• Journal of Korean Neurosurgical Society
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• v.52 no.5
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• pp.491-494
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• 2012

We report a rare complication of iatrogenic spinal intradural following minimally invasive extradural endoscopic procedues in the lumbo-sacral spines. To our knowledge, intradural cyst following epiduroscopy has not been reported in the literature. A 65-year-old woman with back pain related with previous lumbar disc surgery underwent endoscopic epidural neuroplasty and nerve block, but her back pain much aggravated after this procedure. Postoperative magnetic resonance imaging revealed a large intradural cyst from S1-2 to L2-3 displacing the nerve roots anteriorly. On T1 and T2-weighted image, the signal within the cyst had the same intensity as cerebrospinal fluid. The patient underwent partial laminectomy of L5 and intradural exploration, and fenestration of the cystic wall was accomplished. During operation, the communication between the cyst and subarachnoid space was not identified, and the content of the cyst was the same as that of cerebrospinal fluid. Postoperatively, the pain attenuated immediately. Incidental durotomy which occurred during advancing the endoscope through epidural space may be the cause of formation of the intradural cyst. Intrdural cyst should be considered, if a patient complains of new symptoms such as aggravation of back pain after epiduroscopy. Surgical treatment, simple fenestration of the cyst may lead to improved outcome. All the procedures using epiduroscopy should be performed with caution.

• Archives of Plastic Surgery
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• v.36 no.1
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• pp.105-108
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• 2009

Purpose: Epidermoid cyst may be congenital or acquired. Acquired cysts are most commonly of traumatic origin and result from an implantation or downward displacement of an epidermal fragment. Traumatic epidermoid cysts are rare tumors occurring on the nasal tip, especially resulting aesthetic procedure. So, we report a rare case of an iatrogenic epidermoid cyst in the nasal tip following rhinoplasty. Methods: A 44 - years old man had undergone rhinoplasty for several times. First time, the previous augmentation rhinoplasty and wedge osteotomy were performed nineteen months ago, lastly implant removal and unknown filler injection were performed one year ago at another local clinic. He had induration and tenderness on nasal tip and dorsum continued for 3 months. We thought that it caused by foreign body reaction with residual alloderm in nose. For removal of residual alloplastic material, open approach using transcolumellar incision was done. But, incidentally we found cystic mass on the nasal tip. Results: The findings were of an $0.8{\times}0.5{\times}0.5cm$ sized round cystic mass containing cream coloured material with a thick cheese - like consistency. The mass was completely excised and submitted for histology. This confirmed the diagnosis of an epidermoid cyst lined by keratinizing squamous epithelium. There was no induration, tenderness and sign of recurrence after excision of the mass. Conclusion: Epidermal cyst of the nasal tip region represents an unusual clinical lesion and it presents as foreign body reaction. And then, our case demonstrates that meticulous surgical approach and suture technique are the keys to prevention against iatrogenic nasal epidermoid cyst, especially in secondary rhinoplasty.

• Journal of Chest Surgery
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• v.36 no.1
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• pp.51-54
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• 2003

This patient was an 53-year-old man who had undergone Sengstaken-Blackmore tube insertion for esophageal varix bleeding. Two days after Sengstaken-Blackmore tube insertion, he developed severe left hemothorax and was transferred to our hospital. The esophagoscopic findings revealed a large perforation lengthening 8-cm in the intrathoracic esophagus. A left thoracotomy was performed 33 days after the injury due to repeated varix bleedings and poor conditions. An 8-cm longitudinal perforation of the intrathoracic esophagus with gross suppurative empyema was found. Primary repair and esophageal exclusion was performed 2cm proximal and distal to the perforation, using rows of nonabsorbable staplers(TA stapler 60 $\times$ 4.8) and large bore thoracostomy tubes were placed for local drainage. Six days after intrathoracic esophageal exclusion, an esophagogram revealed a leakage at just above the proximal stapling site. A cervical esophageal exclusion was performed using the same method. One hundred thirty seven days after exclusion operation for the intra-thoracic esophageal perforation, the patient was able to eat per orally without any secondary esophageal reconstructive surgery.

• Journal of Dental Rehabilitation and Applied Science
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• v.32 no.4
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• pp.330-337
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• 2016

Gingival recession could occur after orthodontic or endodontic treatment. This could influence not only functional and aesthetic problem, but also patient's treatment satisfaction. There are a lot of techniques for preventing gingival recession, but laterally positioned flap with subepithelial connective tissue graft could get definite advantages such as increase of keratinized gingival width and harmonious color match between graft tissue and surrounding tissue. Clinician should select a right patient case and diagnosis with clinical and radiography exam. In a surgical procedure, getting enough amounts of subepithelial connective tissue and flap coverage should be taken into consideration. The clinical outcomes in this case report shows laterally positioned flap with subepithelial connective tissue graft could be a treatment with predictive outcome.

• Acute and Critical Care
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• v.33 no.4
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• pp.276-279
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• 2018

In pediatric patients, a laryngeal mask airway (LMA) is usually used during minor surgeries that require general anesthesia. No esophageal injury has been reported after insertion of an LMA. We report a case of an esophageal injury with intramural dissection after an $i-gel^{(R)}$ (size, 1.5; Intersurgical Ltd.) insertion in a pediatric patient. A 2-month-old male infant was hospitalized for left inguinal herniorrhaphy. After induction of anesthesia, a trained resident tried to insert an $i-gel^{(R)}$. However, it was only successful after three attempts. Dysphagia was sustained until postoperative day 10, and the pediatrician observed duplication of the esophagus on gastroendoscopy. However, a whitish mucosal lesion, which looked like a scar, was observed, and previous lesions suggestive of esophageal duplication were almost healed on postdischarge day 11. His condition was diagnosed as dysphagia and esophagitis due to an esophageal laceration, not esophageal duplication. He was scheduled for symptomatic treatment with a proton pump inhibitor. In conclusion, although an esophageal injury or perforation in pediatric patients is rare, an LMA insertion or a procedure such as aspiration or nasogastric tube insertion should be performed gently to avoid a possible injury to the esophagus in pediatric patients.

• Journal of Yeungnam Medical Science
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• v.39 no.3
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• pp.235-243
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• 2022

Background: Intrahepatic cholangiocarcinoma (ICC) of the left liver often shows left-sided lymph node (LN) metastasis. If gastric lesser curvature is extensively dissected, it can induce an iatrogenic injury to the extragastric vagus nerve branches that control motility of the pyloric sphincter and lead to gastric stasis. To cope with such LN dissection-associated gastric stasis, we performed pyloroplasty preemptively. The objective of this study was to analyze our 20-year experience of preemptive pyloroplasty performed in 10 patients. Methods: We investigated clinical sequences of 10 patients with ICC who underwent preemptive pyloroplasty following left hepatectomy and extended left-sided LN dissection. Incidence of gastric stasis and oncological survival outcomes were analyzed. Results: All 10 patients were classified as stage IIIB due to T1-3N1M0 stage according to the 8th edition of American Joint Committee on Cancer staging system. The overall patient survival rate was 51.9% at 1 year, 25.9% at 2 years, and 0% at 3 years. Seven patients showed uneventful postoperative recovery after surgery. Two patients suffered from gastric stasis, which was successfully managed with supportive care. One patient suffered from overt gastric paresis, which was successfully managed with azithromycin administration for 1 month. Conclusion: We believe that preemptive pyloroplasty is an effective surgical option to prevent gastric stasis in patients undergoing extensive left-sided LN dissection. Azithromycin appears to be a potent prokinetic agent in gastroparesis.

• The Korean Journal of Pain
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• v.35 no.2
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• pp.224-230
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• 2022

Background: An epidural blood patch (EBP) is a procedure to treat intracranial hypotension that does not respond to conservative treatment. EBPs are commonly repeated when the symptoms persist. In this study, we used a large single-center retrospective cohort and evaluated the factors associated with repeated EBPs. Methods: From January 2010 to December 2020, a total of 596 patients were treated with EBPs for intracranial hypotension. We evaluated the factors associated with repeated EBPs in the entire population, in patients with spontaneous intracranial hypotension (SIH), and in those with available myelographies. Results: In a total of 596 patients, 125 (21.1%) patients required repeated EBPs, and 96/278 (34.5%) in SIH and 29/314 (9.2%) in iatrogenic population. In patients with SIH, international normalized ratio (INR) and cerebrospinal fluid (CSF) leakage on myelographies consistently exhibited significant associations (odds ratio [OR], 1.38; 95% confidence interval [CI], 1.02-1.87; P = 0.043 and OR, 2.18; 95% CI, 1.28-3.69; P = 0.004). In patients with iatrogenic injury, INR and CSF leakage on myelogram did not show difference in repeated EBPs. Conclusions: Repeated EBPs may be more frequently required in patients with SIH. Prolonged INR and CSF leakage were associated with repeated EBPs in patient with SIH. Further studies are needed to determine factors associated with repeated EBP requirements.

• Archives of Plastic Surgery
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• v.50 no.1
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• pp.17-25
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• 2023

A variety of reduction labiaplasty techniques have been introduced to date, but no single technique will offer the optimal solution for every patient. Rather, the technique should be chosen based on anatomical, configurational, and technical considerations, as well as on patients' personal preferences regarded maintenance of the labial rim, maintenance of labial sensitivity, and prevention of iatrogenic thickening of the labium. We reviewed, defined, and assessed labial configurational variety, neurovascular supply, reduction techniques, and patient's preferences as the considerations relevant to the choice of labiaplasty technique. Based on this review, an algorithm was constructed that leads to a choice of reduction technique through five decisions to be made regarding (1) resection or (partial) retention of the labial free rim, (2) the measure of required labial width reduction, (3) labial vascular status, (4) prevention of iatrogenic labial thickening, and (5) preservation of labial sensibility. The choice of techniques includes edge trimming, central spindle form de-epithelialization or full-thickness resection, and three modifications of the wedge resection or de-epithelialization technique. These three modifications comprised a modified anterior resection or de-epithelialization combined with posterior flap transposition, a custom flask resection or de-epithelialization, and a modified posterior wedge resection or de-epithelialization combined with anterior flap transposition. Use of the five decisional steps and the inclusion of modifications of all three conventional reduction techniques offer an improved algorithm for the choice of labioplasty technique.

• Journal of the Korean Association of Oral and Maxillofacial Surgeons
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• v.49 no.4
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• pp.171-183
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• 2023

Objectives: Understanding the lingual nerve's precise location is crucial to prevent iatrogenic injury. This systematic review seeks to determine the lingual nerve's most probable topographical location in the posterior mandible. Materials and Methods: Two electronic databases were searched, identifying studies reporting the lingual nerve's position in the posterior mandible. Anatomical data in the vertical and horizontal dimensions at the retromolar and molar regions were collected for meta-analyses. Results: Of the 2,700 unique records identified, 18 studies were included in this review. In the vertical plane, 8.8% (95% confidence interval [CI], 1.0%-21.7%) and 6.3% (95% CI, 1.9%-12.5%) of the lingual nerves coursed above the alveolar crest at the retromolar and third molar regions. The mean vertical distance between the nerve and the alveolar crest ranged from 12.10 to 4.32 mm at the first to third molar regions. In the horizontal plane, 19.9% (95% CI, 0.0%-62.7%) and 35.2% (95% CI, 13.0%-61.1%) of the lingual nerves were in contact with the lingual plate at the retromolar and third molar regions. Conclusion: This systematic review mapped out the anatomical location of the lingual nerve in the posterior mandible, highlighting regions that warrant additional caution during surgeries to avoid iatrogenic lingual nerve injuries.

• Journal of the Korean Society of Radiology
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• v.81 no.6
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• pp.1448-1452
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• 2020

Hepatic artery pseudoaneurysm is a rare but potentially life-threatening condition that usually occurs after trauma. Early recognition and prompt management are essential for preventing catastrophic consequences, such as hemoperitoneum. We report a rare case of liver abscess caused by Klebsiella oxytoca resulting in hepatic artery pseudoaneurysm without iatrogenic injury. The unique feature of the present case is that the abscess cavity itself became a pseudoaneurysm as a result of fistula formation with the hepatic artery. Vascular complications should be considered in patients with unfavorable clinical course even in the absence of iatrogenic injury. Endovascular treatment is safe and effective.