• Imaging Science in Dentistry
• /
• v.48 no.4
• /
• pp.269-275
• /
• 2018

Purpose: The aim of this study was to evaluate the correlations between measurements made using panoramic radiography and cone-beam computed tomography (CBCT) based on certain anatomical landmarks of the jaws, with the goal of preventing complications due to inaccurate measurements in the pre-surgical planning phase of dental implant placement. Materials and Methods: A total of 56 individuals who underwent panoramic radiography and a CBCT evaluation before dental implant surgery were enrolled in the study. Measurements were performed to identify the shortest vertical distance between the alveolar crest and neighboring anatomical structures, including the maxillary sinus, nasal floor, mandibular canal, and foramen mentale. The differences between the measurements on panoramic radiography and CBCT images were statistically analyzed. Results: Statistically significant differences were observed between the measurements on panoramic radiography and CBCT for all anatomical structures (P<.05). The correlation coefficients (r) between the paired samples obtained from panoramic radiography and CBCT were closely correlated (P<.05), with r values varying from 0.921 and 0.979 for different anatomical regions. Conclusion: The results of this study support the idea that panoramic radiography might provide sufficient information on bone height for preoperative implant planning in routine cases or when CBCT is unavailable. However, an additional CBCT evaluation might be helpful in cases where a safety margin cannot be respected due to insufficient bone height.

• Archives of Craniofacial Surgery
• /
• v.19 no.4
• /
• pp.264-269
• /
• 2018

Background: Orbital resorbable mesh plates are adequate to use for isolated floor and medial wall fractures with an intact bony buttress, but are not recommended to use for large orbital wall fractures that need load bearing support. The author previously reported an orbital wall restoring surgery that restored the orbital floor to its prior position through the transnasal approach and maintained temporary extraorbital support with a balloon in the maxillary sinus. Extraorbital support could reduce the load applied on the orbital implants in orbital wall restoring surgery and the use of resorbable implants was considered appropriate for the author's orbital wall restoring technique. Methods: A retrospective review was conducted of 31 patients with pure unilateral orbital floor fractures between May 2014 and May 2018. The patients underwent transnasal restoration of the orbital floor through insertion of a resorbable mesh plate and maintenance of temporary balloon support. The surgical results were evaluated by the Hertel scale and a comparison of preoperative and postoperative orbital volume ratio (OVR) values. Results: The OVR decreased significantly, by an average of 6.01% (p<0.05) and the preoperative and postoperative Hertel scale measurements decreased by an average of 0.34 mm with statistical significance (p<0.05). No complications such as buckling or sagging of the implant occurred among the 31 patients. Conclusion: The use of resorbable mesh plate in orbital floor restoration surgery is an effective and safe technique that can reduce implant deformation or complications deriving from the residual permanent implant.

• Archives of Plastic Surgery
• /
• v.48 no.1
• /
• pp.69-74
• /
• 2021

Background In inferomedially rotated zygomatic fractures sticking in the maxillary sinus, it is often difficult to achieve complete reduction only by conventional intraoral reduction. We present a new intraoral reduction technique using a Kirschner wire and its clinical outcome. Methods Among 39 inferomedially impacted zygomatic fractures incompletely reduced by a simple intraoral reduction trial with a bone elevator, a Kirschner wire (1.5 mm) was vertically inserted from the zygomatic body to the lateral orbital rim in 17 inferior-dominant rotation fractures and horizontally inserted to the zygomatic arch in nine medial-dominant and 13 bidirectional rotation fractures. A Kirschner wire was held with a wire holder and lifted in the superolateral or anterolateral direction for reduction. Following reduction of the zygomaticomaxillary fracture, internal fixation was performed. Results Fractures were completely reduced using only an intraoral approach with Kirschner wire reduction in 33 cases and through an additional lower lid or transconjunctival incision in six cases. There were no surgical complications except in one patient with undercorrection. Postoperative 6-month computed tomography scans showed complete bone union and excellent bone alignment. Four patients experienced difficulty with upper lip elevation; however, these problems spontaneously resolved after manual tissue lump massage and intralesional steroid (Triamcinolone) injection. Conclusions We completely reduced infraorbital rim fractures, zygomaticomaxillary buttresses, and zygomaticofrontal suture fractures in 84% of patients through an intraoral approach alone. Intraoral Kirschner wire reduction may be a useful option by which to obtain effective and powerful reduction motion of an inferomedially rotated zygomatic body.

• Journal of Dental Anesthesia and Pain Medicine
• /
• v.21 no.4
• /
• pp.357-361
• /
• 2021

Methemoglobinemia is a blood disorder in which an abnormal amount of methemoglobin is produced, and prilocaine is one of the drugs that can cause this disorder. The maximum recommended dose of prilocaine is 8 mg/kg. We report a case of methemoglobinemia caused by the administration of 4.2 mg/kg of prilocaine without other methemoglobinemia-inducing drugs during general anesthesia. A 17-year-old girl with hyperthyroidism and anemia was scheduled to undergo maxillary sinus floor elevation and tooth extraction. The patient's peripheral oxygen saturation (SpO₂) decreased from 100% at arrival to 95% after receiving prilocaine with felypressin following induction of general anesthesia. However, the fraction of inspired oxygen was 0.6. Blood gas analysis showed that the methemoglobin level was 3.8% (normal level, 1%-2%), fractional oxygen saturation was 93.9%, partial pressure of oxygen was 327 mmHg, and arterial oxygen saturation was 97.6%. After administration of 1 mg/kg of methylene blue, her SpO₂ improved gradually to 99%, and the methemoglobin value decreased to 1.2%. When using prilocaine as a local anesthetic, it is important to be aware that methemoglobinemia may occur even at doses much lower than the maximum recommended dose.

• The korean journal of orthodontics
• /
• v.51 no.3
• /
• pp.199-216
• /
• 2021

Objective: The aim of this systematic review was to evaluate the complications and side effects associated with the clinical use of orthodontic miniscrews by systematically reviewing the best available evidence. Methods: A survey of articles published up to March 2020 investigating the complications associated with miniscrew insertion, in both the maxilla and mandible, was performed using 7 electronic databases. Clinical studies, case reports, and case series reporting complications associated with the use of orthodontic miniscrew implants were included. Two authors independently performed study selection, data extraction, and risk-of-bias assessment. Results: The database survey yielded 24 articles. The risk-of-bias assessment revealed low methodological quality for the included studies. The most frequent adverse event reported was root injury with an associated periradicular lesion, vitality loss, pink discoloration of the tooth, and transitory loss of pulp sensitivity. Chronic inflammation of the soft tissue surrounding the miniscrew with mucosal overgrowth was also reported. The other adverse events reported were lesion of the buccal mucosa at the insertion site, soft-tissue necrosis, and perforation of the floor of the nasal cavity and maxillary sinus. Adverse events were also reported after miniscrew removal and included secondary bleeding, miniscrew fracture, scars, and exostosis. Conclusions: These findings highlight the need for clinicians to preliminarily assess generic and specific insertion site complications and side effects.

• Journal of the Korean Association of Oral and Maxillofacial Surgeons
• /
• v.49 no.2
• /
• pp.86-90
• /
• 2023

Objectives: An ectopic tooth is a rare eruption of a tooth out of the normal dental apparatus and occurs commonly with the third molar. Thus, in this study, we reported a case series of ectopic teeth in rare jaw locations and highlight the associated pathology and our experience in the surgical management. Patients and Methods: All cases of ectopic tooth managed at the Department of Oral and Maxillofacial Surgery, University of Maiduguri Teaching Hospital from January 2011 to December 2020 were reviewed. The information retrieved includes biodata, location of the ectopic tooth, signs, symptoms, type of tooth and associated pathology, surgical approach and complications. Results: Ten cases of ectopic teeth were identified over the study period. This comprised 80.0% males with a mean age was 23.3 years. The antrum and lower border of the mandible accounted for 50.0% and 40.0% of the ectopic locations, respectively. Dentigerous cyst was the most associated pathology (70%) and usually presented with pain and swelling. Surgical intervention predominantly via the intraoral route was performed if indicated. Conclusion: Ectopic teeth are rare and not always associated with pathology. A high index of suspicion and radiological investigation are necessary for diagnosis. A more extensive multi-center study is however recommended to determine the prevalence of ectopic teeth other than the third molar.

• Archives of Craniofacial Surgery
• /
• v.24 no.2
• /
• pp.59-65
• /
• 2023

Background: Fibrous dysplasia (FD) is a localized bone disorder in which fibro-osseous tissue replaces the normal bone structure. Patients with craniofacial FD often present with gradual swelling, deformity, and compromised vision or hearing. We previously introduced "the core extirpation method," a novel surgical technique that is minimally invasive like traditional bone shaving but has longer-lasting effects. This study presents the long-term outcomes of our core extirpation method. Methods: We conducted a retrospective analysis of patients who underwent core extirpation for FD of the zygomaticomaxillary region from 2012 through 2021. Computed tomography (CT) scans were performed 6 to 12 months before the operation, immediately before and after the operation, and during follow-up visits. We performed all operations using the upper gingivobuccal approach, and we extirpated the core of the lesion while preserving the cortical structures of the zygoma and the maxilla to maintain symmetrical facial contour. Results: In 12 patients with lesions in the growth phase, anteroposterior/mediolateral (AP/ML) length discrepancies and the volume increased between preoperative and immediate postoperative CT scans. All patients' immediate postoperative AP/ML discrepancies were stable up to 12-17 months postoperatively. Postoperative volume showed continuous lesion growth; the median volume growth rate was 0.61 cc per month. Conclusion: In this article, we present our experiences managing FD using the minimally invasive core extirpation technique, which entails small expected blood loss and can be performed as day surgery. It provides similar cosmetic outcomes as traditional bone shaving but with longer-lasting results. Although there are some limitations with the study's retrospective nature and small sample size, our 4-year follow-up results show promising results of the core extirpation method in well-indicated patients.

• Archives of Craniofacial Surgery
• /
• v.25 no.1
• /
• pp.27-30
• /
• 2024

Fungal sinusitis is relatively rare, but it has become more common in recent years. When fungal sinusitis invades the orbit, it can cause proptosis, chemosis, ophthalmoplegia, retroorbital pain, and vision impairment. We present a case of an extensive orbital floor defect due to invasive fungal sinusitis. A 62-year-old man with hypertension and a history of lung adenocarcinoma, presented with right-side facial pain and swelling. On admission, the serum glucose level was 347 mg/dL, and hemoglobin A1c was 11.4%. A computed tomography scan and a Waters' view X-ray showed right maxillary sinusitis with an orbital floor defect. On hospital day 3, functional endoscopic sinus surgery was performed by the otorhinolaryngology team, and an aspergilloma in necrotic inflammatory exudate obtained during exploration. On hospital day 7, orbital floor reconstruction with a Medpor Titan surgical implant was done. In principle, the management of invasive sino-orbital fungal infection often begins with surgical debridement and local irrigation with an antifungal agent. Exceptionally, in this case, debridement and immediate orbital floor reconstruction were performed to prevent enophthalmos caused by the extensive orbital floor defect. The patient underwent orbital floor reconstruction and received intravenous and oral voriconazole. Despite orbital invasion, there were no ophthalmic symptoms or sequelae.

• Maxillofacial Plastic and Reconstructive Surgery
• /
• v.35 no.6
• /
• pp.368-375
• /
• 2013

Purpose: This study is to evaluate the location of descending palatine artery, the anatomy of pterygomaxillary junction, and the association between the obtained anatomic values and several variables. Methods: We studied 40 patients who were treated for dentofacial deformites from January 2010 to December 2012 in Ulsan University Hospital, Ulsan, Korea. Cone beam computed tomogram (CBCT) was done for all patients. The reference point was approximately 5 to 7 mm above anterior nasal spine on axial image. We evaluated the location of the greater palatine canal (line a: on the coronal view, the shortest line between the center of greater palatine canal and pterygoid fossa; distance a: the distance of line a). We also measured the thickness (line b: on the coronal view, the shortest line between maxillary posterior sinus wall and pterygoid fossa; distance b: distance of line b), width (line c: on the coronal view, the line perpendicular to the line b and the nearest line from the most concave point of lateral pterygoid plate to the medial pterygoid plate; distance c: distance of line c) and height (line d: on sagittal view, the vertically longest line of pterygoid junction; distance d: the distance of line d) in pterygomaxillary junctions. We evaluated the association between the obtained anatomic values and several variables (sex, age, height and weight). Results: The mean distance a was 4.78 mm, mean distance b was 5.53 mm, mean distance c was 8.01 mm and mean distance d was 13.22 mm. The differences between age and mean distance c and weight and mean distance d in pterygomaxillary junctions are statistically significant. Conclusion: There apparently is anatomic variation of pterygomaxillary junctions by various values, particularly weight and age in a Korean clinical population.

• Imaging Science in Dentistry
• /
• v.40 no.1
• /
• pp.25-32
• /
• 2010

Purpose : This study was designed to evaluate the efficacy and utility of panoramic radiograph for the improvement of the periodic oral examinations. Materials and Methods : Clinical examinations and panoramic examinations were done for the 242 subjects of oral examinations. The results of panoramic radiograph interpretation were compared with the clinical findings. Two questionnaires were created. One was carried out before the panoramic examination and the other done afterwards, to find out the subjects' cognition and satisfaction for the clinical and panoramic examinations. Results : 1. Panoramic findings showed a higher detection rate of 31.9% for periodontal diseases, and 23.1% for dental caries than clinical findings. 2. The additional abnormalities detected through panoramic examinations were impacted tooth in 81 subjects (33.6%), maxillary sinus abnormalities in 28 subjects (11.6%), condylar abnormalities in 5 subjects (2.1%), congenital and acquired dental anormalies in 59 subjects (24.5%), and other miscellaneous abnormalities in 34 subjects (14.1%). 3. 164 subjects (67.8%) were satisfied with the current periodic oral examination, and 75 subjects (31.1%) hoped for better accuracy. 4. In the first and second questionnaire, 154 subjects (67.0%) and 163 subjects (70.6%) responded respectively that panoramic examination was necessary, and 193 subjects (83.2%) responded that it actually helped. Conclusion : The panoramic examination was revealed to improve the effectiveness of the periodic oral examination and to increase the satisfaction of the subjects of examination.