Osteomyelitis of the mandible commonly occurs in the mandibular body and is rarely seen in the mandibular condyle. We report a case of actinomycotic osteomyelitis extending from the mandibular ramus to the condyle in a child. A 15-year-old girl was referred to our hospital because of swelling and pain in the left buccal region. Computed tomography (CT) revealed bone resorption and periosteal reaction from the left temporomandibular joint region to the mandibular notch and coronoid process. Based on the CT and magnetic resonance imaging findings, we suspected actinomycotic osteomyelitis of the mandible and then administered penicillin. An abscess was detected in the left parotid masseter region after starting penicillin administration, and necrotic tissue debridement was performed. A group of actinomycetes was identified in the sampled specimen. New bone formation was observed on post-treatment CT, and ^99m Tc bone scintigraphy uptake was reduced. Antibiotic treatment was therefore discontinued after approximately 5 months. The patient is currently recovering well without any signs or symptoms of recurrence

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Bartter syndrome is a rare disorder characterized by severe hypokalemia, metabolic alkalosis, marked elevation of plasma rennin activity, pressor insensitivity to angiotensin II, and normal or low values for plasma sodium, plasma chloride, and blood pressure. We report a patient undergoing sagittal splitting ramus osteotomy who demonstrated Bartter syndrome with retrognathia. A 21-year-old woman was referred to our department because of malocclusion and maxillary protrusion. We diagnosed her as having micrognathia and skeletal open bite. We scheduled sagittal splitting ramus osteotomy under general anesthesia. Because hypokalemia might occur during and after surgery, we consulted a medical doctor in Metabolism and Endocrinology at our hospital, and administered potassium chioride preoperatively. As a result, postoperative hypokalemia did not develop and her general condition remained good. After surgery, the patient showed good occlusion.

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Overview of the alloplastic total joint replacement (TJR) of temporomandibular joint (TMJ) with indications for surgical management and efficiency of the treatment is described.

　The indication of TMJ TJR is the end-stage TMJ diseases such as severe bony ankylosis, end-stage of TMJ rheumatic and osteo-arthritis, and severe idiopathic condylar resorption, in consisting with functional/anatomical loss of condylar process.

　Types of TJR in TMJ are consisted with Stock and Custom made system, and the former type is approved as the medical device by PMDA in 2020 in Japan.

　Overall successful outcome ratio of TMJ TJR in oversea country is around 80%. There was no significant differences between two types of TJR.

　Clinical emphasis is made on a skillful and devised team approach to reduce operative time, bleeding and adverse effect. Importance of pre- and post-operative analysis and feedback to next planning. Current topics regarding surgical modification to Asian population and pre-operative embolization is described.

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The development of velopharyngeal incompetence in patients who have previously received surgery of maxillary advancement has been reported. Here, we report a case of unilateral cleft lip and palate with mild preoperative velopharyngeal incompetence.
The case was a 20-year-old male patient, referred to our clinic with a chief complaint of maxillary retrusion. We confirmed the diagnosis of maxillary retrusion and mandibular prognathism. The patient underwent bilateral sagittal splitting ramus osteotomy and maxillary advancement by distraction osteogenesis with a rigid external distraction device. The velopharyngeal function was evaluated using perceptual speech assessment, nasoendoscopy, and cephalometric analysis. Although the maxillary advancement was larger than 10 millimeters in this case, the patient's velopharyngeal function remained without deterioration after the maxillary distraction.

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本研究では適度な硬度を有する軟質樹脂をネック部の主構成素材に用い上下方向よりも左右方向に変形しやすい「新子供用歯ブラシ」の清掃能を評価するため，通常の硬質樹脂から構成される歯ブラシを対照に，歯垢除去率および歯ブラシの特性を比較検討したところ，以下の結論を得た。

1 ．全歯面を対象とした歯垢除去率は，被験歯ブラシが27.7±12.8％，対照歯ブラシが28.7±13.5％であり，すべての解析（分散分析，t­test, Mann­Whitney's U test）において被験歯ブラシと対照歯ブラシの間で歯垢除去率に有意差は認められなかった。

2 ．被験歯ブラシの特性を評価するため曲げ試験を実施し，たわみ量を測定したところ，対照歯ブラシに比べ上下方向および左右方向で有意差をもって，たわみ量が大きいことがわかった。さらに，上下方向に比べて左右方向へのたわみ量が有意差をもって大きいこともわかった。負荷荷重の増加に伴い，たわみ量も大きくなっていた。

以上より，軟質樹脂からなる「新子供用歯ブラシ」は口腔外傷の低減が期待でき，清掃能も兼ね備えた大変有用な口腔清掃用具であることが示唆された。

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Objectives: The goal of treatment of panfacial fractures is to restore both the function and the preinjury three-dimensional facial contours by accurate buttress reconstruction. However, because most patients with panfacial fractures are medically unstable because of associated neurologic or systemic injuries, treatment of panfacial fractures may have to be delayed. Although there have been some case reports on the treatment of panfacial fractures, these fractures have not been clinically evaluated in Japan. The aim of this study was to investigate the frequency of concurrent trauma, treatment sequence of open reduction and internal fixation （ORIF）, and complications in patients with panfacial fractures.
Methods: Between April 2011 and March 2017, we examined 13 patients （11 males and 2 females; average age, 29.5±14.7 years） who were treated for panfacial fractures at the Department of Oral and Maxillofacial Surgery, Kobe City Medical Center General Hospital.
Results: In 7 patients （53.8％）, intracranial trauma occurred with the panfacial fracture. Ten patients （76.9％） were treated with the “bottom-up and outside-in” procedure and 3 patients （23.1％） with the “top-down and inside-out” procedure. In addition, 2 patients required secondary ORIF because liquorrhea treatment necessitated a delay in fracture repair. Seven patients （53.8％） had postoperative complications.
Discussion and Conclusion: Surgeons need to consider the areas of fracture, fracture complexity, severity of facial injury, and the condition of the midfacial buttresses when choosing an adequate period of surgery and treatment sequence of ORIF for individual patients. Because of the frequent co-occurrence of cranial trauma and panfacial fractures, ORIF cannot be adequately performed as a first-stage surgery in some cases. Therefore, in such cases, ORIF must be included as a second-stage surgery in the treatment sequence. Surgeons must also recognize and try to minimize or prevent the frequent postoperative complications of panfacial fractures.

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Purpose: To assess the maxillary dental arch width expansion and postoperative stability of segmental Le Fort Ⅰ osteotomy combined with horseshoe osteotomy.
Materials and methods: Seventy consecutive cases of segmental Le Fort Ⅰ osteotomy that underwent expansion of the maxillary dental arch width during the two years from January 2018 to December 2019, were examined retrospectively. Two segmental Le Fort Ⅰ osteotomy （Group A）, two segmental Le Fort Ⅰ osteotomy with parasagittal palatal osteotomy （Group B） and two segmental Le Fort Ⅰ osteotomy with additional horseshoe osteotomy （Group C） were performed to relieve the tension of the palatal mucosa. To evaluate the maxillary dental arch width expansions and expansion rates of the three groups, posteroanterior cephalograms were employed before surgery and immediately after surgery. The maxillary dental arch width was measured as the distance between the left and right outermost points of the dental arch. In addition, the maxillary dental arch widths were measured on plaster models of group C before surgery, immediately after surgery, at the end of orthodontic treatment, and at more than 1 year after the end of orthodontic treatment. To assess the postoperative stabilities of group C, the Wilcoxon signed-rank test was used to compare the relapse rates at the end of orthodontic treatment and at least 1 year after the end of orthodontic treatment.
Results: The number of cases in groups A, B and C were 32, 29 and 9, respectively. The mean expansion values of groups A, B and C on posteroanterior cephalograms were 2.3 （1.1-3.6）±0.6, 4.1 （2.9-5.4）±0.7 and 6.6 （4.8-8.8）±1.0mm; the mean expansion rates were 3.4 （1.7-5.4）±0.8, 6.1 （4.0-8.0）±1.0 and 10.0 （8.2-14.4）±1.7％, respectively. The mean relapse rates of 8 cases in group C on plaster models at two stages, the end of orthodontic treatment and at least 1 year after the end of orthodontic treatment, were 10.9 （−4.1 to 41.8）±14.9 and 15.1 （−13.3 to 35.6）±14.1％, respectively. No significant difference was observed in the relapse rates between the two stages （p＝0.547）.
Conclusion: In the segmental Le Fort Ⅰ osteotomy with horseshoe osteotomy group, more than 6mm or 8％ dental arch width expansions were obtained in the posterior part of the maxilla and good postoperative stabilities were observed.

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