양대혈관 우심실 기시 환아의 Sevoflurane을 이용한 깊은 진정 하 치과치료

현홍근,신터전,김영재,김정욱,장기택,이상훈,김종철,김현정,서광석,이정만,신순영,Hyun, Hong-Keun,Shin, Teo Jeon,Kim, Young-Jae,Kim, Jung-Wook,Jang, Ki-Taeg,Lee, Sang-Hoon,Kim, Chong-Chul,Kim, Hyun-Jeong,Seo, Kwang-Suk,Lee, Jung-Man,Shin, 대한치과마취과학회 2012 Journal of Dental Anesthesia and Pain Medicine Vol.12 No.2

Double outlet of right ventricle (DORV) refers to a congenital heart disease in which pulmonary and systemic circulation originates from the right ventricle. In the patient with DORV, it is important to maintain the balance between pulmonary and systemic circulation in anesthetic management. A 4-year-old boy with DORV, who underwent a Blalock-Taussig shunt operation, was transferred to the clinic with a chief complaint of multiple caries. Due to poor cooperability, it was impossible to treat the caries without sedation or general anesthesia. We planned to sedate him with consideration with detrimental effects associated with positive pressure ventilation for dental treatment. After a prophylactic administration of antibiotics, sevoflurane was administered through T-cannula site. Throughout the treatment, His blood remained stable around 80/40 mmHg, oxygen saturation remained around 91%. After 3 hour of sedation with sevoflurane (end-tidal sevoflurane con 1-1.8 vol%), he fully regained consciousness, and discharged from hospital without complications. In case of DORV patient, deep sedation with sevoflurane may be used as effective method of behavioral management during dental treatment.

섭식연하장애와 치과적 관리

현홍근(Hong-Keun Hyun) 대한치과의사협회 2015 대한치과의사협회지 Vol.53 No.11

섭식·연하장애는 수술이나 치료로 인한 기질적 원인, 뇌혈관장애나 뇌성마비, 근육이나 신경장애 등으로 인한 기능적 원인, 그리고 거식증이나 폭식증과 같은 심리적 원인에 의해 발생할 수 있다. 치과의원급에서는 주로 음식물의 인식장애 단계부터 인두로의 전달장애 단계까지의 환자에게 적극적으로 도움을 줄 수 있으며, 그 방법으로는 치의학적 전문지식을 바탕으로 환자의 섭식, 저작과정을 주의 깊게 관찰하여 문제점을 파악하여 각 단계에 적절한 기초 훈련과 섭식 훈련을 실시하는 것이며, 또한 필요시 혀 접촉 보조장치와 같은 장치를 제작하여 환자에게 장착시키고 섭식, 연하 훈련을 시행하여 환자의 연하능력을 개선시켜줄 수 있다. 하지만 무엇보다 가장 중요한 것은 환자가 식전과 식후에 엄격한 구강관리를 시행할 수 있도록 잘 지도하고, 치과의 정기적 방문과 전문적 관리를 통해 구강내 저작기관의 해부학적, 기능적 문제점을 해결해 주도록 하며, 이 때 마다 심리적으로도 환자가 섭식, 연하에 문제가 없도록 세심하게 설명하고 상담해 주는 것으로, 이는 모두 치과의사의 책무라고 할 수 있다. Swallowing disorders or dysphagia, which are difficulties with the act of swallowing, can occur at different phases such as oral, pharyngeal, and esophageal phase in the swallowing process. These disorders can be caused by structural, functional abnormalities or psychological problems. Dentists can actively provide patients suffering from dysphagia with comprehensive professional care, especially from the cognitive stage of food to the pharyngeal stage of the swallow. Many cases of dysphagia can be improved with careful managements based on dental professionals" knowledge, including meticulous evaluation of masticatory and swallowing functions, training on eating and swallowing, and fabrication of palatal or lingual augmentation prosthesis. The important thing is that prevention of these disorders through the oral health care instruction and planned follow-up dental visit at periodic intervals in order to manage the problems caused by anatomical, functional, and psychological reason.

뇌병변장애 환자의 개구 및 연하 촉진을 위한 K-point 자극법

현홍근(Hong-Keun Hyun) 대한치과의사협회 2018 대한치과의사협회지 Vol.56 No.8

Patients with a wide range of cerebrovascular disease may have difficulty in opening their mouths, resulting in failing to swallow foods and maintain their oral hygiene. K-point was introduced as an effective trigger point to stimulate the jaw opening reflex for those patients. K-point stimulation may be useful as one of methods of helping open the jaw for dental examinations, or for placing foods onto the dorsum of the tongue and swallowing them effectively. Although this method cannot always guarantee the success of the jaw opening for every patient, it may still be considered to be an effective one to apply to patients having difficulty in jaw opening and swallowing disorder.

Kostmann 증후군과 골수이형성 증후군 환아의 증례보고

현홍근(Hong-Keun Hyun) Asia association of Disability and Oral health 2008 International Journal of Disability and Oral Healt Vol.4 No.1

Congenital neutropenia or Kostmann syndrome is an inherited disorder manifesting in infancy and characterized by severe bacterial infections. The myelodysplastic syndromes(MDS) are a group of stem cell disorders characterized by a reduction in one or more elements of the peripheral blood. This paper reports a case of Kostmann syndrome and MDS with oral complications such as generalized gingivitis and periodontitis, oral mucosal ulcer, petechiae. The features of these syndromes are reviewed and their oral manifestations and significance to dental management outlined.

유전치 심미수복치료를 위한 임상적 고려

현홍근(Hong-Keun HYUN) 대한치과의사협회 2011 대한치과의사협회지 Vol.49 No.1

The esthetic demands are growing in treatment of primary maxillary incisors as well as permanent ones. There is something dissatisfying about in the keen eyes of the pediatric dentists on their esthetic results of efforts because current tooth color system is created for the purpose of the application to the permanent incisors. In this study using the scientific color measurement device, I would like to introduce a color scheme for the primary maxillary incisors and suggest clinical tips for the better results of resin composite restorations.

IMPACTION OF PRIMARY TEETH ASSOCIATED WITH ODONTOMA: CASE REPORTS

김정우,현홍근,김영재,김정욱,장기택,김종철,한세현,이상훈,Kim, Jung-Woo,Shin, Teo-Jeon,Hyun, Hong-Keun,Kim, Young-Jae,Kim, Jung-Wook,Jang, Ki-Taeg,Kim, Chong-Chul,Lee, Sang-Hoon Korean Academy of Pediatric Dentistry 2012 大韓小兒齒科學會誌 Vol.39 No.1

치아종은 유치나 영구치배의 지속적인 치배 형성이나 법랑기 세포들의 비정상적인 증식의 결과로 발생하는 방사선 불투과성 병소로, 비교적 흔한 치원성 종양이며 인접한 치아의 맹출을 방해 할 수 있다. 치아종은 영구치열기에서 주로 관찰되고, 유치열기에서는 매우 드문 것으로 보고되고 있다. 본 증례 보고에서는 치아종에 의해 매복된 유치가 치아종의 외과적 발거 후 자연 맹출된 증례들을 보고하고자 한다. 매복유치는 계승 영구치의 발육과 맹출 문제를 야기할 수 있기 때문에 치아종이 제거된 후에도 계승 영구치가 맹출할 때까지 장기적인 검사 및 관찰이 필요하다. Odontomas generally appear as small, solitary, or multiple radio-opaque lesions found on routine radiographic examinations. It is a comparatively common odontogenic tumor, and may lead to interfere with the eruption of its associated tooth. In general, odontomas occur more often in permanent dentition and are very rarely associated with primary teeth. This report deals with five rare cases of primary teeth impaction associated with odontomas, with spontaneous eruption occurring in all five cases after simple surgical removal of the odontoma. Impacted primary teeth may be associated with defects in development and eruption of their permanent successors, and thus long-term observation is necessary until the permanent successors erupt.

소아 치과진정법 시행 시 진정심도 감시를 위한 Cerebral State Monitor의 임상적 유용성

신터전,현홍근,김영재,김정욱,장기택,이상훈,김종철,서광석,Shin, Teo-Jeon,Hyun, Hong-Keun,Kim, Young-Jae,Kim, Jung-Wook,Jang, Ki-Taeg,Lee, Sang-Hoon,Kim, Chong-Chul,Seo, Kwang-Suk 대한치과마취과학회 2014 Journal of Dental Anesthesia and Pain Medicine Vol.14 No.1

Background: It is imperative that adequate sedation level should be maintained for safe and effective dental sedation. Cerebral state index (CSI) is a empirically derived parameter calculated from the processed electroencephalography (EEG). We investigated whether CSI can be used as a sedation depth indicator. Methods: We continuously recorded CSI and bispectral index (BIS) values from 10 healthy children aged 3.6 yr undergoing dental sedation. We also evaluated sedation level using the Modified Observer's Assessment of Alertness/Sedation (MOAA/S). The correlation between CSI and BIS, or CSI and sedation score were sought a regression analysis. Results: There were good linearity between CSI values and sedation score. (r = 0.916, P < 0.001) The paired CSI and BIS values showed a significant correlation between the two values. (r = 0.895, P < 0.001) The difference between CSI and BIS values was not statistically significant at deep and conscious sedative levels. Conclusions: The CSI monitor can be easy to monitor sedation depth during dental sedation for children.

마판 증후군 소아 환자의 전신마취 하 치과치료

김경진,박소연,현홍근,신터전,김정욱,Kim, Kyung Jin,Bak, Soyeon,Hyun, Hong-Keun,Shin, Teo-Jeon,Kim, Jung-Wook 대한치과마취과학회 2013 Journal of Dental Anesthesia and Pain Medicine Vol.13 No.4

Multiple caries in a pediatric patient often requires dental treatment under general anesthesia, especially when the patient is suffering from a systemic disease. The patient was a 6-year-old boy with Marfan syndrome and needed extensive dental treatment. Marfan syndrome is an inherited disorder resulting from mutations in Fibrillin-1 gene. Patients are known to have mainly cardiovascular, ocular, and musculoskeletal problems. Although clinical symptoms of the syndrome are age-realted, thus hindering early diagnosis of the disease in young children, our patient had been confirmed by a gene study at a younger age. Medical history of the patient revealed moderate to severe mitral regurgitation and aortic root dilatation, which required mitral valve replacement surgery with a mechanical valve. As a result, the patient was taking warfarin post-operatively and changes in medication had to be made before the dental treatment. Also, prophyalctic antibiotics had to be given before the treatment for prevention of (to prevent the) infective endocarditis. With careful control of the medications and bleeding tendency, general anesthesia and the treatment were done successfully without any complications.

장애 유형별 치과 검진 및 관리에 대한 비교연구

김동현(Dong-Hyun Kim),신터전(Teo-Jeon Shin),현홍근(Hong-Keun Hyun),김영재(Young-Jae Kim),김정욱(Jung-Wook Kim),이상훈(Sang-Hoon Lee),김종철(Chong-Chul Kim),장기택(Ki-Taeg Jang) Asia association of Disability and Oral health 2016 International Journal of Disability and Oral Healt Vol.12 No.2

Regular dental visit of disabled patients is an important strategy for maintenance of oral health because of the lack of awareness of oral care. But there is limited information about follow up period in disabled patients after dental treatment. The aim of this study was to investigate the pattern of dental visit and dental management of special care needs patients according to the types of disabilities. A total of 140 patients who received dental treatment at Seoul National University Dental Hospital from 2010 to 2012 were reviewed. Patients were divided 3 groups according to the types of disabilities (disorder of external physical function, disorder of internal organ, psychic disability). Patient’s characteristic, dental treatment performed, follow up period and frequency were investigated. The mean follow up period was 28.2 months and average frequency of visit was 3.69 times per year. There was no difference in period and annual visit between 3 groups, but significantly difference in cooperation with medical hospital in affiliation. Regular check-up was the most common dental treatment in all groups. In psychic disorder group, the proportion of sedative treatment was significantly higher than other groups. The results of this study provide information necessary for treatment planning and dental management of disabled patients.

Dental Treatment in a Patient with CINCA Syndrome under General Anesthesia

이지민,송지수,현홍근,김영재,김정욱,장기택,이상훈,신터전,Lee, Ji Min,Song, Ji-Soo,Hyun, Hong-Keun,Kim, Young-Jae,Kim, Jung-Wook,Jang, Ki-Taeg,Lee, Sang-Hoon,Shin, Teo Jeon Korean Academy of Pediatric Dentistry 2018 大韓小兒齒科學會誌 Vol.45 No.1

Chronic infantile neurological cutaneous articular (CINCA) 증후군은 만성 염증성 질환으로, 주기적으로 발열을 일으킨다. 이 증후군의 환아들은 전신적인 염증으로 인해 치과적 문제에 노출되기 쉽다. 협조가 어려운 환자에 있어서 전신마취는 행동 조절 방법으로 널리 사용되어 왔으며, CINCA 증후군의 경우 전신적인 염증성 질환이기 때문에 전신마취를 시행할 때 있어 주의를 기울어야 한다. 본 증례 보고에서는 CINCA 증후군을 가진 비협조적 환아를 전신마취 하 치과 치료 시행한 증례보고와 함께 이러한 환아들에서 치과치료 전 고려사항을 고찰하고자 한다. Chronic infantile neurological cutaneous articular (CINCA) syndrome periodically causes fever along with inflammation in multiple organs. Patients with this condition are vulnerable to dental problems due to systemic inflammation. For uncooperative patients, general anesthesia has been widely used to control negative behavior. However, caution should be exercised when administering general anesthesia in these patients because this syndrome is pro-inflammatory. The present case report describes the clinical considerations of the dental treatment of an uncooperative child with CINCA syndrome who was treated under general anesthesia.