• Journal of the Korean Association of Oral and Maxillofacial Surgeons
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• v.28 no.3
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• pp.175-181
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• 2002

Intermaxillary fixation and occusal splint are routine procedure for maxillofacial fracture and orthognathic surgery. When these methods could obstruct oral airway the patients who kept intermaxillary fixation and occusal splint in their mouth, are very difficult to breath after surgery. Nasal bleeding and pharyngeal edema due to nasotracheal intubation, residual effect of muscle relaxants, and anesthetic agent could be contributing factor of airway obstruction. In this study, pulmonary function test was evaluated before and after intermaxillary fixation, and intermaxillary fixation with occusal splint in 22 volunteers. The results were as follows 1. FVC, %FVC, $FEV_1$, $FEV_1%$, PEF, $PEF_{50}$, MVV without intermaxillary fixtion were 4.45L, 88%, 4.03L, 90.9%, 10.26L/s, 5.53L/s, and 136.14L/min, and with intermaxillary fixation were 3.51L, 68.67%, 3.06L, 69.39L, 6.52L/s, 3.94L/s, and 69.39L/min. The results with intermaxillary fixation and occusal splint were 2.15L, 42.41%, 1.71L, 38.81%, 2.83L/s, 1.74L/s, and 37.14L/min. 2. Compared with before and after intermaxillary fixation, all values of pulmonary function test were decreased and after intermaxillary fixation and intermaixillary fixation with occulasal splint, the results were decreased. 3. MVV and PEF were decreased significantly with interaxillary fixtion and occusal splint, and FVC was less decreased. It meant that intermaxillary fixation and occluasal splint induced reduction of respiratory flow significantly, but less reduction of respiratory volume. 4. Intermaxillary fixation and occulsal splint induced increase of airway resistance, decrease of expiratory volume and air flow. So severe respiratory difficulty could be seen to all volunteers who kept intermaxillary fixtion and occusal splint. 5. In classification of respiratory difficulty, intermaxillary fixation with occulsal splint induced complex respiratory difficulty more than intermaxillary fixation only did. From the above results, doctors who care patients kept intermaxillary fixation and occusal splint should be aware of respiratory depression caused by these treatment.

• Journal of The Korean Dental Society of Anesthesiology
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• v.8 no.1
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• pp.22-28
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• 2008

Background: Cerebral palsy (CP) is non-progressive disorder of motion and posture. In CP patient, there are difficulties in dental treatment because of uncontrolled movement of limb and head, and conjoined disabilities such as cognitive impairment, sensory loss, seizures, communication and behavioral disturbances. It is reported that CP patients have high incidence in caries and a higher prevalence of periodontal disease. But, despite the need for oro-dental care, these patients often are unlikely to receive adequate treatment without sedation or general anesthesia because of uncontrolled movements of the trunk or head. Methods: We reviewed the 58 cases of 56 patients with CP 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 19 (2-54) years. The number of male patient was 40 and that of female was 18. They all had severe spastic cerebral palsy and 22 had sever mental retardation, 15 epilepsy, 8 organic brain disorder, 1 blindness, 2 deafness and cleft palate. For anesthesia induction, 14 cases was needed physical restriction who had sever mental retardation and cooperation difficulty, but 44 cases showed good or moderate cooperation. Drugs used for anesthesia induction were thiopental (37 cases), sevoflurane (14 cases), ketamine (3 cases ) and propofol (4 cases). All patients except one were done nasotracheal intubation for airway management and 4 cases were needed difficult airway management and 1 patient already had tracheostomy tube. Mean total anesthetic time was $174{\pm}56$ min and staying time at PACU was $88{\pm}39$ 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.

• The Journal of Korea Assosiation for Disability and Oral Health
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• v.15 no.1
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• pp.65-69
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• 2019

Wolf-Hirschhorn syndrome(WHS) is a congenital disorder caused by deletions of the short arm of chromosome 4. The most common characteristics are mental and growth retardation, dietary disorder and craniofacial features with a characteristic 'Greek warrior helmet' appearance. The dental characteristic of WHS includes delayed development, tooth agenesis, clefts, microdontia, taurodontism, and severely worn dentition. The purpose of this case report is to describe the dental treatment of a patient with WHS. 3-year-old boy with WHS visited the Seoul National University Dental Hospital for dental treatment. He had difficulty with nasotracheal intubation because of craniofacial anomalies and also had poor oral hygiene due to a limitation of mouth opening and dietary disorder. Due to his airway problem, behavior management and severity of dental conditions, dental treatment was performed under general anesthesia. This case suggests general anesthesia can be chosen with WolfHirschhorn syndrome patients to safely care for their dental problems.