Introduction: Neglected fracture is a condition of fracture that is not handled or mishandled, resulting in a state of delay in treatment, or a worse condition and even a disability. The technical difficulty was associated with a greater incidence of complications and often lead to a suboptimal result. A more precise understanding of maxillofacial fracture's demographic patterns will help healthcare providers manage maxillofacial injuries. Method: Twenty-nine patients with neglected maxillofacial fractures were registered in the Division of Plastic Reconstructive and Aesthetic Surgery, Dr. Kariadi Central-General Hospital Semarang, January 2015 to December 2018. The collected information included gender, age, etiology, and site of fracture. Some of the cases are presented. Result: Neglected fracture of maxillofacial occurred predominantly in young adults. The male population was more frequently affected (62%)—most patients with neglected maxillofacial fractures associated with MVA (84%). The Mandible was the most common site of the fracture, followed by ZMC.  Conclusion: The possibility of a fracture of Mandible and ZMC or adjacent bones should be considered in any facial trauma, especially related to MVA injury. Early and proper management will provide a better result.

Summary: Apert syndrome is a type 1  acrocephalosyndactyly, a rare syndrome characterized by the presence of multiple craniosynostoses,  dysmorphic facial manifestations, and syndactyly of hand and feet. It affects 1:100.00 of birth and the second most common of syndromic craniosynostosis. Molecular genetic tests that identify the heterozygous pathogenic variant in FGFR2 genes - identical with Apert syndrome cost too high to be applicable in developing countries. Therefore, the diagnosis of Apert syndrome should be suspected from the clinical findings. Three cases from the Community of Indonesian Apert Warrior Group were collected. These series were based on medical and surgical records. We obtained the patient characteristic from the phenotypic manifestations only. We present cases of 6-years-old male, 2-years-old female, and 3-years-old female, respectively, with similar anatomical findings, such as skull shape abnormality, midface hypoplasia, intraoral disfigurement, and hands and feet deformities that resemble Apert Syndrome. Our series presents similar Apert syndrome characteristics, such as typical craniofacial dysmorphic with symmetrical syndactyly of both upper and lower extremities. These clinical findings are essential to establish an initial diagnostic of Apert Syndrome.

Gangren Fournier adalah infeksi nekrosis polimikroba yang progresif. Baru-baru ini, penggunaan madu baru dikenal dalam pengelolaan gangren Fournier, sedangkan pencangkokan kulit adalah salah satu pilihan yang populer dalam rekonstruksi cacat setelah eksplorasi bedah jaringan nekrotik gangren Fournier. Seorang laki-laki, 55 tahun, datang dengan ulkus multiple pada penis dan skrotum, dan riwayat diabetes mellitus tipe II yang tidak terkontrol, kebiasaan merokok berat dan alkoholisme kronis. Aplikasi madu 20-30 cc dilakukan selama dua minggu setelah tindakan bedah debridemen. Cangkok kulit digunakan untuk melapisi kembali defek kulit yang tersisa. Madu telah dikenal memiliki kemampuan untuk merangsang pertumbuhan sel epitel disamping sifat anti mikroba. Cangkok kulit dengan ketebalan terpisah dianggap memiliki beberapa keuntungan: prosedur satu tahap yang sederhana, morbiditas lokasi donor yang rendah, hemat biaya, dan memungkinkan hasil fungsional dan kosmetik yang wajar. Kami menemukan bahwa penerapan madu dan cangkok kulit dengan ketebalan terpisah dalam pengobatan gangren Fournier sangat bermanfaat, terutama pada fasilitas kesehatan yang terbatas.

Hypermetabolic conditions with nutrition deficiencies are common in patients with extensive burns. Balanced nutrition status is required to achieve adequate wound healing. Mental disorder, which tended to make a patient uncooperative, complicates the management. We report the case of a 35-year-old man with schizophrenia who suffered full- and partial-thickness burns in approximately 38% of total body surface area due to attempted suicide. The patient was hospitalized for 66 days and underwent multiple surgeries. His body mass index (BMI) was continuously low. Tissue injuries provoked inflammatory responses that contributed to metabolic disarrangement, meanwhile the presence of psychiatric disorder complicated the means of nutrition assessment and therapy needed to compensate for the high nutrition demand during the treatment period. Nutrition support should be assessed and adjusted continuously.

Background:Capillary malformations (CMs) and Lymphatic malformation (LMs) are vascular malformations that share a common tendency to cause soft and hard tissue hyperthropy, expressed in the three dimensions of the space. Although middle third of the face is the most commonly involved area, with a predominance of upper lip, the lower lip sometimes involved in some cases too. Vascular malformations of the lip often require reconstructive surgery with meticulous attention to both aesthetic and functional purposes. The lip reconstructive rule of thirds suggests that lower lip defects involving 1/3-2/3 total lip width require closure with lip switch or local advancement flap techniques (Karapandzic, Abbe, or Estlander).Case Description: 36 years old woman with bluish tumor lesion on lower lip since childhood, came to our clinic with history of  small lesion enlarging slowly, bluish in color, elastic in palpation, no bruit in auscultation. She had underwent surgery to reduce the size of lesion twice while childhood and in adult. Then she felt the lesion became bigger and fulfilling the right edge extended to two third of the lower lip. She felt a little bit itchy, and a difficulty in eating. The surgeon performed a wide excision continued using lip reconstruction Karapandzic flap. The final result of the reconstruction is satisfactory for the patient, and no recurrence nor complication existed.Discussion:Vascular malformation which underwent correcting surgery should consider certain guidelines regarding anatomic consideration and therefore appropriate reconstruction according guideline methods, such as close primarily, Karapandzic, Estlander, Abbe, Bernard-Burrow, distant free flap, will provide good anatomical and physiological result in attected lip. The surgeon choose to perform Karapandzic method for this patient because Karapandzic is probably the better choice because it’s better at maintaining oral competence. Larger lip defects over 50% of the lip can be reconstructed by Karapandzic flap. Conclusion: Karapandzic flaps is probably proper alternative due to reducing the larger lower lip defect (more than two-thirds of lip) which give a satisfying result of this patient.