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The dental and oral rehabilitation of patients with severe trauma that involves the oral cavity is demanding and challenging. Recently, advanced surgical techniques and innovations in oral implantology led to more sophisticated treatment modalities that may better fulfill the patients needs in special situations. Young people rather often suffer from accidents--at school and during leisure activities--in a period of their life that has a great impact on their physical, mental and personal development. Thus, the wish for a quick functional and esthetical rehabilitation contrasts with the complex clinical situation and the compromised oral conditions. All persons involved in the rehabilitation process--including the patient--must seek for the best solution that takes into account treatment time, invasivity of procedures and patients morbidity. Further, it is also observed that insurances very much stress the reduction of cost and the simplicity of treatment. This will also influence the treatment planning and the sequence of the procedures as shown by the following case.

A patient presented complex fractures of the face and skull with leg trauma after a traffic accident. Maxillofacial repair used sophisticated procedures: bone grafts, muscle flaps and multiple osteotomies. After reconstructing the mid face and the mandibular repair, bone implants were used to stabilize the maxillary prosthesis. The psychological and functions problems raised in this case are discussed considering the occupational and social outcome.

Postsurgical infection has always been a cause for major concern in ENT surgery. Papers on the topic allowed to identify indications for antibiotic prophylaxis. In ear surgery, in the absence of prior infection (stapes surgery, medium dry ear surgery), studies' results are not in favour of antibiotic prophylaxis. On the other hand, however, when the ear is inflamed or infected, the use of antibiotics is indicated, if possible after having first taken a sample. For nose and sinus surgery, antibiotic prophylaxis seems to be worthless in the absence of a prolonged packing. If a packing has to be maintained or if a transplant is used, an antibiotic administration has to be considered; the most appropriate antibiotic and its mode of use still have to be specified. In case of facial trauma, antibiotic prophylaxis using cefazolin reduces the risk of infection of paraymphysis fractures and angle fractures. The postoperative course after tonsillectomy is simplified by a prolonged antibiotic administration based on ampicillin. In clean cervico-facial surgery, without buccopharyngeal opening, the antibiotic prophylaxis seems to be worthless. In the opposite, antibiotherapy is required in case of buccopharyngeal opening. Indeed the presence of potential pathogenic bacteria in the buccopharyngeal cavity, the difficulties of mucosa closing, the importance of the tumoral extension, the length of the procedure, radiotherapy and use of myocutaneous flaps may all be the cause of a high infection rate (80%) in the absence of antibiotic prophylaxis. Two types of antibiotics seem to be suitable, cefazolin and clindamycin. Antibiotics active against Gram negative bacteria seem to be useless. There is a disagreement concerning the duration of antibiotic administration. The populations studied are too small to obtain significant results. Both points of view (prolonged antibiotic administration or true antibiotic prophylaxis) can be considered. Only large scale prospective studies with an adequate methodology will provide credible data for this debate.

We describe a prefabricated monomaxillary arch, fitted with perpendicular supports with a main bar which provides dento-maxillary setting in the antero-posterior direction and also vertically since it is possible to attach it to the free edge of the teeth. The indications concerning the use of this arch are given in detail. It offers the advantage of being readily adaptable and is therefore easy to use in an emergency.

In spite of a certain reduction in their numbers, facial injuries still raise frequent problems for general surgeons. Car accidents are now less commonly responsible than motorcycle accidents. In the most complex cases, one may find lesions of the soft parts and bony lesions in association. The wounds should be examined carefully, all foreign bodies removed and should only be sutured if one is certain tht the subjacent structures are undamaged, e.g. facial bony canals are often damaged in vertical wounds of the cheek situated behind the anterior border of the masseter muscle. As far as bony lesions are concerned, they rarely give rise to typical breakdowns of the suture lines described by Lefort, but more commonly cause true dislocations which are impossible to describe. Fractures are often undiagnosed owing to oedema which masks them, e.g. those of the malar bone and of the orbit and even those of the nose. This failure to diagnose them is serious for, at a later stage, surgical correction is more difficult and the prejudice is then not only esthetic but also functional, e.g. causing diplopia. Clinical examination of a patient with trauma of the face includes a series of simple gestures which a general surgeion should carry out in order to avoid failure to diagnose such lesions. Although he may not treat them all, he sould recognise them and decide which have priority in the treatment of multiple injuries. Careful inspection and palpation usually permit one to detect bony lesions which XRays then demonstrate only by careful choice of appropriate views.