DOI QR코드

DOI QR Code

치근 절제술의 합병증으로 오인 가능한 재발성 구내 헤르페스

Recurrent Herpetic Stomatitis Mimicking Post-Root Resection Complication

  • 홍성옥 (원광대학교 치과대학 치과보존학교실) ;
  • 이재관 (강릉원주대학교 치과대학 치주과학교실) ;
  • 장훈상 (전남대학교 치의학전문대학원 치과보존학교실)
  • Hong, Sung-Ok (Department of Conservative Dentistry, College of Dentistry, Wonkwang University) ;
  • Lee, Jae-Kwan (Department of Conservative Dentistry, School of Dentistry, Gangneung-Wonju National University) ;
  • Chang, Hoon-Sang (Department of Conservative Dentistry and Dental Science Research Institute, School of Dentistry, Chonnam National University)
  • 투고 : 2013.09.21
  • 심사 : 2013.10.25
  • 발행 : 2013.12.31

초록

본 증례에서는 치근 절제술의 합병증으로 오인할 수 있는 재발성 구내 헤르페스에 대해 보고하고자 한다. 49세 남환이 상악 좌측 제1대구치의 근심협측 치근의 수직파절로 근관치료 후 근심협측 치근절제술을 시행하였다. 19개월 후 환자는 뜨거운 고기를 씹은 후에 좌측 구개부가 헐고 불편하다는 주소로 재내원하였다. 구강 내 검사 시 상악 좌측 제1대구치의 구개측 치은에 농루로 의심되는 융기부위가 관찰되었다. 임상 검사에서 치아는 치주탐침 시 출혈을 보였고 5 mm 이하의 치주낭이 관찰되었으나 치아동요도는 없었다. 방사선 검사에서 구개측 치근에 치주인대강 비후의 소견을 보였다. 농루로 의심되는 부위에 gutta percha cone을 이용한 농루 추적을 시도하였으나 삽입되지 않았다. 시야를 넓혀 구개 전방부를 관찰하였을 때 작은 원형의 궤양이 다수 관찰되었고 환자는 동통을 호소하였다. 이상의 소견으로 비치성 동통으로 판단하여 구강내과에 의뢰하였고 구강내과에서 재발성 구내 헤르페스로 진단하여 항바이러스제 처방 후 환자의 통증 및 구개측 치은의 궤양이 소실되었다.

This case report describes about recurrent herpetic stomatitis mimicking post-root resection complication. A 49 year-old male patient was diagnosed vertical root fracture of the mesiobuccal root of his left maxillary first molar (#26). The mesiobuccal root was resected following root canal treatment of the same tooth. 19 months later, the patient presented with pain on left hard palate after a barbecue party. Intra oral examination revealed a gum boil-like blister at the hard palate corresponding to the apex of the palatal root of #26. On clinical examination, there was bleeding on probing and the periodontal pocket depth was measured less than 5 mm with no tooth mobility. On a periapical radiograph, periodontal ligament space widening was observed. Tracing the sinus tract with gutta percha cone was attempted, however, it was impossible. Extending the field of vision, small multiple round ulcerations were observed at the palate front which caused pain to the patient. Therefore, the pain was considered a non odontogenic and the patient was referred to the department of oral medicine. The patient was diagnosed recurrent herpetic stomatitis and after 3 days of antiviral medication, the pain and ulceration were subsided.

키워드

참고문헌

  1. Whitley RJ, Roizman B. Herpes simplex virus infections. Lancet 2001;357:1513-1518. https://doi.org/10.1016/S0140-6736(00)04638-9
  2. Grunewald K, Desai P, Winkler DC, et al. Threedimensional structure of herpes simplex virus from cryo-electron tomography. Science 2003;302:1396-1398. https://doi.org/10.1126/science.1090284
  3. Arduino PG, Porter SR. Herpes Simplex Virus Type 1 infection: overview on relevant clinicopathological features. J Oral Pathol Med 2008;37:107-121.
  4. Stock C, Guillen-Grima F, de Mendoza JH, et al. Risk factors of herpes simplex type 1 (HSV-1) infection and lifestyle factors associated with HSV-1 manifestations. Eur J Epidemiol 2001;17:885-890. https://doi.org/10.1023/A:1015652713971
  5. Miller CS, Danaher RJ, Jacob RJ. Molecular aspects of herpes simplex virus I latency, reactivation, and recurrence. Crit Rev Oral Biol Med 1998;9:541-562. https://doi.org/10.1177/10454411980090040901
  6. Lafferty WE. The changing epidemiology of HSV-1 and HSV-2 and implications for serological testing. Herpes 2002;9:51-55.
  7. Esmann J. The many challenges of facial herpes simplex virus infection. J Antimicrob Chemother 2001;47 Suppl T1:17-27.
  8. Corey L, Spear PG. Infections with herpes simplex viruses (1). N Engl J Med 1986;314:686-691. https://doi.org/10.1056/NEJM198603133141105
  9. Huber MA. Herpes simplex type-1 virus infection. Quintessence Int 2003;34:453-467.
  10. Chauvin PJ, Ajar AH. Acute herpetic gingivostomatitis in adults: a review of 13 cases, including diagnosis and management. J Can Dent Assoc 2002;68:247-251.
  11. Arduino PG, Porter SR. Oral and perioral herpes simplex virus type 1 (HSV-1) infection: review of its management. Oral Dis 2006;12:254-270. https://doi.org/10.1111/j.1601-0825.2006.01202.x
  12. Eisen D. The clinical characteristics of intraoral herpes simplex virus infection in 52 immunocompetent patients. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 1998;86:432-437. https://doi.org/10.1016/S1079-2104(98)90369-9
  13. Amir J, Harel L, Smetana Z, Varsano I. The natural history of primary herpes simplex type 1 gingivostomatitis in children. Pediatr Dermatol 1999;16:259-263. https://doi.org/10.1046/j.1525-1470.1999.00072.x
  14. Scully C. Orofacial herpes simplex virus infections: current concepts in the epidemiology, pathogenesis, and treatment, and disorders in which the virus may be implicated. Oral Surg Oral Med Oral Pathol 1989;68:701-710. https://doi.org/10.1016/0030-4220(89)90159-X
  15. Siegel MA. Diagnosis and management of recurrent herpes simplex infections. J Am Dent Assoc 2002; 133:1245-1249. https://doi.org/10.14219/jada.archive.2002.0366
  16. Baumgartner JC, Picket AB, Muller JT. Microscopic examination of oral sinus tracts and their associated periapical lesions. J Endod 1984;10:146-152. https://doi.org/10.1016/S0099-2399(84)80117-X
  17. Cohen S, Liewehr F, Diagnostic procedures. In: Cohen S, Burns RC, Pathways of the pulp. St. Louis: Mosby; 2002:3-30.
  18. Scott DA, Coulter WA, Biagioni PA, et al. Detection of herpes simplex virus type 1 shedding in the oral cavity by polymerase chain reaction and enzymelinked immunosorbent assay at the prodromal stage of recrudescent herpes labialis. J Oral Pathol Med 1997;26:305-309. https://doi.org/10.1111/j.1600-0714.1997.tb00220.x
  19. Scott D, Moore S, Ide M, et al. Recrudescent herpes labialis during and prior to early pregnancy. Int J Gynaecol Obstet 2003;80:263-269. https://doi.org/10.1016/S0020-7292(02)00310-7
  20. Lee S-S, Lee S-K. Herpes infection. J Korean Dent Assoc 2010;48:365-370.
  21. Yang S-H, Jung D-H, Lee H-D, et al. Clinical diagnosis of herpes zoster presenting as odontogenic pain. J Korean Acad Conserv Dent 2008;33:452-456. https://doi.org/10.5395/JKACD.2008.33.5.452
  22. Mintz GA, Rose SL. Diagnosis of oral herpes simplex virus infections: practical aspects of viral culture. Oral Surg Oral Med Oral Pathol 1984;58: 486-492. https://doi.org/10.1016/0030-4220(84)90349-9