• Maxillofacial Plastic and Reconstructive Surgery
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• v.17 no.1
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• pp.60-72
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• 1995

Temporomandibular joint ankylosis is the movemental obstacle of mandible which depend on proliferation of bony or fibrous tissue in temporomandibular joint structure by various causes. In order to treat this, various surgical methods have been performed, but no operative methods have been produced consistently successful results. This research has been performed to the patients who had been operated due to temporomandibular joint ankylosis by studying classification, cause, onset, duration, anesthesia and treatment method, symptom, change of mouth opening, complication through medical record, X-ray, follow-up for being a help to proper selection of treatment method and evaluation of prognosis. The author obtained the following results by analyzing 44 cases among patients who had been operated due to temporomandibular joint ankylosis during 8 year hospitalization from 1986 to 1993 in Dept. of Oral & Maxillofacial Surgery of Seoul National University Hospital. 1. The occurrence was in the order of below 10, 20's, 10's, 30's. The average of occurrence was 12.95. Illness period was 50.0% within 10 years and 50% beyond 10 years. The average period of illness was 13.33 years. 2. Trauma occupied 54.5% of causes and inflammation occupied 45.5%. Men had more occurrences due to trauma and there was no difference in case of inflammation. 3. In nasotracheal intubations for general anesthesia, the cases of using fiberoptic laryngoscope occupied 40.9%, direct or blind nasotracheal intubation occupied 40.9% and the cases of using tracheostomy occupied 18.2%. 4. In operative approaching methods, submandibular & preauricular approach were mainly applied, and in operative methods, high condylectomy(Group I) occupied 11.4%, arthroplasty without interpositional material following condylectomy or gap ostectomy(Group II) occupied 11.4%, with interpositional material following high condylectomy (Group III) occupied 40.9%, and using condylar reconstruction following condylectomy or gap ostectomy(Group IV) occupied 36.6%. 5. In change of mouth opening reformed after surgery, Group III showed the best result of average 23.5mm, Group IV showed 16.3mm, Group I showed 14.9mm and Group II showed 10.2mm of reformation. Summarizing the results as written above, it is considered that early treatment is important as soon as possible in Temporomandibular joint ankylosis. It is recommended in surgical method what can lead to postoperative early movement maintaining anatomaical & functional form, and then the development of various surgical methods will be requested.

• Proceedings of the KOR-BRONCHOESO Conference
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• 1977.06a
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• pp.9.1-10
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• 1977

Many etiological factors playa significant role in the development of tracheal stenosis; too high tracheostomy (Jackson, 1921), too small stoma (Greisen, 1966), the treatment with respirator using cuffed tube (Pearson et al., 1968; Lindholm, 1966; Bryce, 1972) and infection (Pearson, 1968). Although the incidence has been reduced due to development of surgical technique and antibiotics, the frequency of tracheal stenosis which produces symptoms after tracheostomy ranges from 1.5 per cent (Lindholm, 1967). In the management of the stenosis, mild cases are treated by mechanical dilatation with silicon tube or stent (Schmigelow, 1929; Montgomery, 1965) combined steroid (Birck, 1970), and in the cases of stenosis causes, these removed under the are bronchoscopy. But in severe stenosis, transverse resection with subsequent end-to-end anastomosis has been used in recent years (Pearson et al., 1968). During about 10 years, 1967 to 1977, a total of 23 patients with tracheal stenosis complicated among the 1, 514 tracheostomies have been treated in Severance Hospital. Now, we have obtained following conclusions by means of clinical analysis of 23 cases of tracheal stenosis. 1. The frequency of tracheal stenosis was 23 cases among 1, 514 cases of tracheostomy (1.5%). 2. Under the age of 5, these are 12 cases (52.2 %). 3. The sex incidence was comprised of 18 males and 5 females. 4. The duration of tracheostomy ranges from 4 days to 16 months. 5. The primary diseases requiring tracheostomy were following; central nerve system lesions 11 cases, upper air way obstruction 10 cases, extrinsic respiratory failure 2 cases. 6. Severe wound infections were only 2 cases. 7. The methods of treatment applied to tracheal stenosis were following; closed observation only 5 cases, nasotracheal intubation combined steroid 5 cases, T-tube stent combined steroid 3 cases, fenestration op. 4 cases, revision 4 cases and transverse resection and end-to-end anastomosis 2 cases.

• The Journal of Korea Assosiation for Disability and Oral Health
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• v.3 no.2
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• pp.75-79
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• 2007

Background: Down's syndrome, or trisomy 21, is the commonest congenital chromosome anomaly. With improvement in medical care, these patients increasingly reach adulthood in spite of their physical maldevelopment and mental retardation. And, the number of those who required general anesthesia for dental treatment is increasing. Methods: We reviewed the 26 cases of 22 patients with Down's syndrome who underwent outpatient general anesthesia for dental treatment at the clinic for the disabled in Seoul National University Dental Hospital. Results: The mean age was 22 years. They all had severe mental retardation and some had congenital heart anomaly, epilepsy, hypothyroidism, acute leukemia, autism, cleft palate, and chronic renal failure. For anesthesia induction, 4 cases was needed physical restriction, but others showed good or moderate cooperation. Drugs used for anesthesia induction was thiopental (17 cases) and sevoflurane (9 cases). All patients received nasotracheal intubation and 3 cases needed difficult airway management. Mean total anesthetic time was $166{\pm}60$ min and staying time at PACU was $92{\pm}48$ min. There was no death or long term hospitalization because of severe complications. Conclusion: If general anesthesia is needed, pertinent diagnostic tests and workup about anomaly, and appropriate anesthetic planning are essential for safety.

• Maxillofacial Plastic and Reconstructive Surgery
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• v.21 no.3
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• pp.277-283
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• 1999

This study was aimed at furnishing the data of Naso-orbito-ethmoidal fractures and aiding treatmenting Naso-orbito-ethmoidal fractures A 5-year review of Naso-orbito-ethmoidal fractures and concomitant injuries is presented. The patients were treated in the Dept. of Oral and Maxillofacial Surgery of Wankwang University Hospital from Jan. 1, 1993 to Dec. 31, 1997. The results were as followes: Male predominated over female by a ratio of 4.6 : 1. The most common reasons is traffic accident(88.2%). The elapsed time from injury to operation is average 9.2 days, and the mean admission days were 79 days and removal of plates were average 217.3 days. The most associated facial bone fractures is Zygomatico-Maxillary complex fracture(20%). Associated injuries were neurologic injury(29.4%), orthopedic injury(23.5%), opthalmologic injury(17.6%), body injury(5.8%), neuropsychologic injury(5.8%) and otolaryngologic injury(5.8%) in this order. The most injured teeth were upper and lower incisors. The intubation methods for surgery were orotracheal(29.57%), submental(29.5%), and nasotracheal technique(41%). Most patients had complications, that were post-traumatic telecanthus, nasal depression, scar formation. This results suggest that early diagnosis and treatment is prerequisits to satisfactory result. Aggressive management of NOE fracture with direct or bicoronal exposure with aid of CT is now an accepted norm.

• Maxillofacial Plastic and Reconstructive Surgery
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• v.34 no.3
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• pp.180-185
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• 2012

Purpose: An accurate preoperative analysis of the patient is essential in orthognathic surgery in order to acquire superior results. In profile, the location of the chin's position may change according to the neck's inclination. This may ultimately affect the amount of surgical movement. During acquisition of cephalometric radiographs, or in supine position, there is a discrepancy in the neck's inclination. This means that there are also various discrepancies between the actual profile and the various preoperative profile images. In the clinical situation, the decision in performing genioplasty usually lies in the analysis of the patient's profile on the operating table at the final stages of orthognathic surgery. This study aims to analyze the different preoperative profile images and to compare their discrepancies. Methods: Fifty eight patients undergoing orthognathic surgery were chosen. These patients were divided into three groups according to angle's classification of malocclusion, as class I, II or III. The right profile of these patients in centric occlusion was taken in natural head position (NHP). This was set as the 'actual profile image.' Another right profile image was taken on the operating table after insertion of the nasotracheal intubation and with muscle relaxants in effect. This was also taken in centric occlusion. The angle (denoted 'A') between the soft tissue glabella-pognion and the true vertical plane was found in the above-mentioned profile images and in the cephalometric radiographs. The differences of these values were analyzed. Results: There were differences in Angle 'A' in all of the preoperative images. These values were however, not statistically significant. Conclusion: In order to gain an esthetic profile during orthognathic surgery, the NHP is shown to be the most reliable position. Images reproducing such head positions should be used in the treatment planning process.

• Journal of The Korean Dental Society of Anesthesiology
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• v.3 no.2 s.5
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• pp.98-102
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• 2003

Patients in end-stage renal disease (ESRD) and chronic renal failure present a number of challenges to the anesthesiologist. They may be chronically iii and debilitated and have the potential for multiorgan dysfunction. A 65-year-old male patient with ESRD was scheduled for oral cancer surgery under general anesthesia. He was in regular hemodialysis three times a week and secondary hypertension with left ventricular hypertrophy was accompanied. He also had chronic metabolic acidosis and hyperkalemia. The day after hemodialysis, general anesthesia was carried out. Uneventful anesthetic induction using thiopental and vecuronium and nasotracheal intubation were carried out. General anesthesia was maintained with isoflurane for 9 hours. During the anesthesia, he did not have any problem but persistently increasing serum potassium level. After anesthetic emergence, he was transferred to intensive care unit for mechanical ventilation. So we report this successful case of anesthetic management in a patient with ESRD for oral cancer surgery, which massive bleeding and long anesthetic time were inevitable in, from the preoperative preparation to anesthetic emergence.

• Journal of The Korean Dental Society of Anesthesiology
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• v.14 no.4
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• pp.205-211
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• 2014

Background: General anesthesia is a necessary method for successful dental treatment for children, compromised patients and the disabled who have difficulty in cooperation. The aim of this study was to assess dental treatment under general anesthesia at the department of pediatric dentistry, Ajou university hospital on children and the disabled. Methods: 217 general anesthesia from June 2010 to June 2014 were assessed for this study. Patient's distribution, treatment pattern, reasons for general anesthesia, distribution of combined operation, duration of anesthesia, treatment, frequency of general anesthesia and agents for general anesthesia were examined. Results: The proportion of male, the disabled were higher and above 19 years age group was the highest. Combined operation with otolaryngology was highest. Main reasons for general anesthesia were mental retardation for the disabled and uncooperative behavior for the non-disabled. Percentage of restorative treatment was the highest. Average anesthesia duration was 186 minutes and average treatment time was 143 minutes. Most of the airway was maintained by nasotracheal intubation and induction was done by sevoflurane. Conclusions: General anesthesia for dental treatment has been increasing for children, the disabled who have a difficulty of cooperation. The demand for dental treatment under general anesthesia is expected to continuously increase. Therefore, continuous research and studies should be done to establish efficiency and safety of general anesthesia and provide an enhanced environment for treatment.

• Journal of Chest Surgery
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• v.25 no.12
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• pp.1508-1515
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• 1992

Between 1975 and 1992, forty five patients with trachea stenosis received tracheoplasty for relief of obstruction. The causes of airway problem are brain contusion[19 cases, 40%], cerebrovascular disease[3 cases, 7%], drug intoxication[8 cases, 18%], psychotic problem[2 cases, 4%], trachea tumor[3 cases, 7%], adult respiratory distress syndrome[9 cases, 20%] and direct trauma[1 case, 2%]. Direct causes of trachea stenosis were complications of tracheostomy[36 cases, 80%], complications of nasotracheal intubation[5 cases, 11%], tumor[3 cases, 6%] and trauma[1 case, 2%]. Thirty one patients underwent the sleeve resection and end-to-end anastomosis. Five patients performed a wedge resection and end-to-end anastomosis. Forteen patients received the Montgomery T-tube for relief of airway obstruction. Four patients have done simple excision of granulation tissue. Two, subglottic stenosis patients were received Rethi procedure[anterior division of cricoid cartilage, wedge partial resection of lower thyroid cartilage and Montgomery T-tube molding] and the other subglottic stenosis patient underwent permanent trachea fenestration. Including cervical flexion in all patients postoperatively, additional surgical techniques for obtain tension-free anastomosis were hyoid bone release technique in two cases, and hilar mobilization, division of inferior pulmonary ligament and mobilization of pulmonary vessel at the pericardium were performed in one case. Cervical approach was used in 39 cases, cervicomediastinal in 12 cases and transthoracic in one case. Complications of tracheoplasty were formation of granulation tissue at the anastomosis site[3 cases], restenosis[9 cases], trachea-innominate artery fistula[2 cases], wound infection[2 cases], separation of anastomosis[2 cases], air leakage[3 cases], injury to a recurrent laryngeal nerve[temporary 8 cases, permanent 2 cases] and hypoxemia[1 case]. Surgical mortality for resection with primary reconstruction was 6.7%, with one death due to postoperative respiratory failure and two deaths due to tracheo-innominate artery fistula.

• Journal of The Korean Dental Society of Anesthesiology
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• v.11 no.2
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• pp.146-152
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• 2011

Background: Elderly patients with progressive dementia including Alzheimer's disease (AD) are more and more often scheduled to undergo general anesthesia for various pathologies including dental problem. But, there is high risk of deterioration of underlying mental diseases and other co-morbidities. So it is important to implement preventive strategies and take adequate measures to minimize negative perioperative events in these patients. Methods: We reviewed the 17 cases of 11 patients with AD who underwent ambulatory general anesthesia for dental treatment at the clinic for the disabled in Seoul National University Dental Hospital. Results: The mean age was 68 (57-81) years. All of them were diagnosed with AD and some had hypertsnsion, bronchiectasis, urinary incontinence. For anesthesia induction, 3 cases (1 patient) was needed physical restraint, but others showed good or moderate cooperation. Drugs used for anesthesia induction was thiopental (11 cases), propofol (3 cases) and sevoflurane (3 cases). All patients received nasotracheal intubation without difficulties. Mean total anesthetic time was 3 hour 44 min ${\pm}$ 60 min and staying time at PACU was 83 ${\pm}$ 34 min. All the patients except one who showed hypertension discharged without any complication. There was no death or long term hospitalization because of severe complications. Conclusions: If general anesthesia is needed, pertinent diagnostic tests and workup about other medical problems, and appropriate anesthetic planning are essential for safety.

• Maxillofacial Plastic and Reconstructive Surgery
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• v.18 no.4
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• pp.607-614
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• 1996

Nasal bone fracture is common in mid-facial trauma patients. In these patients, facial bone and nasal bone fracture are reducted at same time, but definite nasal reduction is difficulty in these patients because of nasotracheal intubation during general anesthesia and facial swelling in early facial trauma patients. If nasal packing and MMF are needed, there are difficult to maintain the reducted nasal bone because of some difficulty in airway maintenance after nasal packing and increasing the patient discomfort. So postoperative nasal deformity is more common in these combined patients. Secondary rhinoplasty is necessary in these patients who have deformed nasal bone, and there are many methods and materials for secondary rhinoplasty. But if primary nasal bone was reducted symmetrically, it is easy in secondary rhinoplasty. We present 7 cases of secondary rhinoplasty in mid-facial trauma patients who had combined nasal bone fracture. In these patients, primary nasal bone reduction carried with closed reduction method during primary facial bone reduction. About 6 months later, we performed secondary rhinoplasty with iliac bone and alloplastic materials. So we report these cases with literatures.