• Journal of Oral Medicine and Pain
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• 제36권1호
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• pp.71-79
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• 2011

공률이 낮은 것으로 알려져 있다. 본 연구의 목적은 이개측두신경을 전달마취하여 수조작할 경우 변위된 관절원판의 정복에 영향이 있는지 여부 및 그 결과에 영향을 미치는 인자들을 조사하는 것이다. 비정복성관절원판변위로 진단된 112명의 환자들에 대해 수조작정복술을 시도하였으며, 그 중 35명의 환자들에서 관절원판 변위가 해소되었다. 관절원판 재위치에 실패한 77명의 환자들 가운데 이개측두신경의 전달마취 시술에 동의하는 49명(평균 연령 $34.3\;{\pm}\; 15.1$, 남자 24명, 여자 25명)에 대해 마취시술 후 수조작 정복술을 다시 시행하였다. 연령, 발병후 경과시간, 술전 능동적개구량을 포함한 요인들과 국소마취 후 수조작 정복 성공률과의 관련성을 분석하였다. 수조작만으로 정복이 되지 않았던 49명 환자 중, 이개측두신경 전달마취 후 19명(38.8%)에서 성공적으로 정복이 되었다. 국소마취 전 49명의 최대 능동적 절치간 개구량은 $25.7\;{\pm}\;6.0$ mm로서 개구가 상당히 제한된 상태였으나, 국소마취 및 수조작 후 관절원판이 성공적으로 재위치된 19명의 개구량은 $46.1\;{\pm}\;4.5$ mm로서 정상범위로 회복되었다. 연령, 발병후 경과시간, 술전 능동적개구량 인자들과 국소마취 후 수조작 정복 성공률과는 유의한 관련성이 없었다. 결론적으로 이개측두신경 전달마취는 수조작정복술과 함께 시행할 경우 비정복성관절원판변위의 정복 성공률을 향상시 키므로, 비정복성관절원판변위의 일차적인 치료 단계에서 적극적으로 활용하는 것이 권장된다.

• Journal of Korean Neurosurgical Society
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• 제37권4호
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• pp.275-281
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• 2005

Objective: The prolactinoma is the most common pituitary tumor and sometimes shows severe invasiveness to the adjacent cavernous sinus, especially in the male patient. The dopamine agonist can be used as an alternative treatment modality to surgery. But, the transsphenoidal or transcranial approach for tumor removal has been more preferred treatment option of neurosurgeons in invasive prolactinoma. Especially rapid decompression of mass effect and resolution of the neurologic deficit is demanded. The prospective study is done in order to identify the therapeutic efficacy of bromocriptine as an initial treatment option for the invasive prolactionomas. Methods: Twenty patients with invasive prolactinoma were studied. Preoperative neurological and endocrinological evaluations were done, and size and invasiveness of the tumor was estimated on MRI. Bromocriptine was administrated by increasing dose planning reaching maximum dose at 1 month of treatment, with close neurological and endocrinological monitoring. At 3months after treatment, MRI was taken and decision was made whether to continue bromocriptine or to have surgical intervention. Results: Thirteen patients showed excellent result with only bromocriptine treatment. These patients showed not only marked reduction of tumor volume and prolactin level, but also, improving clinical symptoms and other hormonal deficits. 13patients who had visual field defect and decreased visual acuity had all improved visual symptoms. But, the remaining 4patients required surgical treatment due to insufficient reduction of tumor size inspite of normalized prolactin level within 3months. Remaining 2patients had $20{\sim}30%$ of tumor size reduction, but prolactin level was not normalized. One patient required radiation therapy. Conclusion: Bromociptine can be used as initial treatment for the invasive prolactinomas with careful monitoring of the neurological and endocrinological status. It should be carefully followed up for tumor size reduction within 3 months after initiation of treatment.

• 대한두개안면성형외과학회지
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• 제22권5호
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• pp.254-259
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• 2021

Background: Prophylactic antibiotics are commonly used in craniofacial surgeries. Despite the low risk of surgical site infection after nasal surgery, a lack of consensus regarding the use of antibiotic prophylaxis in the closed reduction of nasal bone fractures has led to inappropriate prescribing patterns. Through this study, we aimed to investigate the status of prophylactic antibiotic use in closed reductions of nasal bone fractures in Korea. Methods: This retrospective cohort study was conducted using data from the National Health Insurance Service-National Sample Cohort of Korea from 2005 to 2015. We analyzed the medical records of patients who underwent closed reduction of nasal bone fractures. The sex, age, region of residence, comorbidities, and socioeconomic variables of the patients were collected from the database. Factors that affect the prescription of perioperative antibiotics were evaluated using multivariate logistic regression analysis. Results: A total of 3,678 patients (mean±standard deviation of age, 28.7±14.9 years; 2,850 men [77.5%]; 828 women [22.5%]) were included in this study. The rate of antibiotic prescription during the perioperative period was 51.4%. Approximately 68.8% of prescriptions were written for patients who had received general anesthesia. The odds of perioperative prophylactic antibiotic use were significantly higher in patients who received general anesthesia than who received local anesthesia (odds ratio, 1.59). No difference was found in terms of patient age and physician specialty. Second-generation cephalosporins were the most commonly prescribed antibiotic (45.3%), followed by third- and first-generation cephalosporins (20.3% and 18.8%, respectively). In contrast, lincomycin derivatives and aminoglycosides were not prescribed. Conclusion: The findings of this study showed that there was a wide variety of perioperative antibiotic prescription patterns used in nasal bone surgeries. Evidence-based guidance regarding the prescribing of antimicrobial agents for the closed reduction of nasal bone fractures should be considered in future research.

• Journal of the Korean Association of Oral and Maxillofacial Surgeons
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• 제31권6호
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• pp.532-535
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• 2005

The objective of this study is assessment of the efficacy of upper joint space arthrocentesis on prevention of TMJ injury from patient with mantibular fractures. We divided the patients into two groups, one which consist of 24 patients who are taken arthrocentesis while open reduction of mandibular fracture, the other which consist of 27 patients without arthrocentesis from Jan 1999 to Dec 2001. We measured maximum mouth opening, excursive movement range respectively one week, one month, three months later after operation. The patients were instructed to mark on 10 cm VAS for evaluation of TMJ pain during resting, mouth opening, and mastication. We evaluated the signs and symptoms of temporomandibular disorder clinically and radiographically 6 months later. The result of this study is that there is a reduction of pain and increase of range of mandibular motion in both groups but in patients with arthrocentesis there is relatively reduction of pain and increase of range of mandibular motion compared with control group. On the points of 6 months later, temporomandibular disorder occurred in 4 patients (16.7%) in group with arthrocentesis and 13 patients (47.1%) in control group. In conclusion, we think that supplemental therapy such as arthrocentesis is helpful for the recovery of jaw function and prevention of the development of temporomandibular disorder after facial trauma.

• Journal of Korean Neurosurgical Society
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• 제47권5호
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• pp.345-351
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• 2010

Objective : In this study, the Mindfulness Based Stress Reduction (MBSR) program was applied to patients presenting with depression and anxiety after surgery from spontaneous subarachnoid hemorrhage (SAH) and the effects were assessed. Methods : The subjects were patients admitted for cerebral aneurysm rupture and treated by means of surgery from March to December, 2007. More than 6 months had passed after surgery, without any special lesions showing up on computed tomography (CT), and the Glasgow outcome scale (GOS) was 5 points. Among patients with anxiety and depression symptoms, 11 patients completed the program. The MBSR program was conducted once a week, 2.5 hours each, for 8 weeks. The evaluation criteria were : 1) the Beck Depression Inventory (BDI): it measures the type and level of depression, 2) the State-Trait Anxiety Inventory : the anxiety state of normal adults without mental disorder, and 3) Heart Rate Variability (HRV) : the influence of the autonomous nervous system on the sinoarterial node varies continuously in response to the change of the internal/external environment. Results : The BDI value was decreased from 18.5 ${\pm}$ 10.9 to 9.5 ${\pm}$ 7.1 (p = 0.013) : it was statistically significant, and the depression level of patients was lowered. The state anxiety was decreased from 51.3 ${\pm}$ 13.9 to 42.3 ${\pm}$ 15.2; the trait anxiety was reduced from 50.9 ${\pm}$ 12.3 to 41.3 ${\pm}$ 12.8, and a borderline significant difference was shown (p = 0.091, p = 0.056). In other words, after the treatment, although it was not statistically significant, a decreased tendency in anxiety was shown. In the HRV measurement, standard deviation normal to normal (SDNN), square root of the square root of the mean sum of squared differences between adjacent normal to normal intervals (RMSSD), and total power (TP) showed significant increase, Physical Stress Index (PSI) showed a significant reduction, and thus an improvement in the homeostatic control mechanism of the autonomic nervous system was ween. Conclusion : The MBSR program was applied to the patients showing anxiety and depression reaction after SAH treatment, and a reduction in depression symptoms and physiological reactions were observed. The application of the MBSR program may be considered as a new tool in improving the quality of life for patients after surgery.

• Journal of the Korean Association of Oral and Maxillofacial Surgeons
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• 제34권3호
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• pp.388-397
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• 2008

The present study was performed to evaluate the function of the mandible according to the pattern of fracture and treatment methods of condylar fractures of the mandible and help operators in making a treatment plan. Sixty patients (average follow-up period was $7.8{\pm}9.4$ months) who were treated for condylar fracture from June, 2002 to May, 2006 at the Department of Oral and Maxillofacial surgery, Chonnam National University Hospital were reviewed. The common causes of the condylar fracture were traffic accident and fall-down (35.0%). In concomitant injuries, laceration was 46.7% and the fracture of the mandibular symphysis was highest incidence (60.0%). The common site of the fracture was the condylar head (47.8%), followed by subcondyle (36.2%) and condylar neck (15.9%). Under 15 years old patients, the closed reduction was performed in 87.5% out of the patients. All of the condylar fragments were fixed to the mandible with titanium miniplates in cases of open reduction. The mean period of intermaxillary fixation (IMF) was $14.2{\pm}6.5$ days in closed reduction and $10.0{\pm}4.2$ days in open reduction. The old patient with bilateral condylar head fractures, who were treated by closed reduction with IMF for 3 weeks, showed the limitation of mandibular movements. But, there was no significant different results between open reduction and closed reduction with the respect of the Helkimo's mandibular mobility index and clinical dysfunction index (DI). Complications, such as fibrous ankylosis and resorption of the mandibular condyle, were not observed in all patients. These results suggest that the good results can be obtained by closed reduction with proper IMF periods and functional exercise in most condylar fractures of the mandible except severely displaced extracapsular fractures.

• 대한두개안면성형외과학회지
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• 제22권3호
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• pp.148-153
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• 2021

Background: The zygomaticomaxillary complex (ZMC) has a protruded, convex shape and plays a vital role in determining the contour by affecting the width of the middle face. This study aimed to evaluate the efficiency of ZMC fracture reduction and explore detailed directions for outcome improvement. Methods: We conducted a retrospective study of patients diagnosed with unilateral ZMC fracture who underwent ZMC reduction surgery at a single hospital between January 2015 and May 2020. The primary outcome variable was facial asymmetry using the difference in the bilateral malar eminence (ME) position measured by computed tomography scan. The 3-dimensional distance (I_A, asymmetry index) and the distance in each dimension, D_x (anteroposterior distance), D_y (mediolateral distance), and D_z (superoinferior distance) were compared. Results: A total of 101 patients with ZMC fractures and 54 non-fracture patients were enrolled in the study. The mean age of the study sample was 43.49 years (control sample, 43.35 years), and the male-to-female ratio was 66.3:33.7 (control sample, 64.8:35.2). There were 53 and 48 patients with right and left ZMC fractures, respectively. The I_A was not statistically different between the two groups. In terms of position in each dimension, only D_x was significantly different between the two groups. Conclusion: The results show that overall facial asymmetry was recovered after ZMC reduction, but in certain dimension significant difference in ME position has still remained. For further improvement, treatment should be performed to relieve malar depression in the anteroposterior dimension.

• 대한치과마취과학회지
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• 제8권1호
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• pp.1-9
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• 2008

Common dental procedures (local anesthesia and dental treatment) are potentially stress-inducing in many patients, especially medically compromised patients. The body response to dental stress involves the cardiovascular system (an increase in cardiovascular workload), the respiratory organ and the endocrine system (change in metabolism). To minimize the stress to the medical risk patient, the stress reduction protocol was established. The obtained contents were as follows: (1) Recognize the patient's degree of medical risk (2) Complete medical consultation before dental therapy (3) Schedule the patient's appointment in the morning (4) Monitor and record preoperative, perioperative and postoperative vital signs (5) Use psychosedation during therapy (6) Use adequate pain control during therapy (7) Short length of appointment: do not exceed the patient's limits of tolerance (8) Follow up with postoperative pain/anxiety control (9) Telephone the higher medical risk patient later on the same day that treatment was given. This protocol is predicated on the belief that the prevention of or reduction of stress ought to begin before the start of an appointment, continue throughout treatment, and, if indicated, into the postoperative period. The authors used the stress reduction protocol in the care of local anesthesia infected teeth in medically compromised patients. The final prognosis was comfortable without any complications.

• Journal of Oral Medicine and Pain
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• 제41권1호
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• pp.1-6
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• 2016

Purpose: To investigate the efficacy of pregabalin for patients with primary burning mouth syndrome (BMS) who are unresponsive to topical clonazepam therapy. Methods: By searching the clinical electronic records from the Department of Oral Medicine, Pusan National University Dental Hospital from 2012 to 2014, a retrospective analysis was performed on patients with primary BMS who were treated with topical clonazepam therapy during this period. Of the patients who were unresponsive to this therapy, 19 patients who were subsequently treated with pregabalin were included in the study. A pain assessment was performed using the 11-point numerical rating scale at first visit, following topical clonazepam therapy, and again after pregabalin therapy. The treatment outcomes were statistically analyzed using the Wilcoxon signed rank test. Results: Following additional pregabalin administration, the mean pain score was slightly reduced. A total of 7 patients reported a marked response (>50% pain reduction), and 3 patients reported a slight reduction in pain. Pain reduction following pregabalin therapy was statistically significant (p<0.05). Conclusions: Pregabalin has a slight therapeutic effect on patients with primary BMS. Therefore, we recommend pregabalin as an alternative drug for BMS patients who are unresponsive to topical clonazepam therapy.

• Archives of Plastic Surgery
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• 제33권6호
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• pp.711-714
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• 2006

Purpose: Contralateral reduction mammaplasty at the time of breast reconstruction using autogenous tissue gives aesthetically improved results in the patients with mammary hypertrophy or ptosis. It also reduces required flap size for reconstruction and permits discarding zones of poor perfusion, decreasing flap size-related problems such as partial flap loss or fat necrosis. Considering the high rate of bilaterality of breast cancer, it also provides a good opportunity for exploration and occult cancer diagnosis in such high risk group patients. Methods: We retrospectively reviewed 45 consecutive patients who underwent simultaneous breast reconstruction and contralateral reduction mammaplasty was performed about surgical technique, pathologic diagnosis, and subsequent treatment. Results: Three occult breast cancers were found in 45 patients(6.7%); one was microinvasive, and the other two were invasive carcinomas and their mean diameter was 1.2 cm. One patient underwent subsequent breast conserving mastectomy, adjuvant radiation and chemotherapy. The others underwent only radiation and hormone therapy. They were followed up for 10 to 42 months without evidence of recurrence or metastasis. Conclusion: Occult breast cancer diagnosed in reduction mammaplasty specimen will lead to good prognosis due to its early detection. Treatment options depend on pathologic finding, stage, marginal status, and the timing of diagnosis. We recommend adequate markings for orientation and margins, excision with sufficient margin, and confirmation by frozen biopsy for suspected lesions.