Background: Mandibular condyle fractures in pediatric patients can lead to crippling sequelae such as ankylosis, pain and facial deformity if not managed properly. However, there is no consensus on the best approach for treating these fractures in children. Objective: This study aimed to describe the management of mandibular condyle fractures in growing patients across 14 maxillofacial departments worldwide. Methods: A retrospective multicenter study was conducted on children and adolescents aged 0 to 16 who had at least one mandibular condyle fracture. This study included patients who underwent expectant, closed, or open management and were treated over an 11-year period. Results: 180 patients had at least one mandibular condyle fracture, and 37 had a second condylar fracture. One hundred sixteen patients (65%) were males, and 64 (35%) were females (ratio 1.8:1). An expectant strategy was chosen in 51 (28%) patients, a closed treatment—stand-alone maxillomandibular fixation (MMF)—in 47 (26%), and open reduction and internal fixation (ORIF) was performed in 82 (46%) patients. The management varied significantly between the different departments (p < 0.0001). Significant differences were also identified between the fracture type (non-displaced, displaced or comminuted) and the management of the 180 patients with a single condylar fracture. Out of 50 non-displaced fractures, only 3 (6%) had ORIF, 25 (50%) had expectant management, and 22 (44%) had MMF. Out of 129 displaced fractures, 79 (62%) had ORIF, 25 (19%) had a soft diet, and 25 (19%) had MMF. Conclusions: Expectative management, MMF, and ORIF were all effective in treating pediatric mandibular condyle fractures, with a low incidence of complications and asymmetry.

Background/aim: Paediatric maxillozygomatic complex (MZC) fractures are uncommon, and there is a scarcity of data regarding their surgical treatment. The aim of this study was to analyse choices and outcomes of open reduction and internal fixation (ORIF) for MZC fractures among 14 maxillofacial centers around the world.Materials and Methods: This multicentric retrospective observational study included patients ≤16 years of age with quadripod MZC fractures treated with ORIF from January 2011 and December 2022. The following data were collected: age, gender, dentition stage (deciduous, mixed, and permanent), cause of injury, type of fracture, surgical approach, site of osteosynthesis (infraorbital rim, zygomaticomaxillary buttress, frontozygomatic, and zygomaticotemporal sutures), material (titanium or resorbable) and number of plates used, and outcome. The minimum follow‐up was 6 months. Statistical analyses were performed with Fisher's exact test or chi‐squared test, as appropriate.Results: Sixty‐four patients (mean age, 12.3 years) with quadripod MZC fractures were included. Seventy‐two percent of patients received a single‐point fixation. The zygomaticomaxillary buttress was the most common site for fixation, both in single‐point and two‐point fixation schemes, especially in combination with the frontozygomatic suture. Increasing age was associated with a higher rate of plate removal (p < .001). Postoperative complications included 5 (7.8%) cases of wound infections, 2 (3.1%) infraorbital paraesthesia, 1 (1.6%) ectropion. Residual facial asymmetry was found in 5 (7.8%) patients and was not associated with the type of fixation (p > .05).Conclusions: This study highlights the possibility of using ORIF, even with a single point of fixation, for the treatment of displaced quadripod MZC fractures in the paediatric population. The zygomaticomaxillary buttress was the preferred site of fixation and allowed for adequate stabilization with no external scars and a low risk of tooth damage. Future prospective studies with long‐term follow‐up are needed to establish definitive surgical protocols and clarify the surgical decision‐making.

In our retrospective longitudinal study based on the data from 292 patients, we wanted to investigate whether there was an association between weather conditions and the occurrence of odontogenic abscesses (OA) requiring hospitalization. In the adult group (249 patients), the incidence of severe OA was highest in winter (32.9%) during January (11.6%), with the most common localizations being the perimandibular (35.7%) and submandibular (23.3%) regions. We found that changes in mean daily atmospheric pressure five days before hospitalization showed a positive association with the occurrence of OA, especially pressure variations greater than 12 hPa. Atmospheric pressure changes two and five days before hospitalization were also found to be moderate predictors of complications during treatment. Antibiogram analysis revealed resistance of streptococci to clindamycin in 26.3%. In the pediatric group, OA were also most frequent in winter (30.2%), and the perimandibular region (37.2%) and the canine fossa (20.9%) were the most frequent abscess localizations, while an association with meteorological parameters was not demonstrated. Clinical experience teaches us that weather change influences the occurrence of severe OA requiring hospitalization, which we confirmed in this research. To our knowledge, our study is the first to provide a threshold and precise time frame for atmospheric pressure changes.

Background: Oral squamous cell carcinoma (OSCC) causes considerable morbidity and mortality rates, posing a major global health burden. The management of the OSCC is multidisciplinary, but still the gold standard is surgical resection and reconstruction of the postablative defect. The appearance of secondary primary OSCC is not uncommon; however, it is quite rare that it appears on the skin of the flap that was used for reconstruction during the previous surgical therapy. Methods: We present three cases in which a secondary primary OSCC appeared on the skin of two radial forearm free flaps and two on regional pectoralis major flaps. Results: Our case series show that, although relatively rare, there is a chance of a secondary primary tumor on the flap used for intraoral reconstruction after the first oncological reconstruction. According to the latest and available literature, there is still no explanation of the underlying mechanism that leads to this occurrence. Conclusions: The learning point of this case series should be that, aside from the neck metastasis or recurrence of the primary oral cancer, the clinicians should also bear in mind that the flap itself should be physically examined in detail.

Mandibular fractures are common maxillofacial injuries among children and adolescents, but treatment remains controversial. The aim of this study was to analyse the methods and outcomes of open reduction and internal fixation (ORIF) for non-condylar mandibular fractures in paediatric patients among 14 maxillofacial centres. Patients ≤16 years of age undergoing ORIF for non-condylar mandibular fractures between 2011 and 2022 were included. Age, gender, dentition stage, site and type of fracture, surgical approach, material, thickness, and number of plates, and outcome were recorded. 179 patients (mean age, 11.1 years) reported 120 single and 59 double fractures, 79% involving at least one displaced or comminuted site. Single fractures were preferentially treated with rigid osteosynthesis in all dentition groups (64%), while double fractures with non-rigid osteosynthesis in mixed and permanent dentition patients (59% and 43%) and mixed osteosynthesis in deciduous dentition patients (50%). Mean follow-up was 21 months. Surgical would infection was the most common complication (8.9%), followed by minor malocclusion (1.7%) and osteitis (1.7%). In conclusion, the centres opted for fixation patterns like those recommended for adults, favoring non-rigid or mixed osteosynthesis for double fractures. The low complication rate shows ORIF is effective and safe for non-condylar mandibular fractures in paediatric patients.