• Proceedings of the KOR-BRONCHOESO Conference
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• 1979.05a
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• pp.8.2-8
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• 1979

Acute obstruction of the upper airway from trachea, a foreign body or Iaryngospasm may lead to death in a few minutes. The immediate restoration of an adequate airway in these patients may be lifesaving. Spontaneous respiration by means of a needle inserted into the trachea was studied in 21 rabbits using 16, 18, and 20 gauge extrcatheters. The results are as follows; 1) Airway resistance was markedly increased in all experimental animals. consequently tidal volume was also significantly decreased, but this seems to be compensatory by increased of respiratory frequency in l6G group. 2) Blood gas analysis revealed adequate pulmonary ventilation through the constricted airway (about 1/3 of normal sized trachea) during 60 minutes. In the other hand, hypercarbia, hypoxemia, and metabolic acidosis were developed in the group with severe constriction of the upper airway (about 1/4-1/6 of normal sized trachea). 3) The further study is postulated to confirm the the possibility of application of needle trcheostomy in man, but the rabbits were tolerable to the constricted airway with a small sized needle (l6G) into the trachea for 60 minutes.

• Tuberculosis and Respiratory Diseases
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• v.78 no.1
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• pp.31-35
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• 2015

An 18-year-old woman was evaluated for a chronic productive cough and dyspnea. She was subsequently diagnosed with mediastinal non-Hodgkin lymphoma (NHL). A covered self-expandable metallic stent (SEMS) was implanted to relieve narrowing in for both main bronchi. The NHL went into complete remission after six chemotherapy cycles, but atelectasis developed in the left lower lobe 18 months after SEMS insertion. The left main bronchus was completely occluded by granulation tissue. However, the right main bronchus and intermedius bronchus were patent. Granulation tissue was observed adjacent to the SEMS. The granulation tissue and the SEMS were excised, and a silicone stent was successfully implanted using a rigid bronchoscope. SEMS is advantageous owing to its easy implantation, but there are considerable potential complications such as severe reactive granulation, stent rupture, and ventilation failure in serious cases. Therefore, SEMS should be avoided whenever possible in patients with benign airway disease. This case highlights that SEMS implantation should be avoided even in malignant airway obstruction cases if the underlying malignancy is curable.

• Journal of Dental Anesthesia and Pain Medicine
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• v.22 no.5
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• pp.349-356
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• 2022

Background: Awake fiberoptic intubation (AFOI) is the procedure of choice for securing the airway in patients with a difficult airway when undergoing surgeries under general anesthesia. An ideal drug would not only provide conscious sedation but also maintain spontaneous ventilation, smooth intubation conditions, and stable hemodynamics. We compared the effects of dexmedetomidine alone and dexmedetomidine in combination with fentanyl at a dose lower than the standard dose for achieving conscious sedation during AFOI in difficult airway patients undergoing oral cancer and dental surgeries. Methods: We included 68 adult patients undergoing AFOI. The patients were randomized in two groups, wherein Group D received intravenous dexmedetomidine 1 ㎍/kg and Group DF received dexmedetomidine 0.5 ㎍/kg and fentanyl 1 ㎍/kg. The outcomes measured were airway obstruction score, intubation scores, fiberoptic intubation comfort score, sedation score, and hemodynamic variables. Results: Low-dose dexmedetomidine with fentanyl showed similar results as those with the standard dose of dexmedetomidine in terms of airway obstruction, vocal cord movement, degree of cough, degree of limb movements, and intubation comfort. However, the sedation achieved and incidence of hypotension and bradycardia were higher in Group D than in Group DF. Conclusions: A low dose of dexmedetomidine-fentanyl provides satisfactory intubation conditions as those with a standard dose of dexmedetomidine in AFOI, thereby avoiding bradycardia, hypotension, and sedation.

• Tuberculosis and Respiratory Diseases
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• v.62 no.5
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• pp.437-440
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• 2007

Tracheostomy is one of the oldest surgical procedures in medical history. The indications for a tracheostomy include the relief of an upper airway obstruction, long-term mechanical ventilation, and decreased airway resistance to help wean the patient from mechanical ventilator support. Unfortunately, tracheostomy is also associated with a number of problems including, bleeding, infection, pneumothorax, and tracheal stenosis. A pneumothorax is an uncommon complication of a tracheostomy, and can result from direct injury to the pleura or positive pressure ventilation through a dislocation of the tracheostomy tube. We report an uncommon case of a tracheostomy-induced bilateral tension pneumothorax with a review of the literature.

• Maxillofacial Plastic and Reconstructive Surgery
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• v.13 no.1
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• pp.53-62
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• 1991

Tracheostomy may be used to assure airway protection in various clinical situation. It, as a known operation, has a history spanning 2000 years. The first clear account of a successful tracheostomy was recorded in 1546 by Brasavola. Until 1718 the term "bronchotomy" was used to describe the procedure. Heister then introduce the term "tracheotomy and this was later adopted and popularized by Trousseau about 1830. The term "tracheostomy" appeared in medical literature after 1820 and the two terms "tracheostomy" and "tracheotomy" are used interchangeably today. Indications include relief of upper airway obstruction, facilitation of pulmonary toilet, diminution of dead space and need for prolonged mechanical ventilation. The extent of indication of tracheostomy has a tendency to increase, thus oral and maxillofacial surgeons have some opportunities to face a situation that require tracheostomy. So, we reported retrospective study of 31 cases of tracheostomy patient in oral and maxillofacial surgery with reference review to reveal the significance of surgical skill and management capability of emergercy state maxillofacial surgery patients.

• Journal of Dental Anesthesia and Pain Medicine
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• v.16 no.4
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• pp.317-320
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• 2016

A 47-year-old woman was referred for surgical treatment of osteomyelitis of the mandible. She had already undergone three previous surgeries. Pre-anesthetic airway evaluation predicted a difficult airway, due to the thin, retro-positioned mandible, tongue, and atrophic changes in the lips and soft tissue. We inserted packing gauzes in the buccal mucosa for easier mask fitting and ventilation. During direct laryngoscopic intubation with a nasotracheal tube (NTT), fracture of a thin mandible can easily occur. Therefore, we used a fiberoptic bronchoscope to insert the NTT. After surgery, we performed a tongue-tie to protect against airway obstruction caused by the backward movement of the tongue during recovery. The patient recovered without any complications. We determined the status of the patient precisely and consequently performed thorough preparations for the surgery, allowing the patient to be anesthetized safely and recover after surgery. Careful assessment of the patient and airway prior to surgery is necessary.

• Fire Science and Engineering
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• v.21 no.2 s.66
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• pp.105-110
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• 2007

This investigation contains an awareness level on the Basic Emergency Treatment of Kindergarten Teacher in emergency surgery and internal medicine situations which frequently happen at the nursery. The result says there are 59.4% of them who are fully aware of the general emergency treatment but they need to know about education the partial parts. Especially 83.2% of them misunderstood the treatment of unconscious a small child with FBAO and 82.1% of them are confused with the manual ventilation. Also 67.4% of them said they would go to the hospital without giving first aid to a burn and 53.7% have wrong emergency treatment of abrasions. The educational program for the actual situation has been proposal as the responsibility of Kindergarten teachers are raising.

• The Journal of the Korean dental association
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• v.53 no.4
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• pp.238-248
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• 2015

Sleep related breathing disorders(SRBDs) are a group of diseases accompanied by difficulties in respiration and ventilation during sleep. Central sleep apnea, obstructive sleep apnea(OSA), sleep-related hypoventilation, and hypoxemia disorder are included in this disease entity. OSA is known to be the most common SRBDs and studies show its significant correlation with general health problems including hypertension, arrhythmia, diabetes, and metabolic syndrome. The diagnostic process of OSA is composed of physical examinations of the head and neck area and also the oral cavity. Radiologic studies including cephalography, CT, MRI, and fluoroscopy assist in identifying the site of obstruction. However, polysomnography(PSG) is still considered the gold standard for the diagnosis of OSA since it offers both qualitative and quantitative recording of the events during a whole night's sleep. The dentist who is trained in sleep medicine can easily identify patients with the risk of OSA starting from simple questions and screening questionnaires. Diagnosis is the first step to treatment and considering the high rate of under-diagnosis for OSA the dentist may play a substantial role in the diagnosis and treatment of OSA which will eventually lead to the well-being of the patient as a whole person. So the objective of this article is to assist dental professionals in gaining knowledge and insight of the diagnostic measures for OSA including PSG.

• Imaging Science in Dentistry
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• v.49 no.2
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• pp.103-113
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• 2019

Purpose: Anatomical variations of the external nasal wall are highly important, since they play a role in obstruction or drainage of the ostiomeatal complex and ventilation and can consequently elevate the risk of pathological sinus conditions. This study aimed to assess anatomical variations of the nasal cavity and ethmoidal sinuses and their correlations on cone-beam computed tomography (CBCT) scans. Materials and Methods: This cross-sectional study evaluated CBCT scans of 250 patients, including 107 males and 143 females, to determine the prevalence of anatomical variations of the nasal cavity and ethmoidal sinuses. All images were taken using a New Tom 3G scanner. Data were analyzed using the chi-square test, Kruskal-Wallis test, and the Mann-Whitney test. Results: The most common anatomical variations were found to be nasal septal deviation (90.4%), agger nasi air cell (53.6%), superior orbital cell(47.6%), pneumatized nasal septum(40%), and Onodi air cell(37.2%). Correlations were found between nasal septal deviation and the presence of a pneumatized nasal septum, nasal spur, and Haller cell. No significant associations were noted between the age or sex of patients and the presence of anatomical variations (P>0.05). Conclusion: Radiologists and surgeons must pay close attention to the anatomical variations of the sinonasal region in the preoperative assessment to prevent perioperative complications.

• The Journal of Korea Assosiation for Disability and Oral Health
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• v.15 no.1
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• pp.60-64
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• 2019

Swyer-James syndrome (SJS), also known as Swyer-James-MacLeod syndrome and unilateral hyperlucent lung syndrome, is rare acquired pulmonary disorder develops secondary to infectious etiologies in early childhood. Viral respiratory infection such as adenoviruses or Mycoplasma pneumoniae in infancy or early childhood rarely cause Swyer-James syndrome. It is generally characterized on radiographs by a unilateral small lung with hyperlucency and air trapping on expiration. In many cases unaffected lung tissue functions normally, compensating for affected lung portion. Preoperative assessment is needed to determinate individual's pulmonary function. A 4-year-old boy with Swyer-James syndrome visited Seoul National University Dental Hospital Department of pediatric dentistry for caries treatment. Clinical and radiographic examinations revealed multiple carious lesions on deciduous teeth. Considering patient's underling disease, age, and level of cooperation, dental treatment under general anesthesia was scheduled. Dental treatment was done with composite resin and stainless-steel crown. Since ventilation of Swyer-James syndrome patients was diminished because of airway obstruction, close monitoring of ventilation is necessary during dental treatment. Considering pulmonary pathology, general anesthesia rather than sedation is recommended when special behavior management is required for dental treatment. Swyer-James syndrome patients can tolerate general anesthesia and surgery well, according to several reports.