구강안면 운동장애의 임상적 증상 발현

유지원,윤창륙,조영곤,안종모,Ryu, Ji-Won,Yoon, Chang-Lyuk,Cho, Young-Gon,Ahn, Jong-Mo 대한안면통증구강내과학회 2008 Journal of Oral Medicine and Pain Vol.33 No.4

This study was a preliminary study to establish diagnostic criterias and treatment for Orofacial Movement Disorders. The 33 Orofacial Movement Disorder patients who were visited in the department of Oral Medicine from September, 2007 to December, 2007 were selected for this study. We analyzed the age, sex, systemic diseases, the diagnosis and the cause of the patients' chief complaints, the self-consciousness and the types of orofacial movements. The obtained results were as follows : 1. Female were predominant in orofacial movement disorders(81.82% vs 18.18%) and mean age was 78.78(56 to 87) years. 2. They almost had systemic diseases(81.82%). Hypertenstion was the most common disease(22.41%) and diabetes mellitus(17.24%), depression(8.62%), gastritis(8.62%) in turns. 3. In clinical manifestation, temporomandibular disorder was the most frequently complained symptom(33.33%), and soft tissue disease(21.57%), burning mouth syndrome(17.65%), orofacial movement itself(15.69%), diffuse orofacial pain(6명, 11.76%) in turns. 4. Most orofacial movement disorders are idiopathic(72.73%), and related to prosthetic treatment(24.24%), related to antidepressant medication(3.03%) in turns. 5. The jaw-closing type was the most common type of orofacial movement disorders, and lateral type(33.33%), jaw-opening types(16.67%) in turns. 6. There were more patients who did not conscious of their orofacial movements than those who did.(54.55% vs 45.45%). In conclusion, dentists must be consider the orofacial movement disorders in patients who have orofacial pain. Also, dentists should obtain a proper history and perform a clinical examination to avoid misdiagnosis and inappropriate, irreversible treatment.

보툴리눔 톡신을 이용한 구강하악 근긴장이상증의 치료 증례

유지원,홍성주,배국진,윤창륙,안종모,Ryu, Ji-Won,Hong, Seong-Ju,Bae, Kook-Jin,Yoon, Chang-Lyuk,Ahn, Jong-Mo 대한안면통증구강내과학회 2009 Journal of Oral Medicine and Pain Vol.34 No.4

Oromandibular dystonia is a focal neurological movement disorder characterized by involuntary sustained and often painful muscle contraction, usually producing repetitive movements or abnormal positions of the mouth, jaw and.or tongue. Patients suffering from oromandibular dystonia often experience difficulties in chewing, swallowing and speaking, resulting from the impairment of mandibular movements. At present there is no etiologic treatment for oromandibular dystonia, because the pathophysiology of primary and focal dystonia is still incompletely understood. Many treatments such as medication, behavioral therapy, surgery are suggested to decrease the involuntary movements. But these success rates are relatively low and they have a lot of complications. many studies suggested that chemodenervation with botulinum toxin is the most effective treatment for oromandibular dystonia. We reported the 2 cases which were treated oromandibular dystonia with botulinum toxin and reviewed the orofacial movement disorders(especially oromandibular dystonia) and botulinum toxin treatment for oromanfibular dystonia.

Detection of Helicobacter pylori in Saliva of Patient with Oral Lichen Planus

유지원,강승우,윤창륙,안종모,Ryu, Ji-Won,Kang, Seung-Woo,Yoon, Chang-Lyuk,Ahn, Jong-Mo Korean Academy of Orofacial Pain and Oral Medicine 2008 Journal of Oral Medicine and Pain Vol.33 No.3

Lichen planus is a common, chronic inflammatory disease of the skin and mucous membrane for which no precise causes have been confirmed. But it is often connected with infections. Helicobacter pylori(H. pylori) among various bacteria has been associated with the cause of gastritis, peptic ulcer and gastric cancer. Considering the similarities of histological features between gastric ulcer and oral ulcers, it is resonable to assume that H. pylori might also be involved in the development oral mucosal ulceration. So we employed this study to investigate the possible involvement of H. pylori in the aetiology of erosive oral lichen planus. We analyzed detection rate of H. pylori in saliva of patients with erosive oral lichen planus by nested PCR. As a result, it revealed a significant difference statistically by showing positivity in 16 to 21(76.2%) saliva samples of patients group and in 11 of 44(25%) saliva samples of control group(P>0.001). We were able to suppose that H. pylori in saliva can be related to cause of erosive oral lichen planus.

Dysesthesia after Tooth Extraction and Implant Surgery Reported by Dentists

유지원,권정승,Ryu, Ji-Won,Kwon, Jeong-Seung Korean Academy of Orofacial Pain and Oral Medicine 2007 Journal of Oral Medicine and Pain Vol.32 No.3

The purpose of this study was to analyze the nerve damage after tooth extraction and implant surgery, and to establish a predictive model for assessment and management of dysesthesia. In this questionnaire study, the subjects chosen for this study were 276 dentists who answered the questionnaire about dysesthesia after tooth extraction and implant surgery. The analysis of the results consist of the sex and age distribution, affected site, associated symptoms, rate and duration of the recovery. The results are summarized as follows. : 1. There were no significant difference between the sex and the dysesthesia. 2. The most common affected site was the mandibular region. In the group of the implant surgery, 100% affected the mandibular site. The tooth extraction group was 93.2% affected. 3. Pain was one of the most associated symptom with dysesthesia-46.5% of the tooth extraction and 44.8% of the implant surgery. 4. The recovery ratio was 72.3% in the tooth extraction, 71.8% in the implant surgery. Most of them, they recovered in $1{\sim}6$ months. In conclusion, most of dysesthesia may be recovered within 1 year. However, the possibility of persistent dysesthesia should not be neglected. Therefore, practitioners must discuss the possibility of nerve injury with their patients, and include this possibility in the consent forms. Various methods of monitoring recovery of sensation should be considered for objective assessment of prognosis. In addition, immediate referral to orofacial pain specialists can offer the patients an opportunity for more effective and noninvasive treatments.

Case report : Anterior Open bite after injection of Botulinum Toxin on Masseter Muscles

유지원,Ryu, Ji-won The Korean Academy of Orofacial Pain and Oral Medi 2013 Journal of Oral Medicine and Pain Vol.38 No.4

보툴리눔 톡신은 신경독소로, 운동신경 말단부위에서 분비되는 아세틸콜린의 분비를 차단하여 근육의 위축을 유발하게 된다. 의학계 및 치의학계에서는 이를 이용하여 다양한 질환을 치료하는 것을 시도하고 있다. 치과영역에서는 저작근 수축, 심한 이갈이, 안면 틱, 구강안면 운동장애, 교근비대의 치료 등 과활성 근육성 질환을 치료하는 데 사용하고 있다. 악안면 영역에 보툴리눔 톡신을 주입하고 난 뒤 발생되고 있는 합병증으로는, 자연스럽지 못한 안면표정, 통증의 증가, 두통 등이 유발될 수 있다고 보고되고 있다. 본 증례에서는 교근부에 보툴리눔 톡신 주입 후 발생된 전방 개교합 증상에 대하여 보고하고자 한다. Botulinum neurotoxin(BoNT) is a protease exotoxin produced from Clostridium botulinum. It works by blocking the release of acetylcholine from cholinergic nerve endings causing inactivity of muscles or glands. Recently, the therapeutic use of BoNT have expanded to include a wide range of medical and dental conditions. Botulinum neurotoxin type A(BoNT/A) is used off-label in the orofacial region to treat primary and secondary masticatory and facial muscle spasm, severe bruxism, facial tics, orofacial dyskinesias, dystonias, and hypertrophy of the masticatory muscles. Local hematoma, infection, and persistent pain in the injection site are the site-of-injection side effects. Medication-related side effects are adjacent muscle weakness, slurred speech, an alteration in the character of the saliva, and severe headaches. In most cases, these complications are not persistent and bothersome. We reported a case report of a patient who had transient anterior open bite after BoNT/A injection on masseter muscles to treat the refractory myofascial pain.

한국인 소아의 타액에서 Helicobacter pylori의 검출

유지원,이장근,이영수,윤창륙,안종모,Ryu, Ji-Won,Lee, Jang-Keun,Lee, Yong-Su,Yoon, Chang-Lyuk,Ahn, Jong-Mo 대한안면통증구강내과학회 2008 Journal of Oral Medicine and Pain Vol.33 No.1

Helicobacter pylori(H. pylori) has been associated with the cause of peptic ulcer and gastric cancer. H. pylori infection occur mostly during childhood and increase by aging. In route of transmission, Oral cavity does important role. So we employed this study to elucidate route of transmission by detection of H. pylori in infant saliva. We investigated 20 infants aged below 10 years and 20 teens aged below 20 years as study group and 71 adults aged 20 and over years as control group. H. pylori DNA was isolated from 5(25%) infants aged below 10 years, 6(30%) teens and 17(23.9%) adults by nested polymerase chain reaction(n-PCR). There was no statistically significant difference(P>0.05). The obtained results suggest that H. pylori infection is relatively common in saliva of Korean infant and oral cavity may be reservoir of H. pylori.

Case report: Treatment of Facial Nerve Palsy Following Bilateral Sagittal Split Ramus Osteotomy

유지원,Ryu, Ji-Won The Korean Academy of Orofacial Pain and Oral Medi 2013 Journal of Oral Medicine and Pain Vol.38 No.3

양측 하악지 시상 골절단술은 악안면 기형 및 부정교합을 치료하기 위해 흔히 사용되는 필수불가결한 술식이라고 할 수 있다. 하악지 시상 골절단술 후 발생할 수 있는 합병증으로는 하치조 신경 손상, 출혈, 측두하악장애, 부적절한 골면의 유합 및 골절, 재발 등이 있다. 악교정 수술 후 안면신경 마비의 발생 유병율은 최근 0.1 퍼센트로 보고되고 있다. 증상 발생의 원인으로는 안면신경의 압박, 신경의 불완전 또는 완전 손상, 신경의 견인, 마취제에 의한 신경의 허혈 등이 있다. 술 후 발생된 안면 신경의 마비는 환자의 삶의 질을 저해하고 사회활동을 기피하게 함으로써 가장 심각한 합병증 중 하나라고 볼 수 있다. 본 증례에서는 양측 하악지 시상 골전달술을 시행 후 발생한 안면신경 마비에 대하여 보고하고 있다. Bilateral sagittal split ramus osteotomy(BSSRO) of the mandible is an essential and commonly used procedure to correct dentofacial deformities and malocclusion. The possible complications associated with BSSRO include inferior alveolar nerve injury, bleeding, temporomandibular disorder, unfavorable fractures, and clinical relapse. The incidence of facial nerve palsy after orthognathic surgery recently reported is 0.1%. The probable etiologies have included facial nerve compression, complete or incomplete nerve transection, nerve traction, and nerve ischemia from anesthetic injection. Postoperative facial palsy is one of the most serious complications because it reduces the quality of life and significantly reduces social interaction. The case of a 24-year-old patient who underwent bilateral sagittal split ramus osteotomy is described. The medical records and postoperative photographs were reviewed in detail to collect information on the clinical course, treatment, and outcomes.

Clinical Characteristics of Headaches in Temporomandibular Disorder Patients : Primary Headache vs Headache Attributed to TMD

유지원,배국진,홍성주,윤창륙,안종모,Ryu, Ji-Won,Bae, Kook-Jin,Hong, Seong-Ju,Yoon, Chang-Lyuk,Ahn, Jong-Mo Korean Academy of Orofacial Pain and Oral Medicine 2009 Journal of Oral Medicine and Pain Vol.34 No.3

The objective of this study was to describe the prevalence of the headache attributed to Temporomandibular disorder(TMD) symptoms and to investigate the relationships of headache and TMD. 66 patients seeking care for signs and symptoms of Temporomandibular disorders(TMD) and Orofacial pain in the department of oral medicine, Dental Hospital, Chosun University, from January, 2008 to June, 2008, were recruited. The obtained results were as follows : 1. A muscle and TMJ origin combined was the most common in study populations(54.55%), grouped as TMD classification. 2. Tension type headache was the most common in study population(89.39%), grouped as headache classification. 3. 36 patients out of 66(54.55%) had headaches which related to TMD. 4. Out of 36 patients who had suffered the headache which were attributed to TMD, 19 patients(52.78%) described that their headache related to TMD was different from their own primary headaches. In conclusion, headache attributed to TMD is relatively common in the patients who had headaches and TMD symptoms together. And the new headache patterns may related to headache and TMD chronification. Larger-scale studies and more specified and controlled comparison study is needed to confirm the relationship between the headache and TMD.

스트레스와 관련된 구강안면통증의 연구에 있어서 타액내의 스트레스호르몬의 활용

유지원,윤창륙,안종모,Ryu, Ji-Won,Yoon, Chang-Lyuk,Ahn, Jong-Mo 대한안면통증구강내과학회 2007 Journal of Oral Medicine and Pain Vol.32 No.2

많은 질병들과 기존에 존재하는 신체적인 질병들은 스트레스로 인해 발병되거나 크고 작은 스트레스의 영향으로 악화된다. 스트레스의 연구에 호르몬을 사용하는 기본은 신체의 대부분 시스템이 스트레스를 받는 동안 변화를 보인다는 것과 이러한 변화에 호르몬이 스트레스와 확실하게 연관되어 있다는 것을 관찰하는 것이다. 개념적으로 스트레스에 있어서 교감신경계와 시상하부-뇌하수체-부신축의 활성화가 중심적인 역할을 한다는 것이 호르몬의 변화를 측정해야 할 충분한 근거를 제공한다. 에피네프린과 노르에피네프린과 같은 카테콜라민, 코티졸, 테스토스테론 그리고 성장호르몬 등은 스트레스에 예민한 반응을 보인다. 한편 스트레스 연구를 위한 타액표본은 혈액이나 요의 표본과는 달리 스트레스를 주지 않고도 표본을 얻을 수 있으며 신체적인 구속이나 윤리적인 문제 등을 염려하지 않고도 채취가 가능하다는 장점이 있다. 타액내의 호르몬의 수치는 혈액내의 호르몬 수치를 잘 반영하므로 스트레스와 관련된 구강안면통증의 연구에 있어서 타액내의 스트레스 호르몬에 활용도는 매우 높으리라고 사료된다.

증예(症例) : 대장에 국한된 속발성 유전분증 1예

유지원 ( Ji Won Ryu ),남승우 ( Seong Woo Nam ),권혁춘 ( Hyuck Choon Kweon ),최승준 ( Song Jun Choi ),김상용 ( Sang Young Kim ),박현미 ( Heun Mi Park ),안혜선 ( He Sun An ) 전북대학교 의과학연구소 2010 全北醫大論文集 Vol.34 No.2

저자들은 만성 설사와 하지 부종을 주소로 내원한 63세 여자 환자에서 류마티스 관절염과 연관되고 대장에 국한된 속발성 유전분증을 진단하였고 환자의 임상경과를 기존의 문헌 고찰과 함께 보고하는 바이다. Suspicion of gastrointestinal amyloidosis in patients without known history of amyloidosis is difficult, but gastrointestinal amyloidosis should be considered in those older than 30year with unexplained diarrhea, weight loss or malabsorption. We experienced a case of an 63-year-old female in patient with rheumatoid arthritis, who have a chronic watery diarrhea caused by colonic amyloidosis. Congo-red stain and immunohistochemical stain for amyloid A protein of colonoscopic pathologic specimen showed positive response. Other organs such as kidney, heart, liver and skin, were not involved by amyloidosis. She was diagnosed to secondary and localized colonic amyloidosis related with rheumatoid arthritis. In spite of anti-rheumatic therapy, our patient did not recover.