• Maxillofacial Plastic and Reconstructive Surgery
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• 제22권1호
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• pp.110-116
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• 2000

A 61-years old man with diabetes mellitus(DM) was admitted to our hospital, complaining of progressive right periorbital swelling, headache and toothache on the right lower second molar. On the first visit, moderate swelling was noticed from the right periorbital region with exophthalmos and subconjunctival effusion. Intraorally, right lower second molar had a severe periodontal disease and fistular formation on its distal area. From 3 days after hospitalization, the visual acuity of his right eye was gradually worsen and we performed CT scan. CT scan demonstrated an inflammatory change at the right orbit with subperiosteal abscess at the inferior orbital wall, which was extended from the right infratemporal, parapharyngeal and internal pterygoid space. Patient was treated by mean of intraoral(right upper vestibular and retromolar) and extraoral(infraorbital) incision and drainage, massive anti-therapy and DM control. The patient improved gradually and finally was discharged from the hospital, but his visual loss of right side was not recovered.

• Maxillofacial Plastic and Reconstructive Surgery
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• 제33권5호
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• pp.445-448
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• 2011

Mortality associated with maxillofacial infection is relatively low due to the development of antibiotics, and improved oral care. However, inappropriate treatment, delayed treatment, old age, underlying systemic disease, and drug-resistant microorganisms can potentially result in life threatening situations such as cavernous sinus thrombosis, mediastinitis, and sepsis. Sepsis is the most dangerous state with high mortality, ranging from 20~60%. The treatment of sepsis involves properly monitoring vital functions, fluid resuscitation, surgical drainage, and empirical use of high doses of antibiotics until culture results are available. Ventilatory support maybe be required as well. We encountered a 64-year-old patient who died from sepsis that developed as the result of an odontogenic infection. The initial diagnosis was right temporal, infraorbital, buccal, pterygomandibular space abscess. Despite surgical and medical supportive care, the condition progressed to sepsis and after four days the patient died due to multiple organ failure.

• Journal of the Korean Association of Oral and Maxillofacial Surgeons
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• 제30권6호
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• pp.497-503
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• 2004

One of the most difficult problems to damage in dentistry is an odontogenic infection. These infections may range from low-grade, well-localized infections that require only minimal treatment to a severe, life-threatenig fascial space infection. Although the overwhelming majority of odontogenic infections are easily managed by minor surgical procedures and supportive medical therapy that includes antibiotic administration, the practitioner must constantly bear in mind that these infections may become severe in a very short time. We made an investigation was targeting on 78 male and 47 female patients (125 patients in total) who had been hospitalized because of the fascial space abscess on the oral and maxillofacial area and gained a complete recovery in Daegu Catholic University Hospital, Oral & Maxillofacial Surgery from January 1999 to December 2003. By tracing their charts, we could grasp the characteristics such as age, gender, the time of breakout and specific areas of the attacks, making a conclusive study of the statistical analysis and finally, we could reach conclusions. Now, we report the conclusion from the investigation with the literature. The proportion of males and females was approximately 3 to 2, and in age group, patients under 10 years old marked the highest, 22.4%. The patients between the age of 10 and 40 were only 14.4%, yet those who were between 40 and 80 marked 53.6% in contrast. In the monthly distribution, the order was Dec.(13.6%)-Sep.(12%)-Jan.(10.4%) and in seasonal distribution, it was winter(30.4%)-fall(28%)- summer(24.4%)- spring(19.2%). Considering the medical history, D.M. was the highest which was 30.3%, hypertension marked 24.4%, and the patients with both D.M. and hypertension were 9.0%. The major cause of infection of oral and maxillofacial areas was odontogenic infection, which marked about 96%, and especially the cases related to dental caries occurred most frequently, which was 51.2%. In the number of relaxed fascial space, single fascial space was 81.6%, and in the degree of relaxation of fascial space, the buccal space abscess marked 40.8%, following submandibular space abscess, which was 30.4%.

• Journal of the Korean Association of Oral and Maxillofacial Surgeons
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• 제32권6호
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• pp.544-558
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• 2006

Trismus is a common problem to most people experiencing at once in his or her life and to most dental practitioners experiencing frequently. It has a number of potential causes which are single factor or complex factors. Its treatment will depend on the cause. The purpose of this study was to discuss the causes of trismus condition and the various treatments available. This study was made by reviewing of collected data from 86 patients complained of trismus among patients who were diagnosed by TMD, tumor, infection including tetanus, soft tissue anomalies, bony fracture and ankylosis from Jan 2002 to Dec 2004 on department of oral and maxillofacial surgery at Pusan National University Hospital, South Korea. The clinical reviews regarding chief complaints, clinical characteristics, diagnostic examination, treatments and the results on the patients were given as follows. 1. The etiology of trismus commonly were derived from temporomandibular joint(TMJ) disorder, TMJ ankylosis, TMJ tumor, odontogenic maxillofacial infection, mandibular condylar fracture, tetanus. 2. The chief complaints of trismus patients were progressive mouth opening limitation, TMJ pain, malocclusion, facial asymmetry, retrognathic state. 3. Especially, for the differential diagnosis between the fibrous ankylosis and true bony ankylosis, computed tomogram (CT) was useful. Surgical gap arthroplasty on bony ankylosis patients was applied and the gain of mouth opening after operation was average 35.8 mm during 19 months. 4. The tetanus, rarely, also induced the trismus with the range of mouth opening less than 10 mm. The average serum level of tetanus anti-toxin was 0.02-0.04 IU/mL. The limitation of mouth opening was improved into average 38 mm on 4 weeks after injection of 10,000 units of tetanus immune globulin. 5. In the treatment of osteochondroma, TMD, odontogenic infection and fracture, and the others inducing trismus, to obtian the maximum result and decreased inadequate time and effort, it is important to finding the causes from the exact clinical examination and diagnosis.

• Maxillofacial Plastic and Reconstructive Surgery
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• 제32권6호
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• pp.563-566
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• 2010

Retrobulbar abscess is a rare, but severe complication of paranasal sinusitis. The clinical presentations are eyelid swelling, erythema, proptosis, conjunctival chemosis, restricted ocular movement, and decreased visual acuity. Diagnostic methods available for evaluating retrobulbar abscess include sinus X-ray, ultrasonography, computed tomography (CT), and bacterial culture. For the treatment of retrobulbar abscess, immediate surgical drainage and systemic antibiotic therapy are needed. Proper diagnosis and treatments are necessary for preventing visual loss, cavernous sinus thrombosis, subdural abscess, and other lifethreatening complications. A patient, a 30-year-old man, was admitted to our hospital because of progressive eyelid swelling, erythema, ptosis and decreased visual acuity on the right eye after endodontic treatment. The sinusitis occurred secondary to the infection from an upper molar tooth. The spread of the infection led to the orbit via ethmoidal sinus and posterior orbital wall. Immediate surgical intervention was performed and systemic antibiotics was administrated. The symptoms and signs are improved after treatments, so we present our case with a brief review of the literature.

• 대한소아치과학회지
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• 제35권1호
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• pp.136-143
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• 2008

소아의 구강 악안면 부위의 감염은 부비동, 근막간극, 타액선, 악골, 치아 등의 다양한 해부학적 구조물과 연관되어 발생하며 적절히 치료되지 않는다면 짧은 시간 내에 치명적인 상태로 진행될 수 있어 조기 진단 및 치료가 요구된다. 원인은 다양하지만 대부분이 치성 원인으로서, 괴사된 치수로 인한 치근단 병소, 화농성 치주질환, 치관주위 감염 등으로부터 유래된다. 소아의 치성 감염은 치아우식증이 원인인 경우가 대부분이며 병원성 균이 치수를 통해 인접 조직으로 확산되어 치근단 감염 및 농양, 봉와직염, 골수염, Ludwig's angina, toxic shock syndrome 등의 질환을 유발한다고 알려져 있다. 근막간극이란 느슨한 결체조직으로 채워진 근층 사이에 존재하는 잠재적인 공간으로 일반적인 근막간극 농양의 진행과정은 괴사 치수 염증이 치조 농양 형태로 치근 주위로 퍼지고 점차 근막을 침투해 피질골을 통해 잠재적 간극을 이환시킨다. 구강 악안면 부위의 감염이 연조직으로 침투할 경우, 결체조직을 통하여 그리고 근막간극을 따라 가장 조직 저항이 적은 방향으로 확산된다. 이러한 감염은 치아발치, 근관치료, 배농을 포함한 외과적 치료, 항생제 투여 등에 의해 적절히 치료될 수 있다. 본 증례에서는 치성 원인의 견치 간극 농양 및 협부 간극 농양에 이환된 환자들에 대하여 항생제 투여 및 근관치료, 외과적 배농 등을 시행하여 양호한 치료 결과를 얻었기에 보고하는 바이다.

• Maxillofacial Plastic and Reconstructive Surgery
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• 제20권2호
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• pp.152-157
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• 1998

Disturbances of the interrelationship among the host, environment, microorganism will cause the infection clinically. Infection can be classified into bacterial, viral, fungal origin, Bacterial infection is most common due to dental caries, periodontal disease. These infections have the potential to spread via the fascial spaces in the head and neck region. We have undertaken clinical studies on infections in the oral and maxillofacial regions by analyzing 78 hospitalized patients in the Dept. of Oral and Maxillofacial Surgery, Dong-A University Hospital from 1994 to 1997. The results were as fellows; l. Odontogenic infections were most common with the incidence of 84.6%. 2. Considering the number of involved space, single space was 83.3%, double or more space was 16.6%. The most common fascial space involved was submandibular space and followed by buccal space, 3. The most causative organism isolated from the pus cultures was streptococci group 35.4%. 4. Antibiotics were administrated in all cases, and surgical incision and drainage was performed in 87.2%. 5. Combined administration of penicillin and aminoglycoside was most common in 34.6%.. 6. 7 cases were diagnosed as Ludwig's angina and tracheostomy was done in 2 cases of them.

• Journal of Oral Medicine and Pain
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• 제47권4호
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• pp.212-216
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• 2022

Osteomyelitis in the oral and maxillofacial area is a relatively uncommon inflammatory disease that occurs due to odontogenic causes such as endodontic infection, facial trauma, insufficient blood supply caused by some medical conditions, and iatrogenic postoperative infections. Among them, the incidence rate of candida osteomyelitis in this area is minimal; therefore, no consensus on the diagnosis, treatment, and prognosis has not been established yet. With the increasing number of immunocompromised elderly patients, candida osteomyelitis of the jaw is expected to become more prevalent. In this case report, we present an 81-year-old male patient with candida osteomyelitis of the jaw, including the maxillary and ethmoid sinuses.

• Journal of the Korean Association of Oral and Maxillofacial Surgeons
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• 제36권6호
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• pp.515-519
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• 2010

Introduction: Bone defects in the jaw are frequently observed after odontogenic cyst enucleation. The success of bone healing appears to be related to the size of the bone defect, the anatomical location, the patient's age and other parameters. The use of bone grafting material is dependent on the operator's preference. No evidence-based definite treatment protocol has been established. This study evaluated the effect of a bone graft into the defect after odontogenic cyst enucleation. Materials and Methods: A total of 55 patients, who had been treated for an odontogenic cyst with cyst enucleation from 2000 to 2009 at the department of Oral and Maxillofacial Surgery, Samsung Medical Center, were included in this study. Patients who were followed-up for more than 1 year were included. Two groups were defined according to the bone graft (with or without a bone graft) after cyst enucleation. The differences in the healing periods and patterns of bone healing were compared clinically and radiologically. The postoperative 1 year radiographs were analyzed for bone healing and density. Statistical analysis was performed using a Pearson chi square test and Wilcoxon rank-sum test. Results: More infection signs were observed in the bone graft group than in the other group, but there was no statistically significant difference. Radiographically, there was also no significant difference in the size of the radiolucent lesions between the two groups. Conclusion: There was no significant difference in healing between the groups with a bone graft and without bone graft after cyst enucleation.

• Journal of the Korean Association of Oral and Maxillofacial Surgeons
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• 제34권5호
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• pp.562-570
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• 2008

Most purulent maxillofacial infections are of odontogenic origin. Treatment of infection includes the surgical intervention, such as incision and drainage, and adjunctive treatment. The use of high-dose antibiotics is also indicated. The choice of an antibiotics should be based on the knowledge of the usual causative microbes and the results of antibacterial sensitivity test. We have undertaken clinical studies on 119 patients in Dept. of Oral and Maxillofacial Surgery, Inha University Hospital from January 2000 to December 2007. Many anaerobic microbes are killed quickly when exposed to oxygen. Thus the needle aspiration techniques and the transfer under inert gas were used when culturing. The aim of this study was to obtain informations for the bacteriologic features and the effective antimicrobial therapy against maxillofaical odontogenic infections. The obtained results were as follows: 1. The most frequent causes of infections were odontogenic (88.3%), and in odontogenic cause, pulpal infections were the most common causes(53.8%). 2. The buccal and submandibular spaces (respectively 23.5%) were the most frequent involved fascial spaces, followed by masticator spaces (14.3%). 3. The most common underlying medical problems were diabetes (17.6%), however the relation with prognosis was not discovered. 4. The complications were the expiry, mediastinitis, necrotizing fasciitis, orbital abscess, and osteomyelitis. 5. The most common admission periods were 1-2 weeks, and the most patients were discharged within 3 weeks. However, patients who admitted over 5 weeks were about 10%. 6. A total of 99 bacterial strains (1.1 strains per abscess) was isolated from 93 patients (78.2%). The most common bacterium isolated was Streptococcus viridans (46.2%), followed by $\beta$-hemolytic group streptococcus (10.1%). 7. Penicillins (penicillin G 58.3%, oxacillin 80.0%, ampicillin 80.0%) have slightly lower sensitivity. Thus we recommend the antibiotics, such as glycopeptides (teicoplanin 100%, vancomycin 100%) and quinolones (ciprofloxacin 90.0%) which have high susceptibility in cases in which peni cillin therapy failed or severe infections.