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Background: Treating cases that require different surgical specialties requires high-level interdisciplinary coordination, and prioritization of the patient's needs, which is nearly impossible in a war zone. Aim: To document the case of a woman who was diagnosed with multiple fractures from an explosive injury sustained during the October 2023 war in Gaza. Methods: The woman underwent 3 surgical operations, internal fixation for the rib fracture, internal fixation of the left humerus, and fixation of the mandible fracture. She was hospitalized for nearly one month in 2 admission intervals—14 days at the surgical department and 16 days at the intensive care unit. Result: After prolonged interdisciplinary management, recurrent admissions and multiple operations, the patient recovered significantly well. Conclusion: This case highlights the significance of a multidisciplinary approach to managing these types of injuries, and how a severe polytrauma patient can recover when provided with appropriate care in spite of the conflict.

Unfavorable fractures are among the most challenging complications in sagittal split ramus osteotomy (SSRO), potentially increasing surgical morbidity and compromising postoperative outcomes. The preoperative identification of anatomical risk factors through imaging can enhance surgical planning and prevent such events. This study aims to investigate the anatomical factors associated with lingual fracture patterns in SSRO using multislice computed tomography. This retrospective case-control study included 180 mandibular rami from patients who underwent SSRO at a Clinical Research Center for Oral and Maxillofacial Surgery. Fractures were classified according to Plooij (2009), with Types 3 and 4 grouped as cases and Types 1 and 2 as controls. Linear measurements of mandibular ramus thickness, the distance between the mandibular canal and the buccal cortical bone, as well as parameters related to the mandibular lingula were analyzed. The case group showed significantly thinner mandibular bone (p < 0.001) and a shorter canal-cortical distance (p = 0.013), suggesting a direct association between these anatomical variables and unfavorable fracture patterns. Bonferroni post hoc analysis revealed no significant difference between fracture patterns Type 3 and Type 4 (p = 1.000), supporting their grouping in a single analytical category. The presence of third molars was not significantly associated with fracture patterns (p > 0.05). These results underscore the importance of anatomical parameters in predicting the risk of unfavorable fractures. Specifically, reduced bone thickness and proximity of the mandibular canal play a crucial role in the occurrence of unfavorable SSRO fractures. Preoperative evaluation using computed tomography is essential to optimize surgical planning and minimize complications. However, given the limitations of retrospective designs potential biases are acknowledged, and further prospective studies are needed to confirm these findings and improve risk assessment in SSRO.

Background/Aim. Epidemiology of maxillofacial fractures (MFF) varies between populations. This study investigated the epidemiology of MFF treated at the Oral and Maxillofacial Surgery (OMFS) Unit, Hospital Universiti Sains Malaysia (USM). Methods. A retrospective review of 473 medical records of patients with MFF treated from June 2013 to December 2015 was conducted. Information on demographic characteristics of patients, aetiology of injury, types of MFF, and treatment was obtained. Descriptive analysis, Pearson's chi-squared test, and multiple logistic regression analysis were conducted. The level of significance was set at 0.05. Results. Most patients treated for MFF were males (82.2%), aged 30 and below (63.1%), and from Malay ethnic (97.4%). Road traffic accident was the most common cause of MFF (83.1%), with motorcycle accident accounting for most injuries (73.6%). Orbital wall fracture was the most frequent MFF type (51.2%). About half of MFF patients (51.4%) were treated conservatively. Patients aged more than 20 years old were at higher odds of sustaining orbital wall fracture (AOR= 1.76; 95% CI: 1.214-2.558; P= 0.003) but were at lower odds of sustaining mandibular fracture (AOR= 0.47; 95% CI: 0.315-0.695; P= 0.001) than patients who are 20 years old and younger. Helmet use among motorcyclists was significantly associated with the nasal, orbital wall, and maxillary sinus wall fractures (P= 0.006, 0.010, and 0.004, respectively). Conclusion. Motorcycle accident was the most common cause of MFF in Kelantan, Malaysia. Ages of patient and helmet use were associated with the type of MFF sustained. This study provides important information to facilitate the planning of MFF prevention strategies among motorcyclists and emphasizes the importance of using a helmet when riding a motorcycle.

A 17-year-old boy presented to the ED with pain and swelling in his jaw 2 hours after an e-cigarette exploded during use. He had extensive lacerations in his mouth, multiple disrupted lower incisors, and bony incongruity of his left mandible.

Background Epidemiological data is providing vital indicators for organizing the financial resources related to a particular type of trauma, estimating expenses and training of dental practioners and ambulatory medical staff for collaboration with a certain pattern of patients. Knowing the etiology and epidemiology of a certain pathology is significant for approaching its means of prevention. Methods A 10-year retrospective statistical analysis of 1007 patients with maxillofacial fractures treated in a University Clinic of Oral and Maxillofacial Surgery in Romania was performed. The data were extracted from patients’ medical records. Statistical analysis was performed. A value of p  < 0.05 was considered statistically significant. Results The incidence of maxillofacial fractures was high among patients in the 20–29 age group (35.9%). Male patients (90.57%, M:F = 9.6:1), having a low level of education (46.60%) and living in urban areas (53.50%) were more affected. The main cause of maxillofacial fractures was interpersonal violence (59.37%), both in the mandibular and midface topographic regions ( p  = 0.001, p  = 0.002). In urban areas, fractures caused by interpersonal violence and road traffic accidents were predominant, while in rural areas, most of the fractures were due to interpersonal violence, domestic accidents, work accidents and animal attacks ( p  = 0.001). Conclusions Interpersonal violence is the main cause of maxillofacial fractures having epidemic proportions. Male patients aged 20–29 years with a low level of education represent the major risk category. Considering the wide area of interpersonal aggression, both the medical staff in the hospital and in the dental offices must be educated in order to collaborate with possible violent patients. Dentists must be prepared to work on a post-traumatic dento-periodontal field. Taking all measures to prevent inter-human aggression is imperative and will lead to a major decrease in maxillofacial fractures and an overall increase of oral health in a population.

Background Metastasis of breast carcinoma to the oral cavity is an uncommon event, and mandibular involvement is even rarer. This case is notable owing to the delayed occurrence of mandibular metastasis 6 years after the primary diagnosis, highlighting its aggressive behavior, which resulted in a pathological mandibular fracture. Reporting such rare presentations can aid clinicians in identifying atypical metastatic patterns in breast cancer survivors. Case presentation A 45 year-old Persian female with a history of invasive ductal breast carcinoma, diagnosed initially and treated 6 years earlier, presented with facial swelling and pain in the left lower jaw. She had been receiving bisphosphonate therapy for bone metastases. Clinical and radiographic evaluations revealed a radiolucent mandibular lesion with cortical bone perforation. Histopathological and immunohistochemical analyses confirmed metastasis from the primary breast cancer. Despite subsequent radiotherapy and chemotherapy, the lesion progressed, resulting in a pathological mandibular fracture and further metastases to the lungs and liver. Conclusion This case underscores the importance of considering metastatic disease in diagnosing oral lesions in patients with a history of malignancy. Early recognition of atypical presentations such as mandibular metastasis may facilitate timely intervention, although prognosis remains poor in such advanced stages.

[LANGUAGE= \"English\"] High-energy ballistic injuries may cause comminuted facial fractures. Treatment of such fractures might be challenging because of in-fection and soft- and hard-tissue loss. These cases may not be amenable to open reduction and internal fixation. We present 2 cases of gunshot fractures, for which external fixation was used as a surgical step before definitive treatment. With the use of external fixation, existing infection had been controlled and soft tissues had been restored, which allowed oral rehabilitation with reconstruction plates and autogenous bone grafting, if needed.[LANGUAGE= \"Turkish\"] Yüksek enerjili balistik yaralanmalar çok parçalı fasiyal kırıklara yol açabilmektedir. Bu kırıkların tedavisi enfeksiyon ve sert ve yumuşak doku kaybı nedeniyle zorlayıcı olabilir. Böyle vakalar açık redüksiyon ve internal tespit için uygun olmayabilir. Bu raporda eksternal fiksasyonun esas tedavi öncesinde cerrahi bir aşama olarak uygulandığı 2 ateşli silah yaralanması vakası sunuldu. Eksternal fiksasyon uygulaması ile var olan enfeksiyon kontrol altına alınmış ve yumuşak dokular tamir edilmiştir. Bu sayede rekonstrüksiyon plakları ve gerekli ise otojen kemik greftleme yardımı ile oral rehabilitasyona uygun ortam sağlanmıştır.

Aim This study aimed to evaluate radiomorphometric risk factors for mandibular angle fractures (MAFs) by simulating pre-fracture mandibular anatomy using digital reduction techniques on cone beam computed tomography (CBCT) images. Demographic and etiological characteristics were also analyzed to identify factors associated with MAF occurrence. Methods In this retrospective study, 55 patients with mandibular fractures were categorized into two groups: those with mandibular angle fractures (MAF, n  = 20) and those with fractures in other mandibular regions (non-MAF, n  = 35). High-resolution CBCT scans were analyzed following digital fragment realignment using Materialise Mimics 25.0. Radiomorphometric measurements included gonial angle, ramus height, and ramus width. Demographic variables, third molar status, and trauma etiology were evaluated. Statistical analysis was performed using Mann–Whitney U, chi-square, Fisher’s exact, and independent samples t tests, with a significance level of p  < 0.05. Results Patients in the MAF group were significantly younger (median age: 21 vs. 27 years; p  = 0.002) and predominantly male (90%). Third molars were more frequently observed in the MAF group (85%) and were significantly associated with angle fractures ( p  = 0.019). Condylar fractures occurred in 42.9% of the non-MAF group but were absent in the MAF group ( p  < 0.001). Conclusion CBCT combined with digital reduction improves anatomical assessment and standardization in fracture evaluation. Younger age, male gender, and the presence of third molars were significantly associated with MAFs. Third molars may represent a modifiable risk factor for mandibular angle fractures and should be considered carefully in clinical prevention strategies.

Gunshots to the human body can cause direct and indirect injuries. Direct injuries are a consequence of the projectile guiding its way through the body, creating a permanent wound channel and thereby damaging the penetrated as well as the adjacent tissue. In addition, the temporary wound cavity is responsible for indirect injuries occurring distant to the actual wound tract. This can potentially affect different types of tissue, like blood vessels, organs, or bones, that are not directly passed through by the projectile. For this case report, we describe a suicidal headshot to the temporal area where the extension of the temporary wound cavity and its subsequent collapse led to massive energy transfer to the surrounding tissue leading to breakage of the upper dental prosthesis and fractures of the lower jaw. Thereby outlining the ballistic mechanisms causing indirect injury pattern that have to be considered when examining gunshot wounds.

Background This study aims to evaluate the impact of different angular orientations and buccolingual positions of impacted third molars on the incidence of bad splits during sagittal split ramus osteotomy using finite element analysis. Materials and methods A total of 12 mandibular models were constructed, each representing a unique combination of third molar orientations (vertical, distoangular, horizontal, mesioangular) and positions (buccal, lingual, central). A force of 20 N was applied from the osteotomy line toward the proximal and distal segments to simulate the working principle of the Smith Spreader instrument. Results The maximum principal stress followed the order: vertical > distoangular > horizontal > mesioangular. In terms of positional stress distribution, the buccal position generated the highest stress, followed by lingual and central positions. Similar trends were observed across all stress criteria evaluated. Conclusion The orientation and position of impacted third molars have a direct effect on the risk of bad splits during SSRO. Mesioangular and centrally positioned teeth were associated with lower stress levels, indicating lower risk, while vertically oriented and buccally or lingually positioned molars showed significantly higher stress concentrations. Thus, extraction of high-risk impacted third molars prior to surgery is recommended to reduce the likelihood of complications.