• Maxillofacial Plastic and Reconstructive Surgery
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• v.35 no.4
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• pp.236-242
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• 2013

Purpose: The objective of this retrospective study is to evaluate the factors affecting the spread of odontogenic infection. Furthermore, this study was performed to apply to future treatments. Methods: A total of 65 patients, who had received treatment for odontogenic infections from 2010 to 2012 for 3 years, were enrolled in this study. The causes of infection, presence of systemic disease, and complications, durations of treatment, treatment methods, and inflammation levels were compared with the data. Results: Patients over 70 years with systemic disease required immediate drainage, systemic antibiotic therapy and hospitalization. We can determine the direction of the early diagnosis and treatment through blood tests (white blood cells, neutrophil, C-reactive protein [CRP]) and computed tomography. Patients over 70 years with systemic disease had the highest percentage. In addition, these patients showed high levels of inflammation index, such as CRP average of 24.8 and needed for a long-term treatment period and a wide range of surgical incision & drainage several times. Systemic diseases, particularly diabetes mellitus and hypertension, accelerate the spread of infection and had a negative effect that delays healing. Eventually, five of the 65 patients showed serious systemic complications. Conclusion: When evaluating cervico-facial infected patients due to odontogenic infection, the most important thing is deciding the appropriate diagnosis and degree of disease. Considering the patient's systemic status and age, we need to decide the treatment plan. Especially, those patients over 70 years with systemic disease should be treated with rapid surgical approach, and the use of a wide range of antibiotics and intensive care. If proper treatment principle does not apply, severe life-threatening complications will result, such as necrotizing fascitis, acute airway obstruction, mediastinitis, and others.

• Journal of the korean academy of Pediatric Dentistry
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• v.35 no.1
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• pp.136-143
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• 2008

Infections involved with the oral and maxillofacial area are associated with various anatomical structures. If the proper treatment is not done in an immediate period, the infections will be quite fatal. The causes of the infections are numerous, but the most common cause of odontogenic infections in children is a dental caries. It is known to lead to some kinds of diseases such as periapical abscess, cellulitis, osteomyelitis, Ludwig's angina, toxic shock syndrome and so on. The common pathogenic sequence of fascial abscess is a necrotic pulpal inflammation in the form of dentoalvelor abscess which spreads over and gradually penetrates into the fascial membranes through the cortical bones and finally contracts the potential fascial spaces. If the infections of oral maxillofacial area were penetrated into the surrounding soft tissues, then they would diffuse into the directions of the least tissue resistance along with the connective tissues and the fascial spaces. These infections can be properly cured by tooth extraction, endodontic therapy, surgical treatment including Incision & drainage and antibiotics. The purpose of the cases is to report the satisfactory treatment results in the patients derived from the canine fascial space abscesss or buccal fascial space ones of the odontogenic origin.

• Journal of the Korean Association of Oral and Maxillofacial Surgeons
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• v.33 no.3
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• pp.256-259
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• 2007

Abscesses are common in the oral and maxillofacial area. However, secondary thrombosis of the internal jugular vein accompanying the primary abscess is rare. In 1936, Andre Lemeierre studied 20 patients who showed an initial oropharyngeal infection, septicemia, internal jugular vein thrombosis, and secondary spread of the infection, and after then this condition Lemierre syndrome. Clinically, these patients present with tonsilitis lasting several days, continuous fever, and cervical pain. In the past, ligation and excision of the internal jugular vein was often performed. Current therapeutic modality for this condition is appropriate antibiotic prescription and surgical drainage of abscess. This case report presents a patient who showed symptoms of Lemierre syndrome, initiated as an oropharyngeal infection then developed thrombosis of the internal jugular vein. This patient was admitted into Seoul National University Dental Hospital. In addition to routine antibiotic therapy, surgical incision and drainage of the infection site was performed. Without ligation or excision, the thrombosed IJV disappeared eventually. As the Lemierre syndrome is not a common disease, this case report and review of the literature would be useful regarding a treatment of patients with Lemierre syndrome.

• Advances in pediatric surgery
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• v.4 no.2
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• pp.137-143
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• 1998

Intramuscular injection(IM) into the gluteal muscles is a common route of medication, but may lead to complications. A retrospective review of 32 patients who required surgical treatment for local complications of buttock injections in children was made at the Taegu Fatima Hospital during a seven-year nine-month period (March 1990 to December 1997). Local complications included acute inflammation, cellulitis and abscess(71.9 %), and fat necrosis(21.9 %), and injection granuloma(6.2 %). Over the half of injections were on the upper and outer quadrant of the buttock, but the other 43.7 % were in the upper and inner or lower and outer quadrant which are considered unsuitable sites for intramuscular injection. The majority of complications developed within fat tissue(90.6 %) rather than within muscle(9.4 %). Two-thirds of the patients were under 2 years of age, this suggests that it is technically difficult to accurately administer IM injections in small children because muscle mass is smaller compared to subcutaneous. In addition subcutaneous fat is more susceptible to chemical irritation. Staph. aureus was the predominant organism, isolated in 84.6 % of the patients with abscesses. Treatment consisted of needle aspiration, incision and drainage, curettage, or surgical excision. In conclusion, the major factor that contributes to complications following IM of the buttock appears to be the inadvertent intrafat rather than of IM injection. Accurate injection into the muscles based on a knowledge of pelvic anatomy as well as the potential complications is necessary to prevent complications.

• The Journal of Korea Assosiation for Disability and Oral Health
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• v.13 no.2
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• pp.104-107
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• 2017

Kabuki syndrome is characterized by typical facial features (elongated palpebral fissures with eversion of the lateral third of the lower eyelid; arched and broad eyebrows; short columella with depressed nasal tip; large, prominent, or cupped ears), minor skeletal anomalies, persistence of fetal fingertip pads, mild to moderate intellectual disability, and postnatal growth deficiency. A 6-year-old male with kabuki syndrome was referred from the local dental clinic for left facial swelling and dental caries on all primary molars. He was treated for acute periapical abscess with incision and drainage under physical restraint, and left maxillary second primary molar was extracted. Other caries treatment was performed under general anesthesia. As the syndrome involves many different medical problems, special cares should be considered. Dental treatment should be carried out in comprehensive consultation system.

• Maxillofacial Plastic and Reconstructive Surgery
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• v.18 no.2
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• pp.323-336
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• 1996

This is a retrospective study on the patients with infection of the oral and maxillofacial region with the purpose of obtaining some useful data for diagnosis and treatment plan of that relatively common disease in dentistry. The used materials of study were 87 in total, including 52 male patients, 35 female patients who diagnosed and treated at the Department of the Dentistry in Hanyang Medical College Hospital for the period of Jan. 1990 to Dec. 1994. The author analyzed the distribution and incidence of sex, age, admission period, etiologic factors, etiologic teeth, treatment method of infections, pus culture, antibiotics sensibilities and medication. The result obtained as follows : 1. The developmental incidences by sex was superior in male by the ratio of 1.5 : 1 and the infection was most frequently occurred during the third decades(35.6%). 2. The number of admitted patients elevated in February, March, and April, and average of admission period was 9.8 days. 3. Main etiologic teeth showed on lower molar region in adult(63%) and upper molar region in primary dentition(46.1%). 4. Medications were administrated in all of the cases, and surgical incision and drainage were performed in 53% and extraction of the causative teeth were performed in 63.6% of all cases. 5. The most common involved fascial spaces were Buccal space(41.4%), Infraorbital space(27.6%), Submandibular space(16.1%),in order, and 9 cases(10.3%) were Ludwig's Angina. In 68.2% of the patients, and infection involved only one fascial space and in 21.8% of the patients, it involved to more fascial spaces. 6. The most causative organisms isolated from pus culture were Gram-positive facultative cocci(55.5%), and antibiotics sensitivities on the total isolated bacterial strains were exposed chloramphenicol(88.6%), Cephalothin(88.6%), Erythromycin(81.5%), Lincomycin(77.8%) in order, but it showed resistant on Gentamycin(58.3%), Tetracycline(56.5%), Methicillin(38.5%).

• Maxillofacial Plastic and Reconstructive Surgery
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• v.32 no.1
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• pp.62-67
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• 2010

The spreading pathways which is the cause of infection on head and neck area are submandibular space, masticatory space, parapharyngeal space, retropharyngeal space, carotid sheath and mediastinum, etc. If spread to parapharyngeal area involving airway, such infection can be life-threatening by airway obstruction, or can cause vascular injury followed by hemorrhage, nerve injuries. Also, if spread to superficially, necrotizing fasciitis and many complications may occur including gangrene of skin. The key to successful treatment of infection on head and neck area is recognition of spreading pathways, early diagnosis and following therapeutic management. Our department present two cases, one is infection progressed superficially to suprasternal space, another is spreading deep according to parapharyngeal space, subclavian space and carotid sheath followed by airway obstruction, and obtained significant results with surgical incision and drainage, administration of selected antibiotics, continuous post-operative treatment. We report these 2 cases with literatures review.

• Archives of Plastic Surgery
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• v.43 no.1
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• pp.26-31
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• 2016

Background The global prevalence of myelomeningocele has been reported to be 0.8-1 per 1,000 live births. Early closure of the defect is considered to be the standard of care. Various surgical methods have been reported, such as primary skin closure, local skin flaps, musculocutaneous flaps, and skin grafts. The aim of this study was to describe the clinical characteristics of myelomeningocele defects and present the surgical outcomes of recent cases of myelomeningocele at our institution. Methods Patients who underwent surgical closure of myelomeningocele at our institution from January 2004 to December 2013 were included in this study. A retrospective chart review of their medical records was performed, and comorbidities, defect size, location, surgical procedures, complications, and the final results were analyzed. Results A total of 14 patients underwent surgical closure for myelomeningocele defects. Twelve cases were closed with direct skin repair, while two cases required local skin flaps to cover the skin defects. Three cases of infection occurred, requiring incision and either drainage or removal of allogenic materials. One case of partial flap necrosis occurred, requiring secondary revision using a rotational flap and a full-thickness skin graft. Despite these complications, all wounds eventually healed completely. Conclusions Most myelomeningocele defects can be managed by direct skin repair alone. In cases of large defects, in which direct repair is not possible, local flaps may be used to cover the defect. Complications such as wound dehiscence and partial flap necrosis occurred in this study; however, all such complications were successfully managed with simple ancillary procedures.

• Journal of Chest Surgery
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• v.8 no.2
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• pp.159-168
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• 1975

We have experienced 61 cases of Clinically diagnosed tuberculous peripleural abscess which was surgically treated at St. Mary's Hospital of Catholic Medical College from Mar. 1963 to Feb. 1974. Out of them, 52 cases of pathologically confirmed tuberculous peripleural abscess were reviewed and its pathogenesis, treatment and so called "rib caries" were discussed. In the past, they have been described as a variety of the names, such as rib caries, cold abscess of the chest wall, pericostal abscess, lymphadenitis tuberculosa of the chest wall, chronic draining sinuses of the chest wall and other descriptive terms. Although it has been said that the tuberculous abscess on the chest wall developed as a secondary disease from so called "rib caries" but now it has been clear that this abscess occurred not from tuberculosis of the rib but from tuberculous lesion developed between end-othoracic fascia and parietal pleura usually following pulmonary tuberculosis and/or tuberculous pleurisy and the involvement of rib or ribs are secondary one from peripleural abscess, as we confirmed. Therefore we advocate that the nomination, rib caries, should not be used unless there is a primary tuberculous lesion on ribs. The results were as follows: 1. The highest age group of tuberculous peripleural abscess was ranged from the first to third decade (78%) 2. The location of tuberculous peripleural abscess on the chest wall were as follows, 31 cases on the anterior, 19 cases on lateral and 2 cases on the posterior. 3. On x-ray examination, abnormal findings including parenchymal tuberculous lesion and pleural changes were seen is 38 cases. 4. There was no destructive change of periosteum and rib in 23 cases of tuberculous peripleural abseess during operation. However the periosteal denudation and/or rib destruction were found in 29 cases. 5. The all cases of tuberculous peri pleural abscess developed from between endothoraclc fascia and parietal pleura, as we confirmed. With antituberculous therapy, operation should be radical by wide incision on the lesion including thorough curettage with proper drainage of Iiquified caseating materials and appropriate rib resection, if necessary.tion, if necessary.

• Tuberculosis and Respiratory Diseases
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• v.69 no.4
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• pp.284-287
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• 2010

We report the case of a 68-year-old man with a stromal tumor of uncertain malignant potential (STUMP), which had metastasized to the lung. The patient complained of an enlarged mass in the anterior chest. Chest computed tomography (CT) showed a sternal abscess with multiple nodules in both lungs. A thoracoscopic lung biopsy of the nodules and incision/drainage of the sternal mass were performed simultaneously. CT of the pelvis revealed an enlarged prostate with irregular cystic lesions in the pelvis. Prostate biopsy was done and demonstrated hypercellular stroma with minimal cytological atypia, a distinct pattern of STUMP. The sternal abscess proved to be tuberculosis and the lung lesion was consistent with STUMP, which had spread from the prostate. However, to our knowledge, the tuberculous abscess might not be assoicated with STUMP in the lung. The patient refused surgical prostatectomy and was discharged with anti-tuberculosis medication. On one-year follow up, the patient had no evidence of disease progression.