• Journal of the Korean Association of Oral and Maxillofacial Surgeons
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• 제25권4호
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• pp.356-360
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• 1999

PURPOSE : This is to review the complicated jaw fractures that had been referred for revision of the unsatisfactory results, and to provide proper managements for the easily complicated jaw fractures. MATERIALS & METHODS : Twenty-nine patients who had been revised due to malunion or complicated fractures of facial bones for last 3 years were reviewed. The main problems required for revision, type of fractures complicated, the primary managements to be reclaimed, the specialties to be involved, the management to be reclaimed, time elapsed to seek reoperation, type of revision surgeries, residual complication were analysed with medical records, radiographs and final examinations. RESULTS: The major complaints were malocclusion(79.3%), facial disfigurement(41.3%), TMJ problems (13.7%), neurologic problems(10.3%), non-union(10.3%), and infection(6.8%). Unsatisfactory results were occurred most frequently after improper management of the multiple fractures of the mandible (62.2%), combined fractures of maxilla and mandible (20.6%), fracture of zygomatico-maxillary complex and midpalate (17.2%). The complications to be corrected were widened or collapsed dental arches (79.3%), improperly reduced condyles (41.3%), painful TMJ (34.4%), limited jaw excursion (31.0%), over-reduction of zygoma (13.7%), and nonunion with infection(13.7%). and dysesthesia (10.3%). The primary managements were nendereet by plastic surgeons in 82.7%(24/29) and by oral surgeons in 7.6%(2/29). Main causes of malunion are inadequate ORIF in 76%, unawareness & delay in 17%, and delayed due to systemic cares in 17%. 76% of 29 patients had been in state of intermaxillary fixation for over 4 weeks. Revision were done by means of "refracture and ORIF"in 48.2%(14/29), orthognathic osteotomies with bone grafts in 55.1%(16/29), and camouflage countering & alloplastic implantations in 37.9%(11/29), TMJ surgeries in 17.2%, micro-neurosurgeries in 11.6%. Residual complications were limited mouth opening in 24.1% (7/29), paresthesia in 13.7%, resorption of reduced condyle in 10.3%. CONCLUSIONS : Failure of initial treatment of jaw fractures is due to improper diagnosis and inadequate treatment with lack of sufficient knowledge of stomatognathic system. It is crucial to judge jaw fracture and patients accurately, moreover, the best way of treatments has to be selected. Consideration of these factors in treatment could minimize the complication of jaw fractures.

• Journal of Korean Dental Science
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• 제10권2호
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• pp.82-86
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• 2017

Oral and maxillofacial surgery (OMFS) trauma cases are commonly treated under general anesthesia. The purpose of this case report is to introduce an alternative method of anesthesia in patients who refuse general anesthesia. A combination of dexmedetomidine and ketamine for sedation anesthesia in 3 frequent fracture types in the field of OMFS-Le Fort I fracture, mandibular fracture, and alveolar bone fracture-was used. Dexmedetomidine as the single agent has not shown stable success rates for invasive procedures. To overcome some of the pitfalls with dexmedetomidine, combination sedation using ketamine was performed. Visual analogue scale scores were recorded postoperatively. Dexmedetomidine combined with ketamine administration provided safe and effective sedation and anxiolysis for surgical reduction and internal fixation of OMFS fractures. It showed advantages of decreased admission time, reduced expenses, minimal pain, and reduced anesthetic burden for the patient thus ultimately increasing overall satisfaction.

• Archives of Plastic Surgery
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• 제36권2호
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• pp.242-246
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• 2009

Purpose: The majority of nasal bone fractures have been managed by routine procedure of closed reduction and intranasal packing. However, nasal packing can cause nasal injury, hypoxia and patient's discomfort. And, synechiae formation is a frequently occurred after the nasal surgery. Various methods are used to reduce the incidence of synechiae formation. The purpose of this study was to compare routine procedure and nasal packing with reverse "U" shaped silicone sheet with respect to postoperative nasal synechiae formation and final outcome. Methods: We analyzed the medical records of 100 patients with nasal bone fracture who were operated by closed reduction in the last one year. The silicone sheet was designed in reverse "U" fan - shape and inserted between the middle turbinate and the septal wall. Nasal packing was removed at two days after the operation, and silicone sheet was removed at 10 to 14 days. Results: Synechiae in the middle meatus developed in 2 of 75 patients. Although synechiae between the middle meatus and nasal septum occurred in patients, the patients did not complaint of any olfactory disturbance and nasal obstruction. Conclusion: The reverse "U" fan - shape silicone sheet caused less pain for patients and no significant differences in outcome were found. The results of this study suggest that insertion of silicone sheet between the middle meatus and septum can be a useful method in the prevention of intranasal synechiae formation. The reverse "U" silicone sheet is a good alternative for routine packing methods.

• Journal of Trauma and Injury
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• 제27권3호
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• pp.57-62
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• 2014

Purpose: A hamate body coronal fracture is well known as a very rare fracture in the carpal bones and is also hard to diagnose in initial stage due to the bone's architecture. We report our experience in treatment of such a fracture, and we present a review of the relevant literatures. Methods: Four patients who experienced hamate body coronal fractures from October 2006 to October 2013 were enrolled in this study. One patient also had an associated Capitate fracture, and two patients had associated dislocations of the $4^{th}$ metacarpal joint. We performed open reduction and mini-screw fixation on the four patients. In addition, a K-wire was fixed for the two patients with dislocations. Results: The average follow-up period was 24.5 months after surgery, and bone union was observed at the $8^{th}$ week after surgery. We confirmed that bone union had been completed for all the patients, and functional tests showed that joint motion was in the normal range without complications. Conclusion: When a patient has consistent pain on the ulnar side of the wrist, a hamate fracture should be suspected. Computer tomography is better than a simple X-ray scan for confirming the diagnosis of a hamate body coronal fracture. An open reduction and mini-screw fixation led to a good result.

• 한국콘텐츠학회논문지
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• 제12권9호
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• pp.250-256
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• 2012

골밀도 감소에 의해서 발생되는 골감소증, 골다공증 등은 폐경 후 여성에게 유병률이 높은 질환이며, 골다공증 골절에 따른 사회적 의료비 상승으로 의학적 관심이 급증하고 있다. 신부전환자는 체내에 비타민D 합성 능력이 저하되어 칼슘 흡수가 감소하여 뼈의 섬유화가 발생되고, 골밀도가 감소하는 현상이 나타난다. 따라서 신부전환자는 신장 기능 장애로 그치지 않고, 골다공증과 같은 골밀도 감소에 따른 합병증에 노출되어 있다. 본 연구에서는 치료 중에 있는 신부전환자들의 골밀도 변화를 관찰하였고, 신장이식 전후에서 발견되는 골밀도 변화를 분석하였다. 조사대상은 부산 B종합병원 신장내과 내원환자 중 신부전환자 214명을 신장이식의 유무에 따라 골밀도의 변화를 세대별, 성별로 나누어 분석했다. 분석결과 신장이식 환자군에서는 골밀도가 유지되거나 개선되었지만, 비신장이식 환자군에서는 골밀도가 꾸준히 나빠지는 결과를 보였다. 신부전환자는 신장이식을 받는 것이 최선의 치료책으로 사료되며, 신장이식을 통해서 골밀도의 개선이 가능함을 확인하였다. 이는 추가적으로 예상되는 합병증을 예방하기 위한 자료로도 활용할 수 있다.

• Journal of the Korean Association of Oral and Maxillofacial Surgeons
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• 제38권1호
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• pp.50-54
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• 2012

According to Luhr's classification, a fracture in the mandible with a width of less than 15-20 mm is considered to be an atrophic mandibular fracture and its incidence is very rare. Because of the reduced cross-sectional area and smaller contact area of the fractured ends as well as the poorly vascularized bony structure and delayed bone healing, an atrophic mandibular fracture is a great challenge for oral and maxillofacial surgeons. Surgeons tend to perform closed reduction, because open reduction is considered a non-life-saving surgery among elderly patients. Thus, most of them have limited experience in surgical management. According to recent reports, open reduction yields a good result, and the Association for Osteosynthesis (AO) group has recommended open reduction. This is a case report of our two experiences of open reduction and rigid fixation of atrophic mandibular fractures by the AO principle. Articles were also reviewed here.

• 대한족부족관절학회지
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• 제7권2호
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• pp.238-249
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• 2003

Purpose: To report the clinical result of the intraarticular calcaneus fracture after open reduction and internal fixation with plate by lateral approach. Materials and Methods: Thirty-six calcaneal fractures of 33 patients(29 men and 4 women) were treated by open reduction and internal fixation using an lateral approach from March, 1997 to May, 2002 and were followed more than one year. The autogenous iliac bone graft was done in 2 cases but the others didn't. Radiographically B?hler angle and Gissane angle on simple lateral radiograph were measured and in the 15 cases, the step-off(gap) of posterior facet joint on post-operative CT images were followed. The Salama method was used for evaluation of clinical results. Results: According to Sanders classification, 19 cases of the 36 cases were classified as type II. Type III fracture were found in 12 cases and type IV in 5 cases. The following results were obtained: twenty-two cases(61.1%) out of 36 cases were estimated as good or excellent. The good results or more were obtained in 15 cases(78.9%) in type II and 7 cases(58.3%) in type ill, but no case in type IV. B?hler angles were improved from preoperative average 1.6?to postoperative average 23.4?, Gissane angle was improved from preoperative 107.2?to postoperative 122.8?, respectively. Among 36 cases, Computed tomography was carried out in 15 cases. The postoperative step-off (gap) of posterior facet joint on computed tomography was filled with cancellous bone. Satifactory results was obtained in 7 cases with 2mm gap or less and in 6 cases of 2-5mm. There were no satifactory results in 2 cases with 5mm gap or more. Conclusion: Open reduction and internal fixation for intra-articular fracture of calcaneus was thought to be a good treatment modality. It is thought that the lateral approach is one of the good one for surgical treatment, and that accurate reduction of the posterior facet, acceptable recovery of B?hler angle are more important to obtain best results.

• Archives of Plastic Surgery
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• 제38권6호
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• pp.875-878
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• 2011

Purpose: Absorbable implants are frequently used to fix facial bone fractures, because they are radiolucent and compatible with magnetic resonance imaging (MRI). Despite their increasing usage, however, there have been few reports about their long-term side-effects. In this paper, a case in which absorbable implants led to a foreign body reaction 17 months after their insertion is presented. Methods: A previously healthy 19-year-old male fell from a flight of stairs and visited the authors' hospital with right periorbital pain. Zygomaticomaxillary fracture involving right orbital floor was detected via a facial bone computed tomography (CT). Internal fixation with absorbable implants was followed by open reduction. 17 months after the surgery, the patient complained of localized periorbital swelling. Removal of the granulomatous lesion including the absorbable implants along with their biopsy and culture was performed. Results: The granulomatous lesion around the implants was firm and extended into the maxillary sinus. The histologic finding showed a microabscess with a foreign body reaction. Methicillin-sensitive Staphylococcus aureus growth was confirmed in the culture. No definite abnormal symptoms ensued after the complete removal. Conclusion: A microabscess-forming granulomatous lesion around the absorbable implant can cause delayed symptomatic foreign body reaction despite its rare occurrence. Complete removal of the lesion including implants is expected to have a successful outcome if it is encountered.

• Journal of Veterinary Science
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• 제25권4호
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• pp.50.1-50.6
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• 2024

Importance: Canine extraction of large carnivores can pose significant risk due to extensive tissue damage during aggressive bone reduction. This report highlights a rare instance in which the use of a piezoelectric surgical unit (PSU) for maxillary canine extraction in a large carnivore resulted in successful outcomes with minimal tissue damage. Case presentation: A 10-year-old male African lion presented with decreased appetite because of bilateral maxillary canine fractures. Intraoral radiographs revealed enlarged root canals and periapical radiolucency of the fractured canines, leading to a diagnosis of periapical periodontitis and pulpitis. To extract the right maxillary canine, conventional method using hand instrument failed to achieve adequate luxation, necessitating the use of the flat blade of the PSU to sever the periodontal ligament. The left maxillary canine was extracted using PSU from the beginning, and the extraction time was markedly shortened by using PSU without additional alveolar bone damage or bleeding. Conclusion and Relevance: This case demonstrated that utilizing PSU for canine extraction in a lion resulted in periodontal ligament separation, reducing damage to the alveolar bone and shortening surgical time. It suggests the promising application of PSU in tooth extraction for large wild animals, indicating its potential significance in veterinary dentistry.

• Maxillofacial Plastic and Reconstructive Surgery
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• 제23권1호
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• pp.40-47
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• 2001

To investigate epidermiologic trend in maxillofacial fractures. We retrospectively studied 934 patients with maxillofacial fractures between $1981{\sim}1987$ and $1995{\sim}1999$. The results were compared in the previous group (Group A, patients treated between $1981{\sim}1987$) with those in the recent group (Group B, $1995{\sim}1999$). Also, we studied 516 patient between $1995{\sim}1999$ for occupation, associated injuries, treatment and complications. The sex ratio of men to women decreased (5.6 : 1 in Group A vs. 3.5 : 1 in Group B), and the largest age group was 20 to 29 years. There was the highest incidence in September and Fall. The most frequent cause of maxillofacial fracture in both Group A and B was traffic accidents. The distribution of fracture site did not change appreciably, but the frequency of midfacial fracture increased. In the recent group, the largest occupational group was salaried men, and the largest associated injuries of maxillofacial fracture was head and neck injury. Open reduction was used in 91% of the cases, and post-operation complications were infection, neurologic problem, malocclusion, and mouth opening limitation etc. Our results suggest that the clinical features of patients with maxillofacial fractures have changed during the past decade.