• Journal of Trauma and Injury
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• v.19 no.1
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• pp.28-34
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• 2006

Purpose: In maxillofacial surgery, proper preoperative diagnosis is very important in achieving good postoperative results. Although conventional CT scans are useful for visual representations of fractures, they cannot provide direct guidance for reconstructing facial bone fractures. However, the recent technology of multislice scanning has brought many clinical benefits to CT images. Direct correlations can be made between preoperative imaging data and operative planning. The aim of the current study is to evaluate the differences between conventional CT and multidetective three-dimensional CT(3D MDCT) measurements in craniofacial deformities. Methods: From January 2005 to November 2005, MDCT scans of 41 patients were evaluated by comparing them with conventional CT scans. The 3D MDCT images were assessed and reviewed by using a simple scoring system. Results: The 3D MDCT scans offered easy interpretation, facilitated surgical planning, and clarified postoperative results in malar complex fractures, mandibular fractures, and extensive maxillofacial fractures and cranioplasty. However, 3D MDCT images were not superior to conventional CT scans in the diagnosis of blowout fractures. Conclusion: In spite of its limitations, the 3D MDCT provided additional and more comprehensive information than the conventional CT for preoperative assessment of craniofacial deformities. Therefore, the 3D MDCT can be a useful tool for diagnosis and systematic treatment planning in craniofacial skeletal deformities.

• Journal of the Korean Association of Oral and Maxillofacial Surgeons
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• v.27 no.5
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• pp.474-480
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• 2001

Purpose: The aim of this study was to evaluate the complications of open reduction and internal fixation of mandibular fracture with miniplates. Patients and Methods: A total of 134 patients who presented with 196 fractures were analyzed retrospectively. Complications were evaluated for factors such as age, the site of fracture, the severity of fracture, delayed operation, preoperative wound contamination, the site and disposition of teeth in the fracture line and midfacial fractures. Statistical analysis was used to compare complications to risk factors. Results: Of the 134 patients, 20 patients had some form of postoperative complications and complication rate was 14.9%. These complications included infection, plate fracture, malocclusion, wound dehiscence, nerve injury and nonunion. There was a significant correlation between complication rate and the severity of fracture, preoperative wound contamination and the site of the fracture and disposition of teeth(p<0.05). Conclusion: The occurrence of postoperative complications in the treatment of mandibular fractures was related to the severity of fracture, preoperative wound contamination and the site of the fracture and disposition of teeth.

• Journal of Dental Anesthesia and Pain Medicine
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• v.15 no.2
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• pp.101-103
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• 2015

In oral and maxillofacial surgery, many complications associated with nasotracheal tube can be caused. In this case, we reported ballooning tube damage of nasotracheal tube during orthognathic double-jaw surgery and replacement of tube through cut down of tube and tube exchange using airway exchange catheter. The patient scheduled for high Le Fort I osteotomy and bilateral sagittal split osteotomy was intubated nasotracheally with nasal endotracheal tube. During maxilla osteotomy, air bubble was detected in the oral blood. In spite of our repeated ballooning, the results were the same so we changed damaged tube using airway exchange catheter aseptically. Tiny and superficial cutting site was detected in the middle of pilot tube. As we know in our case, tiny injury impeded a normal airway management and prevention is important.

• Journal of Dental Anesthesia and Pain Medicine
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• v.20 no.3
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• pp.155-160
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• 2020

Submental or submandibular intubation has been reported to cause fewer complications than tracheostomy. However, the risk of infection is always inherent because oral wounds are exposed to microbial flora and bacteria in the oral cavity. A novel technique of submandibular intubation was devised to reduce infection and injury to the soft tissues. We would like to report a novel safe technique that can be performed in patients requiring submental or submandibular intubation. This is the first report of submandibular intubation using a sterile disposable camera cable drape. This novel technique of submandibular intubation is safer, more sterile, easier, and less invasive than conventional submandibular intubation.

• Imaging Science in Dentistry
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• v.51 no.3
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• pp.313-321
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• 2021

Ankylosis of the temporomandibular joint (TMJ) is a disabling disease resulting from fibrous or bony fusion of the mandibular condyle and the glenoid fossa. Early diagnosis and surgical treatment are essential to prevent facial deformity and other complications. Conventional radiography has limitations in demonstrating the true extent of ankylosis. It is important for surgeons to be aware of the size and degree of bony ankylosis in order to perform complete resection of the ankylotic mass. In addition, a detailed evaluation of the relationship with adjacent vital structures such as the internal maxillary artery, inferior alveolar nerve canal, external auditory canal, and skull base are crucial to avoid iatrogenic injury. Multidetector computed tomography (MDCT) is the current imaging modality of choice for preoperative assessments. Herein, the authors propose a structured CT reporting template for TMJ ankylosis to strengthen the value of the preoperative imaging report and to reduce the rates of intraoperative complications and recurrence.

• Imaging Science in Dentistry
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• v.49 no.3
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• pp.213-218
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• 2019

Purpose: The aim of this study was to evaluate the relationship between the mandibular canal and impacted mandibular third molars using cone-beam computed tomography (CBCT) and to compare the CBCT findings with signs on panoramic radiographs(PRs). Materials and Methods: This retrospective study consisted of 200 mandibular third molars from 200 patients who showed a close relationship between the mandibular canal and impacted third molars on PRs and were referred for a CBCT examination of the position of the mandibular canal. The sample consisted of 124 females and 76 males, with ages ranging from 18 to 47 years (mean, $25.75{\pm}6.15$ years). PRs were evaluated for interruption of the mandibular canal wall, darkening of the roots, diversion of the mandibular canal, and narrowing of the mandibular canal. Correlations between the PR and CBCT findings were statistically analyzed. Results: In total, 146 cases(73%) showed an absence of canal cortication between the mandibular canal and impacted third molar on CBCT images. A statistically significant relationship was found between CBCT and PR findings (P<0.05). The absence of canal cortication on CBCT images was most frequently accompanied by the PR sign of diversion of the mandibular canal(96%) and least frequently by interruption of the mandibular canal wall(65%). Conclusion: CBCT examinations are highly recommended when diversion of the mandibular canal is observed on PR images to reduce the risk of mandibular nerve injury, and this sign appears to be more relevant than other PR signs.

• Journal of Dental Anesthesia and Pain Medicine
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• v.24 no.2
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• pp.81-90
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• 2024

Nasotracheal intubation (NTI) plays an important role in pediatric airway management, offering advantages in specific situations, such as oral and maxillofacial surgery and situations requiring stable tube positioning. However, compared to adults, NTI in children presents unique challenges owing to anatomical differences and limited space. This limited space, in combination with a large tongue and short mandible, along with large tonsils and adenoids, can complicate intubation. Owing to the short tracheal length in pediatric patients, it is crucial to place the tube at the correct depth to prevent it from being displaced due to neck movements, and causing injury to the glottis. The equipment used for NTI includes different tube types, direct laryngoscopy vs. video laryngoscopy, and fiberoptic bronchoscopy. Considering pediatric anatomy, the advantages of video laryngoscopy have been questioned. Studies comparing different techniques have provided insights into their efficacy. Determining the appropriate size and depth of nasotracheal tubes for pediatric patients remains a challenge. Various formulas based on age, weight, and height have been explored, including the recommendation of depth-mark-based NTI. This review provides a comprehensive overview of NTI in pediatric patients, including the relevant anatomy, equipment, clinical judgment, and possible complications.

• Archives of Plastic Surgery
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• v.34 no.3
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• pp.365-370
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• 2007

Purpose: There are many reports about facial bone fractures, but limited to retrospective data of a single hospital. Etiology and severity of the facial bone fracture have been changed and treatment method and materials have been advanced. In order to reflect those changes and provide up-to-date data of the facial bone fractures in Daegu, we gathered the data and analyzed the epidemiologic study. Methods: The medical records of 1058 fractures in 895 patients were gathered from 5 general hospitals in Daegu during last year and these data were analyzed by following parameters: age, sex, place of residence, occupation, cause of injury, time of injury, location of fracture, length of in-hospital stay, time of operation, treatment method, associated injury, complication. Statistical analysis was performed using the Chi-square test. Results: Most commonly involved age group was 20s(26%) and the sex ratio was 3.4:1(male predominance). Fractures were occurred more in unban and white-color workers. Among variable etiology of injury, traffic accident was the most common cause. Time of injury was heighest at 6 to 7 P.M., on Sunday, in July. Locations of fractures were following sequence: nasal, zygoma, mandible, orbit, maxilla. Mean length of in-hospital stay and time of operation after injury were 6.3 and 3.2 days, respectively. In treatment methods, operative methods were dominant than conservative management and general anesthesia were favored than local anesthesia. Associated injuries were noticed in 188 cases(21.2%) and complications were in 94 cases(8.9%) and among them, ocular problem were common. Conclusion: Compared to previous studies, mean age of occurrence was lowered and the etiologies showed age-specific pattern and reflected the change of lifestyle. In young age groups, sports injury, violence were more dominant and the other hand, traffic accident and fall were dominant in older groups.

• Maxillofacial Plastic and Reconstructive Surgery
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• v.11 no.1
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• pp.21-31
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• 1989

This is a series of continuing research on facial bone fractures of Koreans worked by Dept. of Oral and Maxillofacial surgery, Dental College of Yonsei University, Seoul, Korea, since 1972. The study was based on a series of 630 patients with facial bone fractures treated as in-patient at Yonsei Medical Center, Yonsei University, during the period of Jan., 1982 through Dec., 1987. The results obtained are as follows: 1. The ratio of Men to Women was 4.3 : 1, and admissions for facial bone fractures have been increased year after 1984. 2. The age frequency was highest in the third decade(38.3%), and fourth, second, fifth decade in orders. 3. The traffic accident was the most frequent cause of facial bone fractures (51.3%). 4. The most common location of facial bone fractures was the Mandible(35.3%), and Zygoma complex(29.8%), Nasal bone(15.0%), Maxilla(11.0%) were next in order of frequency. 5. In 291 patients of Mandible fractures, 226(77.7%) had fractures only in Mandible and 65(22.3%) had another facial bone fractures. The most frequent fracture site of Mandible was the Symphysis(43.0%) and Angle(22.4%), and Simple fracture was the most frequent in type of fracture(66.9%). Intermaxillary fixatin & Open reduction was major method of treatment(36.9%). 6. In 394 patients of Midface fractures 323)82.0%) had fractures only in Midface and 71(18.0%) had another facial bone fractures. The most frequent site of Midface fractures was zygoma complex & zygomatic arch(42.7%), and Simple fracture was the most common type of fractures. Observation(Maxilla :44.2%, Zygoma :51.0%) and Open Reduction(Maxilla :20.0%. Zygoma :23.5%) were the major method of treatment. 7. The frequency of Nasal bone fracture was about 1/5 of Midface fractures, and Closed Reduction(45.2%) was the major method of treatment. 8. The complication was reported in only 16 patients, and Malunion was the major complication. 9. Head(44.4%), Lower extrimities(14.5%) and Eye(12.3%) were injured commonly with facial bone fractures. 10. The elapsed time from injury to hospital was within 24 hours in 73.8% of patients, however 15.5% of patients arrived the hospital 72 hours after injury.

• Archives of Craniofacial Surgery
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• v.17 no.1
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• pp.28-30
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• 2016

Major maxillofacial bone injury itself can be life threatening from both cardiovascular point of view, as well as airway obstruction. Significant hemorrhage from facial fracture is an uncommon occurrence, and there is little in the literature to guide the management of these patients. We report a 73-year-old male driver who was transported to our hospital after a motor vehicle collision. The patient was hypotensive and tachycardic at presentation and required active fluid resuscitation and transfusion. The patient was intubated to protect the airway. All external attempts to control the bleeding, from packing to fracture reduction, were unsuccessful. Emergency angiogram revealed the bleeding to originate from terminal branches of the sphenopalatine artery, which were embolized. This was associated with cessation of bleeding and stabilization of vital signs. Despite the age and severity of injury, the patient recovered well and was discharged home at 3 months with full employment. In facial trauma patients with intractable bleeding, transcatheter arterial embolization should be considered early in the course of management to decrease mortality rate.