• Journal of Dental Anesthesia and Pain Medicine
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• v.17 no.4
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• pp.271-280
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• 2017

Background: The number of patients with Alzheimer's disease is growing worldwide, and the proportion of patients requiring dental treatment under general anesthesia increases with increasing severity of the disease. However, outpatient anesthesia management for these patients involves great risks, as most patients with Alzheimer's disease are old and may show reduced cardiopulmonary functions and have cognitive disorders. Methods: This study retrospectively investigated 43 patients with Alzheimer's disease who received outpatient anesthesia for dental treatment between 2012-2017. Pre-anesthesia patient evaluation, dental treatment details, anesthetics dose, blood pressure, duration and procedure of anesthesia, and post-recovery management were analyzed and compared between patients who underwent general anesthesia or intravenous sedation. Results: Mean age of patients was about 70 years; mean duration of Alzheimer's disease since diagnosis was 6.3 years. Severity was assessed using the global deterioration scale; 62.8% of patients were in level ${\geq}6$. Mean duration of anesthesia was 178 minutes for general anesthesia and 85 minutes for intravenous sedation. Mean recovery time was 65 minutes. Eleven patients underwent intravenous sedation using propofol, and 22/32 cases involved total intravenous anesthesia using propofol and remifentanil. Anesthesia was maintained with desflurane for other patients. While maintaining anesthesia, inotropic and atropine were used for eight and four patients, respectively. No patient developed postoperative delirium. All patients were discharged without complications. Conclusion: With appropriate anesthetic management, outpatient anesthesia was successfully performed without complications for dental treatment for patients with severe Alzheimer's disease.

• Journal of the Korean Association of Oral and Maxillofacial Surgeons
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• v.48 no.5
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• pp.292-296
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• 2022

Objectives: During Le Fort I osteotomy, the separation of the pterygomaxillary junction (PMJ) is a difficult procedure for most surgeons because it is invisible. In this process, damage to the posterior structures constituting the sinus or those adjacent to it, including the maxillary sinus posterior wall and pterygoid plate, may occur. We would like to investigate the effects of this on the inside of the maxillary sinus after surgery and whether there are complications. Materials and Methods: One-hundred patients who underwent Le Fort I osteotomy from 2013 to 2020 using cone-beam computed tomography images were classified into two groups (clean-cut type and fractured type) according to the PMJ cutting pattern. In addition, the mucosal thickness in the maxillary sinus was divided into preoperative, postoperative three months, one year, and the change over the course of surgery was evaluated retrospectively. Results: Of the total 100 cases, the clean-cut type numbered 28 cases and the fractured type totaled 72 cases. Among the fracture types, part of the sinus wall and the pterygoid plate were broken in 69 cases, and the maxillary sinus posterior wall was detached in three cases. There was no statistically significant difference in sinus mucosal thickening between the clean-cut type and fractured type of the PMJ, three months and one year after surgery between the two groups. However, there was a significant difference in sinus mucosal thickness at postoperative one year in the case where a partial detachment of the maxillary sinus posterior wall occurred compared to not. Conclusion: Even if there is some damage to the structures behind the PMJ, it may not be reasonable to spend some time on the PMJ separation process considering the overall postoperative complications, if there is no significant difference inside the sinus, or increased probability of postoperative complications.

• The Journal of the Korean dental association
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• v.54 no.6
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• pp.457-467
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• 2016

The National Health Insurance Service(NHIS) has been selectively covering the elderly on the dental implant and removable denture treatment and gradually expanding the eligibility criteria. Every dentist needs to have a good understanding of the insurance policy to provide qualified dental service to the beneficiaries and to avoid confusions and complications. In order to help dentists understand the NHIS requirements, the definitions, categories, and procedures of dental implant and conventional denture treatment are suggested.

• Journal of the korean academy of Pediatric Dentistry
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• v.36 no.4
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• pp.607-612
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• 2009

The malignant tumor in childhood is one of the main causes of children s death due to disease. The traditional treatment for the malignancy is known for the radiation therapy and the chemical therapy or both. However, the treatments tend to induce intraoral complications. Different from adults, almost all children on cancer therapy are expected to have dental complications, because their permanent teeth are on the developmental stage. The degree of dental complication depends on the patient's age, type of chemical and other factors-radiation dose and frequency. In this report, 3 children who had experienced the anti-cancer therapy on their age between 1 and 4 years were selected and dental complications were examined. The children have chance for the various oral complications including the developmental problems such as agenesis, microdontia and hypoplasia of the teeth. Therefore, it's important to understand the side-effects of anticancer therapy during the permanent teeth had been developmental stage in young patients. Also, oral health care specialists, including pediatric and hospital dentist can support the oncology team by providing basic oral care, implementing oral care protocols, delivering emergency dental treatment undergoing anticancer treatment.

• Journal of The Korean Dental Society of Anesthesiology
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• v.4 no.2 s.7
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• pp.90-95
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• 2004

Background: Sevoflurane, a rotatively new inhalational anesthetic. has non-pungent odor and is less reluctant to pediatric patients. The purpose of this study is to examine the feasibility of sevoflurane in inhalational sedation instead of the nitrous oxide for short and simple dental treatments in pediatric patients. Patients and Methods: Fifteen healthy children, whose dental treatment was abandoned due to their little or no cooperation, were selected with their caregivers' written permission. Deep sedation was induced and maintained with oxygen and 1-5% sevoflufane via specially designed nasal mask. Blood pressure, heart rate, oxygen saturation, and electrocardiogram were monitored at 3-nin interval. A dental anesthesiologist, who was independent of dental treatments, was wholly responsible for the sedation procedure. Post-sedation complications and operator's and caregiver's acceptability of this type of inhalational sedation were also investigated. Results: The systolic and diastolic blood pressure, heart rate, and oxygen saturation was significantly depressed during the deep sedation using sevoflurane (P < 0.05). No severe post-sedation complications were found, however, bradycardia was reported in 3 patients. Almost all the operators and caregivers answered that they would adapt this sedation procedure again if possible. Conclusion: In this study, inhalational deep sedation using sevoflurane for dental treatments was found to be very useful. Furthermore, the application of sevoflurane to conscious sedation for pediatric and adult dental patients should be added.

• Journal of the Korean Association of Oral and Maxillofacial Surgeons
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• v.45 no.4
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• pp.192-198
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• 2019

Objectives: Oral and maxillofacial surgeons must gain mastery of various approaches to the midface due to the increasing incidence, complexity, and severity of presenting midfacial fractures. Unlike in the case of other body parts, the need to preserve facial aesthetics makes it more difficult for the surgeon to select an approach for managing the facial injuries. The midfacial degloving (MFD) approach is a combination of intraoral and intranasal incisions made to access the midface without any external incision. The aim of the present study was to evaluate the efficacy of MFD in maxillofacial surgery and to assess its advantages and complications. Materials and Methods: The MFD approach was used in five cases, with three cases treated with open reduction and internal fixation and two cases operated on for posttraumatic deformity. Nasal dorsum augmentation was completed in three cases and nasal osteotomy was performed in one case. The bicoronal flap technique was combined with MFD for frontal bone augmentation in one case. The intraoperative time required for flap completion and the ease of performing the planned procedures were noted. Postoperative evaluation was done for reduction, aesthetics, function, and complications. Results: Access was excellent for performing all planned procedures. Average time spent for flap elevation and exposure of the midface was 63 minutes. Complications like postoperative swelling, infraorbital nerve paresthesia, and intranasal crusting were all transient. No long-term complications like stenosis of the nose, sneer deformity, or weakness of the facial muscles were noticed. Additionally, no complications were noted when MFD was combined with bicoronal flap. Conclusion: Though the MFD approach is technically demanding and takes more time than other facial approaches, it should be learned and applied by maxillofacial surgeons in selective cases, as it provides complete exposure of the midface without facial scarring.

• Journal of Dental Anesthesia and Pain Medicine
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• v.21 no.3
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• pp.261-268
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• 2021

Hemophilia A is a hemorrhagic disease caused by coagulation factor VIII deficiency. In head and neck cancer surgery, especially during a reconstructive one, complications can occur. These include hematomas due to bleeding which can then lead to flap ischemia, necrosis, and impaired wound healing. There are fewer cases of reconstructive surgery in patients with hemophilia A. Here in we report, a reconstructive surgery that involved mass resection, partial glossectomy (right), selective neck dissection (right, Levels I, II, III, IV), and reconstruction at the lateral arm free flap (left) in a 25-year-old man with hemophilia A. The surgery was successfully performed without any complications after pretreatment with Factor VIII concentrate, which has not been reported earlier.

• Journal of Dental Anesthesia and Pain Medicine
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• v.22 no.3
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• pp.227-231
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• 2022

Although rare, complications can occur with anesthetic procedures. The posterior superior alveolar nerve (PSAN) block anesthetic technique has a high success rate, but positive aspiration can cause bruising, transient diplopia, blurred vision, and temporary blindness in approximately 3% cases. When edema occurs, it is occasionally massive, especially in the infratemporal fossa, and the resulting hematoma is usually unsightly. A 20-year-old woman presented with massive edema followed by hematoma in the upper right jaw immediately after PSAN block administration, which subsequently spread to the oral mucosa. The patient did not report any complications during the anesthetic procedure. However, after the injection was administered, the patient experienced anesthetic sensations, which rapidly evolved to facial edema. There was mild pain, but without intraoral or extraoral bleeding. The patient was prescribed medicines and instructed to perform contrast therapy. Although hematomas and edema are rare, they are difficult to prevent. The choice of local anesthetic and appropriate application of the anesthetic technique can minimize their occurrence.

• Journal of Dental Anesthesia and Pain Medicine
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• v.24 no.2
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• pp.81-90
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• 2024

Nasotracheal intubation (NTI) plays an important role in pediatric airway management, offering advantages in specific situations, such as oral and maxillofacial surgery and situations requiring stable tube positioning. However, compared to adults, NTI in children presents unique challenges owing to anatomical differences and limited space. This limited space, in combination with a large tongue and short mandible, along with large tonsils and adenoids, can complicate intubation. Owing to the short tracheal length in pediatric patients, it is crucial to place the tube at the correct depth to prevent it from being displaced due to neck movements, and causing injury to the glottis. The equipment used for NTI includes different tube types, direct laryngoscopy vs. video laryngoscopy, and fiberoptic bronchoscopy. Considering pediatric anatomy, the advantages of video laryngoscopy have been questioned. Studies comparing different techniques have provided insights into their efficacy. Determining the appropriate size and depth of nasotracheal tubes for pediatric patients remains a challenge. Various formulas based on age, weight, and height have been explored, including the recommendation of depth-mark-based NTI. This review provides a comprehensive overview of NTI in pediatric patients, including the relevant anatomy, equipment, clinical judgment, and possible complications.

• The Journal of the Korean dental association
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• v.58 no.9
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• pp.573-582
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• 2020

Today, maxillary sinus graft is considered to be the most prognostic of bone augmentation surgery as a preprosthetic treatment. Implant survival rates of more than 95% can be expected if appropriate decisions are made on the basis of implants, implant surface morphology, and use of a shield over the maxillary sinus front-wall. In addition, maxillary sinus grafty has a low rate of complications, and even if complications occur during or after maxillary sinus graft, most are localized and easily recovered.