Fracture mandibule is a fracture that occurs in the mandible, which is a bone that forms the lower third of the face and plays an important role in maintaining the shape and contour of the face. The mandible is U-shaped and consists of one corpus. And two fruit hair mandibulae. Mandible support tongue as well as muscle the floor of the mouth and plays a role in the function of mastication, articulation and speech of a person. 1,2 Tissue damage to the mandible can cause various problems ranging from impaired airway patency, problems with mastication function or malcollusion, disorders on articulation talk And swallow, until problem cosmetics. The damage that happen on mandible No only limited on network bone, but may involve defects in soft tissues and adjacent structures. 3 This condition can influence health physique, mentally, And quality life somebody. Mandibular fractures are the second most common facial fractures, because they are the most common bone. Which stand out Which located in edge And his position in one third lower face so it is often the target of forced injuries. In addition, it is a place of attachment of the masticatory muscles so that it has active movement. The diagnosis of mandibular fracture can be indicated by the presence of pain, swelling, tenderness, malocclusion, broken teeth, gaps, uneven teeth, asymmetry of the dental arch, intra-oral lacerations, loose teeth and crepitation. 1,2,3 In particular, the treatment of fractures of the mandible and maxillofacial bones was introduced by Hippocrates in 460-375 BC using guidelines occlusion or connection Which ideal between tooth lower And tooth jaw above as the basis for thinking and diagnosis of mandibular fractures. 1,2,4 The goal of mandibular fracture management is to obtain anatomical reduction of the fracture line, get return occlusion before injury, immobilization mandible in a certain period for healing, maintaining adequate nutrition, preventing infection, malunion and nonunion. Good knowledge and understanding of the mandibular structure and management of mandibular fractures are needed by surgeons in order to achieve good mandibular reconstruction.

Neonatal hearing loss is one of the health problems that has received more attention in this decade. This is due to the development of management to improve children's functional, intellectual, emotional, and social abilities. Neonatal hearing loss generally has a sensorineural type that is bilateral with a degree of severe to very severe. 1,2 As much as 80% of sensorineural hearing loss in children is a health problem that is congenital and occurs during the neonatal period. This hearing loss is reported to occur in 1-3% of births and in 2-4% of neonates in the care room. intensive, which more often occurs compared to disorders such as congenital hypothyroidism and phenylketonuria. 3 Based on research conducted in Brussels, Belgium in 2023, found hearing loss occurred in 362 (66.4%) neonates with 133 (24.4%) infants diagnosed with permanent hearing loss. Ninety infants (56 bilateral and 34 unilateral) had sensorineural hearing loss. 4 Congenital hearing loss can be classified based on etiology. As many as 50% from case caused by by genetics, 25% got (infection perinatal, hyperbilirubinemia, birth complications) and the rest are due to idiopathic reasons. A number of factor risk disturbance hearing including history previous family history of hearing loss, craniofacial abnormalities, complex congenital abnormalities associated with congenital hearing loss, infection default (infection TORCH), heavy body born low (1500 g), prematurity (33 weeks), hyperbilirubinemia, ototoxic drugs, bacterial meningitis, low APGAR score within 1 minutes (0-4), low APGAR score within 5 minutes (0-6), mechanical ventilation for 5 minutes days or more and was admitted to the NICU for more than 7 days. 1.5 One of the risk factors that is related to hearing loss is hyperbilirubinemia. Hyperbilirubinemia in neonates is the presence of level bilirubin total in serum on 5 mg/dL accompanied by clinical jaundice. The auditory pathway is a part of the nervous system that is sensitive to the toxic effects of bilirubin. Increased indirect bilirubin in the blood can cross the blood-brain barrier and precipitate in the nucleus cells of the auditory ventricles. Hearing loss due to hyperbilirubinemia can occur at mild to severe levels. Hearing loss occurs about 10-50 times more often in neonates with severe jaundice. Total bilirubin levels have the highest predictability for infant hearing status. 6

Auricular Keloid is a pathological wound healing process due to the fibroproliferative process of abnormal cutaneous tissue where fibroblastic proliferation is not balanced with the apoptosis process. Keloid marked with existence of network growing scar beyond the limits of the original wound area and this scar tissue rarely undergoes spontaneous regression. Trauma, inflammation, surgical scars, and burns can cause scars where if the healing of this wound occurs excessively it will cause the formation of keloids. Although it does not cause mortality, keloids can affect the quality life in a way significant Because influence cosmetics And cause a feeling uncomfortable due to taste painful or itchy that accompanies it. By Therefore, proper keloid management is very important. 1,2 Until moment This governance keloid is a challenge Because Keloid tissue tends to recur after excision. There are various factors that are thought to influence severity and recurrence keloids, such as systemic factors (example influence factor immune And hormonal), local, And genetic (the influence of race and certain genes). Due to genetic influences, the prevalence of keloids is said to be more common in African, Asian, and Hispanic races. The incidence of keloids in the Asian population varies from 4.5% to 16%. 1.3 Area auricular is Wrong One location most frequent the occurrence keloids. Ear piercing is reason most frequent from keloid auricular. In addition factor systemic, and genetic factors, earring material and the type of ear piercing procedure can contribute to the formation of keloids on the auricle. There are various choice keloid management auricle, like surgery, injection steroids, therapy pressure, silicone sheeting, cryotherapy, laser therapy, imiquimoid cream , and radiotherapy. However, until now there is no consensus regarding the therapeutic approach for auricular keloids. Keloid resection may be able to remove the keloid completely, but this treatment option has a fairly high recurrence rate (50-100%) so that various literature submit therapeutic approach combination for effective management of auricular keloids. Several studies have shown that the combination of surgical resection with radiation or postoperative steroid injection has a low recurrence rate. 3,4 In this case report, we report a 21-year-old male patient who own keloid on area lobe auricle consequence process piercing ear around 2 years earlier. Combination management approach resection surgery with postoperative corticosteroid injection showing good outcomes.

Otitis media effusion (OME) is a buildup of fluid in the middle ear. with membrane timpani Which Still intact without accompanied by with sign signs of infection acute. Otitis media effusion or often too referred to as otitis media Serous effusion will generally heal on its own within two to four weeks, but in some cases, it can last for months, even years. Chronic effusion in the ear often results in hearing loss. 1.3 OME often attacks children aged 1 to 3 years, followed by school age, namely 4 to 6 years. As many as 90% child age 10 year at least Once experience One time OME episodes. Although rare, otitis media with effusion can also affect adults. Cases of otitis media with effusion in adults usually occur after the patient has experienced infection channel breathing on Which heavy like sinusitis, reaction severe allergies, drastic changes in air pressure after flying or diving, or etiology other Which can cause dysfunction tube eustachius. Based on the report WHO regarding epidemiology otitis media, prevalence of otitis media effusion in Indonesia reached 3.8%. 3.4 Otitis media with effusion is clinically characterized by decreased function of the tympanic membrane and middle ear due to accumulation of fluid in the middle ear. The accumulation of fluid in the middle ear can be serous or mucoid and causes conductive hearing loss , ringing in the ears, a feeling of fullness in the ear, and sometimes can cause pain due to changes in pressure. 2,5,6 Diagnosis of Otitis media with effusion can be established through anamnesis and physical examination as well as supporting examinations in the form of audiometry and tympanometry. From the anamnesis, it was found that the main complaint that usually brings patients to come for treatment due to otitis media with effusion is a decrease in function. hearing, a feeling of fullness in ears, and pain due to pressure differences. On inspection with use otoscope, looks color dull tympanic membrane, retraction/sunken tympanic membrane, and decreased mobility of the tympanic membrane. Audiometry examination showed conductive hearing loss with tympanometry type B results . 7,8,9 OME treatment therapy includes observation, medication and surgery. OME patients will generally be observed first for three months from the beginning or since being diagnosed with OME. Surgical therapy is recommended for patients who have experienced persistent OME and do not show improvement with medication or persistent hearing loss. According to the Clinical practice guideline Otolaryngol Head Neck Surgery , it is not recommended to give medication such as antibiotics, decongestants, antihistamines to patients O.M. There is choice other in the form of action surgery on patient OME with installation tube tympanostomy. Installation tube tympanostomy aims to provide ventilation of the middle ear cavity which aims to improve threshold limit hearing Also can lighten up process chronic inflammation that occurs in the mucosa of the middle ear. 10

Object foreign in esophagus is object or food Which stopped in in the esophagus And No can enter to in stomach. Swallowed object foreign occurs frequently in people in Southeast Asia, with the type of foreign object swallowed in adults being swallowed like fish bones which occurred in 60% of all cases, followed by chicken bones 16%. 12 In Indonesia, based on research from January 2014 to December 2016 in the Section ENT-KL General Hospital Prof. Dr. R.D. Kandou Manado incident Esophageal foreign bodies aged 0-10 years around 32.1% of the total 56 cases and aged 51 years and above with an incidence of 19.6% of cases. 22 Swallowing a foreign object in the upper digestive tract is a dangerous situation. Which often happen And influenced by various factor like elderly, patients with behavioral disorders, and those with physical risk factors such as peptic or neoplastic stenosis, esophageal motor disorders. 12 Symptoms of foreign bodies in the esophagus include dysphagia, nausea and vomiting, "feeling food stuck", as well as painful chest or epigastrium. In cases of complete obstruction, patients may experience increased production of water saliva. Inspection support Which can done For foreign bodies such as radiology and esophagoscopy. 6 Complications associated with foreign bodies vary depending on the type. object foreign And his condition. On patient Which on purpose swallow foreign object, level complications reported between 3.6% And 7%, without There is death report related. 12 Perforation mucosa more Possible happen on patient Which

foreign mass in the bronchus is a object or material Good organic and inorganic which in a way physiological No There is in the tract tracheobronchial. Case object foreign tracheobronchial is Wrong One problem Which most occurs frequently in the world and is an emergency that can cause airway obstruction and be life-threatening. According to data from the National Safety Council, tracheobronchial foreign bodies are Wrong One reason most frequent death Which No intentional on children, where choking is the cause of 40% of deaths in children under 3 years of age. 1 The highest incidence occurs in children aged 1 to 3 years and the male to female ratio is 2:1 to 3:1. 2 Object foreign can nature organic And inorganic. Manifestation clinical foreign object tracheobronchial in unit emergency emergency very varies And can causing misdiagnosis or delayed diagnosis. Factors that influence the manifestation clinical between other type, characteristic, size, form, location, And duration foreign objects are in the respiratory tract, as well as the age of the patient. 1 In most cases, aspiration object foreign manifest clinical as cough Which persistent without Phlegm. Thing foreign Which size big can cause disturbance breathing, In some cases, if the foreign object does not completely block the airway, it only causes stridor. 1,2

Rhinosinusitis is defined as inflammation of the nose and paranasal sinuses which can nature I or chronic. Etiology from rhinosinusitis between other infection virus, bacteria, fungi, And disease autoimmune 1 . Sinusitis maxillary dentogenetic or sinusitis odontogenic is bacterial maxillary sinusitis, with or without spread to other paranasal sinuses, which occurs as a result of infection of adjacent teeth or complications from dental procedures 2,3 . Sinusitis maxillary dentogenetic generally happen unilateral, with incident reach 25-75% of all cases of chronic maxillary sinusitis 4,6 . Clinically, the symptoms of dentogenic maxillary sinusitis can resemble the symptoms of other rhinosinusitis. However, late diagnosis and improper treatment can lead to serious complications, namely spread to the orbital or intracranial region 4 . Approximately 4-20% of acute rhinosinusitis can experience complications, of which 60-75% is complications orbit 9 . On sinusitis maxillary dentogenic, complications orbital is the most common (69%) 19 . Orbital complications due to the spread of infection from the paranasal sinuses can be divided into 5 categories based on the Chandler classification system, namely preseptal/periorbital cellulitis, postseptal/orbital cellulitis, subperiosteal abscess, orbital abscess, and cavernous sinus thrombosis. Subperiosteal abscess is an abscess that occurs under the periosteum of the orbital wall 7,8 .

Tonsillitis or inflammation of the tonsils is a common disease and accounts for about 1.3% of outpatient visits. Tonsillitis is mostly caused by by viral infection or bacteria, can cause manifestations such as sore throat in mild cases. Acute tonsillitis is a clinical diagnosis, distinguishing between bacterial and viral causes can be difficult, but it is important For prevent use antibiotics in a way excessive. 1 A studies in Saudi Arabia showed that males suffered more from tonsillitis than females (n = 208, 60% and n = 140, 40%, respectively). The most frequently isolated bacteria were Streptococcus pyogenes beta-hemolytic group A , Staphylococcus aureus, S. aureus Which resistant to methicillin, And Klebsiella pneumoniae (n = 68, 19.5%; n = 24, 6.9%; n = 12, 3.4%; And n = 12, 3.4%, consecutively). 2 Studies on group children, obtained tonsillitis most found in the group age pre teenager (6-12 year) that is 69% followed group teenager (13-18 years) 18%, children (4-5 years) 17%. Tonsillitis distribution is more in male patients (58%) than female patients (42%). Culture and sensitivity results showed that the dominant bacteria found were β-hemolytic Streptococci (51.4%), followed by coagulase positive Staphylococci (12.5%) and Pneumococci (9.7%) and only one case of Corynebacterium diphtheria was found . 3

Sudden sensorineural deafness is often also called sudden deafness or sudden sensorineural hearing loss, which is a type of sensorineural hearing loss. on one or second ear Which taking place in fast in period 72 O'clock in the form of decline hearing more from 30 dB at least at 3 frequencies in sequence with audiometric examination. 1 Sudden sensorineural hearing loss is found in 5-20 per 100,000 people in the United States, with an increase of about 4000 cases per year. Most causes of sudden sensorineural hearing loss are idiopathic (90%) and other causes are neoplastic, infectious, autoimmune, neurologic, and ototoxic. Bacterial meningitis acute is one of the most common etiologies Lost of deaf sensorineural sudden on person mature with The most common causative germ is Streptococcus pneumoniae . Other causative bacteria are Streptococcus suis which are at higher risk of infecting individuals who often consume raw processed foods or raw meat cutters who do not use personal protective equipment while working, making them susceptible to contamination with infections by S.suis has been widely reported throughout the world, especially in the Asian continent, such as: China, Thailand, Vietnam and Japan. In recent years, Indonesia has contributed meningitis suis case, especially in Island Bali. Island Bali Which dominated by Hindu residents, they have a passion for eating meat pig in various processed cuisine, not except Red lawar is a mixture of vegetables and raw pig blood. Traditional cooking menu lawar red has known since legacy culinary sect Bairawa who successfully influenced the Hindu Shiva Sidhanta ideology in Bali. 17 although thus, case meningitis due to consumption lawar New red spots have been widely reported in recent years. Based on patient medical records at the ENT - KL Polyclinic, Prof. Ngoerah General Hospital In the period 2014-2017, it was found that 71 cases of meningitis were treated and 44 cases were found to contain S.suis as the bacteria that causes meningitis. Hearing loss in meningitis is thought to occur due to direct damage to the auditory nerve. However, other studies suggest that it is due to inflammation of the cochlea causing fibrosis and ossification cochlea. As many as 50 % sufferer deaf sensorineural suddenly experience decline hearing with degree of deafness moderate to severe and permanent. The recovery rate in patients who do not receive early treatment is 28% – 65% Therefore, it is important to recognize and detect this disorder early in order to support the recovery of hearing function and improve the patient's quality of life. 4,5

Carcinoma of the nose and paranasal sinuses or also called sinonasal carcinoma is tumor malignant Which there is in the cavity rice And sine paranasal. The nasal cavity and paranasal sinuses are cavities that are bounded by the bones face Which is area Which protected so that tumor Which arising in this area is difficult to detect early. The origin of the primary tumor is also difficult to determine, whether from the nose or sinus because usually patients seek treatment when the disease has reached an advanced stage and the tumor has filled the nasal cavity. And all over sine. Most carcinoma sinonasal develop from maxillary sinus and the most common histopathological type found is squamous cell carcinoma. 1-6