• The Korean Journal of Pain
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• v.8 no.1
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• pp.156-158
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• 1995

Total spinal anesthesia is a well documented serious life threatening complication which results from an attempted spinal or epidural analgesia. We had an accidental total spinal anesthesia associated with a cranial nerve paralysis and an eventual unconsciousness during epidural analgesia. A 45-year-old female with an uterine myoma was scheduled for a total abdominal hysterectomy under the epidural analgesia. A lumbar tapping for the epidural analgesia was performed in a sitting position at a level between $L_{3-4}$, using a 18 gauge Tuohy needle. Using the "Loss of Resistance" technique to identify the epidural space, the first attempt failed; however, the second attempt with the same level and the technique was successful. The epidural space was identified erroneously. However, fluid was dripping very slowly through the needle, which we thought was the fluid from the normal saline which was injected from the outside to identify the space. Then 20 ml of 2% lidocaine was administered into the epidural space. Shortly after the spinal injection of lidocaine, many signs of total spinal anesthesia could be clearly observed, accompanied by the following progressing signs of intracrainal nerve paralysis: phrenic nerve, vagus nerve, glossopharyngeal nerve and trigeminal nerve in that order. Then female was intubated and her respiration was controlled without delay. The scheduled operation was carried out uneventfully for 2 hours and 20 minutes. The patient recovered gradually in th4e reverse order four hours from that time.

• Korean Journal of Otorhinolaryngology-Head and Neck Surgery
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• v.60 no.6
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• pp.322-325
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• 2017

Otalgia consists of primary otalgia associated with disorders of the ear itself and referred otalgia due to disorders of organs that share the same innervation with the ear. Disorders of the oral cavity and laryngopharynx served by the glossopharyngeal and vagus nerves are common causes of referred otalgia. Chest pain from myocardial infarction spreads through the afferent pain pathway, especially through the sympathetic nerves in the cardiac plexus and the phrenic nerve, resulting in a typical chest pain or referred pain in the left upper extremity. However, pain spreading through the vagus nerve can theoretically cause referred otalgia. This association between the heart and ear has not been widely acknowledged, even though a referred otalgia can occasionally be the only symptom of the tragic disease, myocardial infarction, and should be taken seriously. We report a patient who complained of left otalgia as the only symptom of myocardial infarction.

• Anatomy and Cell Biology
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• v.56 no.3
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• pp.299-303
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• 2023

The laryngopharyngeal nerve has received much less attention that the other contributions to the pharyngeal plexus i.e., glossopharyngeal and vagus nerves. Often, in descriptions and depictions, the nerve is simply labeled as the sympathetic contribution to the pharyngeal plexus. As there is such scant information available regarding this nerve, the present review was performed. Very little is found in the extant medical literature regarding the laryngopharyngeal nerve. However, based on available data, the nerve is a consistent contributory to the pharyngeal plexus and serves other adjacent areas e.g., carotid body. Therefore, a better understanding of this structure's anatomy is important for those who operate in this area. Further studies are necessary to better elucidate the true function of the laryngopharyngeal nerve.

• The Korean Journal of Pain
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• v.10 no.2
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• pp.246-249
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• 1997

Hiccup is defined as an abrupt involuntary contraction of the diaphragm and intercostal muscles with sudden closure of the glottis 35 msec after onset. The term "intractable" is given to those hiccups with a duration ranging from 24 hours to more than 25 years. Short hiccup bouts are mostly associated with gastric distention or alcohol intake, resolved spontaneously or with simple remedies. In contrast, intractable hiccup is a rare but disabling condition which can induce depression, weight loss and sleep deprivation. Although the pathophysiologic mechanisms of hiccup are still poorly understood, wide variety of pathological conditions such as: brain tumor, abdominal tumor, myocardial infarction, renal failure, abdominal surgery etc., can cause intractable hiccup. A 58-year-old male who had suffered from hepatocellular cancer was consulted from medical department due to intractable hiccup. Initial treatment modalities with administrations of metoclopramide and chlorpromazine and nerve block including phrenic nerve block, cervical epidural block and glossopharyngeal nerve block were not effective. Administration of midazolam and baclofen however achieved desirable effect.

• Maxillofacial Plastic and Reconstructive Surgery
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• v.21 no.4
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• pp.395-400
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• 1999

Elongation of the styloid process (styloid syndrome, Eagle's Syndrome) is named after Eagle who insisted the styloid process as a cause of pain but distinguishable from the glossopharyngeal neuralgia. Eagle's syndrome is characterized by a dull nagging pharyngeal pain, a palpable hardness in the tonsillar fossa, radiopaque elongation and enlargement of the syloid process. This is to report two cases of Eagle's Syndrome. The clinical and radiological features, development and pathogenesis of the Eagle's Syndrome and pathologic findings of the calcified styloid ligaments were described with review of literatures. The external cervical approach to resect the enlarged calcified processes can be an option due to better visualization and accessbility, less infection at risk than intra-oral approach. The findings and results were as follows ; 1. The calcified styloid ligaments accompanied with throat pain were reseded in size of $5.5{\times}48mm(#1,\;Rt)$, $3.6{\times}5mm(#1,\;Lt)$, $5.2{\times}51mm(#2,\;Rt)$ and $3.1{\times}38mm(#2,\;Lt)$. 2. The submandibular approach to resect the calcified styloid process is of help to get better visibility and accessiblilty avoiding the injury to the deep cervial vital structures. 3. The resected styloid processes were examined histopathologically as the matured cortical bones with marrow structures or cartilagenous cells without any findings of neoplasmic changes. 4. The remained process did not show any noticeable regrowth in 3 years after surgical amputation.

• The korean journal of orthodontics
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• v.51 no.3
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• pp.166-178
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• 2021

Objective: To investigate dimensional changes in regional pharyngeal airway spaces after premolar extraction in bimaxillary skeletal protrusion (BSP) patients according to vertical skeletal pattern, and to further identify dentoskeletal risk factors to predict posttreatment pharyngeal changes. Methods: Fifty-five adults showing BSP treated with microimplant anchorage after four premolar extractions were included in this retrospective study. The subjects were divided into two groups according to the mandibular plane steepness: hyperdivergent (Frankfort horizontal plane to mandibular plane [FH-MP] ≥ 30) and nonhyperdivergent groups (FH-MP < 30). The control group consisted of 20 untreated adults with skeletal Class I normodivergent pattern and favorable profile. Treatment changes in cephalometric variables were evaluated and compared. The association between posttreatment changes in the dentoskeletal and upper airway variables were analyzed using linear regression analysis. Results: The BSP patients showed no significant decrease in the pharyngeal dimensions to the lower level in comparison with controls, except for middle airway space (MAS, p < 0.01). The upper airway variable representing greater decrease in the hyperdivergent group than in the nonhyperdivergent group was the MAS (p < 0.01). Posttreatment changes in FH-MP had negative correlation with changes in MAS (β = -0.42, p < 0.01) and inferior airway space (β = -0.52, p < 0.01) as a result of multivariable regression analysis adjusted for sagittal skeletal relationship. Conclusions: Decreased pharyngeal dimensions after treatment in BSP patients showed no significant difference from the normal range of pharyngeal dimensions. However, the glossopharyngeal airway space may be susceptible to treatment when vertical dimension increased in hyperdivergent BSP patients.

• Maxillofacial Plastic and Reconstructive Surgery
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• v.42
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• pp.27.1-27.9
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• 2020

Background: Mandibular setback surgery can change the position of the mandible which improves occlusion and facial profile. Surgical movement of the mandible affects the base of the tongue, hyoid bone, and associated tissues, resulting in changes in the pharyngeal airway space. The aim of this study was to analyze the 3-dimensional (3D) changes in the hyoid bone and tongue positions and oropharyngeal airway space after mandibular setback surgery. Methods: A total of 30 pairs of cone-beam computed tomography (CBCT) images taken before and 1 month after surgery were analyzed by measuring changes in the hyoid bone and tongue positions and oropharyngeal airway space. The CBCT images were reoriented using InVivo 5.3 software (Anatomage, San Jose, USA) and landmarks were assigned to establish coordinates in a three-dimensional plane. The mean age of the patients was 21.7 years and the mean amount of mandibular setback was 5.94 mm measured from the B-point. Results: The hyoid bone showed significant posterior and inferior displacement (P < 0.001, P < 0.001, respectively). Significant superior and posterior movements of the tongue were observed (P < 0.05, P < 0.05, respectively). Regarding the velopharyngeal and glossopharyngeal spaces, there were significant reductions in the volume and minimal cross-sectional area (P < 0.001). The anteroposterior and transverse widths of the minimal cross-sectional area were decreased (P < 0.001, P < 0.001, respectively). In addition, the amount of mandibular setback positively correlated with the amount of posterior and inferior movement of the hyoid bone (P < 0.05, P < 0.05, respectively). Conclusion: There were significant changes in the hyoid bone, tongue, and airway space after mandibular setback surgery.

• Journal of Oral Medicine and Pain
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• v.35 no.1
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• pp.41-47
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• 2010

Burning mouth syndrome(BMS) is a chronic oral pain and a symptom complex disorder usually unaccomplished by mucosal lesion or other clinical and laboratory signs of organic disease. BMS is characterized by a spontaneous burning sensation that mainly affects middle-aged and postmenopausal women. The etiology of BMS is poorly understood even though evidence for a possible neuropathic pathogenesis. BMS cause from various local or systemic factor, including nutritional deficiencies, hormonal change, local infection, dental procedure, dry mouth, medication and systemic disease including diabetes mellitus. Many studies suggest peripheral alteration in sensory of trigeminal nerve system. BMS patients with supertaster indicates pathologies of central and peripheral nerve system induced by an alteration in the taste system at the level of chorda tympani and glossopharyngeal nerve. The author discuss our current understanding of etiology and pathogenesis of BMS that refered chronic oral pain.

• Journal of Pharmacopuncture
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• v.7 no.2
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• pp.57-64
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• 2004

This study was carried to identify the component of Small Intestine Meridian Muscle in human, dividing the regional muscle group into outer, middle, and inner layer. the inner part of body surface were opened widely to demonstrate muscles, nerve, blood vessels and the others, displaying the inner structure of Small Intestine Meridian Muscle. We obtained the results as follows; 1. Small Intestine Meridian Muscle is composed of the muscle, nerve and blood vessels. 2. In human anatomy, it is present the difference between a term of nerve or blood vessels which control the muscle of Meridian Muscle and those which pass near by Meridian Muscle. 3. The inner composition of meridian muscle in human arm is as follows ; 1) Muscle ; Abd. digiti minimi muscle(SI-2, 3, 4), pisometacarpal lig.(SI-4), ext. retinaculum. ext. carpi ulnaris m. tendon.(SI-5, 6), ulnar collateral lig.(SI-5), ext. digiti minimi m. tendon(SI-6), ext. carpi ulnaris(SI-7), triceps brachii(SI-9), teres major(SI-9), deltoid(SI-10), infraspinatus(SI-10, 11), trapezius(Sl-12, 13, 14, 15), supraspinatus(SI-12, 13), lesser rhomboid(SI-14), erector spinae(SI-14, 15), levator scapular(SI-15), sternocleidomastoid(SI-16, 17), splenius capitis(SI-16), semispinalis capitis(SI-16), digasuicus(SI-17), zygomaticus major(Il-18), masseter(SI-18), auriculoris anterior(SI-19) 2) Nerve ; Dorsal branch of ulnar nerve(SI-1, 2, 3, 4, 5, 6), br. of mod. antebrachial cutaneous n.(SI-6, 7), br. of post. antebrachial cutaneous n.(SI-6,7), br. of radial n.(SI-7), ulnar n.(SI-8), br. of axillary n.(SI-9), radial n.(SI-9), subscapular n. br.(SI-9), cutaneous n. br. from C7, 8(SI-10, 14), suprascapular n.(SI-10, 11, 12, 13), intercostal n. br. from T2(SI-11), lat. supraclavicular n. br.(SI-12), intercostal n. br. from C8, T1(SI-12), accessory n. br.(SI-12, 13, 14, 15, 16, 17), intercostal n. br. from T1,2(SI-13), dorsal scapular n.(SI-14, 15), cutaneous n. br. from C6, C7(SI-15), transverse cervical n.(SI-16), lesser occipital n. & great auricular n. from cervical plexus(SI-16), cervical n. from C2,3(SI-16), fascial n. br.(SI-17), great auricular n. br.(SI-17), cervical n. br. from C2(SI-17), vagus n.(SI-17),hypoglossal n.(SI-17), glossopharyngeal n.(SI-17), sympathetic trunk(SI-17), zygomatic br. of fascial n.(SI-18), maxillary n. br.(SI-18), auriculotemporal n.(SI-19), temporal br. of fascial n.(SI-19) 3) Blood vessels ; Dorsal digital vein.(SI-1), dorsal br. of proper palmar digital artery(SI-1), br. of dorsal metacarpal a. & v.(SI-2, 3, 4), dorsal carpal br. of ulnar a.(SI-4, 5), post. interosseous a. br.(SI-6,7), post. ulnar recurrent a.(SI-8), circuirflex scapular a.(SI-9, 11) , post. circumflex humeral a. br.(SI-10), suprascapular a.(SI-10, 11, 12, 13), first intercostal a. br.(SI-12, 14), transverse cervical a. br.(SI-12,13,14,15), second intercostal a. br.(SI-13), dorsal scapular a. br.(SI-13, 14, 15), ext. jugular v.(SI-16, 17), occipital a. br.(SI-16), Ext. jugular v. br.(SI-17), post. auricular a.(SI-17), int. jugular v.(SI-17), int. carotid a.(SI-17), transverse fascial a. & v.(SI-18),maxillary a. br.(SI-18), superficial temporal a. & v.(SI-19).

• Journal of Oral Medicine and Pain
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• v.32 no.2
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• pp.177-185
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• 2007

Iatrogenic injury following dental treatments and the use of local anesthetics may cause taste disorders. The aims of this study were to investigate quantitative and qualitative changes of taste due to unilateral inferior alveolar nerve block anesthesia and further to evaluate potential effects on taste function related to anesthesia or hypoesthesia of inferior alveolar nerve, possibly occurring after dental procedure. 30 healthy volunteers in their twenties participated in this study (male to female = 1:1, mean age of $24.0{\pm}1.8$ years). Each subject received inferior alveolar nerve block anesthesia on his or her right side with 2% lidocaine HCl containing 1:100,000 epinephrine. Before and after anesthesia, electrogustometric test and chemical localized test for salty, sweet, sour and bitter tastes were performed on the eight sites in the oral cavity; right and left anterior and lateral tongue and circumvallate papilla of the tongue and soft palate. Unilateral inferior alveolar nerve anesthesia produced elevation of electrical taste threshold and reduction of intensity ratings for all 4 tastes (salty, sweet, sour and bitter) over anterior and lateral tongue and circumvallate papilla on the ipsilateral side (p<0.05). Contralateral sides exhibited decreased intensity ratings for salty and sweet taste (p<0.05) on anterior and lateral tongue while there was no significant difference in electrogustometric testing. Based on the results of this study, it is assumed that unilateral local anesthesia on inferior alveolar nerve can affect chorda tympani and glossopharyngeal nerves on the same side, leading to taste deficits. Taste intensity on the contralateral side may, in part, be deteriorated as well.