• Journal of the Korean Association of Oral and Maxillofacial Surgeons
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• 제42권1호
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• pp.13-19
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• 2016

Objectives: As the craniofacial and neck regions are prime areas of injury in bear attacks, the careful management of soft and hard tissue injuries and selection of reconstructive options is of the utmost importance. This study will review the incidence and patterns of bear mauling in eastern India reported to our department and the various modalities used for their treatment over a period of 7 years. It also documents the risks of infection in bear mauling cases and the complications that have occurred. Materials and Methods: Twenty cases were treated over the study period. Cases were evaluated for soft and hard tissue injuries including tissue loss and corresponding management in the craniofacial region. Cases were also evaluated for other associated injuries, organ damage and related complications. Results: Various modalities of treatment were used for the management of victims, ranging from simple primary repairs to free tissue transfers. Simple primary repairs were done in 75% of cases, while the management of the injured victims required reconstruction by local, regional or distant flaps in 25%. Free tissue transfers were performed in 15% of cases, and no cases of wound infection were detected in the course of treatment. Conclusion: Knowledge of various reconstructive techniques is essential for managing maxillofacial injuries in bear mauling cases. Modern reconstructive procedures like free tissue transfer are reliable options for reconstruction with minimal co-morbidity and dramatic improvement in treatment outcomes.

• International Journal of Oral Biology
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• 제42권3호
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• pp.129-135
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• 2017

The present study investigated the role of spinal glutamate recycling in the development of orofacial inflammatory pain or trigeminal neuropathic pain. Experiments were carried out on male Sprague-Dawley rats weighing between 230 and 280 g. Under anesthesia, a polyethylene tube was implanted in the atlanto-occipital membrane for intracisternal administration. IL-$1{\beta}$-induced inflammation was employed as an orofacial acute inflammatory pain model. IL-$1{\beta}$ (10 ng) was injected subcutaneously into one vibrissal pad. We used the trigeminal neuropathic pain animal model produced by chronic constriction injury of the infraorbital nerve. DL-threo-${\beta}$-benzyloxyaspartate (TBOA) or methionine sulfoximine (MSO) was administered intracisternally to block the spinal glutamate transporter and the glutamine synthetase activity in astroglia. Intracisternal administration of TBOA produced mechanical allodynia in naïve rats, but it significantly attenuated mechanical allodynia in rats with interleukin (IL)-$1{\beta}$-induced inflammatory pain or trigeminal neuropathic pain. In contrast, intracisternal injection of MSO produced anti-allodynic effects in rats treated with IL-$1{\beta}$ or with infraorbital nerve injury. Intracisternal administration of MSO did not produce mechanical allodynia in naive rats. These results suggest that blockade of glutamate recycling induced pro-nociception in na?ve rats, but it paradoxically resulted in anti-nociception in rats experiencing inflammatory or neuropathic pain. Moreover, blockade of glutamate reuptake could represent a new therapeutic target for the treatment of chronic pain conditions.

• 치위생과학회지
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• 제15권6호
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• pp.845-850
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• 2015

이번 연구는 진료실 내 안전사고에 의한 외상 경험 실태와 예방 실천에 대해 파악하는 연구이다. 치과 병 의원에서 종사하고 있는 치과위생사 366명을 대상으로 자기기입식 설문조사를 실시하였다. 최근 6개월 동안 외상 경험은 연구대상자 366명 중 307명(83.9%)이 경험한 적이 있다고 응답하였고 유형으로는 전체응답자 366명 중 찔림이 294회(80.3%)로 가장 경험이 많았고 절상, 찰과상, 화상 순이었다. 외상 원인으로는 찔림의 원인이 된 기자재 중 explorer가 93명(25.4%)으로 가장 많았으며 needle이 66명(18.0%)로 그 다음으로 나타났다. 절상(베임)은 blade가 36명(9.8%), 화상 원인은 sterilizer로 26명(7.1%), 찰과상 원인은 movable cart 47명(12.8%)으로 가장 많았다. 찔림 경험을 한 후 응급처치로 알코올 솜으로 닦는 경우가 40.8%으로 가장 많았고, 응급실 방문은 없는 것으로 나타났다. 절상(베임)을 경험 한 후 응급처치로 베타딘으로 소독하는 경우가 42.8%으로 가장 많았고, 화상을 경험 후 응급처치는 찬물로 씻는 경우가 73.0%으로 절반이 넘게 나타났다. 일반적 특성에 따른 외상 경험의 차이를 조사한 결과 연령, 근무경력(p<0.001), 최종학력(p=0.006), 직위, 업무영역(p=0.001)에서 통계적으로 유의한 차이가 있다고 나타났다. 일반적 특성에 따른 안전사고 예방 실천도의 차이를 조사한 결과 외상 경험 여부(p=0.030), 연령(p=0.015)과 치과유형(p=0.003)이 통계적으로 유의한 차이가 있는 것으로 나타났다. 치과 외상 경험 실태와 안전사고 예방 실천에 관련된 연구를 통하여 진료실 내 안전사고 예방이 체계적인 과정으로 확립되어야 하고 정기적인 교육을 통하여 안전에 대한 중요성을 부여하여야 한다.

• Journal of Dental Anesthesia and Pain Medicine
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• 제19권1호
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• pp.55-66
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• 2019

Background: Postoperative nausea and vomiting (PONV) frequently occurs following bimaxillary orthognathic surgeries. Compared to opioids, Nefopam is associated with lower incidences of PONV, and does not induce gastrointestinal tract injury, coagulopathy, nephrotoxicity, or fracture healing dysfunction, which are common side effects of Nonsteroidal anti-inflammatory drugs. We compared nefopam- and fentanyl-induced incidence of PONV in patients with access to patient-controlled analgesia (PCA) following bimaxillary orthognathic surgeries. Methods: Patients undergoing bimaxillary orthognathic surgeries were randomly divided into nefopam and fentanyl groups. Nefopam 120 mg or fentanyl $700{\mu}g$ was mixed with normal saline to a final volume of 120 mL. Patients were given access to nefopam or fentanyl via PCA. Postoperative pain intensity and PONV were measured at 30 minutes and 1 hour after surgery in the recovery room and at 8, 24, 48, and 72 hours after surgery in the ward. The frequency of bolus delivery was compared at each time point. Results: Eighty-nine patients were enrolled in this study, with 48 in the nefopam (N) group and 41 in the fentanyl (F) group. PONV occurred in 13 patients (27.7%) in the N group and 7 patients (17.1%) in the F group at 8 hours post-surgery (P = 0.568), and there were no significant differences between the two groups at any of the time points. VAS scores were $4.4{\pm}2.0$ and $3.7{\pm}1.9$ in the N and F groups, respectively, at 8 hours after surgery (P = 0.122), and cumulative bolus delivery was $10.7{\pm}13.7$ and $8.6{\pm}8.5$, respectively (P = 0.408). There were no significant differences in pain or bolus delivery at any of the remaining time points. Conclusion: Patients who underwent bimaxillary orthognathic surgery and were given nefopam via PCA did not experience a lower rate of PONV compared to those that received fentanyl via PCA. Furthermore, nefopam and fentanyl did not provide significantly different postoperative pain control.

• Journal of Dental Anesthesia and Pain Medicine
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• 제16권4호
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• pp.263-271
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• 2016

Background: Bone injury is common in many clinical situations, such as surgery or trauma. During surgery, excessive reactive oxygen species (ROS) production decreases the quality and quantity of osteoblasts. Remifentanil decreases ROS production, reducing oxidative stress and the inflammatory response. We investigated remifentanil's protective effects against $H_2O_2$-induced oxidative stress in osteoblasts. Methods: To investigate the effect of remifentanil on human fetal osteoblast (hFOB) cells, the cells were incubated with 1 ng/ml of remifentanil for 2 h before exposure to $H_2O_2$. For induction of oxidative stress, hFOB cells were then treated with $200{\mu}M$ $H_2O_2$ for 2 h. To evaluate the effect on autophagy, a separate group of cells were incubated with 1 mM 3-methyladenine (3-MA) before treatment with remifentanil and $H_2O_2$. Cell viability and apoptotic cell death were determined via MTT assay and Hoechst staining, respectively. Mineralized matrix formation was visualized using alizarin red S staining. Western blot analysis was used to determine the expression levels of bone-related genes. Results: Cell viability and mineralized matrix formation increased on remifentanil pretreatment before exposure to $H_2O_2$-induced oxidative stress. As determined via western blot analysis, remifentanil pretreatment increased the expression of bone-related genes (Col I, BMP-2, osterix, and $TGF-{\beta}$). However, pretreatment with 3-MA before exposure to remifentanil and $H_2O_2$ inhibited remifentanil's protective effects on hFOB cells during oxidative stress. Conclusions: We showed that remifentanil prevents oxidative damage in hFOB cells via a mechanism that may be highly related to autophagy. Further clinical studies are required to investigate its potential as a therapeutic agent.

• Journal of Dental Anesthesia and Pain Medicine
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• 제17권1호
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• pp.37-46
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• 2017

Background: In oxidative stress, reactive oxygen species (ROS) production contributes to cellular dysfunction and initiates the apoptotic cascade. Autophagy is considered the mechanism that decreases ROS concentration and oxidative damage. Propofol shows antioxidant properties, but the mechanisms underlying the effect of propofol preconditioning (PPC) on oxidative injury remain unclear. Therefore, we investigated whether PPC protects against cell damage from hydrogen peroxide ($H_2O_2$)-induced oxidative stress and influences cellular autophagy. Method: COS-7 cells were randomly divided into the following groups: control, cells were incubated in normoxia (5% $CO_2$, 21% $O_2$, and 74% $N_2$) for 24 h without propofol; $H_2O_2$, cells were exposed to $H_2O_2$ ($400{\mu}M$) for 2 h; $PPC+H_2O_2$, cells pretreated with propofol were exposed to $H_2O_2$; and 3-methyladenine $(3-MA)+PPC+H_2O_2$, cells pretreated with 3-MA (1 mM) for 1 h and propofol were exposed to $H_2O_2$. Cell viability was determined using 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide thiazolyl blue (MTT) reduction. Apoptosis was determined using Hoechst 33342 staining and fluorescence microscopy. The relationship between PPC and autophagy was detected using western blot analysis. Results: Cell viability decreased more significantly in the $H_2O_2$ group than in the control group, but it was improved by PPC ($100{\mu}M$). Pretreatment with propofol effectively decreased $H_2O_2$-induced COS-7 cell apoptosis. However, pretreatment with 3-MA inhibited the protective effect of propofol during apoptosis. Western blot analysis showed that the level of autophagy-related proteins was higher in the $PPC+H_2O_2$ group than that in the $H_2O_2$ group. Conclusion: PPC has a protective effect on $H_2O_2$-induced COS-7 cell apoptosis, which is mediated by autophagy activation.

• Journal of the Korean Association of Oral and Maxillofacial Surgeons
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• 제30권1호
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• pp.34-42
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• 2004

The appropriate care to the dental emergency patients is much important in the aspect of community dental service. To attain such a purpose, the sacred duty of the training of oral and maxillofacial surgeons is required. So, a retrospective study on the characteristics of dental injuries and diseases in emergency care unit will be very meaningful. This study was carried by reviewing the charts and radiographic films of 3,394 patients, treated for dental emergency at Wonju Christian Hospital, Republic of Korea, from January 1, 1993 to December 31, 2002. All patients were classified to 6 groups including trauma, toothache, infection, hemorrhage, TMJ disorder and the others. The clinical characteristics of diseases and treatment modalities according to each group were analyzed. The trauma (73.9%) was the most frequent cause in dental emergency patients, and acute toothache, odontogenic infection, oral hemorrhage, and TMJ disorder were next in order. Gender prediction was male (68%), there were many patients on May and December in the monthly frequency, and the most frequent age group was from 0 to 9 years. In the trauma group, male (68.6%) was predominant, and soft tissue injuries and primary closures were the most frequent type of injury and treatment. In jaw fractures, traffic accidents were the most cause and the weakest site was mandibular symphysis area, and mandibular angle, condyle, and body area were next in order. In the acute toothache group, the cause was dental pulpitis mostly and treatment for that was drug administration mainly. Buccal space abscess in infection group had the largest incidence (24.5%), and common treatments were incision and drainage and medications. In the hemorrhage group, a major cause was postoperative bleeding (60.3%) and hemostasis was obtained by pressure dressing, curettage and suture. For the TMJ disorder group, the peak incidence (63.8%) was shown in the post-traumatic myofascial pain dysfunction syndrome and its primary care was medication such as analgesics and sedatives. In the other group, the various specific symptoms were complained due to acute sialadenitis, trigeminal neuralgia, acute stomatitis, chemical burn, terminal stage neuritis of head and neck cancer, and foreign body aspiration. In conclusion, for the rapid and proper care of the emergency dental diseases, well-trained education should be presented to the intern and resident course of oral and maxillofacial surgery. And it is demanded that oral and maxillofacial surgeons must be prepared in knowledge and skill for such emergency care.

• 대한소아치과학회지
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• 제41권2호
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• pp.145-151
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• 2014

본 연구의 목적은 전신질환으로 입원한 환자의 소아치과 협진 의뢰 현황에 대한 통계분석을 실시하여 소아치과로 의뢰되는 전신질환 환자 실태를 파악하는 것이다. 2012년 한 해 동안 연세대학교 세브란스 병원에 전신질환으로 입원한 소아환자 중 소아치과에 의뢰되어 실제 진료를 받았으며 그 기록이 온전한 391건을 대상으로 하였다. 환자의 나이, 성별, 전신질환명, 협진의뢰과, 협진주소, 치과적 진단명, 치과적 치료 내용, 사망여부로 분류하여 통계 분석하였으며 환자 정보의 수집은 연세의료원의 Clinical Data Retrieval System을 이용하였다. 총 288명의 환자(M:F=166:122)가 소아치과로 의뢰되었으며 평균 연령은 5.9세였다. 재활의학과에서 129건(33.1%), 소아혈액종양내과에서 80건(20.5%), 소아심장과에서 51건(13.0%), 소아신경과에서 44건(11.3%)이 의뢰되었다. 협진주소는 기본 구강검진(156cases, 39.7%), 치아우식증(55cases, 14.0%), 수술 전 검진(50cases, 12.8%)순으로 많았으며 이 외에도 구강통증, 외상, 치아동요도, 교정치료, 자해로 인한 외상, obturator 제작 등 다양한 주소로 의뢰되었음이 확인되었다. 협진 의뢰된 환자의 절반 가량은 특별한 치료 없이 구강검사만을 시행하였으며(193건, 49%), 보존치료 및 예방치료는 각각 63건, 60건으로 비슷한 것으로 나타났다. 전신질환으로 입원한 환자의 소아치과 의뢰 현황을 분석한 결과 구강검진을 포함한 다양한 주소로 의뢰됨이 확인되었으며 재활의학과 및 소아혈액종양내과에서 가장 많은 의뢰가 이루어졌다. 의뢰된 환자의 치과적 진단명은 치아우식증이 가장 많았고 이에 대한 비침습적이고 예방적 치과치료가 주로 이루어졌다. 입원환자의 전신건강관리와도 밀접한 구강질환 예방 및 처치를 위하여 치과협진이 독려되어야 할 것이며 이를 위한 의사 및 보호자의 인식 개선이 요구된다.

• Imaging Science in Dentistry
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• 제39권3호
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• pp.149-156
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• 2009

Purpose : The purpose of this study was to develop a stent-based image guided surgery system and to apply it to oral and maxillofacial surgeries for anatomically complex sites. Materials and Methods : We devised a patient-specific stent for patient-to-image registration and navigation. Three-dimensional positions of the reference probe and the tool probe were tracked by an optical camera system and the relative position of the handpiece drill tip to the reference probe was monitored continuously on the monitor of a PC. Using 8 landmarks for measuring accuracy, the spatial discrepancy between CT image coordinate and physical coordinate was calculated for testing the normality. Results : The accuracy over 8 anatomical landmarks showed an overall mean of $0.56{\pm}0.16\;mm$. The developed system was applied to a surgery for a vertical alveolar bone augmentation in right mandibular posterior area and possible interior alveolar nerve injury case of an impacted third molar. The developed system provided continuous monitoring of invisible anatomical structures during operation and 3D information for operation sites. The clinical challenge showed sufficient accuracy and availability of anatomically complex operation sites. Conclusion : The developed system showed sufficient accuracy and availability in oral and maxillofacial surgeries for anatomically complex sites.

• 한국학교보건학회지
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• 제21권2호
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• pp.107-117
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• 2008

Purpose: To investigate the utilization of medical care benefits of school personnel on duty in Seoul. Method: The subjects were 551 workers under Seoul Metropolitan Office of Education(male 301, female 250) who got medical care benefits from March 2000 to February 2005. To analyze the data, frequency, chi-square test, and t-test by SAS package 9.12 were used. Result: The results show that elementary school personnel got the highest ranking, 314(57.0%). Among subjects, 57.2% personnel got accident when they were working on their own duty, 21% during school events and 13.5% were during commutes. They got medical care from orthopedics 75.9%, neurosurgery 7.6%, dental 4%, and 8 male and 2 female died during these days. The most frequent diseases of males and female were fracture and joints related disease. The reason of most health problem was due to injury(92.3%). Conclusion: The results of this study suggest that the continuous health care services like regular health check for school personnel, or social safety network to prevent injury are needed.