• Archives of Craniofacial Surgery
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• v.20 no.4
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• pp.274-278
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• 2019

Orbital tuberculosis is a rare form of extrapulmonary tuberculosis, even in endemic areas. It may involve the soft tissue, lacrimal gland, periosteum, or bones of the orbital wall. We present a case of orbital tuberculosis on the lower eyelid. An 18-year-old woman with no underlying disease visited our clinic for evaluation of an oval nodule ($1.5{\times}1.2cm$) on the right lower eyelid. Incision and drainage without biopsy was performed 2 months ago in ophthalmology department, but the periorbital mass had deteriorated, as the patient had erythematous swelling, tenderness, and cervical lymphadenopathy. Visual acuity was normal; there were no signs of proptosis, diplopia, or ophthalmoplegia. Computed tomography revealed a small abscess cavity without bony involvement. We performed an excision and biopsy through a percutaneous incision under local anesthesia. Histological examination revealed a granuloma and was diagnosed as orbital tuberculosis. The patient was additionally treated with anti-tuberculosis therapy for 6 months and recovered without complication or recurrence by 7 months. Orbital tuberculosis occurs in patients with or without associated pulmonary tuberculosis, and should be considered as a differential diagnosis in patients with inflammatory orbital disease and an orbital mass. If recurrence occurs despite adequate initial treatment, we recommend an additional examination and excisional biopsy.

• Journal of the Korean Association of Oral and Maxillofacial Surgeons
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• v.45 no.3
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• pp.152-157
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• 2019

Objectives: The number of elderly patients with systemic basal disease requiring invasive dental treatment has increased. Appropriate prediction of surgical invasiveness and combined use of psychosedation are thought to contribute to safe whole-body management. Dexmedetomidine (DEX) exhibits analgesic and anti-anxiolytic properties and causes mild respiratory depression. Studies regarding DEX use in elderly non-intubated patients are scarce. We aimed to use retrospective data to determine an effective dose of DEX to induce adequate sedation in elderly patients undergoing invasive dental surgery under local anesthesia. Materials and Methods: One hundred two patients aged 70 to 96 years were presumably appropriately controlled with sedation. DEX was administered at an initial loading dose of 2.0 to $3.1{\mu}g/kg/hr$ for 10 minutes. We divided the patients into five groups by age and compared their blood pressures and heart rates. Results: In all five groups, blood pressure decreased suddenly at approximately 15 and 20 minutes after DEX administration. A marked decrease in blood pressure was noted in patients aged 75 to 79 years. Conclusion: For elderly patients aged 75 years and above, the initial loading dose of DEX needs to be reduced to lower than half that required for young and middle-age adults.

• Archives of Craniofacial Surgery
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• v.22 no.1
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• pp.52-55
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• 2021

Complete surgical excision within a margin of normal healthy bone is the treatment of choice for intraosseous hemangioma. A 56-year-old man visited with complaints of a firm, mildly tender, immovable, and palpable mass on the right forehead (size: 1.5×1.5 cm). Non-contrast brain computed tomography performed preoperatively revealed a 1.5 cm heterogenous osteolytic lesion with suspected internal trabeculation in the right frontal bone. Under general anesthesia, a 2 cm transverse incision was made on the forehead skin rather than bicoronal incision. Full-thickness en bloc resection of the frontal bone including the mass was performed. The frontal bone was removed with care taken not to damage the frontal sinus mucosa. The frontal sinus was sealed with a collagen patch (Tachocomb) and a cranioplasty was performed using bone cement. At 6 months postoperative, a clean wound was confirmed without any complications, and there was no local recurrence. Surgical excision of intraosseous hemangioma in the frontal sinus bone can be performed via direct incision or the bicoronal approach. In this case, the direct incision approach was used to achieve smaller scars and faster recovery than the bicoronal approach.

• Journal of the Korean Association of Oral and Maxillofacial Surgeons
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• v.48 no.2
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• pp.125-129
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• 2022

Sialolithiasis is a condition in which the salivary gland excretory duct is obstructed due to the formation of calcareous deposits and is uncommon in children compared to adults. The treatment modalities range from a conservative approach involving hydration to a surgical approach. Though several studies have analyzed the sialolith micromorphology structures, studies on pediatric sialoliths remain scarce. This brief communication aims to describe the sialolith micromorphology to understand the mechanism of mineralization and growth of pediatric sialoliths. A 6-year-old Korean female presented with swelling under her tongue. The intraoral examination revealed a painless yellowish hard mass beneath the tongue near the Wharton's duct which was suspected as a sialolith. After receiving the informed consent, the sialolithotomy was performed under local anesthesia. The obtained stone was analyzed through histopathology and transmission electron microscope examinations to understand the mechanism of mineralization and growth of pediatric sialolith. The micromorphology and growth processes of pediatric sialolith remain undescribed. More comprehensive microscopic studies are needed regarding their distinctive characteristics. By expanding knowledge about sialoliths micromorphology, development of new preventive, diagnostic and patient-tailored treatment methods of pediatric sialolithiasis will be enhanced.

• Archives of Craniofacial Surgery
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• v.22 no.4
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• pp.199-203
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• 2021

Primary cutaneous CD4+ small/medium T-cell lymphoproliferative disorder is a rare disease characterized by a single mass on the face or upper part of the trunk. It usually presents an asymptomatic and favorable progression, and its histopathologic findings include small and medium-sized lymphoid cells. The authors report a case of primary cutaneous CD4+ small/medium T-cell lymphoproliferative disorder on the forehead. A 51-year-old man presented with a protruding mass on his forehead that the patient had noted 1 month previously. Surgical excision and a permanent biopsy were performed under local anesthesia. Based on the biopsy results, the mass was diagnosed as a primary cutaneous CD4+ small/medium T-cell lymphoproliferative disorder. There was no evidence of recurrence at a 15-month follow-up visit.

• Journal of Trauma and Injury
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• v.35 no.4
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• pp.282-286
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• 2022

Complete cricotracheal separation, which is the most severe type of laryngeal trauma, is an uncommonly seen injury that clinicians have limited experience in managing. However, it is potentially fatal. Due to limited exposure to this condition, mismanagement can occur, which may further aggravate the patient's condition. The most crucial part of managing this injury is to establish a secure airway. Tracheostomy under local anesthesia is the preferred method of airway stabilization, in order to avoid further injuries to the airway caused by endotracheal intubation. Here, we discuss the management of complete cricotracheal separation based on a case experienced in the east coast region of Malaysia, where this type of injury is rarely encountered.

• Medical Lasers
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• v.8 no.1
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• pp.35-38
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• 2019

Thread-lifting is a minimally invasive procedure that shows good results and fewer complications as compared with those results and complications of standard surgery. Many procedures and techniques have been developed to create a younger appearance of facial/neck skin for aging people, and the demand for an improved aesthetic appearance is increasing. Since the incidence of side effects is much less than that of non-absorbable threads, which can lead to complications such as foreign body reactions, polydioxanone (PDO) threads are predominantly used for face lift procedures. A 66-year-old woman presented to our clinic with inflamed palpable masses. She had undergone a face lift with absorbable threads in our clinic 5 months previously. Excisional biopsy was performed with the patient under local anesthesia. During the operation, any threads were not detected and there was both fibrotic scar tissue and granulomatous tissue. For effectively promoting healing and managing the scars, treatment with LDM^®-MED was performed on the day after surgery. The treatment was performed according to the author's protocol. Although foreign body granuloma as a complication after using non-absorbable thread types have been previously reported, it is relatively rare to find this type of complication after using absorbable thread. In this report, we present a case in which a 66-year-old female with foreign body granuloma after undergoing a face lift using absorbable threads was treated with the application of dual-frequency ultrasound, which promoted wound healing.

• Journal of the korean academy of Pediatric Dentistry
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• v.51 no.2
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• pp.109-131
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• 2024

This review aims to examine safety concerns in pediatric dental care and underscore the need for comprehensive patient safety initiatives within the Korean Academy of Pediatric Dentistry. Drawing insights from the prevailing patient safety policies of the American Academy of Pediatric Dentistry, case reports, and systematic reviews, this review elucidates issues such as dental fires during sedation, ocular complications from local anesthesia, and surgical emphysema. This review highlights the significance of safety toolkits encompassing infection control, medical error reduction, dental unit waterline infection, and nitrous oxide safety in pediatric dental settings, underscoring the need to foster a safety culture. Furthermore, this study explores the curriculum for pediatric dentistry residency programs, emphasizing concepts such as high-reliability organizations and mortality and morbidity conferences. The study suggests the need for initiatives to enhance patient safety, including establishing safety committees, expanding reporting systems, policy development, and supporting research related to patient safety. In conclusion, this study underlines key messages, emphasizing the utmost priority of patient safety, acknowledging the inevitability of human error, promoting effective communication, and cultivating a patient safety culture. These principles are vital for advancing patient safety in pediatric dental care and improving outcomes among pediatric patients.

• Journal of the Korean Society of Radiology
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• v.85 no.5
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• pp.981-985
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• 2024

We present a case of iatrogenic iliac vein rupture with venous thrombosis during total hip arthroplasty that was endovascularly treated with the insertion of covered and uncovered stents, aspiration, and balloon maceration of the thrombus. We describe in detail, with a schematic diagram, an endovascular treatment method that can be performed under local anesthesia alone and explain how to overcome the situation when the diameter of the covered stent is inadequate to cover the iliac vein.

• Journal of Dental Anesthesia and Pain Medicine
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• v.15 no.3
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• pp.121-128
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• 2015

Background: The authors studied the hemodynamic effect influent by using the novel high concentration of lidocaine HCl for surgical removal impacted lower third molar. The objective of this study was to evaluate the hemodynamic change when using different concentrations of lidocaine in impacted lower third molar surgery. Methods: Split mouth single blind study comprising 31 healthy patients with a mean age of 23 years (range 19-33 years). Subjects had symmetrically impacted lower third molars as observed on panoramic radiograph. Each participant required 2 surgical interventions by the same surgeon with a 3-week washout period washout period. The participants were alternately assigned one of two types of local anesthetic (left or right) for the first surgery, then the other type of anesthetic for the second surgery. One solution was 4% lidocaine with 1:100,000 epinephrine and the other was 2% lidocaine with 1:100,000 epinephrine. A standard IANB with 1.8 ml volume was used. Any requirement for additional anesthetic and patient pain intra-operation was recorded. Post-operatively, patient was instructed to fill in the patient report form for any adverse effect and local anesthetic preference in terms of intra-operative pain. This form was collected at the seven day follow up appointment. Results: In the 4% lidocaine group, the heart rate increased during the first minute post-injection (P < 0.05). However, there was no significant change in arterial blood pressure during the operation. In the 2% lidocaine group, there was a significant increase in arterial blood pressure and heart rate in the first minute following injection for every procedure. When the hemodynamic changes in each group were compared, the 4% lidocaine group had significantly lower arterial blood pressure compared to the 2% lidocaine group following injection. Post-operatively, no adverse effects were observed by the operator and patient in either local anesthetic group. Patients reported less pain intra-operation in the 4% lidocaine group compared with the 2% lidocaine group (P < .05). Conclusions: Our results suggest that a 4% concentration of lidocaine HCl with 1:100,000 epinephrine has better clinical efficacy than 2% lidocaine HCl with 1:100,000 epinephrine when used for surgical extraction of lower third molars. Neither drug had any clinical adverse effects.