This is a brief report of 4 paediatric cases of COVID-19 infection in Malaysia Background: COVID-19, a coronavirus, first detected in Wuhan, China has now spread rapidly to over 60 countries and territories around the world, infecting more than 85000 individuals. As the case count amongst children is low, there is need to report COVID-19 in children to better understand the virus and the disease. Cases: In Malaysia, until end of February 2020, there were four COVID-19 paediatric cases with ages ranging from 20 months to 11 years. All four cases were likely to have contracted the virus in China. The children had no symptoms or mild flu-like illness. The cases were managed symptomatically. None required antiviral therapy. Discussion: There were 2 major issues regarding the care of infected children. Firstly, the quarantine of an infected child with a parent who tested negative was an ethical dilemma. Secondly, oropharyngeal and nasal swabs in children were at risk of false negative results. These issues have implications for infection control. Consequently, there is a need for clearer guidelines for child quarantine and testing methods in the management of COVID-19 in children.

Distraction osteogenesis (DO) is a tissue engineering method to regenerate new bone. The application of DO in the field of oral and craniomaxillofacial surgery has provided a promising alternative as it can be integrated with conventional surgical technique for bone lengthening or expansion. This technique has the advantages of providing superior amount of bone lengthening thus eliminating the need of autogenous graft and donor site morbidity, can be applied in young patients and allows simultaneous expansion of the surrounding soft tissues. In this chapter, we provide a comprehensive overview of the background history and development of DO which is based on Ilizarov technique, along with its basic principles, indications, classification of DO devices and protocol in craniomaxillofacial bone lengthening or expansion. Its clinical applications which include alveolar DO, mandible DO, maxilla DO, transport DO and craniofacial DO are clarified. This technique however requires proper understanding of clinical and technical components to avoid potential complications which include relapse, infection, adjacent structure injury, device failure and other complications. The emerging results of research and advances in DO are further elaborated at the end of this chapter.

No abstract

Temporomandibular joint (TMJ) dislocation is a common occurrence, but diagnosis can be missed if patients do not complain. Delayed presentation complicates the management of a straightforward reduction. We present a case of a 24-year-old man who had bilateral TMJ dislocation of unknown duration after motor vehicle accident. The accident left him bedridden with speech difficulty. He was totally dependent on Ryles' and percutaneous endoscopic gastrotomy tubes for feeding. Computed tomography revealed dislocation of condyles anterior to articular eminences. The bilateral TMJ dislocations were reduced surgically via bicoronal with preauricular extension approaches. However, the surgery was challenging due to tissue changes around the joint accompanied by masticatory muscles atrophy. Postoperatively, he was placed on intermaxillary fixation for 2 weeks followed by elastics training. Three months later, the patient's mastication returned completely to function. Delayed management of bilateral TMJ dislocation is undoubtedly challenging and somewhat frustrating; nevertheless, we manage to achieve satisfactory outcome in improving the patient's quality of life.