• Journal of Dental Anesthesia and Pain Medicine
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• v.21 no.6
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• pp.507-525
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• 2021

Local anesthesia is indispensable in dentistry. Worldwide, millions of local anesthetic injections are administered annually, and are generally considered safe invasive procedures. However, adverse effects are possible, of which dentists should be aware of. This scoping review aimed to provide an extensive overview of the reported literature on the adverse effects of dental local anesthesia. The types of papers, what is reported, and how they are reported were reviewed. Additionally, the incidence and duration of adverse effects and factors influencing their occurrence were also reviewed. An electronic search for relevant articles was performed in PubMed and Embase databases from inception to January 2, 2020. The titles and abstracts were independently screened by two reviewers. The analysis was narrative, and no meta-analysis was performed. This study included 78 articles. Ocular and neurological adverse effects, allergies, hematomas, needle breakage, tissue necrosis, blanching, jaw ankylosis, osteomyelitis, and isolated atrial fibrillation have been described. Multiple adverse effects of dental local anesthesia have been reported in the literature. The results were heterogeneous, and detailed descriptions of the related procedures were lacking. Vital information concerning adverse effects, such as the dosage or type of anesthetic solution, or the type of needle used, was frequently missing. Therefore, high-quality research on this topic is needed. Finally, the adverse effects that are rarely encountered in real-world general practice are overrepresented in the literature.

• Journal of the Korean Association of Oral and Maxillofacial Surgeons
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• v.50 no.2
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• pp.110-115
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• 2024

A 22-year-old male patient presented to the clinic with severe pain in the preauricular area with an inability to completely occlude the jaw. Facial computed tomography and magnetic resonance imaging revealed a well-defined lesion that was tentatively diagnosed as a benign tumor or cystic mass. Surgical approach of a lesion in the condyle is delicate and problematic as many vulnerable anatomical structures are present. There are several methods for surgery in this area. Typically, an extraoral approach is dangerous because of potential injuries to nerves and arteries. The intraoral approach also presents difficulties due to the lack of visibility and accessibility. On occasion, coronoidectomy may be performed. The goal here was to determine an easier and safer new surgical approach to the condyle. We reached the anterior part of the pterygoid plate in the same method as in Le Fort I surgery. From this point, through the external pterygoid muscle, approaching the anterior aspect of the condyle is relatively easy and safe, with minimal damage to the surrounding tissues. Pus was drained at the site, and the lesion was diagnosed as an abscess. Pain and inability to close the mouth resolved without recurrence.

• Journal of the Korean Association of Oral and Maxillofacial Surgeons
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• v.37 no.4
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• pp.264-271
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• 2011

Purpose: This study evaluated retrospectively the postsurgical facial hard tissue profile of a Le Fort I osteotomy with/without posterior impaction and rigid internal fixation to correct mandibular prognathism. After observing a difference between the two groups, this measurement was used to prepare a treatment plan for 2-jaw surgery. Patients and Methods: Thirty patients who had undergone orthognathic surgery in Pusan National University Dental Hospital were enrolled in this study. Fifteen patients were treated using a Le Fort I osteotomy with posterior impaction and mandibular setback bilateral sagittal split ramus osteotomy, and the other fifteen patients were treated without posterior impaction. The preoperative (T0), immediate postoperative (T1) and six-month follow-up period (T2) cephalograms were taken and difference between T1-T0 and T2-T2 was analyzed. Results: Both groups was FH-ABp, SNB and ANB showed significant changes in the measurement, whereas only the posterior impaction group showed a change in the SN-U1, occlusal plane, posterior facial height, surgical movement difference from the L1 and B-point. There was no significant statistical change between the immediate postoperative (T1) and six-month follow-up (T2) hard tissue analysis in the two groups. Conclusion: A Le Fort I osteotomy with posterior impaction is considerable for patients with a flat occlusal plane angle, large posterior facial height, prominent B-point, pogonion and labioversed incisal inclination if the indications are well chosen.

• The Korean Journal of Physiology and Pharmacology
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• v.2 no.6
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• pp.687-693
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• 1998

This study was performed to examine the mean arterial pressure and nociceptive jaw opening reflex after microinjection of glutamate into the amygdala in freely moving rats, and to investigate the mechanisms of antinociceptive action of amygdala. Animals were anesthetized with pentobarbital sodium (40 mg/kg, ip). A stainless steel guide cannula (26 gauge) was implanted in the amygdala and lateral ventricle. Stimulating and recording electrodes were implanted into each of the incisor pulp and anterior digastric muscle. Electrodes were led subcutaneously to the miniature cranial connector sealed on the top of the skull with acrylic resin. After 48 hours of recovery from surgery, mean arterial pressure and digastric electromyogram (dEMG) were monitored in freely moving rats. Electrical shocks (200 ${\mu}sec$ duration, $0.5{\sim}2$ mA intensity) were delivered at 0.5 Hz to the dental pulp every 2 minutes. After injection of 0.35 M glutamate into the amygdala, mean arterial pressure was increased by $8{\pm}2$ mmHg and dEMG was suppressed to $71{\pm}5%$ of the control. Injection of 0.7 M glutamate elevated mean arterial pressure by $25{\pm}5$ mmHg and suppressed dEMG to $20{\pm}7%$ of the control. The suppression of dEMG were maintained for 30 minutes. Naloxone, an opioid receptor antagonist, inhibited the suppression of dEMG elicited by amygdaloid injection of glutamate from $28{\pm}4\;to\;68{\pm}5%$ of the control. Methysergide, a serotonin receptor antagonist, also inhibited the suppression of dEMG from $33{\pm}5\;to\;79{\pm}4%$ of the control. However, phentolamine, an ${\alpha}-adrenergic$ receptor antagonist, did not affect the suppression of dEMG. These results suggest that the amygdala can modulate both cardiovascular and nociceptive responses and that the antinociception of amygdala seems to be attributed to an augmentation of descending inhibitory influences on nociceptive pathways via serotonergic and opioid pathways.

• Imaging Science in Dentistry
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• v.38 no.1
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• pp.17-22
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• 2008

Purpose: It is important to determine the bucco-lingual inclination of implants on radiographs before the implant surgery. The purpose of this study was to compare the buccolingual inclination in alveolar bone and the tooth with dental cone beam CT and to prepare the standard for the buccolingual inclination of implant. Materials and Methods: Axial, panoramic, and buccolingually sectioned images of 80 implant cases with stent including straight marker using CB $Mercuray^{TM}$ (Hitachi, Japan) were evaluated. The comparison of the buccolingual inclination of remained alveolar bone with the tooth and the marker on butcolingually sectioned views was performed statistically. Results: The average buccolingual inclination of remained alveolar bone and tooth was $82.8{\pm}4.6^{\circ}\;and\;85.8{\pm}4.7^{\circ}$ (p<0.05, r=0.96) at the 1st molar area and $76.4{\pm}1.7^{\circ}\;and\;82.7{\pm}1.7^{\circ}$ respectively (p>0.05, r=0.12) at the 2nd premolar area in upper jaw. The average buccolingua1 inclination of remained alveolar bone and tooth was $81.3{\pm}8.3^{\circ}\;and\;87.5{\pm}6.3^{\circ}$ (p>0.05, r=0.85) at the lower 2nd premolar area and $94.3{\pm}6.6^{\circ}\;and\;93.3{\pm}7.2^{\circ}$ respectively (p>0.05, r=0.91) at the 1st molar area in lower jaw. The inclinations of markers were very different from those of remained bone at the most of areas except the upper 2nd premolar area (r=0.79). Conclusion: We recommend dental CBCT analysis for determining the buccolingual inclination of dental implant, because of significant difference, in average, between the bucco1ingual inclination of remained alveolar bone and tooth.

• Archives of Craniofacial Surgery
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• v.12 no.1
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• pp.12-16
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• 2011

Purpose: This study examined the biomechanical stability of four different plating techniques in the experimental model of mandibular subcondyle fracture. Methods: Twenty standardized bovine tibia bone samples ($7{\times}1.5{\times}1.0cm$) were used for this study. Each of the four sets of tibia bone was cut to mimic a perpendicular subcondyle fracture in the center area. The osteotomized tibia bone was fixed using one of four different fixation groups (A,B,C,D). The fixation systems included single 2.0 mm 4 hole mini adaption plate (A), single 2.0 mm 4 hole dynamic compression miniplate (B), double fixation with 2.0 mm 4 hole mini adaption plate (C), double fixation with a 2.0 mm 4 hole mini adaption plate and 2.0 mm 4 hole dynamic compression miniplate (D). A bending force was applied to the experimental model using a pressure machine (858 table top system, $MTS^{(R)}$) until failure occurred. The load for permanent deformation, maximum load of failure were measured in the load displacement curve with the chart recorder. Results: Double fixation with a 2.0 mm 4 hole mini adaption plate and a 2.0 mm 4 hole dynamic compression miniplate (D) applied to the anterior and posterior regions of the subcondyle experimental model showed the highest load to failure. Conclusion: From this study, double fixation with an adaption plate and dynamic compression miniplate fixation technique produced the greatest biomechanical stability. This technique may be considered a useful means of fixation to reduce the postoperative internal maxillary fixation period and achieve early mobility of the jaw.

• Maxillofacial Plastic and Reconstructive Surgery
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• v.15 no.2
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• pp.81-91
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• 1993

Arthrosis of the temporomandibular joint is defined as a disease of a joint with chief complaint of pain, clicking, limited jaw movements. Generally, most patients with the temporomandibular arthrosis can be treated conservatively with muscle relaxation therapy combined with mandibular repositioning prostheses, followed by occlusal equilibration, restorative dentistry and/or orthodontics, and many other forms of treatment. In case prior nonsurgical treatment proved to be ineffective or the disease is chronic and severe, surgical operation is recommended. For patients with arthrosis of the temporomandibular joint, only discectomy as therapeutic method of the surgical treatment should not be applied and the removed articular disc of the temporomandibular joint should be replaced. Allograft such as Proplast-Teflon, Silastic, etc have been used as replacements of removed articular disc. However, these allograft materials have caused complications such as inflammatory changes, foreign body reactions. As a result, a replacement material which is autogenous, space occupying, easy to harvest and less inflammatory change has been developed. Auricular cartilage with perichondrium satisfies many of these requirements. The apparent advantages of autogenous auricular cartilage as an interpositional graft after a discectomy are as follows, (1) the form of the external ear corresponds to joint morphology, (2) a graft of adequate size can be harvested, (3) the form of the external ear remains unchanged after surgery, (4) the graft can be obtained adjacent to the surgical site, (5) biologically acceptable material is used, (6) the additional expense of allogenic graft is avoided. Because we considered autogenous auricular cartilage as a good replacement material, removed articular disc has been replaced with fresh autogenous auricular cartilage in the case of three patients. The result of the treatment is favorable, and the cases being presented here.

• Maxillofacial Plastic and Reconstructive Surgery
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• v.23 no.2
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• pp.107-114
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• 2001

Objectives : To compare jaw bone density of young adults (control group) and post-menopausal women(experimental group) in periapical and panoramic film. Materials and Methods : The bone mineral density values of lumbar and femur were measured by dual-energy X-ray absorptiometry(DEXA) and T scores of lumbar were obtained. T scores were classified into 3 group (T<-2.5, $-2.5{\leqq}T<-1$, $-1{\leqq}T$). Radiographic densities of alveolar bones were measured from interdental bones of premolar, molar areas in the maxilla and mandible and expressed into copper step wedge thickness by Scion $Image^{(R)}$ program. We considered these values of step wedge thickness as bone density of alveolar bone. Panorama mandibular index(PMI) was calculated by the method that the height of the inferior cortex of the mandible was divided by the height from the lower border of the mandible to the superior edge of the mental foramen. Bone density of alveolar bone and PMI were analysed statistically. Results : There were significant differences in bone mineral density of lumbar and femoral neck between control and experimental groups. There were also significant differences in bone density of premolar and molar area of jaw between control and experimental groups by MANOVA test. When considered lumbar T variables, there was only difference in interdental bone density of maxillary molar area between control and experimental group, but there was interaction. Interdental bone density of experimental group was appeared higher in $-1{\leqq}T$ group and lower in T<-2.5 group than control group. There was significant difference in PMI between control and experimental groups, but there was also inter action, thus, PMI of experimental group was appeared higher in $-1{\leqq}T$ group and lower in T<-2.5 group than control group. Conclusion : There were significant differences of alveolar density and cortical bone thickness between young men and post-menopausal women in periapical and panoramic film. These differences were dependent on lumbar T.

• Maxillofacial Plastic and Reconstructive Surgery
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• v.30 no.6
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• pp.561-566
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• 2008

This is a retrospective clinical study on 2,955 patients who had visited the Emergency Room of Sang-gye Paik Hospital and then been treated in the Department of Oral and Maxillofacial Surgery during recent 4 years from Aug. 2002 to Dec. 2006. The obtained results were as follows. The total number of patients was 2,955 and the ratio of male to female was 1.72:1. The age distribution peak was the 1st decade (30.8%), followed by the 3rd decade (14.3%) and the 4th decade (14.0%). Trauma (62.3%) was the most frequent cause in dental emergency patients, pulpitis (13.0%) and infection patients were next in order of frequency. In trauma patients group, facial bone injury, tooth injury, soft tissue injury were included and soft tissue injury group was most prevalent, followed by tooth injury group and facial bone group. In total patient, the ratio of admission was 3.5%. We obtained the results of the distribution of primary emergency care in the traumatic injury, causal distribution of the jaw fracture, distribution of related medical department in multiple associated injuries, distribution of emergency care in infection, causal distribution and control methods of oral bleeding, distribution of TMJ disorder. The trauma patient group was major in the dental patients who had visited the emergency room, but other various groups were included. So we should analyze the pattern and the variation of the dental emergent patient to provide the proper treatment.

• Journal of the Korean Association of Oral and Maxillofacial Surgeons
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• v.33 no.2
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• pp.169-172
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• 2007

The Varicella zoster virus is responsible for two common infectious diseases: chicken pox(Varicella) and shingles(Herpes zoster). Chicken pox is the primary infection. After the initial infection, the virus remains dormant in sensory ganglia until reactivation may occur decades later. The subsequent reactivation is Herpes zoster. Herpes zoster of the trigeminal nerve distribution manifests as painful, vesicle eruptions of the skin and mucosa innervated by the affected nerve. Oral vesicles usually appear after the skin manifestrations. Reports of osteomyelitis of jaw after trigeminal herpes zoster are extremely rare. We report a case of osteomyelitis on mandible caused by herpes zoster infection which was treated by antiviral drug, curettage. At 1 year post-operatively, mandibular mucosa had healed without recurrent sign. But post-herpetic neuralgia is remained.