• Radiation Oncology Journal
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• v.31 no.4
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• pp.206-215
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• 2013

Purpose: Re-irradiation (re-RT) is considered a treatment option for inoperable locoregionally recurrent head and neck cancer (HNC) after prior radiotherapy. We evaluated the efficacy and safety of re-RT using Helical Tomotherapy as image-guided intensity-modulated radiotherapy in recurrent HNC. Materials and Methods: Patients diagnosed with recurrent HNC and received re-RT were retrospectively reviewed. Primary endpoint was overall survival (OS) and secondary endpoints were locoregional control and toxicities. Results: The median follow-up period of total 9 patients was 18.7 months (range, 4.1 to 76 months) and that of 3 alive patients was 49 months (range, 47 to 76 months). Median dose of first radiotherapy and re-RT was 64.8 and 47.5 $Gy_{10}$. Median cumulative dose of the two courses of radiotherapy was 116.3 $Gy_{10}$ (range, 91.8 to 128.9 $Gy_{10}$) while the median interval between the two courses of radiation was 25 months (range, 4 to 137 months). The response rate after re-RT of the evaluated 8 patients was 75% (complete response, 4; partial response, 2). Median locoregional relapse-free survival after re-RT was 11.9 months (range, 3.4 to 75.1 months) and 5 patients eventually presented with treatment failure (in-field failure, 2; in- and out-field failure, 2; out-field failure, 1). Median OS of the 8 patients was 20.3 months (range, 4.1 to 75.1 months). One- and two-year OS rates were 62.5% and 50%, respectively. Grade 3 leucopenia developed in one patient as acute toxicity, and grade 2 osteonecrosis and trismus as chronic toxicity in another patient. Conclusion: Re-RT using Helical Tomotherapy for previously irradiated patients with unresectable locoregionally recurrent HNC may be a feasible treatment option with long-term survival and acceptable toxicities.

• Maxillofacial Plastic and Reconstructive Surgery
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• v.32 no.3
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• pp.260-264
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• 2010

Treatment of the mandibular fracture consists of reduction and fixation. The apparatus that is used to keep the jaws together during healing will often reduce the fracture as well. When the jaws are brought together and intermaxillary elastic rubber traction is placed, the occlusion of the teeth will help to orient the fractured parts into good position. Intermaxillary fixation, that is, fixation obtained by elastic bands between the upper & lower jaws to which suitable anchoring devices have been attached, will successfully treat most fractures of the mandible. Arch bars are perhaps the ideal method for intermaxillary fixation. Several types of ready-made arch bars are used. But, daily occupational life and oral hygiene is difficult to maintain during the period of longterm immobilized intermaxillary fixation (commonly 6-8 weeks), owing to malnutrition and emotional disorders in a position of the patient with mandibular fractures. Most mandibular fractures heal well enough to allow removal of fixation in about 6 weeks. Though there are many complications of mandibular fracture, such as infection, hemorrhage, trismus, paresthesia and nonunion, it is favorable to attain the short-term removable intermaxillary fixation care by use of an additive incision & drainage establishment on the oral lacerated wounds of adjacent mandibular compound fractures. The purpose of an additive incision & drainge establishment is the prevention of wound infection & nonunion by removing the hematoma & seroma in the fracture sites.

• Journal of the korean academy of Pediatric Dentistry
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• v.31 no.3
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• pp.453-458
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• 2004

Mandibular fracture is less common in children than in adults. However, children are more susceptible to ankylosis and developmental disorders, and don't respond as well to intermaxillary fixation compared to adults. On the other hand, bone fracture is healed more quickly in children and complications are scarce. Mandibular fracture in children is usually treated successfully with acrylic splint therapy with or without the use of eyelet wires and intermaxillary fixation. Severe complications that include ankylosis and developmental disorders may occur. The frequency and severity of such complications can be mitigated with a shorter duration of intermaxillary fixation and good post-operative care. Encouraging mandibular physical therapy by increasing patient motivation may be necessary in such cases where the patient's response is poor and the duration of intermaxillary fixation increases; when the patient is unable to undergo physical therapy, or when intermaxillary fixation is not necessary with the patient showing only minor symptoms such as trismus. In this case report, a 6 year-old girl with bilateral condylar fracture was treated with elastic in both the upper and lower jaws to allow mandibular physical therapy using a Benoist's appliance, which allows opening, lateral, and protrusive retrusive movements of the mandible. A 7-month follow-up showed beneficial therapeutic effects such as increased mandibular movement and prevention of condylar ankylosis.

• Journal of Oral Medicine and Pain
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• v.35 no.2
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• pp.155-163
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• 2010

Dermatomyositis (DM) is an idiopathic inflammatory connective tissue disorder and a systemic autonomic immune disease which shows a progressive muscle weakness and characteristic rash. It is identified by a characteristic rash accompanying, or more often preceding muscle weakness. Pathognomonic skin lesions are a blue-purple discoloration on the upper eyelids with edema (heliotropic rash), a flat red rash on the face and upper trunk, and erythema of the knuckles with a raised violaceous scaly eruption (Gottron's papule). The myopathy represents inflammatory and degenerative changes primarily affecting proximal muscles. DM often involves GI tract and respiratory system with as risk of 15-25% internal malignancy. It's managed with sun protection since muscle weakness as well as a rash could be aggravated by sun exposure. Systemic corticosteroid is an initial therapy and other immunosuppressive agent has been used as alternatives. Facial muscles are unaffected and masticatory muscles are rarely affected in DM. We present trismus close to muscle contracture in a patient with DM. Therefore, it needs continuous mouth-opening exercise to prevent progressive muscle contracture and to ensure normal mouth opening.

• Korean Journal of Head & Neck Oncology
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• v.15 no.1
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• pp.35-39
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• 1999

Objectives: The treatment for squamous cell carcinoma of the tonsil remains controversial. Surgery or radiation therapy alone is effective in treating early tonsil cancer, but results with single treatment modality in advanced disease have been disappointing. We retrospectively analyzed 37 patients with advanced squamous cell carcinoma of the tonsil for two treatment modalities in an effort to identify more efficacious therapeutic options. Materials and Methods: From 1990 through 1997, 37 patients who were treated primarily with surgery, were retrospectively sudied. The patients were grouped into two groups according to the method of treatment, extended tonsillectomy followed by irradiation and/or postradiation neck dissection(Group I) and a combination of composite resection and postoperative radiation(Group II). Results: The three year disease-tree survival in patients with stage IV lesions was 59.09% for the Group I patients, and 56.25% for the Group II patients. This difference was not statistically significant(p=0.775). The primary tumor recurrence rate in Group I was 16.7% in contrast to 23.1% for Group II. The local recurrence rate in the neck was 16.7% for the Group I patients and 23.1% for the Group II patients. There was no significant difference in the frequency of recurrences in the primary or neck in the patients treated with extended tonsillectomy or composite resection(p=0.639). Fistula formation and aspiration occurred in four patients after composite resection. Additionally, there were three trismus, one soft tissue necrosis, and one velopharyngeal insufficiency. Major complications were not observed in the patients treated with extended tonsillectomy and irradiation: velopharyngeal insufficiency was observed in eight patients and soft tissue necrosis in two patients. Conclusion: Extended tonsillectomy followed by irradiation may be an effective therapy with low morbidity in selected patients with tonsil cancer.

• Archives of Plastic Surgery
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• v.35 no.1
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• pp.110-115
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• 2008

Purpose: The objective of this study is to propose an effective management of unstable zygomatic arch fracture. The reduction methods of arch fracture were relatively simple but the maintenance of reduction state is very troublesome. On this, authors introduce an effective management method of unstable zygomatic arch fracture. Methods: Authors experienced 23 cases of unstable segmental zygomatic arch fractures and used Thermo-splint in all cases. All the arch fractures were reduced through Gillies' approach under the general anesthesia. After the reduction, the most effective suspension points were marked on the covering skin of the fractured arch. A needle of heavy nonabsorbable suture material was inserted toward the marking site under the reduced zygomatic arch. And then Therm-splint was dipped in the hot water, and we got the splint pattern of patient face. Reshaped Thermo-splint was trimmed and fixated with previous suspension suture materials. More additive suspension was done if necessary. The splint was applied for in two to three weeks postoperatively. Results: In all the cases, good cosmetic and functional results were observed without severe complications. There were 4 cases of incomplete reductions but they also had no specific problems. There were no facial nerve symptom and scar(stitch mark). Postoperative slight tenderness and trismus were completely subsided after removal of the splint. Conclusion: The Thermo-splint safely protect and maintain the postoperative reduction state. The application, maintenance and removal were easy and simple. It could be reformed to any contour of face and had enough rigidity for supporting. Above all these things, effective prevention of displacement and easy manipulation were significant merit. Authors experienced good results with Thermo-splint, and would introduce it for another method of management of zygomatic arch fracture.

• Journal of Dental Rehabilitation and Applied Science
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• v.28 no.1
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• pp.87-101
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• 2012

Bruxism is extensively defined as a diurnal or nocturnal parafunctional habit of tooth clenching or grinding. The etiology of bruxism may be categorized as central factors or peripheral factors and according to previous research results, central factors are assumed to be the main cause. Bruxism may cause tooth attrition, cervical abfraction, masseter hypertrophy, masseter or temporalis muscle pain, temporomandibular joint arthralgia, trismus, tooth or restoration fracture, pulpitis, trauma from occlusion and clenching in particularly may cause linea alba, buccal mucosa or tongue ridging. An oral appliance, electromyogram or polysomnogram is used as a tool for diagnosis and the American Sleep Disorders Association has proposed a clinical criteria. However the exact etiology of bruxism is yet controversial and the selection of treatment should be done with caution. When the rate of bruxism is moderate or greater and is accompanied with clinical symptoms and signs, treatment such as control of dangerous factors, use of an oral appliance, botulinum toxin injection, pharmacologic therapy and biofeedback therapy may be considered. So far, oral appliance treatment is known to be the most rational choice for bruxism treatment. For patients in need of esthetic correction of hypertrophic masseters, as well as bruxism treatment, botulinum toxin injection may be a choice.

• Korean Journal of Bronchoesophagology
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• v.3 no.2
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• pp.293-301
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• 1997

The tonsillitis has long been one of the most common disease in the otolaryngologic field. Peritonsillar abscess occurs when bacterial infection of the tonsil spreads to the potential peritonsillar space deep behind the tonsil, and it usually occurs in patients with recurrent tonsillitis or in those with tonsillitis who have been inadequately treated. We studied retrospectively 71 patients who had been diagnosed as acute tonsillitis and 82 patients who had been diagnosed as peritonsillar abscess and had admitted in our department of the Ulsan Dong Kang Hospital from January, 1995 to September, 1997. Especially in the bacteriologic studies, we compared acute tonsillitis and peritonsillar abscess with chronic tonsillitis. The following results were obtained： 1) The sex distributions of acute tonsillitis were 47 males(66%) and 24 females(34%) cases, but 57 males(70%) and 25 females(30%) in cases of peritonsillar abscess. There were predominant in male and frequently affected in second and third decades in 53 cases(76%) of acute tonsillitis and 56 cases(68%) of peritonsillar abscess. 2) It was same found in each season. 3) The duration from onset of symptom to visit in our department was 3.92 days in cases of acute tonsillitis and 5.95 days in cases of peritonsillar abscess in average 4) The major symptoms were sore throat, swallowing difficult. And others were fever, fatigability, dysarthria, trismus, headache, otalgia. 5) Among the 71 cases of acute tonsillitis and 82 cases of peritonsillar abscess, most temperature of patients at visit were 36.6-37.5 $^{\circ}C$ in each 36 cases(51%), 57 cases(70%). 6) In each disease, 35 cases(47%), 45 cases(75%) consisted of single infection and 39 cases(53%), 15 cases(25%) consisted of mixed infection. In acute tonsillitis, 111 strains were isolated from 74 cases, the most common strain was 69 strains(62.2%) of $\alpha$-hemolytic streptococci. In the peritonsillar abscess, 77 strains were isolated from 60 cases, the most common strain was 49 strains(63.6%) of $\alpha$-hemolytic streptococci. In chronic tonsillitis, 563 strains were isolated from 382 cases, the most common strain was 334 strains(50.3%) of $\alpha$-hemolytic streptococci. 7) In acute tonsillitis and peritonsillar abscess, the most common leukocyte levels were reported with 10, 000-15, 000/$\mu$L in 23 cases(32%). The CRP levels were reported with abnormal findings in 61 cases(97%), 63 cases(95%) above 0.3 in each cases.

• Clinical and Experimental Pediatrics
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• v.50 no.4
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• pp.363-368
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• 2007

Purpose : It has been reported that deep neck abscesses are recently increasing again. We analyzed pediatric cases with deep neck abscesses during the last several years to contribute to the treatment of the disease. Methods : The clinical data of 30 children under 16 years of age with deep neck abscess from February 2001 to July 2006 were analysed retrospectively. Results : The mean age was 9 years (2-16 years), and the male/female ratio was 19/11. Abscesses in the peritonsillar space were most common (57%), followed by the retropharyngeal (30%) and parapharyngeal (13%) spaces. Upper respiratory infection in 10 cases (33%), dental infection in four case (14%), cervical lymphadenitis in three case (10%) and sinusitis in two case (6%) contributed to the development of deep neck infections. The frequent symptoms were fever in 16 case (53%), sore throat in 15 case (50%), poor oral intake in 10 (33%), odynophagia in eight (27%), and neck pain in eight (27%). Unilateral tonsillar hypertrophy and displacement in 15 case (50%) were most common. Neck mass in 13 patients (43%), neck stiffness in three (10%) and trismus in three (10%) were also found. Bacteria were isolated in 8 among 10 pus cultures; Streptococcus species 7 and Micrococcus luteus 1. All of those bacteria except Micrococcus luteus were sensitive to penicillin G. Surgical intervention was applied to 12 cases (40%), and the remaining 18 patients (60%) were treated with antibiotics only. There were no differences between the two groups in the duration of admission and antibiotic treatment. No complicated cases were observed. Conclusion : Peritonsillar abscesses were most frequent. Upper respiratory infection was the most common predisposing factor, followed by dental infection and sinusitis. Symptoms of respiratory tract obstruction were not found. The most common pathogens were Streptococcus species. Deep neck abscesses in children, if diagnosed at the early stage, possibly can be treated by antibiotics only, without surgical intervention.

• Pediatric Infection and Vaccine
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• v.18 no.2
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• pp.163-172
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• 2011

Purpose : The purpose of this study was to review our recent experiences with deep neck abscesses in children and adolescents and to provide helpful information in treatment and diagnosis by comparing them with those in other available literatures. Methods : Medical records of 36 children and adolescents admitted for deep neck abscess at two hospitals from January 2000 to October 2010 were reviewed retrospectively. Results : Male to female ratio was 1.4 : 1 and the mean age was 6.5 years. Painful neck swelling and fever were the most frequent symptoms in patients under thirteen years of age whereas trismus and headache were frequent symptoms in patients over fourteen years of age. Submandibular space was the most common site of deep neck abscess in patients under thirteen years of age, whereas peritonsillar space was the most common site in patients over fourteen years of age. The results of bacterial cultures were positive in 61.5% of drained cases. Staphylococcus aureus was the most commonly identified bacteria in 6 patients (37.5%) and 5 of them were under 2 years of age. Twenty six patients received surgical drainage while the others were treated with antibiotics only. There were no statistically significant differences in the durations of admission, fever after admission, and antibiotic treatment between surgical and medical treatment groups. Conclusion : The common sites of deep neck abscess, associated symptoms, and causative organisms were different between children and adolescents. As there were no differences in durations of admission, fever, or antibiotics treatments between surgical and medical treatment groups, surgical drainage may be avoided by early recognition and suspicion. However, if there is no improvement of symptoms or size of abscesses within 48-72 hours of antibiotic treatment, surgical drainage should be considered.