• The korean journal of orthodontics
• /
• v.40 no.2
• /
• pp.115-126
• /
• 2010

This case report describes the treatment of a 66 year old adult patient with a diagnosis of severe obstructive sleep apnea who was intolerant of nasal continuous positive airway pressure (nCPAP) treatment and oral appliance therapy. An alternative treatment of snoring and obstructive sleep apnea (OSA) with 2 orthodontic microimplants anchored to the mandible providing skeletal anchorage for mandibular advancement was implemented. After a 2 week healing period, a custom designed facemask provided extraoral anchorage to which the microimplants were connected to for titratable mandibular advancement. Microimplant Mandibular Advancement (MiMA) therapy resulted in resolution of the symptoms of severe OSA with a reduction of the apnea-hypopnea index (AHI), snoring and OSA symptoms.

• Journal of Yeungnam Medical Science
• /
• v.23 no.2
• /
• pp.227-231
• /
• 2006

The Valsalva maneuver is described as an expiratory effort against a closed glottis or airway. It leads to elevation of retinal venous pressure and may result in retinal hemorrhage. A fifty two- year-old man presented with an acute reduction of central visual acuity in his right eye which occurred after considerable straining at stool. Detailed past medical history revealed that he suffered from chronic constipation and hypertension. There were one disc sized subhyaloid hemorrhage and three small intraretinal hemorrhages around the fovea at the dilated fundus examination. After three months of follow-up without any treatment, the retinal hemorrhages resolved without any sequelae. Here we report a patient with sudden visual loss and retinal hemorrhage.

• Journal of Korean Neurosurgical Society
• /
• v.54 no.5
• /
• pp.423-425
• /
• 2013

We present a case report to remind surgeons of this unusual complication that can occur in any surgery, even posterior cervical spine surgery under general anesthesia and discuss its causes, treatment methods, and the follow-up results in the literature. The peripheral Tapia's syndrome is a rare complication of anesthetic airway management. Main symptoms are hoarseness of voice and difficulty of tongue movement. Tapia's syndrome after endotracheal general anesthesia is believed to be due to pressure neuropathy of the vagus nerve and the hypoglossal nerve caused by the endotracheal tube. To our knowledge, no report has been published or given an explanation for Tapia's syndrome after posterior cervical spine surgery. Two patients who underwent posterior cervical surgery complained hoarseness and tongue palsy postoperatively. There is no direct anatomical relation between the operation, the vagus nerves and the hypoglossal nerves, and there is no record of displacement or malposition of the endotracheal tube. After several months, all symptoms are resolved. To avoid this problem in posterior cervical spine surgery, we suggest paying special attention to the position of the endotracheal tube to avoid excessive neck flexion before and during the positioning of the patient.

• Journal of Korean Society of Occupational and Environmental Hygiene
• /
• v.30 no.2
• /
• pp.226-235
• /
• 2020

Objectives: This study was to investigate the signs and notations of skin absorption, carcinogenicity, germ cell mutagenicity, and reproductive toxicity in the occupational exposure limits of Korea and of other advanced countries. Methods: Information on occupational exposure limits in Korea, the USA, the UK, Germany, and Japan was investigated through the Internet, and items marked as carcinogenicity and skin absorption were compared by country. Results: Legal occupational exposure limits have been greatly simplified. However, in the case of HSE WEL, skin absorption, carcinogenicity classification, sensitization, and in the case of DFG MAK, skin absorption, carcinogenicity, pregnancy risk group, germ cell mutagenicity, airway and skin sensitization, photo contact sensitization, and vapor pressure were provided. Conclusions: It is desirable to indicate the carcinogenicity and skin absorption within permissible limits, and to include information on critical effects in chemical substance exposure limits to uphold the right to know of industrial hygienists and workers in Korea. It is also necessary to clarify the precautions, limitations and protections for skin absorption.

• Journal of the Korean Institute of Electrical and Electronic Material Engineers
• /
• v.24 no.7
• /
• pp.605-608
• /
• 2011

In this study, OSA (the obstructive sleep apnea) periods were detected in patients with OSA during sleep because of the treatment was different according to the frequency and symptoms of obstructive sleep apnea. ANS (autonomic nervous activity) was changed by obstructive sleep apnea periods so we intended to detect the periods to care the obstructive sleep apnea patients. RR intervals, SDNN (standard deviation of normal to normal) and RMSSD (root mean square standard deviation) were calculated in time domain analysis and LF (low frequency), HF (high frequency), NHF (normalized high frequency), NLF (normalized low frequency) were calculated in frequency domain analysis of HRV (heart rate variability) with obstructive sleep apnea patients. In this paper, SDNN (standard deviation of normal to normal) of time domain analysis were decreased in the obstructive sleep apnea periods. And NLF and LF/HF ratio were increased and NHF (normalized high frequency) was decreased in the frequency domain analysis. The parameters can be used to treat obstructive sleep apnea patients by detecting the obstructive sleep apnea periods such as CPAP (continuous positive airway pressure).

• Journal of Oral Medicine and Pain
• /
• v.43 no.3
• /
• pp.61-69
• /
• 2018

Obstructive sleep apnea (OSA) is a relatively common, but greatly underdiagnosed sleep-related breathing disorder, characterized by recurrent collapse of the upper airway during sleep. OSA has been associated with a variety of cardiometabolic disease, such as hypertension, coronary artery disease, cardiac arrhythmia, cerebrovascular disease and metabolic dysfunction. Neurocognitive impairment, including excessive daytime sleepiness, increased risk of motor vehicle accidents, is also related to OSA. Sleep fragmentation and related arousals during sleep lead to intermittent hypoxia, sympathetic activation, oxidative stress, systemic inflammation and metabolic dysregulation which provide biological plausibility to this pathologic mechanism. Extensive studies demonstrated that OSA is a modifiable risk factor for the above mentioned diseases and oral appliances (OAs), although continuous positive air pressure (CPAP) is a first-line therapy of OSA, are not inferior to CPAP at least in mild OSA, and may be an alternative to CPAP in CPAP-intolerant subjects with OSA. The goal of this article is to provide a current knowledge of pathologic link between OSA and cardiovascular disease, focusing on intermittent hypoxia, sympathetic activation, oxidative stress and metabolic dysregulation. Then, previous epidemiologic studies will be reviewed to understand the causal relationship between OSA and cardiovascular disease. Finally, the effects of OAs will be updated via recent metaanalyses compared to CPAP.

• Journal of The Korean Dental Society of Anesthesiology
• /
• v.11 no.2
• /
• pp.177-182
• /
• 2011

There are five principal causes for excessive bleeding in the immediate postextraction phase ; (1) Vascular wall alteration (wound infection, scurvy, chemicals, allergy) (2) Disorders of platelet function (genetic defect, drug-aspirin, autoimmune disease) (3) Thrombocytopenic purpuras (radiation, leukemia), (4) Inherited disorders of coagulation (hemophilia, Christmas disease, vitamin deficiency, anticoagulation drug-heparin, coumarin, aspirin, plavix). If the hemorrhage from postextraction wound is unusually aggressive, and then dehydration and airway problem are occurred, the socket must be packed with gelatine sponge(Gelfoam) that was moistened with thrombin and wound closure & pressure dressing are applied. The thrombin clots fibrinogen to produce rapid hemostasis. Gelatine sponges moistened with thrombin provide effective coagulation of hemorrhage from small veins and capillaries. But, in dental alveoli, gelatine sponges may absorb oral microorganisms and cause alveolar osteitis (infection). This is a case report of bleeding and infection control by the circumferential suture and iodoform gauze drainage on infected active bleeding extraction socket under sedation and local anesthesia in a 71-years-old male patient with anticoagulation drug.

• Journal of Korean Neurosurgical Society
• /
• v.30 no.sup1
• /
• pp.159-164
• /
• 2001

Reduction cranioplasty is one of the treatment modality among many treatment options for macrocephaly with hydrocephalus. The most previous techniques of reduction cranioplasty have some disadvantages such as difficult airway maintenance, pressure sore due to modified prone position, severe venous infarct due to obstruction of venous blood flow and large amount of bleeding from the dissection of superior sagittal sinus to obtain bone fragment needed. A 28-month-old girl had extreme macrocephaly. She couldn't control head rotation and keep sitting position. The operation was performed at supine position with adequate exposure of entire calvarium and the hinge was made in occipital bone fragment that covered posterior part of superior sagittal sinus. Bleeding volume and the other complications were decreased and acceptable reduction was achieved with this method.

• Journal of Rhinology
• /
• v.25 no.2
• /
• pp.99-102
• /
• 2018

Lateral pharyngoplasty is a surgical option for treatment of obstructive sleep apnea (OSA). Here, we present a case involving a 40-year-old healthy man who underwent surgery, including lateral pharyngoplasty and robotic tongue base resection, for OSA. There were no intraoperative or immediate postoperative complications. However, on postoperative day 3, the patient presented with swelling in the temporal and buccal areas and was diagnosed with subcutaneous emphysema, later confirmed by computed tomography. The patient was carefully monitored under conservative care and discharged without complications. Although subcutaneous emphysema following tonsillectomy is a rare complication and usually resolves with conservative management, in certain cases, it might require surgical intervention. Lateral pharyngoplasty involves tonsillectomy and additional incision along the tonsillar fossa, which makes it susceptible to pharyngeal wall defects and, consequently, subcutaneous emphysema. Additionally, lateral pharyngoplasty and robotic tongue base resection cause pain and might thus contribute to the increase in intrapharyngeal pressure, which might aggravate subcutaneous emphysema. Lateral pharyngoplasty should be performed with meticulous dissection of the superior pharyngeal constrictor muscle. Healthcare providers should be aware of these complications and, upon suspicion of the same, place the patient under close observation to prevent life-threatening situations.

• Journal of Korean Dental Science
• /
• v.16 no.1
• /
• pp.80-86
• /
• 2023

We report two rare cases of extensive bilateral subcutaneous emphysema that occurred during ordinary dental procedures. An air-driven high-speed handpiece, routinely used in dental procedures may cause subcutaneous emphysema when high pressure air is introduced into the loose connective tissues below the dermal layer. The first case occurred with surgical extraction of the lower third molar. The air introduced into the fascial spaces near the surgical field spread to the contralateral spaces, as well as the neck and chest areas. The second case also showed extensive bilateral subcutaneous emphysema caused by the introduction of compressed air from the handpiece during crown preparation without any invasive procedure. Cases where the emphysema extends beyond the treatment site to involve the contralateral cervicofacial areas have been rarely reported. Predicting the occurrence of subcutaneous emphysema is difficult, so it is important to exercise caution during routine dental treatment. If significant bilateral cervicofacial swelling is suspected to be due to subcutaneous emphysema, prompt diagnosis with securing the patient's airway will be necessary.