Clinico-statistical observation was performed on 175 cases of oral and maxillofacial injuries in pediatric patients under 15 years of age at the Department of Dentistry, Oral and Maxillofacial Surgery, Hiroshima City Hospital during the past 11 years from 1987 to 1997.
The following conclusions were drawn.
1. The incidence of injuries in pediatric patients was 15.6% of all pediatric outpatients.
2. The ratio of male to female was 1.7: 1.
3. By age distribution, 2 years of age showed a high incidence and under 5 years of age occupied majority.
4. The number of pediatric patients of injuries each year was almost no change and the average was 15.9.
5. The most common cause of oral and maxillofacial injuries was falls (69.7%).
6. The direct visit was the most common way of consulting.
7. The majority of pediatric patients with injuries had soft tissue injuries.
8. The common site of soft tissue injuries was frenulum of upper lip or lower lip.
9. The common treatment of pediatric patients with injuries was bloodless operation or progress observation.

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In this study, we conducted a clinico-statistical observation to clarify the actual status of pediatric outpatients treated at our department. This study included 1, 670 children less than 16 years old who were brought to the Outpatient Clinic between April 1994 and March 1998. These children comprised 9.8% of the patients initially consulting the Outpatient Clinic during this period. Concerning gender, there were 933 boys and 737 girls. Mean age was 6.8 years. Among boys, mean age was 6.3 years. Among girls, mean age was 7.6 years. There were 189 oneyear-old infants (11.3%), showing the highest percentage by age group. This percentage was followed by that for 3-year-old infants (7.9%) and that for 2-year-old infants (7.7%).
Concerning disease, the incidence of trauma 36.5%, that of dental diseases such as caries and pulpitis was 32.1%, and that of inflammation was 7.2%. Of 1, 670 children, 584 children (34.9%) were referred to our department. This group consisted of 221 children (37.8%) referred from other hospitals and 363 children (62.2%) treated in our hospital. Most (87.3%) of the 221 children from other hospitals were referred by dental practitioners. Of the children treated in our hospital, 29.6%, 29.3% and 22.3% consulted the Department of Pediatrics, Kidney Center and Heart Institute of Japan, respectively.
Furthermore, 566 children (33.8%) consulted the Emergency Outpatient Unit. These children consisted of 341 boys (60.2%) and 225 girls (39.8%). There were 415 infants, comprising approximately 75%. Concerning disease, 452 children (79.9%) had sustained trauma, showing the highest percentage. Dental diseases showed the second highest percentage, followed by inflammation. Morbidity in children brought to the Outpatient Clinic was 35.4% for boys (330 boys) and 32.0% for girls (236 girls). These 566 children comprised 33.9% of the children overall. Diseases involving consultation with other departments were classified. Cardiovascular diseases were observed in 211 children (30.8%), urological diseases in 108 children (15.8%), and respiratory diseases in 102 children (14.9%).

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Clinical study was performed on 53 patients under 15 years of age with supernumerary teeth in the anterior region of maxilla at the Department of Maxillofacial Surgery, Yamaguchi University Medical Hospital for 10 years (1989-1998). In the 53 patients, 68 supernumerary teeth were found: 38 patients with one, 15patients with two. The ratio of male to female was 3: 1. In most cases, the presence of supernumerary teeth had been found in the patients aged 6-7 years (52.9%). Forty-three percent of the patients had problems such as mid-line space, abnormal arrangement of the teeth and delayed eruption of incisor. Most of them located around the central incisor and palatal side. Supernumerary teeth were extracted most frequently between 6 and 8 years old.

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Dens invaginatus is called dens in dente, the developmental tooth anomaly and rarely observed in the maxillary incisor. We reported a case of dens invaginatus complicated internal and external dental fistula.
A 8-year-old girl was referred to our department because of swelling on the mentum. Radiography showed the apical periodontitis by dens invaginatus of 1_??_. We treated in root canal treatment and apexification of 1_??_. After that we operated the mental skin with fistulectomy and keloplasty. The patient has no recurrence of the apical periodontitis as of 8 months after root canal filling.

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Dentigerous cysts are the most common odontogenic jaw cysts in children. However, multiple dentigerous cysts in nonsyndromic children are rare. We described a case of dentigerous cysts of the second premolor teeth in both jaws of a 10-year-old boy. Marsupialization of the cysts was performed. There has been no recurrence about two years after the surgical treatment.

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Infantile facial injuries are frequently characterized by soft tissue injury, and jaw fractures are less common. Since they are not very common in infants, method of treatment has not yet been established for this age. Non-invasive procedures, rather than invasive procedures, tend to be employed for infantile jaw fractures, so as not to impair jaw growth and the subsequent development of permanent teeth. However, the primary dentition is incomplete during infancy, and infants can not tolerate long-term internal maxillary fixation. For these reasons, invasive procedures become inevitable. Although choosing the methods of treatment and postoperative management was difficult, we performed invasive reduction and fixation for fracture of mandible in a one-year-old infant who had sustaind injuries resulting from a fall.

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We report two cases of subluxation of upper incisors, in which repositioning was performed by M. T. M. with good prognosis.
Case 1 was a boy aged 7 years and 7 months who sustained trauma 21_??_1 in a fall. On initial examination, 21_??_1 were displaced lingually, which prevented posterior occlusion. Since the injury was three days old, M. T. M. was used for repositioning. After three weeks of M. T. M., retention was performed for two weeks. At 4 months after the fall, as 1 showed inflammation in the coronal pulp, vital pulpotomy was performed. The course after treatment has been good for the last three years, although narrowing of the pulp cavity was observed in 1_??_1. In 21_??_1, the pulp was vital, and root formation was complete without changes in the tooth color.
case 2 was a boy aged 14 years and 9 months, who came with fresh injury in the maxillary anterior region in a collision, accompanying lingual displacement of _??_12 and extrusion of _??_2. On initial examination, root formation was complete and the pulp was positive in the pulp vitality test in _??_12. For treatment, reposition by M. T. M. for 2 months, followed by retention for 6 months. Since the pulp became negative in the vitality test 6 months after the collision, root canal treatment was performed. Long-term retention was thought to be necessary for extruded teeth.
Thus, it was demonstrated that M. T. M. causes minimal damage to the pulp of teeth presenting old luxation with little root resorption of extruded teeth, which is associated with a poor prognosis, facilitating long-term preservation of the teeth.

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The authors reported a case of plunging ranula treated with intraoral approach. The patient, a 11-year-old boy, had been aware of a swelling in the left submandibular region. The growing or disappearing of the region was during several years. At the first visit to us, the face of the patient was asymmetrical with a diffuse swelling of the left submandibular region. The overlying skin of the region was normal color, and palpation gave us an impression of the existence of a soft mass with fluctuation. Fine-needle aspiration prior to the surgery yielded yellowish mucinous material. The patient was operated on with a clinical diagnosis of plunging ranula on July 13, 1998. After surgery we tried to put pressure on it by using the elastic bandage. Postoperative course, about 8 months after the operation, was uneventful without recurrence.

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