Forty cases of pediatric maxillofacial fractures, except for alveolar fractures, in children under the age of 16 years treated from January 1986 to December 1991 in our department were reviewed and analysed. Their characteristic features were as follows.
1. There were 27 boys and 13 girls and the ratio of boy to girl was 2.1: 1. By age distribution, the highest occurence was in the 13-16 age group.
2. The majority of patients (70%) visited our department within 3 days after injuries and the most (87%) came by reference.
3. The causes of maxillofacial fractures were traffic accidents (50%), falls (25%) and blows (15%). The most cases of the traffic accident were found in the 13-16 age group.
4. The frequency in occurrense of the maxillofacial fractures according to the location was 77.5% in mandible, 15% in maxilla, and 7.5% in both maxilla and mandible.
The most common locations of mandibular fractures were condyle (45%), symphysis (34%) and angle (13%). The most frequent locations in children less than 4 years were symphysis and in children more than 4 years were condyle.
5. As for the time of injuries, many cases occured on Sunday and/or Thursday and in June. On the contrary, the fewest cases occured on Wensday and in February. The time zone concentrated from 12 to 16 o'clock.
6. Open reduction was performed on 15 cases (37.5%) of maxillofacial fractures. The most common osteosynthesis consisted of mini-plate (47%) and circumference wiring (33%). Thirteen cases (52%) in a conservative procedure were treated with maxillo-mandibular fixations.
In the most cases of the middle third facial fractures, clinical courses were followed up.
7. Therapeutic results in all cases were found to be successful.

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Clinico-statistical observation was performed on 1128 pediatric patients under 13 years of age with oral and maxillofacial injuries at the Department of Oral and Maxillofacial Surgery, Nara Medical University during the last 10 years (19th. October 1981-18th. October 1991). The following conclusions were drawn.
1. The incidence of traumas in pediatric patients was 35.7% of all patients with injuries.
2. The ratio of male to female was 1.8: 1. By age distribution, aged 1 group showed a high incidence. In proportion to aging, decreasing number of the patients was recognized.
3. The frequency of traumas was higher in October than in the other months and lower in Februarty. There were higher on Sunday than in the other days and lower on Friday.
4. The common causes of traumas were falls (69.8%), play (12%) and traffic accidents (5.6%).
5. Of 1128 pediatric patients with injuries, 880 had soft tissue injuries, 345 had teeth injuries, 52 had alveolar bone fractures and 27 had mandibular and/or midface fractures.
6. The most common site of soft tissue injuries was the lower lip mucosa.
7. The most common site of teeth injuries was the anterior teeth in the upper jaw.
8. The most common site of alveolar bone fractures was at the symphysis of the mandible.
9. The frequency of the mandibular fractures was 90.1% in all maxillo-facial fractures.
10. The common site of mandibular fractures was condyle (48.7%), symphysis (30.8%), molar region (15.4%) and mandibular angle (5.1%).
11. Teeth fixation was performed on 261 teeth for the treatment of teeth injuries.
12. Teeth fixation was performed on 34 cases with alveolar bone fractures.
13. For the treatment of mandibular and/or midface fractures, open reduction was performed on 8 cases. The most common treatment for mandibular fractures was inter-maxillary fixation (75%).

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Clinical analysis was made of 11 cases of pediatric patients under 15 years of age with sedation for oral surgery and dental treatment in Okayama University Dental Hospital during the last 5 years (January 1990-December 1994).
1. The cases of surgery for cysts or malformation were the most common.
2. The preorerative complications were central nervous dysfunction and respiratory problem (asthma).
3. For the method of sedation, intravenous sedation was the most common, and intravenous sedation+nitrous oxide inhalation sedation was secondarily common.
4. For the intravenous sedation, flunitrazepam was mainly used.
5. The number of intraoperative complication was only one, bradycardia, but none of the postoperative complication was found.

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In a total of 16 patients with cleft lip and palate, the secondary bone grafting in alveolar clefts was performed mainly to enable orthodontic movement of teeth into the grafted area. The postoperative complications were examined.
Particulate marrow and cancellous bone (PMCB) were harvested from the iliac crest by using a trephine bur and grafted into the alveolar bony defect. No severe early complication was observed in either donor or recipient sites. As to late complications, the resorption of alveolar ridge was observed in 7 cases in which the orthodontic treatment started more than 3 months (3 to 21 months, the mean: 11 months) after the grafting, and the transient protrusion of canine apex from the nasal side of the grafted area was observed in 3 cases.
Thus, to get better results, it was suggested that the orthodontic treatment should be carried out within 3 months postoperatively and the recipient bed should be prepared as close to the nasal floor as possible.

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Clinico-statistical observation on the pediatric inpatients during the period of 4 years 7 months from April 1990 to October 1994 at the First Department of Oral and Maxillofacial Surgery, Kagoshima University Dental School was performed and compaired with our previous report.
The following results were obtained;
1) Total pediatric inpatients were 151 persons consisting of 80 males and 71 females.
2) On the average inpatiens of the year, 1980's was 60.3 cases, and the first half of 1990's was 32.9 cases. There had a decreasing tendency of the pediatric inpatients.
3) The percentage categorized according to disease were as follows; congenital anomaly and deformity 66.2%, trauma 13.2%, tumor 9.9%, cyst 6.1%, infection 2.6%, and others 2.0%. Trauma, tumor and cyst were upward trend, congenital anomaly and deformity, and infection were downward trend on the comparison between 1980's and the first half of 1990's.
The decreasing tendency of pediatric inpatients were caused that the decreasing a birth rate, fullness of the Oral Surgery and pediatric dentistry on the outskirts and so on.

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The alar base on the cleft side in the complete unilateral cleft lip is markedly displaced to laterally, caudally and dorsally. To correct the nasal deformity associated with complete cleft lip, it is very important to construct the nasal floor and to align the alar base. The cleft margin flap of the philtral segment is used for lining the lateral nasal vestibular defect created by freeing the alar base from the maxilla. In this paper, authors stress the importance of the nasal floor reconstruction at primary operation and report the techninque in detail and postoperative results.

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We have reviewed the records of 256 patients receiving minor surgical procedures performed on outpatients at the Pediatric Dentistry Department of Showa University Dental Hospital during the 15 years from 1977 to 1992.
1. The mean annual number of outpatient minor surgical procedures was about 20 and the male to female ratio was 1.6: 1.
2. Numbers of procedures were as follows: extraction of impacted excessive teeth in 2/3 of the total patients, followed by exposure of impacted permanent teeth, application of traction and extraction.
3. Regarding extraction of impacted excessive teeth, instances of a single inverted tooth were often observed and the approach for extraction was often from palatal approach.
Average time of surgery was 70 minutes.
4. Regarding exposure or traction application to impacted permanent teeth, most often involved were the upper permanent central incisors and upper canines.
The surgery time for exposure of the first permanent molars and lateral incisors had a tendency to be prolonged.

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A patient presenting lymphangiomatous macroglossia associated with open-bite was followed up for thirteen years and evaluated using dental casts measurement of and cephalometric analysis and auditory observations during speech. The patient was a 3-year-old female who visited our clinic first with a chief complaint of tongue thrusting in may 1979. She was treated using chin-cap and crib plate, but tongue thrusting persisted.
The patient had undergone tongue reduction at 7 years of age because she was resistant to preservative therapy before her growth spurts and her open-bite was resolved naturally 2 years after surgical intervention.
The overall observation period was thirteen years.
Results obtained were as follows:
1) Post operative enlargement was not due to a lymphangioma.
2) Her occlusion, especially overjet and overbite showed normal data 2 years after surgical intervention.
3) The patient had normal mandibular formation cephalometrically at 17 years old.
4) She had no speech problems 2 years after surgical intervention.
These results suggest the timing of tongue reduction should scar be before the anterior teeth replacement stage i. e. before the growth spurt.

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Hotz et al. reported that with the use of Hotz-type orthopedic plate (Hotz-type plate) in infants with cleft lip and palate starting immediately after birth, it is possible to improve the difficulty in sucking milk and to promote satisfactory growth of the palate. We have recently investigated the effectiveness of Hotz-type plate by sending questionnaire to the families of our patients.
Subjects were 52 infants with cleft and palate with difficulty in sucking milk or possible developement of such difficulty, who were selected from among patients who had treatment in our section between September 1985 and October 1991. The questionnaire was sent by mail. Of tha 26 persons (81.3%) who replied that the volume of sucked milk changed as a result of using Hotz-type plate, 21 (80.8%) said that the daily sucked volume “increased”. Five persons (19.2%) replied that they “did not know”. There were no cases of “decreased sucked volume”. As regards the length of sucking time, one person (3.8%) replied that the time “lengthened”, while 21 (80.8%) said it “shortened”. Four persons (15.4%) said they “did not know”.
In our section, the treatment with the use of Hotz-type plate was started soon after birth. As a result, the difficulty in sucking milk was improved, thereby promoting the proper growth of the infants and at the same time, allaying the anxiety of the patients' families. Thus, it made it possible to select the most appropriate time for operation. Such treatment was also useful in building up mutual trust between doctors and patients' families.

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Lymphangioma is usually seen in the tongue, lip or cheek, but rarely in the parotid gland. We reported a case of cystic lymphangioma in the parotid gland in 1-year-old baby. He was reffered to our hospital with a complaint of painless tumor of the right parotid gland. The tumor was a round mass measuring 35×30mm with CT scan and it was diagnosed as hemangioma or lymphangioma. The tumor had gradually decreased in size, then we decided to follow it. In his 9-year-old, the tumor increased in size again, so it seems to be better to remove it completely by surgery. The lesion was excised completely from extraoral approach. The surgical specimen was consisted of dilated lymphatic vessels with endothelial cells in histologically. Histological diagnosis was cystic lymphamgioma of the right parotid gland. The postoperative course has been good without any evidence of recurrence for 30 months after the operation. Many reports about the treatment have been presented up to date, but we consider the surgical excision is the best treatment.

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Cationic soap have a strong sterilizing action and few side effect in regularly using concentration. And so, it is generally in use for a sterilizer and a disinfectant. High concentrated cationic soap, however, have a strong corrosional action, and some dead cases caused by this disinfectant were reported. We experienced an iatrogenic accident of corrosion of oral mucosa caused by high concentrated benzethonium chloride.
A case report: The patient was a 3 month-old baby. At plastic surgery of lip, we disinfected intraoral mucosa, by mistaken, with 10% benzethonium chloride solution. At postoperative 1st day, the patient had a fever of from 37.8° to 38.5°C, and his tongue was swelling and per os was a little. At 3rd day, it was found that widespread oral membrane were errosive and/or necrotic; hard and soft palate, upper alveoler and lower molar part, and lower part of left side tongue. His fever was at 38°C leveled, activity was poor, face color was pale and limbs were cold. Additionally, he had severe diarrhea.

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A case of calcifying epithelioma was reported in this paper. A 7-year-old female consulted our hospital regarding a mass with slight tenderness in the left cheek region. Result from the examination of contrast enhanced CT scan of the lesion, the nature of the mass was supposed to be located just below the skin, and to be well defined from circumferential tissue. The operation was performed intraorally under general anesthesia. Histopathologically, the mass consisted of mostly shadow cells and calcification was occasionally observed. According above findings, a histological diagnosis was done as a calcifying epithelioma. The prognosis of this lesion is favorable. There is no evidence of recurrence in this patient during 2 years and 10 months since the operation.

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Simple bone cyst is a relative unusual lesion which occurs in the jaws as well as in other long bone of the skeleton. The lesion is asymptomatic, and often discovered during routine roentgenographic examination of the patient. The etiology of the lesion is unknown, but the theory of origin from medullary hemorrhage following traumatic injury has been widely accepted.
This is a report of three cases of simple bone cyst in children and includes a review of the literature.

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Two cases of replantation of unerupted upper incisor exhibited abnormal direction of eruption and/or malposition are presented.
In case 1, the patient was a 7-year old boy. Radiographic examination revealed two median upper supernumerary teeth, one which was erupted and another impacted, and the inversely impacted maxillary incisor. In case 2, the patient was a 6-year old boy. A median supernumerary tooth and the maxillary incisor impacted holizontally were revealed.
In both cases, we extracted supernumerary teeth and replanted the tooth germ of the upper incisor under general anesthesia. The findings and prognosis were as follows;
1) In case 1, the incisor erupted 14 months after the replantation, and the internal and external root resorption were not observed.
2) In case 2, the incisor had not erupted, but the root had been radiographically developing by degrees.
3) Good results after the replantation were shown in both cases. However, it was suggested that these teeth need to be treated orthodontically after the eruption.

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We report the case of odontoma that was found at six years old patient in a regular roentgenologic examination for cleft lip and palate.
Under the consideration of growth of the maxilla the odontoma was not removed until the patient became sixteen years old.

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Neurinoma (Schwannoma) may be in all parts of the body, but it is rare in the regions of the jaw and oral cavity. Recently we experiences a case of neurinoma developed in the sublingual area of the tongue.
A 13-year-old girl was referred to our department with a complaint of painless swelling in the sublingual area of the tongue. The mass was 23mm×15mm×13mm in diameter, definitive, elastic hard and movable. The clinical diagnosis was benign tumor in the sublingual area of the tongue. After excision of the tumor under general anesthesia, it was found to be encapsuled. Histopathologically, the surgical speciment revealed a figure of schwannoma (Antoni type A).

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Calcifying epithelioma is a rare lesion in the oral and maxillofacial region. Since the authors treated a case of this disease arising in the right cheek region of an infant, clinical course and pathohistological findings were reported here with a brief review of the literatures.
The patient was 8-year-old boy, visiting our clinic with the complaint of a tumor in the right cheek region. Although the tumor was pointed out by a dermatologist when he was two years old, it had not been treated because he was suffered from asthma. The tumor was of bone-like hardnass and movable under the skin with the size of a thumb's head. The blue pigmentation appeared on the facial skin just above the tumor. X-ray CT shows heterogeneous calcification of the tumor in the subcutaneous tissue, but no continuity was found between the tumor and the right-side mandible. The tumor was totally removed under general anesthesia. The pathohistological examination of the specimen revealed basophilic cells and shadow cells along the calcified tissue, which represented a typical findings of calcifying epithelioma.

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We reported a case of aneurysmal bone cyst of the mandible in a child.
10-year old boy was referred to our clinic, with swelling of the left mandible. Intraoral examination revealed a relative firm swelling, extending from the lower left first premolar to the left first molar and the mucosa over that area was normal. Radiographs revealed a monocystic radiolucency in the left mandibular molar-premolar region. A clinical diagnosis of jaw cyst or ameloblastoma were suspected from these findings.
At exploratory excision, the cortex of the outer surface of the ramus was thinned and showed irregular elevations. The bone defect contained blood-filled, spongy tissue. But excessive bleeding was not observed.
Histologically, there were numerous large and small blood-filled cavernous spaces, and most of these spaces were lined by young conective tissue, some parts of which contained some giant cells and in some areas new bone formations were seen.
The histologic diagnosis was aneurythmal bone cyst.
Angiography of the left external carotid artery showed no pooling of contrast medium corresponding to the radiolucent area.
Under general anesthesia, at first we indicated the left external carotid artery to avoid excessive bleeding, but total blood loss was 374ml by surgery. Therefore ligature the artery was not needed.
All the cystic tissue was completely removed from the cavity intraorally by careful curettage. There were no sign of recurrence 3 years after surgery.

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We reported a case of odontogenic keratocyst of the mandible on three-year-old girl. Radiographically it showed a unilocular radiolucent lesion from the left lower second deciduous molar to the whole mandibular ramus with marked bone expansion. Histopathologically the epithelium of the cyst lining showed parakeratosis or orthokeratosis, and rete peg formation in some part. Inflammatory cell infiltration and scattered epithelial islands were found in the fibrous connective tissue. Although we performed marsupialization of the cyst for the initial treatment, the wound was soon cloesd. So we enucleated the cyst. Postoperative course was uneventful. After 5 years' follow up, the radiograph showed no sign of recurrence of the cyst.

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