• Title, Summary, Keyword: Orocutaneous Fistula

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Multiple foreign bodies causing an orocutaneous fistula of the cheek

  • Kim, Woo Ju;Kim, Woo Seob;Kim, Han Koo;Bae, Tae Hui
    • Archives of Craniofacial Surgery
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    • v.19 no.2
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    • pp.139-142
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    • 2018
  • Foreign bodies impacted in the maxillofacial region are often a diagnostic challenge. They can be a source of chronic inflammatory reactions and infections leading to the formation of an orocutaneous fistula. Such orocutaneous fistulas cause significant morbidity in most patients, eventually requiring surgery. Recently, we encountered a very rare case of an orocutaneous fistula caused by multiple foreign bodies in the cheek. Precise removal of the foreign bodies was required, and a double-sided anterolateral thigh free flap was used to reconstruct the defect. Surgeons should be aware of the complications of multiple foreign bodies and should be able to diagnose these on careful clinical examination.

Awake intubation in a patient with huge orocutaneous fistula: a case report

  • Kim, Hye-Jin;Kim, So-Hyun;Kim, Tae-Heung;Yoon, Ji-Young;Kim, Cheul-Hong;Kim, Eun-Jung
    • Journal of Dental Anesthesia and Pain Medicine
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    • v.17 no.4
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    • pp.313-316
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    • 2017
  • Mask ventilation, the first step in airway management, is a rescue technique when endotracheal intubation fails. Therefore, ordinary airway management for the induction of general anesthesia cannot be conducted in the situation of difficult mask ventilation (DMV). Here, we report a case of awake intubation in a patient with a huge orocutaneous fistula. A 58-year-old woman was scheduled to undergo a wide excision, reconstruction with a reconstruction plate, and supraomohyoid neck dissection on the left side and an anterolateral thigh flap due to a huge orocutaneous fistula that occurred after a previous mandibulectomy and flap surgery. During induction, DMV was predicted, and we planned an awake intubation. The patient was sedated with dexmedetomidine and remifentanil. She was intubated with a nasotracheal tube using a video laryngoscope, and spontaneous ventilation was maintained. This case demonstrates that awake intubation using a video laryngoscope can be as good as a fiberoptic scope.

CARE OF TRISMUS AND OROCUTANEOUS FISTULA BY ODONTOGENIC INFECTION IN A DISABLED PATIENT (장애환자에서 치성감염에 의한 아관긴급과 구강피부누공의 관리)

  • Oh, Ji-Hyeon;Son, Jeong-Seog;Yoo, Jae-Ha;Kim, Jong-Bae
    • The Journal of Korea Assosiation for Disability and Oral Health
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    • v.9 no.2
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    • pp.111-117
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    • 2013
  • Some odontogenic infections erode into fascial spaces directly and spread toward lymphatic tissues and blood streams. The principal maxillary primary spaces are the canine, buccal, and infratemporal space, the next secondary spaces are the masseteric, temporal and pharygeal space. As a result of the infection, trismus and orocutaneous fistula may be occurred. Trismus is owing to conditions not associated with temporomandibular joint itself and may be of myogenic, neurogenic, or psychogenic nature. Muscular trismus is due to infection adjacent to the elevator muscles of the jaw. The four principles of treatment of infection are as follows: (1) removal of the cause, (2) establishment of drainage, (3) institution of antibiotic therapy, and (4) provision of supportive care, including rest, nutrition and physiotherapy. Jaw physiotherapy is necessary to increase the amount of mouth opening and regain normal muscle tone. If proper care of odontogenic infection could be attained, the orocutaneous fistula will heal and close spontaneously by wound contraction mechanism of natural homeostatic response. This is a case report of the care of trismus and orocutaneous fistula due to fascial space abscess by advanced odontogenic infection in a physically disabled patient.

Postoperative orocutaneous fistula closure using a vacuum-assisted closure system: a case report (구강암 수술 후 발생한 구강 경부 누공(orocutaneous fistula) 치료 시 진공 음압 폐쇄(vacuum-assisted closure) 시스템을 이용한 상처 치료)

  • Lee, Seung-June;Kwon, Jin-Il;Lim, Kyung-Min;Kim, Hyung-Jun;Cha, In-Ho;Nam, Woong
    • Journal of the Korean Association of Oral and Maxillofacial Surgeons
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    • v.36 no.5
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    • pp.413-416
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    • 2010
  • Fleischmann et al. first described the concept of using sub-atmospheric pressure to treat open or infected wounds in 1993. Since then, Argenta and Morykwas developed subatmospheric, or negative pressure dressings in 1997 as a means of managing complicated wounds. Since its introduction in 1997, the vacuum-assisted closure (VAC) system has been used widely in general plastic surgery, general surgery, and orthopedic surgery to manage complicated wounds of the torso and extremities. However, there is a paucity of literature describing its use in the head and neck region, particularly in oral and maxillofacial surgery. We report a successful case of postoperative orocutaneous fistula closure using a VAC system in a 59-year male with a review of the relevant literature.

Orocutaneous fistulas of odontogenic origin presenting as a recurrent pyogenic granuloma

  • Lee, Jin Hoon;Oh, Jae Wook;Yoon, Sung Ho
    • Archives of Craniofacial Surgery
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    • v.20 no.1
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    • pp.51-54
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    • 2019
  • Orocutaneous fistulas, or cutaneous sinuses of odontogenic origin, are uncommon but often misdiagnosed as skin lesions unrelated to dental origin by physicians. Accurate diagnosis and use of correct investigative modalities are important because orocutaneous fistulas are easily confused for skin or bone tumors, osteomyelitis, infected cysts, salivary gland fistulas, and other pathologies. The aim of this study is to present our experience with a patient with orocutaneous fistulas of odontogenic origin presenting as recurrent pyogenic granuloma of the cheek, and to discuss their successful treatment.

Intermaxillary Fixation under Oral Intubation in a Patient with Le Fort I Fracture: a Case Report (상악골 Le Fort I 골절 환자에서 경구 기관 내 삽관 하에서의 악간고정 및 정복: 증례보고)

  • Choi, Eun-Joo;Lee, Seok-Ryun
    • Journal of The Korean Dental Society of Anesthesiology
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    • v.14 no.4
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    • pp.233-236
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    • 2014
  • In order to reduce jaw fracture accompanied by basal skull or nasal fracture, submental intubation could be generally performed. Albeit submental intubation has been widely accepted, it could develop complications such as nerve injury, glandular duct injury, and orocutaneous fistula. Here, we suggest oral intubation for overcoming complications and providing more stable surgical environment in emergency case. Under oral intubation maintaining in retromolar triangle and buccal corridor space, intermaxillary fixation was successfully underwent in 38-years-old female patient with Le Fort I fracture accompanied by pneumocephalus.

Fibular flap for mandible reconstruction in osteoradionecrosis of the jaw: selection criteria of fibula flap

  • Kim, Ji-Wan;Hwang, Jong-Hyun;Ahn, Kang-Min
    • Maxillofacial Plastic and Reconstructive Surgery
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    • v.38
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    • pp.46.1-46.7
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    • 2016
  • Background: Osteoradionecrosis is the most dreadful complication after head and neck irradiation. Orocutaneous fistula makes patients difficult to eat food. Fibular free flap is the choice of the flap for mandibular reconstruction. Osteocutaneous flap can reconstruct both hard and soft tissues simultaneously. This study was to investigate the success rate and results of the free fibular flap for osteoradionecrosis of the mandible and which side of the flap should be harvested for better reconstruction. Methods: A total of eight consecutive patients who underwent fibula reconstruction due to jaw necrosis from March 2008 to December 2015 were included in this study. Patients were classified according to stages, primary sites, radiation dose, survival, and quality of life. Results: Five male and three female patients underwent operation. The mean age of the patients was 60.1 years old. Two male patients died of recurred disease of oral squamous cell carcinoma. The mean dose of radiation was 70.5 Gy. All fibular free flaps were survived. Five patients could eat normal diet after operation; however, three patients could eat only soft diet due to loss of teeth. Five patients reported no change of speech after operation, two reported worse speech ability, and one patient reported improved speech after operation. The ipsilateral side of the fibular flap was used when intraoral soft tissue defect with proximal side of the vascular pedicle is required. The contralateral side of the fibular flap was used when extraoral skin defect with proximal side of the vascular pedicle is required. Conclusions: Osteonecrosis of the jaw is hard to treat because of poor healing process and lack of vascularity. Free fibular flap is the choice of the surgery for jaw bone reconstruction and soft tissue fistula repair. The design and selection of the right or left fibular is dependent on the available vascular pedicle and soft tissue defect sites.

Endotracheal Intubation Using Submandibular Approach for Maxillofacial Trauma Patients: Report of 2 Cases

  • Youn, Gap-Hee;Ryu, Sun-Youl;Oh, Hee-Kyun;Park, Hong-Ju;Jung, Seunggon;Jeong, Seongtae;Kook, Min-Suk
    • Journal of The Korean Dental Society of Anesthesiology
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    • v.14 no.4
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    • pp.227-232
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    • 2014
  • The indication for submandibular intubation is the requirement for intraoperative maxillomandibular fixation (MMF) in the presence of injuries that preclude nasotracheal intubation. Thus, We reported 2 cased of endotracheal intubations via submandibular approach that is applicable in patients with skull base fractures for a reliable general anesthesia. Endotracheal intubation via submandibular approach was applied during general anesthetic procedures for open reduction in three patients with Le Fort II, III or nasoorbitoethmoid (NOE) fractures. No complications due to submandibular intubation, such as infection, postoperative scarring, nerve injury, hematoma, bleeding, or orocutaneous fistula, were observed following submandibular intubation. Endotracheal intubation via submandibular approach is effective in patients with skull base fractures. In our method, the tube connector is removed in orotracheal intubation in order to avoiding the tube removal or displacement. The advantages of this method are very simple, safe, and to provide the good operation field.

Submental intubation: alternative short-term airway management in maxillofacial trauma

  • Kumar, Ravi Raja;Vyloppilli, Suresh;Sayd, Shermil;Thangavelu, Annamala;Joseph, Benny;Ahsan, Auswaf
    • Journal of the Korean Association of Oral and Maxillofacial Surgeons
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    • v.42 no.3
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    • pp.151-156
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    • 2016
  • Objectives: To assess submental route intubation as an alternative technique to a tracheostomy in the management of the airway in cranio-maxillofacial trauma, along with an assessment of its morbidity and complications. Materials and Methods: Submental intubation was performed in 17 patients who had maxillofacial panfacial trauma and management was done under general anesthesia during a period of one year from 2013 to 2014 at Departments of Oral and Maxillofacial Surgery and Dentistry, the Malankara Orthodox Syrian Church Medical College, Kochi, India. Results: In all 17 cases, the technique of submental intubation was found to be simple and reliable. Hypertrophic scars were noted in three cases, orocutaneous fistula and mucocele in one case each. All these complications were managed comfortably without significant morbidity to the patient. Conclusion: Submental intubation is a good technique that can be used regularly in the management of the airway in cranio-maxillofacial trauma, but with some manageable complications.

Osteoradionecrosis of Jaw in Head and Neck Cancer Patient Treated with Free Iliac Bone and Umbilical Fat Pad Graft

  • Choi, Yuri;Kim, Su-Gwan;Moon, Seong-Yong;Oh, Ji-Su;You, Jae-Seek;Jeong, Kyung-In;Lee, Sung-Seok
    • Maxillofacial Plastic and Reconstructive Surgery
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    • v.36 no.2
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    • pp.62-66
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    • 2014
  • Osteoradionecrosis is one of the most serious complications of patients receiving radiation therapy. It is characterized by hypovascularity, hypocellularity, and hypoxia-inducing necrosis of bone and soft tissue following delayed healing. In this case, a 72-year-old man was referred to the Department of Oral and Maxillofacial Surgery complaining of trismus following extraction three months before first visit. He had a history of right tonsillectomy, radical neck dissection and radiotherapy performed due to right tonsillar cancer seven years prior. After the diagnosis of osteoradionecrosis on right mandibular body and angle, conservative antibiotic therapy was used first, but an orocutaneous fistula gradually formed, and extensive bony destruction and sequestrum were observed. Sequestrectomy, free particulated iliac bone and umbilical fat pad graft were performed via a submandibular approach under general anesthesia. Preoperative regular exams and delicate wound care led to secondary healing of the wound without vascularized free flap reconstruction.