• Maxillofacial Plastic and Reconstructive Surgery
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• v.13 no.1
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• pp.53-62
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• 1991

Tracheostomy may be used to assure airway protection in various clinical situation. It, as a known operation, has a history spanning 2000 years. The first clear account of a successful tracheostomy was recorded in 1546 by Brasavola. Until 1718 the term "bronchotomy" was used to describe the procedure. Heister then introduce the term "tracheotomy and this was later adopted and popularized by Trousseau about 1830. The term "tracheostomy" appeared in medical literature after 1820 and the two terms "tracheostomy" and "tracheotomy" are used interchangeably today. Indications include relief of upper airway obstruction, facilitation of pulmonary toilet, diminution of dead space and need for prolonged mechanical ventilation. The extent of indication of tracheostomy has a tendency to increase, thus oral and maxillofacial surgeons have some opportunities to face a situation that require tracheostomy. So, we reported retrospective study of 31 cases of tracheostomy patient in oral and maxillofacial surgery with reference review to reveal the significance of surgical skill and management capability of emergercy state maxillofacial surgery patients.

• Tuberculosis and Respiratory Diseases
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• v.46 no.5
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• pp.628-635
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• 1999

Background : Maximal expiratory flow rate is determined by the size of airway, elastic recoil pressure and the collapsibility of airway in the lung. The obstruction of expiratory flow is one of the major functional impairments of emphysema, which represents COPD. Nevertheless, expiratory narrowing of upper airway may be recruited as a mechanism for minimizing airway collapse, and maintaining lung volume and hyperinflation by an endogenous positive end-expiratory pressure in patients with airflow obstruction. We investigated the physiologic role of trachea in respiration in emphysema. Method : We included 20 patients diagnosed as emphysema by radiologic and physiologic criteria from January to August in 1997 at Seoul Municipal Boramae Hospital. Chest roentgenogram, high resolution computed tomography(HRCT), and pulmonary function tests including arterial blood gas analysis and body plethysmography were taken from each patient. Cross-sectional area of trachea was measured according to the respiratory cycle on the level of aortic arch by HRCT and calibrated with body surface area. We compared this corrected area with such parameters of pulmonary function tests as $PaCO_2$, $PaO_2$, airway resistance, lung compliance and so on. Results : Expiratory cross-sectional area of trachea had significant correlation with $PaCO_2$ (r=-0.61, p<0.05), $PaO_2$ (r=0.6, p<0.05), and minute ventilation (r=0.73, p<0.05), but inspiratory cross-sectional area did not (r=-0.22, p>0.05 with $PaCO_2$, r=0.26, p>0.05 with $PaO_2$, and r=0.44, p>0.05 with minute ventilation). Minute ventilation had significant correlation with tidal volume (r=0.45, p<0.05), but it had no significant correlation with respiratory frequency (r=-0.31, p>0.05). Cross-sectional area of trachea had no significant correlation with other parameters of pulmonary function including $FEV_1$, FVC, $FEV_1$/FVC, peak expiratory flow, residual volume, diffusing capacity, airway resistance, and lung compliance, whether the area was expiratory or inspiratory. Conclusion : Cross-sectional area of trachea narrowed during expiration in emphysema, and its expiratory area had significant correlation with $PaCO_2$, $PaO_2$, and minute ventilation.

• Tuberculosis and Respiratory Diseases
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• v.42 no.6
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• pp.813-822
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• 1995

Background: Bronchial hyperresponsiveness and abnormal response such as a loss of distensibility are pathophysiologic characteristics if bronchial asthma. The only means of direct in vivo measurement of airway size had been a tantalium bronchography, until high-resolution computed tomography(HRCT) enabled to measure noninvasively two dimensional airway area more accurately and reliably. Method: To investigate airway area responses to bronchial provocation with methacholine and evaluate the major sites of bronchial constriction in patients with bronchial asthma. We examined HRCT scans in five patients with bronchial asthma who had significant bronchoconstriction(20% or more decrease in $FEV_1$) using CT scanner(5,000T CT, Shimadzu Co, Japan) before and in 3~5 min. after methacholine inhalation. Airways which were matched by parenchymal anatomic landmarks in each patient before and after methacholine inhalation were measured using film scanner(TZ-3X scanner; Truvel Co. Chatsworth CA, USA) and a semiautomated region growing method. Results: 1) We identified 9 to 12 airways in each patient which were matched by parenchymal anatomic landmarks before and after methacholine inhalation. 2) Airway responses to methacholine are quite different even in a patient. 3) The constriction of small airways(average diameter <2 mm; area < $3.14mm^2$) was 48.7%(8.3; SEM, n=43), being more prominant than that of large airways(average diameter >2 mm; area > $3.14mm^2$), 53.8% (4.4;SEM, n=10), but not significantly different(p>0.05). 4) There was no significant difference in the degree of constriction between upper(44.3% +5.8; mean + SEM, n=30) and lower lung regions(56.7% +4.5, n=23). Conclusions: Thus airway responses to methacholine bronchoprovocation is quite variable in a patient with bronchial asthma and has no typical pattern in patients with bronchial asthma.

• Tuberculosis and Respiratory Diseases
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• v.45 no.4
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• pp.876-881
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• 1998

Tracheal papillomatosis is rare. When the disease starts during childhood, it usually appears to be self-limiting if properly managed. In adults, however, the disease sometimes runs a more protracted course with a higher risk of developing cancer. The tumors are derived from the tracheal surface epithelium and tracheal mucous glands and usually grow exophytically. Treatment has traditionally been with repeated endoscopic resection. However, in view of its viral origin, attempts have been made to control the disease with interferon. A 67 years-old man was presented with exertional dyspnea. He was treated for bronchial asthma at another hospital. There was no improvement in his symptom. He was referred to this hospital, and a bronchoscopic biopsy showed tracheal papillomatosis. He was undergone bronchoscopic laser therapy with symptomatic improvement.

• Journal of the korean academy of Pediatric Dentistry
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• v.49 no.4
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• pp.357-367
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• 2022

Sleep disordered breathing (SDB) is a disease characterized by repeated hypopnea and apnea during sleep due to complete or partial obstruction of upper airway. The prevalence of pediatric SDB is approximately 12 - 15%, and the most common age group is preschool children aged 3 - 5 years. Children show more varied presentations, from snoring and frequent arousals to enuresis and hyperactivity. The main cause of pediatric SDB is obstruction of the upper airway related to enlarged tonsils and adenoids. If SDB is left untreated, it can cause complications such as learning difficulties, cognitive impairment, behavioral problems, cardiovascular disease, metabolic syndrome, and poor growth. Pediatric dentists are in a special position to identify children at risk for SDB. Pediatric dentists recognize clinical features related to SDB, and they should screen for SDB by using the pediatric sleep questionnaire (PSQ), lateral cephalometry radiograph, and portable sleep monitoring test and refer to sleep specialists. As a therapeutic approach, maxillary arch expansion treatment, mandible advancement device, and lingual frenectomy can be performed. Pediatric dentists should recognize that prolonged mouth breathing, lower tongue posture, and ankyloglossia can cause abnormal facial skeletal growth patterns and sleep problems. Pediatric dentists should be able to prevent these problems through early intervention.

• Korean Journal of Clinical Laboratory Science
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• v.52 no.3
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• pp.278-283
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• 2020

Central sleep apnea (CSA) is characterized by respiratory failure of at least 10 seconds without any effort of the chest and abdomen in the absence of upper airway resistance during sleep. In this case, the patient experiences respiratory failure that does not meet the CSA diagnostic criteria and CSA symptoms. Magnetic resonance imaging diffusion-weighted imaging (MRI DWI) scans revealed a lateral medullary infarction. Continuous positive airway pressure (CPAP) was applied as a primary treatment for CSA and respiratory failure. During the titration of CPAP, the apnea-hypopnea index (AHI) and arousal index (AI) were worse than the results before its use (AHI: 42.5/hr→82.8/hr, AI: 21.7/hr→40.8h). As a result, adaptive servo-ventilation (ASV) was chosen as the secondary treatment. Compared to the night-polysomnography results before the ASV treatment, the AHI improved (42.5/hr→8.6/hr). Therefore, ASV is a potential treatment for CSA and respiratory failure in these patients.

• The Journal of Korea Assosiation for Disability and Oral Health
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• v.12 no.1
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• pp.20-26
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• 2016

Sympathetic reaction to grotesque facial injuries with oral bleeding can trigger confusion and generate inefficiency among emergency room personnel. Regardless of the extent of the injury, or of the sympathy elicated, the victim must be evaluated and treated as a whole patient with multiple trauma. There must be no confusion as to order of importance in the steps of evaluation : 1. airway 2. hemorrhage 3. shock 4. associated injuries 5. local injury 6. triage of facial injuries. The most dangerous aspect of oral hemorrhage is the possibility of its obstructing the upper airway. Swallowing large amounts of blood will usually cause gastric irritation and lead to vomiting, thus further complicating the management of the patient. Once a clear airway is assured and hemorrhage have been controlled, consideration is given to possible associated injuries before undertaking treatment of the facial injuries themselves. Status of the cardiopulmonary, gastrointestinal and neuromuscular systems all have a bearing on decisions concerning facial injury treatment. In this light, treatment priority becomes exceeding important. On the other hand, the importance of facial injuries should never be minimized, especially in a mentally retarded patient with oral hemorrhage. This is a case report about oral hemorrhage control as treatment priority in a mentally retarded patient.

• Tuberculosis and Respiratory Diseases
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• v.65 no.1
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• pp.41-48
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• 2008

Bronchial mucoepidermoid carcinoma is uncommon, representing 0.2% of all lung tumors. The disease usually presents with symptoms of airway obstruction and recurrent pneumonia. It is commonly classified into two grades in Korea, low and high. We report a case of a bronchial mucoepidermoid carcinoma in a 40-year-old woman who complained of symptoms of an upper respiratory infection. The histological grade after a bronchoscopic biopsy was intermediate. A left upper lobectomy was performed as treatment. The TNM stage of this case was IA (T1N0M0). In addition, 25 cases of bronchial mucoepidermoid carcinoma from 1984 in Korea are also reviewed from the viewpoint of the relationship between the histological grade, TNM stage and clinical course of the tumor.

• Journal of Dental Anesthesia and Pain Medicine
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• v.22 no.2
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• pp.155-159
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• 2022

Cohen syndrome is a rare genetic disorder associated with mutations in the VPS13B gene. Individuals with this disorder present with diverse clinical manifestations, including muscle hypotonia, intellectual disabilities, and typical facial characteristics, such as prominent upper central incisors and micrognathia. General anesthesia was administered to a 23-year-old man with Cohen syndrome. Although we observed prominent upper central incisors, an overjet of 10 mm, micrognathia, and thyromental distance of 4 cm, hypotonia was not observed in the patient. Intubation was rendered difficult when performing a direct laryngoscopy. However, smooth intubation was achieved using a video laryngoscope. The patient's train of four (TOF) count remained zero close to 60 min after rocuronium administration, suggesting that the drug's muscle-relaxant effect may have been prolonged. A TOF ratio of 0.79 was confirmed 130 min after rocuronium administration, and a TOF ratio of 1.0 was confirmed after administration of 150 mg of sugammadex. The patient's respiration remained stable after extubation, and no recurarization of muscle relaxation was observed. As demonstrated in this case report, it is important to closely monitor recovery from muscle relaxation and prepare multiple techniques for airway management in general anesthesia management of patients with Cohen syndrome.

• Korean Journal of Head & Neck Oncology
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• v.36 no.2
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• pp.45-50
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• 2020

Extranodal Natural Killer (NK)/T-cell lymphoma, nasal type, is a subtype of non-Hodgkin lymphoma, strongly associated with Epstein-Barr virus. Extranodal NK/T-cell lymphoma mostly affects the nasal cavity and there has been no report of the disease's occurrence at the base of tongue. Here we report a case of 43-year-old man who presented with a diffuse ulcerative lesion at the base of tongue. Because the patient had oral bleeding, tracheostomy and lingual artery ligation was performed via a transcervical approach to control bleeding and protect the upper airway. We performed a deep biopsy through the lateral pharyngotomy approach, and finally, the patient was diagnosed with extranodal NK/T-cell lymphoma, nasal type. We report this rare case of extranodal NK/T cell lymphoma at the base of tongue with a literature review.