We analyzed clinical data from 22 patients （15males, 7females; median age 39years; range 15 to 77years） treated with surgical therapy for mandibular condyle fractures in our hospital during the past 21years. The most frequent cause of injury was slips, trips and falls in 8 （36.3％） of the 22patients. Thirteen of them fractured only the condyle, and nine fractured various mandibular bones as well as the condyle. All condylar fractures were unilateral, mainly the displacement type with large deviation of bone fragments, and located between the lower neck and the base. The locations of surgical skin incisions to approach the fractures were submandibular （n＝15）, preauricular （n＝6） and submandibular combined with preauricular （n＝1）. The only adverse effect of surgery was transient slight facial palsy in 7 （31.8％） patients, which disappeared within an average of five months. The average period of post-procedural inter-maxillary fixation was 2 to 3weeks during the first 5years, and 3.3days thereafter. Fixation period did not influence occlusion and jaw movement function. No complicating malocclusion was evident at six months postoperatively, but 3 （13.6％） patients had trismus of ≤ 40mm.
Patients with large deviation of bone fragments, occlusal disruption or fractures at the lower neck or base were surgically treated, with relatively good outcomes.

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This report presents a case of penetrating maxillary injury caused by a piece of metal that was removed using X-ray fluoroscopy. A 23-year-old man was referred to our hospital presenting with oronasal bleeding and a white lip laceration caused by accidental injury from a nail gun. Clinical examination revealed a penetrating wound in the left white lip and a foreign body （a nail head） on the mucosa of the anterior maxillary sulcus. Computed tomography images showed that a radiopacity similar to the nail, approximately 70mm long, was embedded in the maxillary bone from the anterior maxillary alveolus to the medial plate of the pterygoid process through the hard palate. Although the nail was removed while the patient was under general anesthesia, a foreign body （a connecting wire） remained in the maxillary bone, which we successfully removed using X-ray fluoroscopy. No postoperative complications occurred, and the patient was discharged seven days after the nail was removed. X-ray fluoroscopy is considered to be very useful for removing foreign bodies embedded in the maxillofacial area not only in soft tissue but also in bone.

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Panfacial fracture is frequently associated with soft-tissue injuries and loss of bony structures that can lead to severe post-traumatic deformities and dysfunctions. Fractures malunite and soft tissues shrink if appropriate treatment is not provided soon after injury, making treatment extremely difficult. We report a case of facial malunion following delayed treatment for panfacial fracture successfully treated by mandibular distraction osteogenesis. In a traffic accident, a 65-year-old man suffered bilateral orbital floor, Le Fort Ⅰ/Ⅱ, and mandibular symphyseal fractures. The orbital floor and mandible were openly reduced and internally fixed at another hospital; other fractures in this region were conservatively managed. However, the treatment was inappropriate and three months later he was referred to our hospital because of severe malocclusion and mouth-opening limitation. Clinical examination showed a narrowed mandibular dental arch and crossbite on the right molars. Computed tomography revealed that the mandible was fixed inappropriately at the symphyseal region and bone healing in the right mandible was deviated to the lingual side. We performed mandibular midline distraction using a custom-made tooth-borne distractor （first stage） and Le Fort Ⅰ osteotomy （second stage）. The postoperative course was uneventful, and the patient regained stable occlusion and satisfactory mouth opening.

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Treatment for fractures of the jaw in infants takes place during growth and development, which is a process of continuous change; therefore, the treatment needs to be chosen carefully in consideration of the infant’s subsequent growth and development, including tooth eruption. Conservative treatment is chosen particularly often in the case of mandibular condylar fractures and it is important to avoid the subsequent development of dysfunction, such as temporomandibular joint （TMJ） ankylosis. Treatment must therefore take into account early recovery of oral function.
We encountered two infants with combined fractures of the bilateral mandibular condyle and the body of the mandible. To treat the fracture of the body of the mandible in the first infant, a 1-year-old boy, we performed circumferential wiring, whereas in the second infant, a 2-year-old girl, we performed open reduction using a titanium plate. Conservative treatment was provided to both infants to treat the mandibular condylar fracture.
Fractures of the jaw in infants are thought to have a strong tendency to be treated through bone remodeling which restores the jaw to its normal position or leads to functional healing. At 4 years after surgery, both infants showed correction of the positions of the glenoid fossa and the condyle without the development of any TMJ ankylosis. We plan to continue long-term follow-up of these infants.

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The mandibular condyle is one of the common sites of mandibular fracture. Mandibular condylar fractures can be treated using either closed reduction or surgical open reduction. Furthermore, the operation can either be performed by an extraoral and intraoral approach. An 18-year-old male patient who had been involved in a traffic accident was referred to our department with the chief complaint of pain in the right temporomandibular jaw, which caused him difficulty opening his mouth. A computed tomography scan showed fractures of the right mandibular condylar base and mandibular body. We performed intraoral open reduction and internal fixation of the mandibular condylar base fracture using a contra-angle driver and IVRO retractor. No problems occurred in the postoperative course and, 12 months after surgery, the patient maintains stomatognathic function and has made a sufficient recovery.

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We report a case of mandibular fracture associated with upper airway stenosis due to glossoptosis. The patient was a 91-year-old female who had injured her lower jaw in a fall at a nursing care home. Panorama radiography showed a fracture line on both sides of the mandibular body. Computed tomography （CT） demonstrated glossoptosis and upper airway stenosis. The patient underwent open reduction via an intra-oral approach using mini plates and a reconstruction plate under general anesthesia. Her airway stenosis disappeared and the results of postoperative CT were appropriate. Although glossoptosis can cause upper respiratory tract obstruction, patients with decreased cognitive function may not be aware of this change. Mandibular fracture in patients with senile dementia therefore requires careful follow-up.

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