• Maxillofacial Plastic and Reconstructive Surgery
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• 제29권3호
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• pp.250-254
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• 2007

Dentigerous cysts are the most common type of developmental odontogenic cysts. They form as a result of a separation of the follicle from around the crown of an unerupted tooth. Usually this lesion can be asymptomatic. Such cysts are often discovered accidently on inspection of x-rays. In other advanced cases, cortical bone expansion, displacement of teeth, secondary infection can be observed. The treatment of dentigerous cyst is enucleation. And according to size, location of lesion and environmental structure marsupialization can be considered. However, Marsupialization takes long treatment time and, cystic tissues are remained so secondary surgery may be needed for total removal., Risks of oroantral fistula, damage on maxillary sinus wall and infraorbital nerve can be considered as complications of conventional surgical treatment of cysts located in maxillary sinus. We treated third molar origin dentogerous cyst located in maxillary sinus removing endoscopically both the tooth and an associated dentigerous cyst. We report our clinical experience with literature review.

• 대한기관식도과학회지
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• 제17권1호
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• pp.46-49
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• 2011

Background and Objectives Cervical necrotizing fasciitis is a fulminant disease associated with necrosis of connective tissue, spread along the fascial plane, and high mortality. We analyzed the clinical characteristics and treatment outcome of this rare fatal disease. Materials and Methods We retrospectively reviewed the medical records of 19 patients treated for cervical necrotizing fasciitis from January 1999 to January 2009. Mean age was 53.7 years. Results The most common predisposing illness was tonsillitis (36.8%), followed by odontogenic infection (15.7%). Diabetes mellitus was most common underlying disease. Liver cirrhosis and chronic renal failure were found in 2 patients each. All patients were treated with combination of parenteral antibiotics and wide surgical debridement by transcervical and/or thoracotomy approach. Multiple surgical debridements were performed in 7 patients. Tracheotomy was performed in most of the patients (88.8%). Period of total hospitalization and Intensive care unit was 23 days and 10.1 days. Two patients died of disease and overall survival rate was 89.4%. Conclusion Early surgical management and care in intensive care unit are essential for cervical necrotizing fasciitis. Possible complications such as respiratory failure, mediastinitis or sepsis should be carefully evaluated.

• Journal of Oral Medicine and Pain
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• 제46권1호
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• pp.9-13
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• 2021

Herpes zoster is caused by reactivation and multiplication of a latent varicella-zoster virus infection. Reactivation can frequently occur in older adults and immunosuppressed individuals. It is hypothesized that this is related to an aging society and a corresponding increase in the number of people with underlying chronic diseases, such as cancer and diabetes, that lower immunity. Clinically, the patient complains of pain, and a vesicular rash presents on one side of the face up to the midline in the dermatomes associated with the affected ganglion. Herpes zoster of the oral mucosa is rare. When oral lesions do occur, they are most often concurrent with pathognomonic unilateral linear vesicular skin lesions, facilitating both clinical diagnosis and management of the condition. Cases limited to the oral mucous membrane alone are most unusual. Treatment includes antiviral agents and analgesics for pain control. Antivirals should be administered within 72 hours of onset. Early diagnosis and treatment are important to avoid complications, such as postherpetic neuralgia. The present case report describes the adequate management of a patient diagnosed with shingles which affected the right side of the face and oral cavity. In addition, a literature review is presented.

• 대한소아치과학회지
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• 제38권4호
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• pp.413-420
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• 2011

Garre 골수염은 혈류 순환 및 영양 공급의 장애로 골이 괴사되거나, 세균 감염이 증가되면 발생한다. Garre 골수염은 치수나 치주 감염에서 시작된 치성계 감염과 이의 진행에 따른 골막 하 농양이 주요 원인이 되며, 외상으로 인한 악골의 복합 골절시 2차 감염, 국소적인 치은의 외상에 의해서도 발생할 수 있다. 상악에서보다 하악에서 많이 발생되며 호발 부위는 하악 제1대구치이다. 임상증상으로 이환 부위의 하악골은 팽창되어 있으나 구강점막은 정상적 색조를 가지며 안면 불균형을 나타낸다. 방사선사진 상 심한 우식증을 가진 치아의 치근단 병소를 관찰할 수 있으며, 자극을 받는 골조직 부위의 치밀골 증가로 골수강은 좁아지거나 폐쇄되며 외양이 불규칙하게 나타난다. 치료 방법으로는 항생제의 투여, 원인치의 발치 또는 근관치료, 절개 및 배농술 등이 알려져 있다. 본 증례는 15세 이하의 소아환자에서 악골 골수염이 발생한 경우, 장기적인 항생제 투여나 항생제 투여 및 근관 치료를 병용하여 성공적으로 치료된 증례이다. 소아 환자의 경우 성인에 비하여 증상이 경미하므로 주의 깊은 병력 청취와 임상 검사를 통한 진단이 요구되며, 증상이 사라진 경우에도 재발을 방지하기 위하여 장기간의 추적 검사가 요구된다.

• Journal of Chest Surgery
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• 제41권1호
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• pp.82-88
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• 2008

배경: 하행성 괴사성 종격동염은 구인두에서 염증이 발생한 후 경부간막을 통해 종격동으로 진행함으로써 발생하는 종격동 결체조직의 중증 염증질환이며, 적절한 항생제의 사용과 적극적인 배농술에도 여전히 높은 사망률을 보인다. 본 연구에서는 하행성 괴사성 종격동염으로 진단되어 치료한 환자들의 수술 전 상태, 수술방법, 수술 후 경과등에 대한 성적을 분석하였다. 대상 및 방법: 1998년 9월부터 2007년 8월까지 8명의 환자가 하행성 괴사성 종격동염으로 진단되어 치료하였다. 모든 환자에서 진단 즉시 광범위 항생제를 사용하면서 응급 배농술을 시행하였고, 세균학적 감수성 검사에 따라 항생제를 선택, 사용하였다. 수술방법으로는 경부수술만 시행한 경우가 2예, 경부 및 개흉술을 통하여 수술한 경우가 6예였다. 결과: 증상발현부터 내원까지의 기간은 평균 $4.6{\pm}1.8$일($1{\sim}9$일)이었다. 감염의 원인으로는 치성감염이 4예(50%), 인두 농양이 2예(25%), 불명확한 경우가 2예(25%)였다. Endo 등의 분류에 따라서는 I형이 2예, IIA형이 3예, IIB형이 3예였으며, 원인균은 6예에서 동정되었는데, 연쇄상구균이 4예, 포도상구균이 1예, 클렙시엘라균이 1예였다. 개흉술의 비율은 75%였다. 수술 후 2명의 환자가 사망하여 사망률은 25%였고, 사망의 원인은 모두 패혈증성 쇼크에 의한 다발성 장기부전이었다. 사망 환자들은 모두 초기 배농을 경부절개만 시행하였던 경우였으며, 염증조절이 실패한 경우였다. 결론: 하행성 괴사성 종격동염은 조기진단이 필수이며, 진단 후 혐기성 균을 제어할 수 있는 항생제를 포함한 충분한 항생제 투여와 함께 즉각적인 배농을 시행하여야 한다. 배농시에는 비록 국한적인 염증이라고 판단되더라도 경부절개 및 적절한 흉부접근을 통해 적극적으로 시행하여야 하겠다.

• Maxillofacial Plastic and Reconstructive Surgery
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• 제22권4호
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• pp.420-429
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• 2000

Oral & maxillofacial infections are most commonly odontogenic in origin. Although such infections are usually self-limiting, they may occasionally spread deeply into fascial spaces or planes far from the initial site of involvement. If early diagnosis and appropriate therapy is delayed, complications such as mediastinal extension, retropharyngeal spread and airway obstruction could happen to the patients. For the study of the microbiology, we have retrospectively analysed the oral & maxillofacial infected patients in the Dept. of Oral & Maxillofacial Surgery. In-Ha University Hospital from 1997 September to 2000 April. The results were as follows 1. The male patients were more common than female, with male 61.9% and female 38.1%. 2. Dental originated infections were most common cause with the incidence of 62%. 3. Most common fascial space involved was buccal space 42cases(37.2%) followed by submandibular space 13cases(11.5%), infraorbital space 13cases(11.5%), masseteric space 11cases(9.7%), periapical abscess 11cases(9.7%). 4. The causative organisms isolated from the pus culture were Gram Positive Bacterial species, which were 46cases(31.9%) of Streptococcus viridans, 16cases(8.6%) of ${\alpha}$ and ${\beta}-hemolytic$ streptococcus, 4cases(3.1%) of Strep.-group D non enterococci, 7cases(5.1%) of Staphylococcus Coa. neg., 5cases(3.9%) of Staphylococcus aureus, 3cases(2.3%) of Enterococcus faecalis, 1case(0.8%) of Bacillus species, 1case(0.8%) of Peptostreptococcus, 1case(0.8%) of Clostridium and Gram negative bacterial species, which were 4cases(3.1%) of Acinetobacter baumannii, 2cases(1.6%) of Pseudomonas aeruginosa, 2cases(1.6%) of Burkholderia cepacia, 1case(0.8%) of Neisseria species, 1case(0.8%) of Klebsiella pneumoniae, 1case(0.8%) of Klebsiella oxytoca, 1case(0.8%) of Escherichia coli. 5. In drug sensitivity test, high resistant tendency was found in Penicillin system(Penicillin G 83.3%, Ampicillin 60%) and Aminoglycosides (Gentamycin 50%, Tobramycin 45.5%), but tertiary Cephalosporin system(Cefoperazone 9.1%, Ceftazidime 18.2%), and glycopeptides system (Teicoplanin 0%, Vancomycin 0%) showed lower resistancy.

• 대한소아치과학회지
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• 제34권4호
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• pp.651-657
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• 2007

치아종은 치성 종양 중 가장 흔한 형태로 증상이 없는 경우가 대부분이며 종종 영구치의 매복이나 맹출지연을 유발한다. 이는 치아를 구성하는 법랑질, 상아질, 백악질, 치수로 구성되며, 형태에 따라 복합 치아종과 복잡 치아종으로 구분된다. 복합 치아종은 다수의 작고 치아와 유사한 형태를 지니며 상악 전치부에 호발하고, 복잡 치아종은 무정형의 치성조직으로 구성되어 있으며 전체 치아종의 약 25%를 차지하고 하악 구치부에 호발한다. 치아종의 병인은 확실치는 않으나 국소적인 외상, 감염, 유전적 요인이 관여할 것이라 추측된다. 치료는 보존적인 외과적 적출술이 추천되며 재발은 거의 없다. 다음의 두 증례는 각각 하악 제 1대구치와 하악 측절치의 맹출 지연을 주소로 본원에 내원한 환아들로, 매복치 상방의 복잡 치아종을 외과적 적출술을 시행하고 매복치의 외과적 노출 및 교정적 견인을 시행하여 양호한 결과를 보였기에 보고하는 바이다.

• Journal of the Korean Association of Oral and Maxillofacial Surgeons
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• 제31권5호
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• pp.417-421
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• 2005

This study was to analyze the changes of levels of alkaline phosphatase before and after enucleation of jaw cysts combined with bone grafting, and to evaluate biochemically the effectiveness of the early detection of bone healing and infection as a prognostic marker. Eighteen patients (13 males, 5 females) with cystic lesions of the jaws were divided into two groups. The bone graft group underwent enucleation and bone graft. The control group underwent only enucleation. Both groups were measured levels of ALP before surgery, and plus-minus 4 weeks postoperatively. The more discriminating results were obtained in the bone graft group. The results were as follows : 1. Levels of ALP after enucleation of jaw cysts were decreased in all patients with and without bone graft. 2. The bone graft group showed more marked decrease in variation of levels of ALP than the control group.(p=0.008) This should be considered as a result of increased osteoblastic activity and new bone formation. 3. Such variation could be used as a prognostic marker for bone healing after cyst operation. In the cost/benefit ratio, measurement of ALP activity could be useful as a convenient procedure in routine clinical practice.

• Journal of the Korean Association of Oral and Maxillofacial Surgeons
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• 제41권1호
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• pp.52-56
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• 2015

Clinical features of masticator-space abscess (MSA) are very similar to those of parotitis or temporomandibular disorder (TMD), making early differential diagnosis difficult. Local causes of MSA include nerve block anesthesia, infection after tooth extraction, and trauma to the temporomandibular joint (TMJ); the systemic cause is immunodeficiency. Odontogenic causes account for most etiologies, but there are also unusual causes of MSA. A 66-year-old male patient visited the emergency room (ER) presenting with left-side TMJ pain three days after receiving an acupressure massage. He was tentatively diagnosed with conventional post-trauma TMD and discharged with medication. However, the patient returned to the ER with increased pain. At this time, his TMD diagnosis was confirmed. He made a third visit to the ER during which facial computed tomographic (CT) images were taken. CT readings identified an abscess or hematoma in the left masticator space. After hospitalizing the patient, needle aspiration confirmed pus in the infratemporal and temporal fossa. Antibiotics were administered, and the abscess was drained through an incision made by the attending physician. The patient's symptoms decreased, and he was discharged.

• Journal of the Korean Association of Oral and Maxillofacial Surgeons
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• 제37권6호
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• pp.439-447
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• 2011

Introduction: In today's society, the rapid and appropriate care of the dental emergency patients is much more important. So, a retrospective study on the characteristics of emergency dental injuries and diseases will be very meaningful. Materials and Methods: This retrospective clinical study was carried by reviewing the radiographic films and emergency chart of 11,493 patients who had visited the emergency room of Hallym Sacred heart Hospital and were treated in the Department of Oral and Maxillofacial Surgery from January 2006 to December 2010. Results: The male to female ratio was 1.9:1. The highest monthly incidence was observed in May (10.4%) and June (8.9%) and the peak age distribution was the first decade (56.0%), followed by the second decade (16.0%). Trauma was the most common cause in dental emergency patients, followed in order by toothache, odontogenic infection, temporomandibular joint (TMJ) disorder and oral hemorrhage. Soft tissue injury was most prevalent in the trauma group, followed by tooth injury and facial bone fractures. In the tooth injury group, tooth fracture (56.7%) showed the highest incidence followed in order by tooth subluxation (18.2%), tooth concussion (16.9%), tooth avulsion (11.5%) and alveolar bone fractures (3.7%). In the facial bone fracture group, mandibular fractures (81.8%) showed the highest incidence followed in order by maxilla fractures (15.7%), nasal bone fractures (9.0%), zygomaticomaxillary complex fractures (5.4%), orbital bone fractures (2.5%). In mandibular bone fractures, the most common location was the symphysis (70.1%), followed in order by the mandibular angle (33.0%), mandibular condyle (22.8%) and mandibular body (13.6%). In the infection group, a submandibular space abscess (46.2%) was most common followed in order by a buccal space abscess (17.4%), canine space abscess (16.9%) and submental space abscess (12.3%). TMJ dislocation (89.3%) showed the highest incidence in the TMJ disorder group, followed by TMJ derangement (10.7%). In the other group, a range of specific symptoms due to post operation complications, trigeminal neuralgia, chemical burns and foreign body aspiration were reported. Conclusion: For the rapid and appropriate care of the dental emergency patients, well-organized system should be presented in oral and maxillofacial surgery. And it is possible under analysis of pattern and the variation of the dental emergency patients.