• Journal of Chest Surgery
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• v.39 no.2 s.259
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• pp.111-116
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• 2006

Background: Perforation of the esophagus is a deadly injury that requires expert management for survival. The mediastinal contamination with microorganisms, gastric acid, and digestive enzymes results in a mediastinitis that is often fatal if untreated. Material and Method: Between January 1990 and June 2004, 38 patients with esophageal perforation were treated in our hospital. Retrospective review of these cases has been performed. Result: There were 28 males and 10 females. The mean age was 43.84$\pm$18.89 years (range $1{\~}73$ years). Spontaneous rupture was found in $34\%$ of perforations, iatrogenic perforation in $32\%$ and traumatic perforation in $34\%$. Perforation occurred in the cervical esophagus in 8 cases, thoracic esophagus in 29 and abdominal esophagus in 1. In the cervical esophageal perforation, managements were primary closure in 8 and drainage in 2. In the thoracic esophageal perforation, managements were primary closure in 14, resection in 3 and conservative management in 12. The mortality rate was $25\%$ in cervical esophageal perforation and $34.5\%$ in thoracic esophageal perforation. We revealed risk factor of esophageal perforation to be peropertaive septic condition (p=0.005). Conclusion: Most important risk factor of esophageal perforation was preoperative septic condition. Preoperative prompt and aggressive preoperative treatment may improve the survival rate of esophageal perforation.

• Journal of the korean academy of Pediatric Dentistry
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• v.30 no.3
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• pp.348-353
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• 2003

Early detection and prudent management of mesiodens or supernumerary tooth should be considered essential in reducing disturbance in the eruption and position of the adjacent permanent incisor. While it is true that the presence of diastema may be regarded as normal at the early mixed dentition stage, the early detection and removal of the mesiodens is a prerequisite to facilitate spontaneous alignment or subsequent approximation of the permanent central incisors. In many cases, diastema due to mesiodens can be physiologically corrected spontaneously after the extraction of mesiodens. The best choice of treatment of diastema may be observation. Orthodontic intervention is required only spontaneous closing of diastema does not occur within observation period. In orthodontic intervention, careful treatment plan should be established. Clinician gives considerations to angulation of central and lateral incisor, proximity of lateral incisor, developmental stage and position of canine, pattern and extent of anterior crowding. Orthodontic movement should be done slowly with light force. In addition, periodic radiographic observation are needed to monitor the root development and root resorption. Case 1, 2 and 3 showed physiologic closures after the extraction of mesiodens. In these cases, acceptable alignment of central and lateral incisors was obtained. In case 4, orthodontic correction for diastema was performed successfully after the extraction of mesiodens. After the orthodontic closure of the diastema, it was decided that a retainer was not needed, because the dentition was under a dynamic stage in exchanging teeth and also developing arches.

• Journal of the korean academy of Pediatric Dentistry
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• v.32 no.1
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• pp.152-157
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• 2005

Hypophosphatemia rickets, also known as Vitamin D-resistant rickets(VDRR) and refractory rickets, is a form of rickets which is resistant to the usual doses of vitamin D. VDRR is characterized by decreased renal tubular reabsorption of inorganic phosphate and is easily diagnosed by a normal blood calcium, hypophosphatemia, and slightly elevated alkaline phosphatase. Clinical features of Hypophosphatemia rickets included lateral bowing deformities of the legs, short stature, scoliosis, and enlargement of wrist and ankles. Dental finding in patient with VDRR were spontaneous dental abscesses in caries free teeth and other dental findings included delayed eruption, delayed apical closure, thin and hypoplastic enamel, absent or poorly defined lamina dura, enlarged pulp chambers, and numerous accessory canals and pulp horns that extend up and into the dentinoenamel junction. we reported the clinical feature and treatment of VDRR child who was referred from the department of pediatrics for early loss of primary teeth and its treatment.

• Journal of Chest Surgery
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• v.31 no.1
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• pp.46-51
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• 1998

Treatment of esophageal perforation when diagnosed late remains controversial. Ten consecutive patients since 1990 were treated late(later than 24 hours) for esophageal perforation with primary repair. Four perforations were iatrogenic, 3 were spontaneous, 2 were foreign body aspiraton and 1 was trauma. The interval from perforation to operation was 116 hours in mean and 48 hours in median value. The principles of repair included (1) a local esophagomyotomy proximal and distal to the tear to expose the mucosal defect and intact mucosa beyond, (2) debridement of the mucosal defect and closure, (3) reapproximation of the muscle, and (4) adequate drainage. The repair was buttressed with parietal pleura or pericardial fat in 9 patients. Associated distal obstruction was treated with dilation and esophagomyotomy intraoperatively. There was one mortality and cause of death was massive gastric bleeding due to gastric ulcer on 33rd day after operation. Five patients had leak at the site of repair and these cases were treated completely with conservative treatment except a mortality case. In conclusion, in the absence of malignant or irreversible distal obstruction, meticulous repair of perforated esophagus and adequate drainage are preferred approach, regardless of the duration from the injury to the operation.

• Korean Journal of Bronchoesophagology
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• v.11 no.1
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• pp.15-20
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• 2005

Background : It is well-known that esophageal perforation (EP) is difficult in diagnosis and has high mortality rate despite proper management. There are disputes in regarding the reatment in cases of delayed diagnosis although in the early diagnosed cases, operation is recommended without arguments. Methods: From April, 2001 to December, 2004, nine patients who were diagnosed as EP in our hospital were analyzed retrospectively about the causes, the interval between the cause and the treatment, and operation methods. Results: There were 8 male and one female with men age of 49.3 years (range: 25-67 years). The causes of EP included perforations following operations of corvical spine in three cases, spontaneous perforation(Boehaave syndrome) in two cases, foreign bodies in two cases, operation of esophageal diverticulum in one case and blunt trauma bytraffic accident in one case. Mean interval between the first treatments and the causes was 11.6 days (range: 2-30 days). The sites of perforation were upper third of esophagus in three cases, middle third in three cases and lower third in three cases. All except two cervical cases presented as mediastinitis or empyema at the time of diagnosis. Primary repair and irrigation had been performed in 7 cases but five cases out of them required more than two procedures. Conclusions : More than one procedure wasrequired in the treatment of EP because of contaminations and infections which had been spread at the time of initial manifestatios, howeverprimary closure and massive irrigation is the best method in order to preserve esophagus unless the remaining esophagus is extensively damaged.

• Journal of Dental Rehabilitation and Applied Science
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• v.39 no.3
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• pp.146-157
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• 2023

The bite collapses due to posterior teeth loss or wear results in inadequate space for restoration and esthetic concerns. Increasing the occlusal vertical dimension to improve space deficiency rotates the mandible posteriorly, creating a gap between the maxillary and mandibular anterior teeth, leading to loss of anterior guidance. To solve this problem, the prosthodontics or orthodontics treatments are the commonly used methods for proper anterior guidance. However, it is reasonable to assume that the anterior teeth can naturally relapse to their original position when the occlusal force is eliminated. Therefore, this case report aimed to test whether natural relapse could recover the lost anterior guidance to develop a less invasive and more convenient treatment method. Digital superimposition was used to evaluate the changes in anterior teeth alignment to confirm the change of the recovered anterior guidance. The appropriate indications for this new treatment method were defined and applied clinically.

• Journal of the korean academy of Pediatric Dentistry
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• v.36 no.2
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• pp.298-304
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• 2009

XLH (X-linked hypophosphatemic rickets) is a form of rickets which is resistant to the usual dose of vitamin D and inherited in a X-linked dominant manner. It is also known as vitamin D-resistant rickets or familial hypophosphatemic rickets. Here we report a 6-year-and-6-month-old female patient of XLH who is diagnosed with in SNUB. She was referred from local clinic for impaction of maxillary left permanent incisor and its treatment. She presents bowing deformities of the legs, short stature, enlargement of wrist and ankles and spontaneous dental abscesses of clinically sound teeth delayed eruption, taurodontism, delayed apical closure, enlarged pulp chambers, and absent or poorly defined lamina dura. The purpose of this case is to review the literatures of XLH and report the dental and medical characteristics of this patient.

• Journal of Chest Surgery
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• v.9 no.2
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• pp.298-310
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• 1976

A clinical analysis was performed on 118 cases of the benign esophageal diseases experienced at Department of Thoracic Surgery, Seoul National University Hospital during 20 year period from 1957 to 1976. Of 118 cases of the benign esophageal diseases, there were 84 patients of esophagenal stenosis, 14 of esophageal perforation, 8 of esophageal atresia, 7 of achalasia, 2 of hiatal hernia, 2 of esophageal foreign body and one of esophageal diverticulum. Fifty-one patients were male and sixty-seven were female, and ages ranged from one day to sixty-four years with peak incidence in the age group of 20 to 29 years. All but one of the esophageal stenosis were caused by corrosive esophagitis and ages ranged from three to sixty-four years with peak incidence in third decade. Main symptoms of the esophageal stenosis were dysphagia, weight loss and chest pain in order and mostly began between one month and one year after ingestion of corrosive agents. Corrosive esophageal stenosis developed most frequently in middle one-third of the esophagus and about one-forth of them were diffuse. Operations were performed on 72 patients of esophageal stenosis of whom 26 patients had esophagocologastrostomy, 21 gastrostomy, 20 esophagogastrostomy, 4 esophagojejunogastrostomy and 2 pharyngogastrostomy. There were 5 deaths in the postoperative period, an operative mortality of 6.9 percent, and 20 patients had one or two complications; eight were anastomotic leaks, 6 gangrenes of replaced loop, 4 wound abscesses and others. The causes of the esophageal perforation were traumatic in 7 cases, caustics in 4 and spontaneous in 3, and the most frequent site of the perforation was lower one-third of the esophagus. Frequent symptoms of the esophageal perforation were pain, fever, dysphagia and dyspnea, and preoperatively there were mediastinitis in 8 cases, empyema in 7, lung abscess in 3 and others. All 14 patients of the esophageal perforation underwent operation: primary closure in 7 cases, drainage in 4, esophagogastrostomy in 2 and 'esophageal diversion in one. There were 4 postoperative deaths and 11 postoperative complications occurred in 7 patients. The duration of symptoms in achalasia was between 3 months and 25 years, with an average duration of 6. 2 years. Frequent symptoms of the achlasia esophagi were dysphagia, regurgitation, pain and weight loss in order. All 7 patients of achlasia underwent modified Heller's operation where 2 patients had complications, restenosis in one and esophageal perforation in another. All 8 patients of congenital esophageal atresia had distal tracheoesophageal fistula and were admitted within 5 days of life, but there were pneumonic consolidation on chest X-ray in patients. Five patients underwent one staged operation with the result of 2 deaths and one anastomotic leak.

• Journal of the korean academy of Pediatric Dentistry
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• v.40 no.1
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• pp.41-47
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• 2013

Maxillary canines are the most commonly impacted or ectopically erupted teeth. If we find the abnormality of maxillary canines early, we can manage it reasonably and systematically. If we cannot see the spontaneous normalization at the periodic recall, primary canine extraction will be the next treatment choice. However, if the primary canine is extracted too early, the extraction socket will be filled with hard bone and then the eruption pathway can be locked. So it is more beneficial to extract the primary canine at the period about 6 months before the normal canine eruption time. The next treatment plan can be surgical and orthodontic approaches before the root apical closure of the impacted canine. Sometimes, surgical extraction and further prosthetic procedure can be needed for a severely malposed impacted canine or badly resorpted incisor. This is the case of the idiopathic mesial movement of impacted maxillary canines.

• Journal of Chest Surgery
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• v.41 no.3
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• pp.347-353
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• 2008

Background: Esophageal perforation is an emergency that. requires early diagnosis and effective treatment. A delay in diagnosis and treatment. significantly increases morbidity and mortality. Material and Method: Thirty-seven patients with esophageal perforation were surgically treated at our institutions between January 1990 and December 2006. We retrospectively reviewed the results of surgical treatment for esophageal perforation to understand the risk factors affecting survival inpatients. Result: Patients ranged in age from 21 to 87 years, with an average age of $52.7{\pm}16.98$ years. Thirty-one of the patients were men and six were women. There were 23 patients (62%) with spontaneous perforations, 10 patients (27%) with a traumatic perforation, and 4 patients (11%) with an iatrogenic perforation. The site of esophageal perforation was the cervical esophagus in 5 patients, the thoracic esophagus in 31 patients, and the abdominal esophagus in one patient. Twenty-nine patients underwent primary closure of the perforation and five patients had T-tube drainage. Exclusion-diversion procedures were performed in two patients and an esophagectomy was performed in one patient. There were six cases of mortality (16.22%) and 25 cases of postoperative complications in 15 patients (40.5%). Patients that were treated later than 24 hours after detection of the perforation showed a statistically significant high morbidity and mortality rate (p<0.05). Conclusion: The most important risk factor of esophageal perforation was the time interval between detection of the perforation and the initiation of treatment. A prompt diagnosis and effective treatment are necessary to decrease morbidity and mortality.