• 대한치과보철학회지
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• 제52권4호
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• pp.359-365
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• 2014

치아가 얼마 남지 않은 부분 무치악 환자들에 있어 이중관(Double crown)을 이용한 치료의 성공적인 결과에 대해서 여러 문헌에서 보고 되고 있다. 이중관 가철성국소의치(Double crown removal partial denture)는 잔존치의 치주적인 상태가 좋지 않은 환자에게 치료의 대안이 될 수 있다. 이중관 가철성 국소의치는 특히 치주상태가 좋지 않고, 임플란트를 식립하기에는 의과적으로 문제가 있는 환자(Medically compromised patient)에게는 수술에 대한 부담 없이 치료할 수 있어 심리적이고 경제적인 이점이 존재한다. 본 증례에서는 상악은 다수의 치아가 잔존하여 고정성 보철물로 수복이 가능한 상태였고, 하악은 소수 잔존치만 남아있고 치주 상태가 매우 불량하여 잔존치를 이용한 클라스프 가철성 국소의치로는 수복하는 것이 거의 불가능하였다. 또한 환자는 1년 전에 하악 전치부 부위의 골수염으로 인한 수술병력으로 임플란트 식립이 어려운 상황이었다. 이러한 악조건에서 하악의 소수 잔존치를 이용한 이중관 의치는 2년이상의 기간동안 기능적, 심미적인 면에서 만족스러운 결과를 얻었기에 이를 보고하고자 한다.

• Maxillofacial Plastic and Reconstructive Surgery
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• 제40권
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• pp.25.1-25.4
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• 2018

Background: Some of head and neck cancer patients are in compromised general condition after ablation surgery and chemoradiation therapy, which makes secondary free tissue transfer quite challenging. Elderly cancer patients also have some risk for microvascular surgery with lengthened general anesthesia. In those cases, the pedicled flap vascularized by supraclavicular artery could be considered as an alternative to free flap. Despite several authors have demonstrated the clinical reliability of supraclavicular artery island flap (SCAIF), to date, SCAIF has not been widely used among reconstructive surgeon. In this article, we clarified vascular flow pattern and introduce simple surgical technique of SCAIF with a literature review. Case presentation: Three patients who had underwent previous neck surgery and adjuvant therapy received maxillofacial reconstruction using SCAIF. It required only a few landmarks, flap harvesting was carried out, and the elapsed time gradually decreased to 15 min with experiences. There were no remarkable morbidities in both donor and recipient sites. Conclusion: SCAIF exhibited minimal anatomic variations and short learning curve of surgical techniques, which might be valuable reconstruction modality for beginning surgeon. And it can be beneficial option for the patients with vessel-depleted neck, medically compromised status for lengthened general anesthesia and failed free tissue transfer.

• 대한장애인치과학회지
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• 제2권2호
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• pp.153-155
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• 2006

Many patients with mental retardation need extensive dental treatment because they have much difficulty in maintaining their oral hygiene. However, because they are not cooperative and not manageable, they require physical restraints, drug induced sedation or general anesthesia. General anesthesia is useful in control of the patients who cannot be treated in other ways. Additionally, general anesthesia provides more safe environment for medically compromised patients. And medical treatment can be provided simultaneously under general anesthesia. Furthermore, almost all treatment can be provided without visiting several times. This case reports of periodontal, restorative and ophthalmological treatment of patient with mental retardation under general anesthesia.

• 대한치과의사협회지
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• 제57권7호
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• pp.372-378
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• 2019

The dental implants in modern dentistry brought out a new era in everyday dental practice. Increasing of dental implants usage, various failures and complications has occurred. Failures and complications of dental implant treatments that can happen in implant surgery, in mechanical or prosthetic problem and in biological aspect. The aim of this study was to assess implant failures for 6 years as well as find out how to overcome implant failure. In Jeju National University hospital, 26 dental implants in 17 patients were removed by implant failure through 2013.1.1.-2018.12.31. Each implant failure case was analyzed in report form with various informations about failure retrospectively. The present study showed 26 failed dental implants of 17 patients were removed. 13 implants(50%) of 8 patients(47.06%) were failed before functional loading and 13 implants(50%) of 9 patients(52.94%) were failed after functional loading. 11 implants(42.31%) of 7 patients(41.18%) with medical disease were extracted. 6 implants(23.08%) of 5 patients(29.41%) with additive bone graft were failed. We discuss with 26 failed dental implants of 17 patients about their causes, solutions and prevention retrospectively for 6 past years. Precise diagnosis and treatment planning are needed. Medically compromised patients and patients with implants and additive bone grafts should be cautiously treated with high failing possibilities.

• 대한장애인치과학회지
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• 제3권1호
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• pp.6-10
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• 2007

Many disabled patients need extensive dental treatment because they have much difficulty in maintaining their oral hygiene. However, because they are not cooperative and not manageable, they require physical restraints, drug induced sedation or general anesthesia. General anesthesia is useful in control of the patients who cannot be treated in other ways. Additionally, general anesthesia provides more safe environment for medically compromised patients. The aim of the present study was to investigate a kind of disorder, sources of referral, preoperative oral condition, experience of dental visit, and performing general anesthesia or not of 930 disabled patients in Kyung-Hee University dental hospital for 30 years.

• 정신신체의학
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• 제16권2호
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• pp.81-86
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• 2008

섬망은 자연적으로 발생하는 상태는 아니며 더욱이 내인성 질환은 아니다. 그러나, 섬망은 일부 특정인구 집단에서 발생하는 데, 노인 또는 내과적 상태가 악화된 환자들에서 흔히 발생된다. 이것은 체계적인 섬망역학 연구의 제한점으로 작용한다. 일반 인구 집단에서는 그 발생이 상대적으로 적기 때문에 섬망에 대한 많은 역학 연구들은 노인에 집중되었다. 그리고, 연구에 사용된 섬망 평가도구들의 민감도와 특이도도 매우 다양하다. 노령, 남자, 불량한 인지 및 기능 상태, 그리고 알코올 남용이 잘 알려진 섬망의 위험 인자들이다. 저자는 노인, 치매 환자, 고관적 골절 환자, 중환자실 입원 환자, 말기 암 환자, 그리고 뇌졸중 환자에서의 섬마의 역학에 대하여 다루게 될 것이다.

• Journal of the Korean Association of Oral and Maxillofacial Surgeons
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• 제39권1호
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• pp.3-8
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• 2013

Reconstruction of oral soft-tissue defects following resection of oral carcinomas can be achieved using various techniques including microsurgical tissue transfer. However, there seems to be a role for regional or local flaps. Small to medium-size defects can be functionally reconstructed with the platysma myocutaneous flap as an excellent choice particularly in medically compromised patients not being eligible for free tissue transfer. The present paper reviews the indication, surgical technique, and complications following reconstruction of defects of the oral cavity with the platysma myocutaneous flap.

• Maxillofacial Plastic and Reconstructive Surgery
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• 제13권2호
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• pp.222-230
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• 1991

Pyogenic orofacial infections are most commonly odontogenic in origin. Although such infections are usually self-limiting and spatially confined, purulent material may occasionally borrow deeply into contiguous fascial space or planes far from the initial site of involvement. The incidence of orofacial infection remains low in this modern era of preventive dental care and antibiotic therapy, but severe orofacial infections are most frequently observed in the medically compromised patients. We experienced 5 cases of severe orofacial odontogenic infection associated with medical diseases, and then concluded as follows : 1. The average hospitalized period was about 5 weeks, and the signs that indicated that the infections were controlled usually appeared in third week after incision and drainage. 2. The involved medical diseases were diabetes mellitus iatrogenic Cushing's syndrome, rheumatoid arthritis, malnutrition, etc. 3. The medical diseases should be treated coincidently with control of infection.

• Journal of the Korean Association of Oral and Maxillofacial Surgeons
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• 제45권4호
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• pp.207-214
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• 2019

Objectives: Medically compromised patients often fear required dental surgical procedures that can increase the risk of medical emergency when combined with reduced tolerance for stress. A stress reduction protocol (SRP) helps doctors minimize treatment-related stress and improves patient management with minimum complications. Diabetes and co-morbid hypertension carry 4-fold risk of aggravation of cardiovascular emergencies and 7.2-fold risk of mortality. Diabetic neuropathy can result in difficult diagnosis of myocardial infarction and reduces chances of surviving a myocardial infarction compared with a non-diabetic person. The aim of the study was to assess the feasibility of a protocol for management of patients having both diabetes and hypertension who required minor oral surgery to minimize the rate of cardiovascular emergencies. Materials and Methods: A prospective study was conducted in 140 patients having both diabetes and hypertension who required minor oral surgical procedures. A systematic approachable protocol was designed for management of such patients. Results: Among 140 patients, 6 patients (4.3%) had cardiovascular complications, while 3 patients (1 with syncope and 2 with hypertension) did not require any intervention other than observation. Two patients were managed with aspirin and nitroglycerin, and 1 patient had possible myocardial infarction (overall incidence 0.7%) with chest pain, S-T segment elevation on electrocardiogram, and troponin level of 0.60 ng/mL. Conclusion: The proposed protocol helps to improve management of patients having both diabetes and hypertension. We recommend that patients with uncontrolled diabetes and uncontrolled hypertension and/or patients having history of cardiovascular complication should be treated in a medical facility with a readily available cardiology unit. This facilitates prompt response to emergency and instant implementation of treatment, helping to reduce morbidity and mortality.

• Journal of the Korean Association of Oral and Maxillofacial Surgeons
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• 제28권5호
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• pp.383-389
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• 2002

This is a retrospective study on emergency patients with active oral bleeding. The study was based on a series of 135 patients treated as emergency patients at Wonju Christian Hospital, from Jan. 1, 1997, to Dec. 31, 2001. The postoperative bleeding was the most frequent cause of active oral bleeding in emergency room and bleeding from trauma and medically compromised (bleeding disorders) patients were next in order of frequency. In the injury of maxillofacial vessels, peak incidence was occurred in the inferior alveolar vessel (42.9%), followed by the submucosal vessel of lip & cheek, the superior alveolar vessel, and sublingual vessels. The most common disease of bleeding disorders was vascular wall alteration (infection, etc), followed by liver disease, thrombocytopenic purpura, anti-coagulation drugs in order. In the characteristics of dental diseases on bleeding disorders, periodontal disease and alveolar osteitis (osteomyelitis) were more common. The hemostasis was most obtained by use of wound suture, simple pressure dressing, drainage for infection control and primary interdental wiring of fracture. In the complication group, the infrequent incidence was showed in vomiting, hypovolemic shock, syncope, recurred bleeding & aspiration pneumonia. In the uncontrolled oral bleeding, the injured vessels were suspected as skull base & ethmoidal vessels. In this study, authors found that the close cooperation between the dentistry (Oral and maxillofacial surgery) and the medicine (emergency & internal medicine) was the most important for early proper control of active oral bleeding. And then post-operative wound closure, drainage for infection control and previous systemic evaluation of bleeding disorders were critical for the prevention of postoperative bleeding in the local dental clinic.