mandibular fractures, although dislocation into the middle cranial fossa is rare. We report a case of dislocation of the condylar head into the middle cranial fossa in a patient with mandibular fracture sustained in a traffic accident. A 38-year-old woman was injured when the bicycle she was riding collided with a car. She was admitted to our hospital with general bruising and malocclusion. CT showed fracture of the left-sided mandibular body, condylar head and the mandibular fossa of the right temporal bone. Remarkably, the right-sided condylar head protruded into the middle cranial fossa, and MRI showed an epidural hematoma. The neurosurgeon opted for conservative treatment. After placing an intermaxillary fixation （IMF） and performing occlusal guidance, we performed open reduction and internal fixation of the mandibular body, but not of the left-sided condylar fracture. Postoperatively, intermaxillary elastic was used and opening training was performed. Subsequently, occlusion was restored and remained stable during the follow-up period.

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【緒言】上顎洞内真菌球の形成が歯科治療に起因するとされる文献は散見されるが顎顔面外傷術後に起因する症例はほとんどみられない。
【症例の概要】症例は48歳女性，28年前の顎顔面骨折に対し観血的整復及びプレート固定をされていた。その後8年間に渡り鼻症状を認め繰り返し抗菌薬を処方されていたが改善は認められず当科紹介来院した。初診時は鼻汁を認めるが口腔内症状は無く，パノラマにて右側上顎洞内不透過像とCTでは右側上顎洞内の異物様病変と小石灰化物を認めた。
プレート撤去後に右側上顎洞前壁を開窓し病変摘出した。病理組織診断によりアスペルギルス症および真菌球と診断された。
【考察】石灰化所見はアスペルギルス症の特徴であり本症例でも鑑別の一助となった。本症例の真菌球は外傷時に迷入した異物，骨折治療時に使用したプレートあるいは骨片，または抗菌薬の長期投与に起因すると考えられ，顎顔面外傷後に鼻症状を認めた場合は長期的な経過観察と精査が必要である。

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Piercings, especially in the oral area, are associated with several complications. The tongue and lips are areas that are commonly pierced, with the tongue being particularly sensitive due to its high vascularity and critical location in the upper respiratory tract. Long-term bleeding and infection can lead to serious, life-threatening complications.
We report a case of a 27-year-old woman who attempted a tongue piercing. While inserting the needle, it deviated from its intended path and went from the dorsum of the tongue to the floor of her mouth. After the needle was inserted, the patient experienced bleeding in the pierced area and was unable to locate the needle, prompting her to visit a nearby hospital. The possibility that the needle had migrated to the floor of the mouth was considered. During the initial consultation, a puncture site was identified in the middle of the dorsum of her tongue. Computed tomography showed a needle-shaped radiopaque area extending from the midline of the tongue to the sublingual area and mental spine. Surgical removal of the foreign body was successfully performed under general anesthesia. There was no postoperative infection at the wound site and the patient recovered well.

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Accidental ingestion of instruments during dental treatment is one type of accidental injury. If the tip of the fracture fragment is sharp, there is a risk of gastrointestinal rupture, so immediate action is required when it occurs. In the present report, we describe a case in which a fracture fragment of a carbide bar was accidentally swallowed during extraction of a mandibular wisdom tooth, and was removed under upper gastrointestinal endoscopy. A 42-year-old male was referred by a local dentist to our department in August 2021 for extraction of a left-sided mandibular wisdom tooth. The crown of the left mandibular wisdom tooth had partially erupted and there was no evidence of inflammation of the surrounding gingiva. Panoramic radiography revealed that the left mandibular wisdom tooth was centrally inclined and semi-embedded. Extraction was performed under local anesthesia. The mucoperiosteal valve was formed and the crown and root division of the left mandibular wisdom tooth was being performed when the carbide bar fractured. A panoramic radiograph taken immediately afterwards revealed an opaque image in the pharyngeal region that could have been fracture fragments, but computed tomography （CT） showed no fracture fragments in the head and neck region. An abdominal X-ray showed an opaque image in the gastric region, which was thought to be a fracture fragment. On the same day, the patient underwent endoscopic removal of the foreign body from the upper gastrointestinal tract at the Department of Gastroenterology of this hospital.

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Penetrating foreign bodies are almost always removed at or shortly after the time of the injury. In the present case, we report the discovery and removal of a piece of glass during a routine dental procedure. The foreign body was believed to have been from a traffic accident more than 20 years earlier. The patient was a 49-year-old man who was referred to our department for extraction of a tooth. Panoramic X-rays revealed a foreign body in his left chin. He had suffered facial injuries during a car accident more than 20 years earlier, but the details of his treatment for those injuries were unknown.
Alternatively, could this be:
Based on computed tomography and ultrasonography findings, the foreign body was suspected to be a piece of glass. Treatment was planned for removal of the foreign body under general anesthesia.
Since glass is sharp, if left unattended, it can damage surrounding tissues as it passes through the body due to forces such as body movement and external impacts. Therefore, upon discovery, treatment needs to be planned taking into consideration the clinical symptoms, size of the foreign body, and its location. Moreover, when extracting glass as a foreign body, care must be taken to avoid causing secondary complications.

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Although patients with tongue piercing problems are encountered in clinical practice, cases in which a self-operated piercing needle has penetrated deep into the oral floor are rare. We describe a case in which a needle became embedded deep within the patient’s oral floor during self-piercing, and its location was confirmed using 3D-computed tomography angiography （3D-CTA） imaging, followed by removal of the needle. The patient was a 23-year-old man who was referred to our department after being transported to an emergency department because a piercing needle had migrated deep into the floor of his mouth. Computed tomography （CT） imaging showed a linear opaque signal from the oral floor to the inferior border of the mandible. As there are many important blood vessels in the deep part of the oral floor, we used 3D-CTA imaging to confirm that the needle was not in close proximity to any blood vessels. With the diagnosis of a foreign body embedded within the oral floor, an intraoral approach was performed under general anesthesia to remove the foreign body, which was a 50-mm-long needle. Postoperatively, the patient had an uneventful course and was discharged on the fifth day of hospitalization. After discharge, there were no signs of infection or neurological deficits.

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