• Proceedings of the KOR-BRONCHOESO Conference
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• 1983.05a
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• pp.5.4-6
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• 1983

A tracheostomy is performed to relieve an upper airway obstruction, to facilitate bronchial toilet, to decrease dead space, to assist ventilation and as an elective procedure in head and neck surgery. Many complications are associated with tracheostomy, both in the actual performance of the operation and in the postoperative management. Recently the authors report one case ; a two years old children got a severe burn on face and neck and received tracheostomy and have carried tracheostomy cannula for 10 years, at last the cannula was worn out and the 12 years old boy came to the hospital.

• Journal of Oral Medicine and Pain
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• v.46 no.4
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• pp.150-154
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• 2021

Deep neck infection (DNI) is a potentially serious pathology that can lead to serious complications and high rate of mortality. Since DNI affects the cervical spaces, which can compromise airway, aggressive antibiotic administration and prompt surgical drainage are essential for recovery. Although most causes of DNI are known to be dental infections, developmental cysts such as dentigerous cysts are relatively few causes. In this case, we report a rare patient with severe deep neck space infection caused by infected third molar with dentigerous cyst.

• The korean journal of orthodontics
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• v.54 no.1
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• pp.69-73
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• 2024

Since its inception in Europe in the 1950s, alveolar molding treatment for neonates with complete cleft lip and palate has undergone significant evolution in both design and application methodology, demonstrating effectiveness in normalizing the alveolar cleft and nasal shape. However, excessively wide alveolar clefts accompanied by disproportionately wide total maxillary arch pose significant challenges when utilizing conventional alveolar molding methods involving cyclical adding and grinding of acrylic on molding plates. The current report introduces a novel alveolar molding method named Biocreative Alveolar Molding Plate Treatment (BioAMP), which can normalize the maxillary alveolar cleft and arch shape without laborious conventional acrylic procedures. BioAMP sets the target arch form and provides unrestricted space for natural growth of the maxillary alveolar bones while systematically reducing the total maxillary arch width in precise increments. Two exemplary cases are presented as proof-of-concept, showcasing the clinical innovation of BioAMP.

• Maxillofacial Plastic and Reconstructive Surgery
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• v.22 no.4
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• pp.420-429
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• 2000

Oral & maxillofacial infections are most commonly odontogenic in origin. Although such infections are usually self-limiting, they may occasionally spread deeply into fascial spaces or planes far from the initial site of involvement. If early diagnosis and appropriate therapy is delayed, complications such as mediastinal extension, retropharyngeal spread and airway obstruction could happen to the patients. For the study of the microbiology, we have retrospectively analysed the oral & maxillofacial infected patients in the Dept. of Oral & Maxillofacial Surgery. In-Ha University Hospital from 1997 September to 2000 April. The results were as follows 1. The male patients were more common than female, with male 61.9% and female 38.1%. 2. Dental originated infections were most common cause with the incidence of 62%. 3. Most common fascial space involved was buccal space 42cases(37.2%) followed by submandibular space 13cases(11.5%), infraorbital space 13cases(11.5%), masseteric space 11cases(9.7%), periapical abscess 11cases(9.7%). 4. The causative organisms isolated from the pus culture were Gram Positive Bacterial species, which were 46cases(31.9%) of Streptococcus viridans, 16cases(8.6%) of ${\alpha}$ and ${\beta}-hemolytic$ streptococcus, 4cases(3.1%) of Strep.-group D non enterococci, 7cases(5.1%) of Staphylococcus Coa. neg., 5cases(3.9%) of Staphylococcus aureus, 3cases(2.3%) of Enterococcus faecalis, 1case(0.8%) of Bacillus species, 1case(0.8%) of Peptostreptococcus, 1case(0.8%) of Clostridium and Gram negative bacterial species, which were 4cases(3.1%) of Acinetobacter baumannii, 2cases(1.6%) of Pseudomonas aeruginosa, 2cases(1.6%) of Burkholderia cepacia, 1case(0.8%) of Neisseria species, 1case(0.8%) of Klebsiella pneumoniae, 1case(0.8%) of Klebsiella oxytoca, 1case(0.8%) of Escherichia coli. 5. In drug sensitivity test, high resistant tendency was found in Penicillin system(Penicillin G 83.3%, Ampicillin 60%) and Aminoglycosides (Gentamycin 50%, Tobramycin 45.5%), but tertiary Cephalosporin system(Cefoperazone 9.1%, Ceftazidime 18.2%), and glycopeptides system (Teicoplanin 0%, Vancomycin 0%) showed lower resistancy.

• Tuberculosis and Respiratory Diseases
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• v.45 no.1
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• pp.169-175
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• 1998

Background: Heliox is known to decrease $PaCO_2$ in patients with increased airway resistance by increasing minute ventilation and reducing work of breathing(WOB). Besides these effect, heliox is expected to decrease functional anatomic dead space owing to improvement of peak expiratory flow rate(PEFR) and enhancement of gas distribution. We investigated whether heliox can decrease $PaCO_2$ even at the same minute ventilation (VE) and WOB with $N_2-O_2$ to speculate the effect of the heliox on the anatomic dead space. Material and Method: The subjects were 8 mechanically ventilated patients with asthma or upper airway obstruction(M : F=5 : 3, $68{\pm}10$years) who were under neuromuscular paralysis. The study was consisted of three 15-minutes phases: basal $N_2-O_2$ heliox and washout Heliox was administered via the low pressure inlet of servo 900C, and respiratory parameters were measured by pulmonary monitor(CP-100 pulmonary monitor, Bicore, Irvine, CA, USA). To obtain the same tidal volume(Vt) in heliox phase, the Vt on monitor was adjusted by the factor of relative flow rate of heliox to $N_2-O_2$. Dead space was calculated by Bohr equation. Results: 1) Vt, VE, peak inspiratory pressure(PIP) and peak inspiratory flow rate(PIFR) were not different between $N_2-O_2$ and heliox. 2) PEFR was higher on heliox($0.52{\pm}0.19$L/sec) than $N_2-O_2$($0.44{\pm}0.13$L/sec)(p=0.024). 3) $PaCO_2$(mmHg) were decreased with heliox($56.1{\pm}14.1$) compared to $N_2-O_2$($60.5{\pm}15.9$)(p=0.027). 4) Dead space ventilation(%) were decreased with heliox($73{\pm}9$ with $N_2-O_2$ and $71{\pm}10$ with heliox)(p=0.026). Conclusion: Heliox decreased $PaCO_2$ even at the same VE and WOB with $N_2-O_2$, and the effect was considered to be related with the reduction of anatomic dead space.

• Archives of Reconstructive Microsurgery
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• v.8 no.1
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• pp.71-76
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• 1999

Until recently, the cranial base tumors were deemed unresectable due to the inability to diagnose the extent of the involvement accurately and to approach and excise the tumor safely. With refinements in CT and NMR scanning and development of craniofacial techniques, reconstruction becomes absolutely crucial in allowing successful resection of these tumors. Resection of these tumors may sometimes result in massive and complex extirpation defects that are not amendable to local tissue closure. In such cases, the free tissue transfer was a useful alternative because it can provide large amount of well-vascularized tissues and reliable separation of intracranial space from bacterial flora of the upper airway. The microvascular free tissue transfer was used in 9 patients at our center to reconstruct the cranial base defects. Of these, 8 were free rectus muscle flaps, and 1 was free latissimua dorsi muscle flap. There were 1 case of partial flap loss and 1 case of postoperative wound infection. The large, complex defects were successfully reconstructed by one stage operation and the functional and aesthetic results were satisfactory with acceptable complication rates.

• Journal of the Korean Society of Laryngology, Phoniatrics and Logopedics
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• v.27 no.1
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• pp.54-57
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• 2016

Percutaneous dilatational tracheostomy (PDT) has become an increasingly popular method of establishing an airway for patients in need of chronic ventilator assistance. We report a rare case of a 42-year-old female who developed extensive subcutaneous emphysema, bilateral pneumothoraces, pneumomediastinum, and pneumoperitoneum after percutaneous dilatational tracheostomy. The patient suffered from amyotrophic lateral sclerosis, and underwent PDT after a period of mechanical ventilation. During PDT, tracheostomy tube was inserted into the paratracheal space. Follow-up chest radiography and computed tomography of chest and abdomen revealed extensive subcutaneous emphysema, bilateral pneumothoraces, pneumomediastinum, and pneumoperitoneum. The patient was treated successfully with insertion of the thoracostomy tube and conservative care.

• Journal of Korean Neurosurgical Society
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• v.58 no.3
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• pp.304-307
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• 2015

Only a few cases of anterior longitudinal ligament (ALL) injury related with retropharyngeal hematoma without fracture have previously been reported. The treatment of choice for retropharyngeal hematoma is generally considered to be conservative care, but we believe that early surgery of this pathology would be better in certain situations. Here, we describe two cases with life-threatening large retropharyngeal hematomas related with ALL injuries and operated on at an early stage. Two previously healthy patients visited the emergency room with neck pain and dyspnea after falling. Serious neck swelling was observed and lateral neck X-ray showed severe widening of the prevertebral space. Due to dyspnea progression, emergency endotracheal intubation was performed. Although there was no primary cause of the retropharyngeal hematoma on preoperative examination, ALL tearing was intraoperatively confirmed during early surgery. The in-hospital evolutions of the patients were favorable after surgery. We should bear in mind the possibility of ALL injury and perform early surgery where possible given the earlier convalescence and good prognosis.

• Archives of Craniofacial Surgery
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• v.10 no.1
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• pp.40-43
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• 2009

Purpose: Extensive midface defect following total maxillectomy with orbital exenteration and cheek skin resection should be three dimensionally reconstructed with a large flap that have a sufficient volume of tissue and multiple skin islands. We describe our transverse rectus abdominis myocutaneous(TRAM) free flap with three skin islands which was successfully used in this situation. Methods: A 58-year-old man was performed enbloc total maxillectomy including orbital contents and wide cheek skin because of invasive maxillary squamous cell carcinoma. He was immediately reconstructed with TRAM flap that was designed not vertical but transverse fashion for providing sufficient skin area. Also, deepithelialization procedure making for multiple skin islands was done in flap insetting period when appropriate modification according to the intraoperative situation was possible. Dead space was completely obliterated by bulky muscular tissue, and three skin islands were used for lining of lateral nasal wall, palatal surface, and cheek skin restoration. Results: Postoperative course was satisfying. Maintaining of proper ipsilateral nasal airway, loss of rhinolalia and oronasal regurgitation of food particles, and restoration of cheek contour were successfully obtained. Conclusion: We report clinical experience of threedimensional reconstruction using free TRAM flap after total maxillectomy with orbital exenteration.

• Clinical and Experimental Pediatrics
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• v.53 no.10
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• pp.872-879
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• 2010

Obstructive sleep apnea (OSA) in children is a frequent disease for which optimal diagnostic methods are still being defined. Treatment of OSA in children should include providing space, improving craniofacial growth, resolving all symptoms, and preventing the development of the disease in the adult years. Adenotonsillectomy (T&A) has been the treatment of choice and thought to solve young patient's OSA problem, which is not the case for most adults. Recent reports showed success rates that vary from 27.2% to 82.9%. Children snoring regularly generally have a narrow maxilla compared to children who do not snore. The impairment of nasal breathing with increased nasal resistance has a well-documented negative impact on early childhood maxilla-mandibular development, making the upper airway smaller and might lead to adult OSA. Surgery in young children should be performed as early as possible to prevent the resulting morphologic changes and neurobehavioral, cardiovascular, endocrine, and metabolic complications. Close postoperative follow-up to monitor for residual disease is equally important. As the proportion of obese children has been increasing recently, parents should be informed about the weight gain after T&A. Multidisciplinary evaluation of the anatomic abnormalities in children with OSA leads to better overall treatment outcome.