• Journal of Korean Dental Science
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• v.10 no.2
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• pp.82-86
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• 2017

Oral and maxillofacial surgery (OMFS) trauma cases are commonly treated under general anesthesia. The purpose of this case report is to introduce an alternative method of anesthesia in patients who refuse general anesthesia. A combination of dexmedetomidine and ketamine for sedation anesthesia in 3 frequent fracture types in the field of OMFS-Le Fort I fracture, mandibular fracture, and alveolar bone fracture-was used. Dexmedetomidine as the single agent has not shown stable success rates for invasive procedures. To overcome some of the pitfalls with dexmedetomidine, combination sedation using ketamine was performed. Visual analogue scale scores were recorded postoperatively. Dexmedetomidine combined with ketamine administration provided safe and effective sedation and anxiolysis for surgical reduction and internal fixation of OMFS fractures. It showed advantages of decreased admission time, reduced expenses, minimal pain, and reduced anesthetic burden for the patient thus ultimately increasing overall satisfaction.

• Journal of Korean Foot and Ankle Society
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• v.16 no.1
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• pp.19-25
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• 2012

The ankle impingement syndrome is an established cause of ankle dysfunction. In most cases with suspected ankle impingement, the diagnosis can be possible on the basis of mechanism of injury involved and the clinical examination. An appropriate imaging study should be selected where clinical doubt about the exact diagnosis exists. Radiography plays an important role in the initial assessment of these conditions, especially in anterior and posterior impingement. Magnetic resonance arthrography seems to be the most accurate means of assessing the capsular abnormalities present in anterolateral and anteromedial impingement and for confirmation of possible concomitant injury. Surgical treatment can be considered for the patients who did not respond to conservative treatment for more than 6 months, and has a low complication rate and a high level of success.

• Journal of Chest Surgery
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• v.53 no.4
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• pp.205-210
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• 2020

Esophageal anastomotic leak is the most common and serious complication following esophagectomy. However, the standard treatment for anastomotic leaks remains unclear. Recently, endoscopic vacuum therapy has become an important non-surgical alternative treatment method for patients with esophageal anastomotic leak. This treatment involves the endoscopic placement of a sponge connected to a nasogastric tube into the defect cavity or lumen. Subsequently, continuous negative pressure is delivered to the cavity through the tube. Several studies have reported a treatment success rate of 80% to 100%. In this study, we review the mechanism of action, the method of performing the procedure, its safety and efficacy, and prognostic factors for failure of endoscopic vacuum therapy in the management of patients with anastomotic leak, and on this basis attempted to confirm the possibility of establishing a standardized treatment protocol using endoscopic vacuum therapy.

• Journal of Chest Surgery
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• v.54 no.4
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• pp.325-329
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• 2021

Chylothorax is caused by lymphatic leakage, which can develop after thoracic surgery and is associated with cancer. Although prospective randomized trials have not been performed, radiological interventions have been performed in several cases with persistent chylothorax, adjunct to 2 weeks of conservative management. The success rate of such interventions is diverse due to anatomical variations, although the results are promising. However, in cases of treatment failure after cycles of interventions, a team approach may be necessary to determine whether surgical management is warranted.

• The korean journal of orthodontics
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• v.32 no.4 s.93
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• pp.235-240
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• 2002

Surgical-orthodontic treatment is an increasingly more common dental procedure whose unique psycho-social or psychological feature has not been fairly quantified objectively. Since the treatment of a surgical-orthodontic (or orthodontic) patient is part science and part art, a subjective recognition of a patient about his or her own treatment may be more important than technical success during and after treatment. Therefore, the knowledge of the patient's underlying psychological status could be useful in the prediction of patient's response to surgical-orthodontic (or orthodontic) treatment. The purpose of this study was to investigate and evaluate the psychological difference between conventional orthodontic patient and surgical-orthodontic patient by using locus of control (LOC) examination. Locus of control scale has been proven to be extremely useful in the prediction of a variety of human behaviors. Two types of locus of control data (I-score, Internal locus of control score : I-score, External locus of control score) were obtained for 42 surgical-orthodontic patients and randomly selected 42 conventional orthodontic patients (as a control group) matched for age and gender. No statistically significant difference was observed in the scale of internal and external locus of control between the groups of surgical-orthodontic patients and conventional orthodontic patients. However, in the group of surgical-orthodontic patients, males showed lower E-score (external locus of control score, higher internal locus of control tendency) than females. The results of this study suggested that the psychological background of surgical-orthodontic patients, in contrast with that of cosmetic surgery patients, has a similar disposition with that of orthodontic patients.

• Maxillofacial Plastic and Reconstructive Surgery
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• v.32 no.2
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• pp.154-161
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• 2010

Many edentulous posterior maxilla are found to be compromised by alveolar resorption and increased pneumatization of the sinus. One of the surgical procedures to overcome this anatomical limitation is sinus floor elevation with bone graft, which is reported as more appropriate and more successful procedure. Commonly, if the residual bone height is over 5mm, sinus floor elevation is operated through transcrestal approach using osteotome technique. But, it is possible for patients to feel discomfort during operation and dizziness after operation while malleting, sinus floor elevation, using osteotome technique. Some instruments and methods has been used to overcome these problems and use more easily. The aim of this study is to compare between the surgical procedure of sinus floor elevation using Hatch reamer technique and that of sinus floor elevation using osteotome technique. From 2004 Feb to 2007 Oct, we investigate patients (osteotome group: 72, Hatch reamer group: 70) who were given implant surgery with sinus floor elevation (osteotome group: 92, Hatch reamer group: 98). We analysed gender, age, residual bone height, amount of sinus floor elevation, used graft material, total success rate, failure rate by residual bone height and implant type and discomfort during operation, etc. The results obtained were as follows. 1. In the amount of sinus elevation was osteotome group was $3.85{\pm}1.02\;mm$ and Hatch reamer group was $3.93{\pm}1.38\;mm$. There was no statistically significant difference between the two groups (P > 0.05). 2. At the total success rate, osteotome group was 92.4% and Hatch reamer group was 94.9%. There was no statistically significant difference between the two groups (P > 0.05). 3. On the discomfort during the operation by using numerical rating scale, osteotome group was $2.87{\pm}0.83$ and Hatch reamer group was $1.12{\pm}0.64$. There was statistically significant difference between the two groups (P < 0.05). The Hatch reamer group clinical results was similar to osteotome group and we thought that Hatch reamer technique can overcome the faults of osteotome technique.

• Journal of the Korean Association of Oral and Maxillofacial Surgeons
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• v.33 no.4
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• pp.340-349
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• 2007

Free flap transplantation with microvascular anastomosis has been successfully performed by development of surgical technique, materials and postoperative monitoring equipments of flap. But success rate of microvascular anastomosis is influenced by various factors, and failure rate is about 5-10%. The most influential factor for success rate is surgical technique and other factors that influence failure of microvascular anastomosis are ischemic time of free flap, thrombus formation of anastomosis region and vascular spasm. In this study, vascular patency and thrombus formation in experimental micro-venous anastomosis, and endothelial repair were observed with histologic analysis, scanning electron microscopy, transmission electron microscopic examination. The results were obtained as follows: 1. In vascular patency test in 30 minute and 7 days after micro-venous anastomosis with heparin irrigation, all of 12 anastomosis site were good vascular patency. 2. In thrombus formation in 2 weeks group(Experimental I), 2 site of 6 cases were observed thrombus, and in 4 weeks group(Experimental II), 1 site of 6 cases were observed thrombus. 3. In histologic examination, normal vein(Control Group) showed continued internal elastic lamina, well formed thick smooth muscle layer and connective tissue. The group of 2 weeks after microvenous anastomosis(Experimental I) showd locally recovered internal lamina, discontinued internal lamina, disorganized smooth muscle cells and granulation tissue around suture silk. In the group of 4 weeks after micro-venous anastomosis(Experimental II), anastomosis site showed almostly continued internal lamina, disorganized smooth muscle cells and cicartrized tissue around suture silk. 4. In scanning electron microscope examination in 2 weeks(Experimental I) after micro-venous anastomosis, mesh fibrin formation showed near to endothelial cells, and in 4 weeks after micro-venous anastomosis(EXperimental II), numerous blood cells and fibrin mesh formation was seen associated with irregular endothelial cell arrangement. 5. In transmission electron microscope examination in 2 weeks after micro-venous anastomosis(Experimental I), irregular arrangement of smooth muscle cells was seen adjacent to collagenized tissue around suture silk. In 4 weeks after micro-venous anastomosis(Experimental II), denuded venous wall composed of relatively well arranged smooth muscle cells was covered by endothelial cells, but fibroblast cells and foreign body giant cells near to suture silk was remained. From the results obtained in this study, results of good vascular patiency and anti-thrombotic effect of heparin were obtained as a local irrigation solution, and repair of venous endothelial cell was observed in 2 weeks after micro-venous anastomosis.

• Journal of the Korean Association of Oral and Maxillofacial Surgeons
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• v.32 no.2
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• pp.117-128
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• 2006

Free flap transplantation with microvascular anastomosis has been successfully performed by development of surgical technique, materials and postoperative monitoring equipments of flap. But success rate of microvascular anastomosis is influenced by various factors, and failure rate is about 5-10%. The most influential factor for success rate is surgical technique and other factors that influence failure of microvascular anastomosis are ischemic time of free flap, thrombus formation of anastomosis region and vascular spasm. Many studies has been published in microvascular anastomosis with histologic effect for irrigating solution. But local irrigation solution has been used clinically in microvascular anastomosis, the comparison with each solution, microhistological study for endothelial cell repair and vascular patency has not been reported. The heparin which is anti-thrombotic agent, and urokinase which is fibrinolytic agent are used for this study. Vascular patency and thrombus formation in experimental micro-arterial anastomosis, and endothelial repair were observed with histologic analysis, scanning electron microscopy, transmission electron microscopic examination. The results were obtained as follows: 1. In vascular patency test in 30 minute and 7 days after micro-arterial anastomosis, equal effects of good vascular patency were obtained in group of local irrigation with heparin and urokinase. 2. In thrombus formation in 7 days after micro-arterial anastomosis, equal effects of minimal thrombus formation were obtained in group of local irrigation with heparin and urokinase. 3. In toluidin blue staining in 7 days after micro-arterial anastomosis, local destruction of endothelial cell and inner elastic lamina were seen and endothelial repair was not seen. 4. In scanning electron microscope examination in 7 days after micro-arterial anastomosis, endothelial cell was not seen in peripheral to suture materials, thrombus associated fibrin network was observed. 5. In transmission electron microscope examination in 7 days after micro-arterial anastomosis, inflammatory cell was seen within smooth muscle cells in site of endothelial cell destruction, smooth muscle cell around suture material were arranged irregularly, some collagenous change were seen. From the results obtained in this study, same results of good vascular patency and anti-thrombotic effect of heparin and urokinase were obtained as a local irrigation solution, and repair of endothelial cell was not seen in 7 days after micro-arterial anastomosis.

• Journal of Korean Foot and Ankle Society
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• v.23 no.2
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• pp.58-66
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• 2019

Purpose: To evaluate the efficacy of antibiotic-loaded cement spacers (ALCSs) for the treatment of diabetic foot infections with osteomyelitis as a salvage procedure and to analyze the risk factors of treatment failure. Materials and Methods: This study reviewed retrospectively 39 cases of diabetic foot infections with osteomyelitis who underwent surgical treatment from 2009 to 2017. The mean age and follow-up period were $62{\pm}13years$ and $19.2{\pm}23.3months$, respectively. Wounds were graded using the Wagner and Strauss classification. X-ray, magnetic resonance imaging (or bone scan) and deep tissue cultures were taken preoperatively to diagnose osteomyelitis. The ankle-brachial index, toe-brachial index (TBI), and current perception threshold were checked. Lower extremity angiography was performed and if necessary, percutaneous transluminal angioplasty was conducted preoperatively. As a surgical treatment, meticulous debridement, bone curettage, and ALCS placement were employed in all cases. Between six and eight weeks after surgery, ALCS removal and autogenous iliac bone graft were performed. The treatment was considered successful if the wounds had healed completely within three months without signs of infection and no additional amputation within six months. Results: The treatment success rate was 82.1% (n=32); 12.8% (n=5) required additional amputation and 5.1% (n=2) showed delayed wound healing. Bacterial growth was confirmed in 82.1% (n=32) with methicillin-resistant Staphylococcus aureus being the most commonly identified strain (23.1%, n=9). The lesions were divided anatomically into four groups; the largest number was the toes: (1) toes (41.0%, n=16), (2) metatarsals (35.9%, n=14), (3) midfoot (5.1%, n=2), and (4) hindfoot (17.9%, n=7). A significant difference in the Strauss wound score and TBI was observed between the treatment success group and failure group. Conclusion: The insertion of ALCSs can be a useful treatment option in diabetic foot infections with osteomyelitis. Low scores in the Strauss classification and low TBI are risk factors of treatment failure.

• Journal of the korean academy of Pediatric Dentistry
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• v.35 no.3
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• pp.516-522
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• 2008

In the case of the impacted teeth, the clinician has to consider development of tooth, site of impaction, eruption path, and cooperation of patient. If there are genetic or general factors to effect the eruption of tooth, the clinician treats these first and then takes the early treatment for eruption guidance. If there are physical factors to intercept eruption, the clinician put them off first. However, if there are no factors to effect eruption of tooth and enough space for eruption, the clinician can consider extraction of deciduous teeth, forced eruption and surgical reposition. In case of surgical repositioning, proper time for root development, proper socket formation, and minimal trauma are important for success. This case presents displaced impacted maxillary central incisor with dilacerated root. The development of root is Nolla's stage 7, and the tooth was treated by surgical repositioning. We can observe no root resorption and good healing pattern.