• Journal of the Korean Association of Oral and Maxillofacial Surgeons
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• 제35권6호
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• pp.499-501
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• 2009

Because sublingual region is well-vascularized and sublingual artery is passed throughout this region, it should be careful not to perforate lingual cortex when placing dental implant on mandible. A 83-years-old male complained severe sublingual hematoma, hemorrhage and dyspnea came our outpatient department. He had received dental implant placement in the same day. He needed hemostasis and airway control. If soft tissue of sublingual region and the artery are injured, it may result in life-threatening excessive hemorrhage. In dental implant surgery, especially mandible, we should recognize the accurate shape of mandible and anatomy of sublingual region. It is important to stop anticoagulant agent before surgery. When a patient has airway obstruction, the operator should manage airway quickly.

• Maxillofacial Plastic and Reconstructive Surgery
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• 제33권2호
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• pp.171-175
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• 2011

Implant placement on the anterior mandible is considered a common and safe surgical procedure. However, severe hemorrhage can occur if branches of the sublingual artery, which run through the lingual cortical plate of the mandible, are damaged. Excessive hemorrhage caused by injury to the sublingual artery can result in life-threatening problems such as airway obstruction. A 54-year old male patient without any generalized systemic conditions was referred due to active bleeding after implant placement in the anterior mandible. Gauze compression with surgicel and bosimin were performed and hemostasis was achieved. The patient was discharged after 3 days without any supplementary bleeding.

• Journal of the Korean Association of Oral and Maxillofacial Surgeons
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• 제39권1호
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• pp.27-30
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• 2013

Dental implantation in the mandibular anterior region is considered a safe and reliable surgical procedure. On the other hand, several articles have reported that inadvertent hemorrhage of the sublingual artery can result in life-threatening airway obstruction. Surgical ligation under intubation or tracheostomy is the most widely used approach for controlling mouth floor bleeding in this highly vascular region. Nonetheless, surgically exploring the bleeding focus is difficult because of anatomical distortion followed by widespread edema and swelling. Since swelling of the mouth floor advances quickly, timely management is essential for favorable postoperative outcome. This paper reports a case of immediate hemorrhage control with angiographic embolization to perform rapid hemostasis before the ongoing swelling causes airway obstruction. Less invasive, angiographic embolization can prevent neurovascular damage during a surgical exploration of injured vascular structures on the mouth floor.

• Korean Journal of Radiology
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• 제21권12호
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• pp.1285-1293
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• 2020

Objective: To evaluate the effects of vasodilators on contrast enhancement and transluminal attenuation gradient (TAG) of coronary arteries at coronary computed tomography angiography (CCTA). Materials and Methods: We retrospectively reviewed CCTA scans of patients who underwent double-acquisition CCTA; CCTA without a vasodilator, and CCTA during a intravenous (IV) infusion of nitrate. Among them, we enrolled 19 patients who had no significant atherosclerotic lesions or coronary spasms. In the control group, 28 patients were enrolled who showed normal coronary arteries on CCTA, which was acquired by a conventional method (sublingual vasodilator). We measured the TAG and Hounsfield units for each of the three major epicardial coronary arteries (reported as 'ProxHU') and then compared the results between the nitrate administration methods (CT without vasodilator [CT_pre], CT with IV vasodilator [CT_iv], and CT with sublingual vasodilator [CT_sub]). Results: The mean TAG showed a significant difference between the coronary arteries (right coronary artery [RCA] > left anterior descending artery [LAD] > left circumflex artery [LCX], p < 0.05), while there was no difference in ProxHU of each coronary artery in all three types of nitrate administration methods (p > 0.05). The TAG of CT_pre group showed steeper slope than those of vasodilator groups (CT_iv and CT_sub) on LAD and LCX ([LAD: CT_pre = -22.1 ± 6.66, CT_iv = -16.76 ± 5.78, and CT_sub = -16.47 ± 5.78, p = 0.005], [LCX: CT_pre = -31.26 ± 17.43, CT_iv = -23.74 ± 14.06, and CT_sub = -20.94 ± 12.15, p = 0.051]), while that of RCA showed no significant differences (p = 0.600). When comparing proxHU, CT_iv showed higher proxHU than that of CT_pre or CT_sub, especially on LCX (CT_pre = 426.7 ± 68.3, CT_iv = 467.9 ± 84.9, and CT_sub = 404.9 ± 63.3, p = 0.013). ProxHU showed a negative correlation with TAG on all three of methods (r = -0.280, p < 0.001). Conclusion: TAG in CCTA was significantly affected by vasodilator administration. Both TAG and ProxHU of coronary arteries tend to increase with vasodilator administration on CCTA.

• 대한핵의학회지
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• 제21권2호
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• pp.175-182
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• 1987

For measurement of ventricular performance, ejection fraction (EF) has gained wide acceptance. But EF is influenced not only by changes in muscle function but also by changes in cardiac loading conditions. In case of valvular heart disease which is variable in loading conditions, EF cannot be reliable as an index of myocardial contractility. The end systolic pressure (ESP)-end systolic volume (ESV) relation, howver, is known to represent myocardial contractility, independent of changes in loading conditions. Similar results can be obtained by using peak-systolic pressure (PSP) instead of ESP. To evaluate the utility of the peak systolic pressure-end systolic volume index (PSP-ESVI) relation as an index of myocardial function, we measured $PSP&ESVI$ in 19 partents with coronary artery disease before $(PSP_1\;&\;ESVI_1)$ and after $(PSP_2\;&\;ESVI_2)$ sublingual administration of nitroglycerin. PSP was measured with standard mercury sphygmomanometer during gated blood pool scintigraphic study. ESVI was measured by count derived method after attenuation correction. $PSP_2\;&\;ESVI_2$ measurement was started when the fall of PSP was greater than 5 mmHg after 7-14 minutes post-administration of nitroglycerin. Mean values $({\pm}S.D.)$ of $PSP_1\;&\;ESVI_1$ was $124.9({\pm}20.7)mmHg\;&\;59.4({\pm}39.9)ml/M^2$. Mean values $({\pm}S.D)$ of $PSP_2\;&\;ESVI_2$, was $113.2({\pm}19.9)mmHg\;&\;37.5({\pm}26.1)ml/M^2$. There was a significant difference between mean values of $PSP_1\;&\;PSP_2$, (p<0.01), and mean values of $ESVI_1\;&\;ESVI_2$, (p<0.01). $PSP_1-PSP_2/ESV_1-ESVI_2,\;PSP_1/ESVI_1$ and EF were in the range of 0.14-5.19 mmHg/ml/$M^2$, 0.67-7.68 mmHg/ml/$M^2$ and 10.8%-74.5% respectively. $PSP_1-PSP_2/ESVI_1-ESVI_2$, and EF showed exponential correlation (r=0.85, P<0.01). The correlation coefficient between $PSP_1/ESVI_1$ and EF was 0.73(p<0.01). With the above results, we suggest that $PSP_1-PSP_2/ESVI_1-ESVI_2$, and $PSP_1/ESVI_1$, can be used as an index of myocardial function.

• 대한핵의학회지
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• 제37권5호
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• pp.278-287
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• 2003

목적: 생존심근 진단에 있어 니트로글리세린 투여 Tc-99m-MIBI 게이트 심근SPECT의 진단성능을 휴식/지연재분포 Tl-201 심근SPECT와 비교하였다. 대상 및 방법: 22명의 관상동맥질환자에서 Tl-201 휴식/디피리다몰 부하 Tc-99m-MIBI 게이트 지연재분포 Tl-201 심근SPECT를 시행하였다. 이 때 게이트SPECT 시행 후 니트로글리세린 0.6 mg을 설하투여하고 연이어 그 자리에서 게이트SPECT를 1회 더 반복 시행하였다. 환자들에게 관상동맥우회로술을 시행하고 3개월 후 게이트 심근SPECT를 추적검사로 시행하였다. 20 분절 모델을 이용하여 각 분절에서 휴식, 지연재분포, 기저상태와 니트로글리세린투여 후의 심벽운동 및 수축기비후화 등을 정량하였다. 정량화된 생존심근 예측지표들 중, (1) 휴식기 Tl-201 섭취, (2) Tl-201 지연재분포, (3) 기저상태의 수축기비후화, (4) 니트로글리세린 투여 후의 수축 기비후화, 네 가지의 예측성능을 평가하고 비교하였다. 결과: 총 100개의 분절이 분석에 포함되었으며, 이 중 66개(66%)의 분절이 재관류 후 기능 회복을 보였다. 최적 기준점인 50%를 기준으로 하였을 때, ROC 곡선 분석에서 휴식기 Tl-201 섭취와 Tl-201 지연재분포의 민감도, 특이도는 각각 79%와 44%, 그리고 82%와 44%였다. 또한 15%를 기준으로 하여, 기저상태 수축기비후화와 니트로글리세린 투여 후 수축기비후화의 민감도, 특이도는, 각각 49%, 50%와 64%, 65%였다. ROC 곡선의 AUC는 니트로 글리세린 투여 후 수축기비후화가 기저시 수축기비후화에 비하여 유의하게 높았다(p=0.004). 결론: 니트로글리세린 투여 Tc-99m-MIBI 정량적 게이트 심근SPECT는 기능이상 심근에서 기능 회복을 예측하는데 유용한 검사이다.

• Journal of the Korean Association of Oral and Maxillofacial Surgeons
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• 제39권6호
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• pp.263-268
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• 2013

Objectives: The interforminal region, between the mandibular foramen, is known as a relatively safe area that is free of anatomic structures, such as inferior alveolar nerve, submandibular fossa, and lingual side of the mandible is occasionally neglected for its low clinical importance. Even in the case of a severely constricted alveolus, perforation of the lingual cortical bone had been intended. However, anterior extension of the inferior alveolar canal, important anatomic structure, such as concavity of lingual bone, lingual foramina, and lingual canal, has recently been reported through various studies, and untypical bleeding by perforation of the lingual plate on implantation has also been reported. Therefore, in this study, we performed radiographic and statistical analysis on distribution and appearance frequencies of the lingual foramina that causes perforation of the mandibular lingual cortical bone to prevent complications, such as untypical bleeding, during surgical procedure. Materials and Methods: We measured the horizontal length from a midline of the mandible to the lingual foramina, as well as the horizontal length from the alveolar crest to the lingual foramina and from the lingual foramina to the mandibular border by multi-detector computed tomography of 187 patients, who visited Dankook University Dental Hospital for various reasons from January 1, 2008 to August 31, 2012. Results: From a total of 187 human mandibles, 110 (58.8%) mandibles had lingual foramina; 39 (20.9%) had bilateral lingual foramen; 34 (18.2%) had the only left lingual foramen; and 37 (19.8%) had the only right lingual foramen. Conclusion: When there is consistent bleeding during a surgical procedure, clinicians must consider damages on the branches of the sublingual artery, which penetrate the lingual foramina. Also, when there is a lingual foramina larger than 1 mm in diameter on a pre-implantation computed tomography, clinicians must beware of vessel damage. In order to prevent these complications and progress with a safe surgical procedure, a thorough radiographic examination before the surgery is indispensable. Further, clinicians should retract lingual flap definitely to confirm the shape of the lingual bone and existence of the lingual foramina.

• 구강회복응용과학지
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• 제29권4호
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• pp.337-346
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• 2013

정중설공은 하악 전치부에 존재하는 해부학적 구조물로서, 구강저의 혈행을 담당하는 설하 동맥이 통과한다. 임플란트 시술 시 설하 동맥의 손상으로 인한 대량 출혈을 예방하기 위해서는 CBCT를 통한 정중설공의 주의 깊은 관찰이 필요하다. 본 연구의 목적은 하악 정중설공의 해부학적 특성인 출현빈도, 위치, 직경과 그 수를 성별과 나이에 따라 CBCT 이미지를 이용하여 평가하기 위함이다. 2008년 11월부터 2011년 5월까지 전남대학교 치과병원을 내원한 62명의 CBCT 이미지(남성 41명, 여성 21명; 평균 연령 43세; 연령 분포 9~85세)를 평가하였다. 하악 전치부 CBCT에서 관찰되는 정중설공의 출현빈도, 수, 위치, 수직적 거리와 직경을 계측하였다. 62명의 환자(100%) 모두에서 설극 상방에 1개 이상의 정중설공을 관찰할 수 있었고, 56명(90.32%)은 다수의 정중설공을 가지고 있었다(2개 64.52%, 3개 25.8%). 42명(66.13%)의 환자에서 하악 양 중절치 사이의 정중설공을 관찰할 수 있었다. 치조정에서 설극까지의 평균 높이는 24.21 mm 였고, 하악골 하연에서 정중설공까지의 평균높이는 14.53 mm, 하악골에서의 상대적인 높이는 0.45였다. 설공의 평균 직경은 0.93 mm였다. CBCT를 통해 정중설공의 출현빈도, 위치, 직경과 그 수를 쉽게 확인할 수 있다. 전치부 임플란트 시술 시 대량 출혈의 합병증을 예방하기 위해서는 임플란트 식립 전 CBCT를 촬영하여 개개인의 정중설공의 해부학적 평가하는 것이 필요할 것이다.