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In Germany, suicides by firearms are not very common in contrast to deaths by hanging and intoxications. The use of historical muzzle-loading firearms in the context of suicides is a rarity. Contact shots from muzzle loaders cause an unusual wound morphology with extensive soot soiling. We report the case of a 59-year-old man, who committed a planned complex suicide by shooting into his mouth with a replica percussion gun in combination with hanging. The gunshot injury showed strong explosive effects in the oral cavity with fractures of the facial bones and the skull associated with cerebral evisceration (so-called Krönlein shot). Due to the special constellation of the case with hanging immediately after the shot, external bleeding from the head injuries was only moderate. Therefore, the head injuries could be assessed and partially reconstructed already at the scene.

Changing ambient pressure can lead to medical conditions in body cavities filled with air. Intraoral pain elicited by changes in pressure is referred to as barodontalgia. Dental barotraumas are defined as pressure-induced damages of teeth and restorations. The pathophysiologic background so far is not completely clear. The present study deals with dental and orofacial symptoms which can occur as a result of pressure variations. With the aid of cantonal administrations, diving associations, and tunnel construction firms, 520 pressure-exposed individuals (499 scuba/ professional divers, 21 caisson workers operating at excess pressure) were questioned regarding dental problems. A personal interview was conducted with affected individuals. Problems in the dental area were experienced by 15% of all respondents. Toothaches were suffered by 10.2% of the participants. Tooth injuries occurred in 6.3% of all interviewees (26 fractured amalgam restorations, 4 crown fractures, 3 losses of tooth fragments). A proportion of 11.3% among the respondents complained about temporomandibular joint problems or mucosal irritations (for example aphthae) related to the mouthpieces. Barotraumas outside the dental area were incurred by 31.9% of the divers. Of these, 69.9% concerned the ears and 65.6% occurred during the descent. Based on the results obtained from the survey and taking into account the current literature, recommendations for the prevention of barotraumas in divers and caisson workers were prepared. Diagnostic exclusion of dental pathologies and avoidance of retentive reconstruction materials are important factors for the prevention of barodontalgias and dental barotraumas.

Oral jewelry is popular. One of the most widely spread types are so-called tooth diamonds made of composite materials which are applied to the teeth with an adhesive. Note that parents are required to sign a release form for under-aged patients in Switzerland. Tooth cap grills and gold teeth are considered status symbols within the Hip-Hop fashion scene. However, tooth ornaments favour the accumulation of plaque and can diminish the ability to articulate. With respect to jewelry in oral soft tissue especially tongue and lip piercings are of significance to dentists. Besides the systemic complications, which are mostly caused by a lack of hygiene or the failure of noting medical contraindications by the piercer, local complications occur frequently. After surgery, pain, swelling, infections as well as hemorrhages or hematomas can be observed. Long-term effects can be problematic: gingival recession can be discernes mainly in the case of lip piercings the loss of hard tooth substance in the case of tongue piercings. Because of that, conservation therapies can become indespensable. Patients wearing dental jewelry have to be aware of risks of tooth damage, and they regularly have to undergo dental check-ups. Information campaigns--for dentists as well as patients--are necessary.

In the medicolegal literature reports of suicides with weapons designed for self-defence, especially gas pistols, are rare. We report on a suicide of a 54-year-old woman who fired a fatal shot in her mouth with an unmanipulated blank cartridge pistol, make Röhm RG 8, calibre 8 mm. The autopsy findings (lips and mucosa of the buccal vestibule without injuries, but extensive lesions of the tongue and the middle and rear third of the smooth palate) suggest that the shot was fired - as observed by a witness - with the barrel of the weapon inside the oral cavity. Both macroscopic inspection and histological investigations excluded the possibility that death was caused by an injury of the brain, in particular the brain stem. The immediate cause of death was deep aspiration of chyme with concurrent aspiration of blood.

In children unintentional ingestions of metasilicate- containing machine dishwashing agents have caused corrosive injuries of the mouth and esophagus in up to 50% of all cases. Whether substituting the corrosive ingredient by disilicates and carbonates reduces the number of corrosive injuries was studied in a 2-year prospective follow-up of 396 unintentional childhood ingestions. Symptoms of possible mucous membrane injury by machine dishwashing agents containing disilicates and carbonates (group DC) were compared to ingestions of irritating but definitely non-corrosive surfactants (group S). A total of 396 DC cases were followed, 86 of which showed initial symptoms such as crying, drooling, vomiting, or unwillingness to drink. Endoscopy of the esophagus performed in 17 children was normal in 13 cases and showed a general reddening of the esophageal mucosa in the remaining 4 children. None had corrosive oral lesions. This demonstrates a significant reduction of mucous membrane lesions compared to the older metasilicate-containing machine dishwashing agents. The toxic effects of the new dishwashing agents (group DC) are only slightly more pronounced than compared to 188 control cases of group S.

Background: The frequency of local and cardiovascular side effects of microlaryngoscopy is generally underestimated. There are no data available in the literature from recent and prospective clinical trials., Patients and Methods: We examined 81 patients between 03/1998 and 03/2000 who underwent microlaryngoscopy in our department. This was done following a standard protocol before, during and after surgery. Side effects of endotracheal intubation were avoided by using supraglottic jet-ventilation., Results: In 79% of our cases we encountered side effects due to the microlaryngoscopic procedure.86% of them were reversible lesions,hematomas and edemas of the mucous membranes or mild cardiovascular dysregulations. In two cases there was a dental complication (one fracture, one dislocation), and seven cases of moderate hemodynamic effects were noted., Conclusions: The incidence of tissue damage caused by microlaryngoscopic endoscopes is much higher than commonly assumed in clinical practice. This has to be explained to the patient when obtaining his written consent to a certain microlaryngoscopic procedure and to be considered during the postoperative follow up.The consequent use of tooth protection and a good control of muscle relaxation and analgesia can be effective in preventing side effects.

The introduction of stable osteosynthesis of mandibular fractures in the late 1960s for trauma patients meant an increase in quality of life. Intermaxillary immobilization and time in hospital could be reduced significantly. Later on, miniplates became popular in most trauma centers to treat mandibular fractures. Compared to the technique of stable osteosynthesis, miniplating is less demanding and the complication rates are similar. In midfacial fractures, too, miniplate osteosynthesis could guarantee three-dimensional stability. With the help of microplates even the smallest bony structures can be fixed following reduction. Degradable plates, which are available today, are used for craniofacial and midfacial indications; however, up to now degradable plates are not suitable for load-bearing areas.

The increasing distribution and social acceptance of body piercing induced us to investigate the nature and rate of complications brought about by this fashionable injury of the unscathed body. All dentists, maxillofacial surgeons and clinics within the region of the association of dentists of Bremen were asked to register all patients presenting between June and October 1998 in whom piercings of the head and neck area were visible. Response was good; 699 piercings in 273 persons were recorded and some exemplary photographs made. Some 47 persons showed local complications which ranged from keloid formation and temporary infections to cartilage necrosis and disturbances in sensibility. General diseases were described as well, mainly allergies and hepatitis. In accordance with the seriousness of the complication the medical treatment required varied. Nine persons had to be treated in hospital. In 14 cases patients suffered permanent damage. Piercings cause severe complications and considerable expense to the public health service.

Internal gunshot wounds in the head and neck region are complicated. Two cases of such injuries in the head and neck region are introduced and therapeutic approaches are discussed. If there are no severe additional injuries, the treatment of choice is the endoscopic removal of the projectile. Alternatively, the projectile has to be taken out by conventional surgery, using the approach which induces the least stress for the patient.

Oral and facial piercing with different kinds of body art are being observed more frequently in medical and dental practices. Principally, piercing is not a new form of body art and is traditional in different geographical areas. Various materials are used. Besides tongue and lip piercing, different locations of the face such as the eyebrows and the nose are anatomical areas of piercing. The aim of this article is to demonstrate different forms of oral piercing, illustrated by own observations. The piercing procedure is briefly described. Piercing is usually performed without local anaesthesia and stepwise. In a literature review, the possible risks and complications are summarised. Postprocedural complications are oedema, haemorrhage and infection. Other complications are foreign body granulomas or allergies, particularly against nickel. Dentists, and oral- and maxillofacial surgeons should be in a position to advise patients with oral or facial piercings or those who plan to have this type of body art performed.

Report about a homicide case, where a female taxi driver was killed by a shot through the neck. The partly confessing perpetrator maintained that he had shot the woman by using a signal pen loaded with a signal cartridge. The lethal injuries were not compatible with the averment of the perpetrator. Shooting experiments were performed using the signal pen loaded with signal cartridges as well as using the signal pen connected with a short barrel (= pen gun) and loaded with small-bore bullets (cal. .22). Shots were done through a flash ranging chronograph and to the cervical spines of slaughtered calfs. The ballistic data compared with the wound morphology led to the reconstruction of the homicide.

Two cases of bullet injuries inflicted in suicidal intention are represented. In the first instant the barrel of a rifle in the second the barrel of a revolver was inserted to the oral cavity before the shot was fired.

A prison inmate was referred to us for diagnostic procedures and therapy due to a combination of pneumomediastinum with emphysema of neck and face. External injuries were absent and pathogenesis remained uncertain until thorough examination of the patient revealed two intraoral wounds, presumably from a needle, reaching into the maxillary sinus. This large subcutaneous emphysema of the face, neck and mediastinum was the result of an exaggerated Valsalva maneuver. With this self-inflicted injury, unknown to us, the prisoner achieved the desired immediate admission to hospital.

Grinding of the hard tissues of the teeth with diamond points and airotor led to bullet-like flying off of part of the instrument. The causes were investigated: Unsatisfactory fixation in the turbine head, deficient material in the rotating instrument, unnecessary notches in the shaft resulting in reduction of diameter, and finally the so far uncorrected radial vibration of the rotating instrument. All of these causes may result in plastic deformation or breakage of the points.

A device for the prevention of intraoral soft tissue injuries in comatose patients with uncoordinated chewing movements is presented. Shape and material of the device, which is easily fashioned and handled, are designed to protect oral and buaccal soft tissue structures against self inflicted injuries.