• Journal of Korean Dental Science
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• v.7 no.2
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• pp.94-98
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• 2014

Numerous oral and maxillofacial surgeons have found facial space infections after tooth extraction. Most of these infections can be managed easily, but some of them could be life-threatening. Among the facial infections, temporal space infections are rare. Most temporal space infections could be observed as secondary to maxillary third molar infections, maxillary sinusitis, and maxillary sinus fractures. Note, however, that there are insufficient studies on temporal space abscess due to mandibular second molars, especially with acupuncture. A 74-year-old female came to our hospital with severe trismus and facial swelling on the right temporal, buccal, posterior auricular, and cervical regions. The patient had undergone extraction of tooth #47 secondary to dental caries by a general dentist about a month ago. After the dental procedure, the patient had been treated with acupuncture therapy around the right temporomandibular joint area at the oriental medicine clinic. We performed emergency incision and drainage under general anesthesia and started antibiotic treatment with IV ampicillin/sulbactam 3 g every 24 hours and vancomycin 1 g every 24 hours for 5 days. The patient's symptoms subsided and ultimately disappeared. Temporal space abscess after mandibular molar extraction is quite rare. In this case, the spreading mechanism against gravity is considered to be acupuncture therapy.

• Journal of The Korean Dental Society of Anesthesiology
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• v.11 no.1
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• pp.16-21
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• 2011

Background: Since introduced by Gow-Gates GA in 1973, Gow-Gates mandibular nerve block (GMNB) has played an important role in the area of dental local anesthesia. However, compared to the conventional inferior alveolar nerve block (IANB), this technique seems to fail to attract the attentions of general practitioners in South Korea. The aim of this study was to prove the clinical real value, mainly the anesthetic efficacy, of GMNB in minor oral surgery. Methods: The study group comprised 40 patients (15 males and 25 females) who were randomly allocated to receive GMNB or IANB for extraction of third molars. Both techniques utilized two 1.8 ml dental cartridges of 2% lidocaine including 1:100,000 epinephrine for each patient. Pulpal and gingival tissue anesthesia of mandibular premolars and molars were recorded at 0, 15 and 40 minutes after administration of local anesthetics using both an electric pulp tester and a sharp dental explorer. Results: The success rates of pulpal and gingival tissue anesthesia in the IANB group were not significantly different from the GMNB group in overall efficacy. Patient's and operator's satisfaction ratings were also not significantly different between two groups. Interestingly, the injection pain of GMNB group was significantly lower than that of IANB group. Conclusion: This study demonstrated that the anesthetic efficacy of pulpal and gingival tissue of GMNB was not inferior to that of IANB. The GMNB could be a good alternative of the IANB in most of minor oral surgical procedures.

• Maxillofacial Plastic and Reconstructive Surgery
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• v.30 no.3
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• pp.296-301
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• 2008

Actinomyces is a part of the normal oral flora, but under certain circumstances it may become pathogenic. Actinomycosis is a chronic granulomatous infective disease caused by microaerophilic Gram-positive bacteria of the genus actinomyces. It can involve almost any system, but principally affects the head and neck. Because the lesions in the submandibular region and the angle of the jaw give the face a swollen, indurated appearance, actinomycosis of mandible can be easily misdiagnosed in its acute or early state of infection. In these cases the disease usually presented as a swelling suggestive of an abscess or mimicking a neoplasm. The yield from standard cultures was poor and repeated sampling and anaerobic culture may be needed to obtain a positive culture. So actinomycosis should always be considered in a differential diagnosis of all infections of the cervicofacial area. Diagnosis of actinomycosis is made based on the histopathology, the clinical presentation and past dental history. We experienced a case of actinomycosis in the masseter muscle and present the case with review of literature.

• Journal of Dental Anesthesia and Pain Medicine
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• v.23 no.3
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• pp.163-171
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• 2023

Background: Surgical extraction of impacted mandibular third molars is the most common procedure performed by oral surgeons. The procedure cannot be performed effectively without achieving profound anesthesia. During this procedure, patients may feel pain during surgical bone removal (at the cancellous level) or during splitting and luxation of the tooth, despite administration of routine nerve blocks. Administration of intraosseous (IO) lignocaine injections during third molar surgeries to provide effective anesthesia for pain alleviation has been documented. However, whether the anesthetic effect of lignocaine is the only reason for pain alleviation when administered intraosseously remains unclear. This conundrum motivated us to assess the efficacy of IO normal saline versus lignocaine injections during surgical removal of impacted mandibular third molars. The aim of this study was to assess the efficacy of IO normal saline as a viable alternative or adjunct to lignocaine for alleviation of intraoperative pain during surgical removal of impacted mandibular third molars. Methods: This randomized, double-blind, interventional study included 160 patients who underwent surgical extraction of impacted mandibular third molars and experienced pain during surgical removal of the buccal bone or sectioning and luxation of the tooth. The participants were divided into two groups: the study group, which included patients who would receive IO saline injections, and the control group, which included patients who would receive IO lignocaine injections. Patients were asked to complete a visual analog pain scale (VAPS) at baseline and after receiving the IO injections. Results: Of the 160 patients included in this study, 80 received IO lignocaine (control group), whereas 80 received IO saline (study group) following randomization. The baseline VAPS score of the patients and controls was 5.71 ± 1.33 and 5.68 ± 1.21, respectively. The difference between the baseline VAPS scores of the two groups was not statistically significant (P > 0.05). The difference between the numbers of patients who experienced pain relief following administration of IO lignocaine (n=74) versus saline (n=69) was not statistically significant (P > 0.05). The difference between VAPS scores measured after IO injection in both groups was not statistically significant (P >0.05) (1.05 ± 1.20 for the control group vs. 1.72 ± 1.56 for the study group) Conclusion: The study demonstrates that IO injection of normal saline is as effective as lignocaine in alleviating pain during surgical removal of impacted mandibular third molars and can be used as an effective adjunct to conventional lignocaine injection.

• Journal of the Korean Association of Oral and Maxillofacial Surgeons
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• v.33 no.1
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• pp.40-45
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• 2007

Objective. The objective of this international comparative study was to investigate the clinical features and outcome of the treatment of infratemporal fossa abscess (IFA). Study design. This retrospective study was conducted at the Deptartment of Oral and Maxillofacial Surgery of Hallym University and "Iuliu Hatieganu" University of Medicine and Pharmacy. Ten-year records of patients were reviewed in Romania and six-year records were reviewed in Korea. The collected data was then analyzed. Results. A total of 36 cases were found to be IFA (12 males and 24 females: average age; $36.3{\pm}15.5$ yrs: 34 cases from Romania and 2 cases from Korea). The annual frequency of IFA in Romanian and Korean hospitals was 3.40 and 0.33 respectively (P<0.001). The etiology was septic anesthesia (33.3%), infection occurring after extraction (30.6%), periapical lesion (13.9%), impacted third molar (8.3%), post-extraction alveolitis (5.6%), and unknown (8.3%). A successful outcome was seen in 27 patients (75.0%) after initial treatment. The main complication after initial treatment was restricted movement of the mouth (9 cases). Conclusion. The etiology of IFA was various and minimal swelling hampered early diagnosis. To prevent IFA, preoperative painting with antiseptic agent must be stressed and proper drainage proved important to relieve pain and to prevent further complications.

• Journal of the Korean Association of Oral and Maxillofacial Surgeons
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• v.46 no.4
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• pp.266-274
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• 2020

Objectives: Melatonin induces human stem cells, converts pre-osteoblasts to mature osteoblasts, and reduces the duration of this transition. However, melatonin itself prevents activation of osteoclasts. Here, we evaluate the role of melatonin in prevention of bisphosphonate-related osteonecrosis of the jaw. Materials and Methods: In this experimental-interventional study, 30 rats were evaluated in 3 groups. The first and second groups received saline and zoledronic acid, respectively, for 4 weeks and the third group received 4 weeks of zoledronic acid and 3 weeks of melatonin simultaneously. First-right-maxillary-molar extraction was performed for all animals, which were sacrificed after 4 weeks of recovery. The extraction sockets were examined histologically for the presence of osteonecrosis, number of osteoclasts and fibroblasts, severity of inflammation, and vascularization. Data were analyzed by chi-square, one-way ANOVA, Tukey, Kruskal-Wallis and Fisher's exact statistical tests (α=0.05). Results: Osteonecrosis was observed in 20%, 90%, and 70% of the first, second and third groups, respectively (P=0.008). The lowest number of osteoclasts and fibroblasts was seen in the third group. Conclusion: Melatonin may effectively prevent some undesirable side effects of bisphosphonates. However, further studies are required to confirm the results of this study.

• Journal of Dental Anesthesia and Pain Medicine
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• v.22 no.2
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• pp.145-153
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• 2022

Background: Postoperative analgesia (POA) is an important determinant of successful treatment. Dexmedetomidine (DEX) has recently gained attention as a promising adjuvant to local anesthetics (LA). The present study aimed to evaluate the efficacy and safety of levobupivacaine (LB) as an adjuvant during inferior alveolar nerve block (IANB) in the extraction of lower impacted third molars (LITM). Methods: A prospective, randomized, placebo-controlled, triple-blind, parallel-arm, and clinical study was performed on 50 systemically healthy participants who required removal of an asymptomatic LITM. Using a 1:1 distribution, the participants were randomized into two groups (n = 25). Group L (control group) received 1.8 mL of 0.5% LB and 0.2 mL normal saline (placebo) and Group D (study group) received a blend of 1.8 mL of 0.5% LB and 0.2 mL (20 ㎍) DEX. The primary outcome variable was the duration of POA and hemodynamic stability, and the secondary variable was the total number of analgesics required postoperatively for up to 72 h. The participants were requested to record the time of rescue analgesic use and the total number of rescue analgesics taken. The area under the curve was plotted for the total number of analgesics administered. The pain was evaluated using the visual analog scale. Data analysis was performed using paired students and unpaired t-test, Mann-Whitney U test, Chi-square test, and receiver operating characteristic analysis. Statistical significance was set at P < 0.05. Results: The latency, profoundness of anesthesia, and duration of POA were statistically significant (P < 0.05). The differences between mean pain scores at 6, 12, 24, 48, and 72 h were found to be significant (each P = 0.0001). Fewer analgesics were required by participants in group D (2.12 ± 0.33) than in L (4.04 ± 0.67), with a significant difference (P = 0.0001). Conclusion: Perineurally administered LA with DEX is a safe, effective, and therapeutic approach for improving latency, providing profound POA, and reducing the need for postoperative analgesia.

• CELLMED
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• v.2 no.1
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• pp.6.1-6.4
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• 2012

The traumatic removal of the mandibular third molar may promote post chirurgic consequences such as orofacial pain and limited mandibular movements. The aim of this case report is to describe the use of an anterior bite plane and complementary therapies (low level laser therapy and acupuncture) to treat the muscular dysfunction and the painful symptoms. A 33 year-old male patient who had a severe malocclusion and signs and symptoms of temporomandibular dysfunction was submitted to an initial clinical examination: electromyography of the masticatory muscles and IRM of the temporomandibular joint. After treatments, the results showed reduced pain symptoms and an increase of the mandibular movements and adequated electromiographic activities. The authors concluded that the combination therapies may be used as an alternative treatment because it satisfied the functional requirements of the patient and provided an asymptomatic clinical condition.

• Journal of the Korean Association of Oral and Maxillofacial Surgeons
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• v.29 no.2
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• pp.135-139
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• 2003

A dentigerous cyst is an epithelium-lined sac that surrounds the crown of an unerupted tooth or odontoma. And the most common sites of this cyst are the mandibular and maxillary third molar and maxillary cuspid a areas. Clinically, expansion of bone with subsequent facial asymmetry, extreme displacement of teeth, severe root resorption of adjacent teeth and pain are all possible sequelae of this cyst. The standard treatment for a dentigerous cyst is enucleation and extraction of the involved tooth. But in large cysts, this can lead to functional, cosmetic and psychologic consequences to the patients. So recently, more conservative methods are used. We report 5 cases of dentigerous cysts in pediatric patient which were treated by a conservative approach, By this methods, we can preserve teeth and guide eruption of the teeth which are involved in cystic area.

• Journal of The Korean Dental Society of Anesthesiology
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• v.3 no.1 s.4
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• pp.10-18
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• 2003

Background: Studies on the pain have been dealing with many different ways for last several centuries. Especially, preemptive analgesia is being used as a method to control the postoperative pain. Many studies on its efficacy have been processed in different ways about various drugs, administration methods and times for various operations. And the value of preemptive analgesia are still controversial regarding the results of other clinical studies. The authors performed a clinical study on efficacy of preemptive analgesia using an non-steroidal anti-inflammatory drug (NSAID) for the surgical extraction of impacted third molar teeth and present the more effective pain treatment after oral surgery with literature review. Methods: Using a randomized double blind test design, this study compared the analgesic efficacies of an NSAID, Talniflumate 370 mg. This drug administrated first either 1 hour preoperatively (experimental group) or when the pain developed moderately to severely over 5 scale of verbal rating scales (0-10) to respective 30 patients undergoing the removal of impacted third molars. Pain intensity and the time from the end of surgery were assessed postoperatively whenever the patients demanded additional drug over 5 scale for forty eight hours using same verbal rating scales. Results: The sex distribution, the age of the patients. and the time required for surgery in two groups were similar. The average first time for demanding additional drug after surgery was 163.9 minutes in experimental group and 191.5 minutes in control group. At this time, the average pain intensity was 5.8 in experimental group and 6.1 in control group. And the average second time for demanding additional drug was 365.5 minutes in experimental group and 351.8 minutes in control group. At this time. the average pain intensities were 6.6 in experimental group and 6.2 in control group. No statistically significant difference was found between the average first times and second times, and the average pain intensities at first and second times in two groups. Conclusions: From these results the efficacy of preemptive analgesia used in this study was not appeared. This clinical study indicates that many NSAIDs administrated preoperatively in present practices have weak efficacy of preemptive analgesia for postoperative pain, thus the authors recommend that only postoperative analgesics are adequate without preoperative use of analgesics.