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뇌기저부 골절후 발생된 과도한 구인두 출혈의 구인두 전체 신속압박에 의한 응급지혈: 증례보고
모동엽,유재하,최병호,김하랑,이천의,유미현,Mo, Dong-Yub,Yoo, Jae-Ha,Choi, Byung-Ho,Kim, Ha-Rang,Lee, Chun-Ui,Ryu, Mi-Heon 대한악안면성형재건외과학회 2010 Maxillofacial Plastic Reconstructive Surgery Vol.32 No.2
Excessive oral and maxillofacial bleeding causes upper airway obstruction, bronchotracheal & gastric aspiration and hypovolemic shock. Therefore, the rapid & correct bleeding control is very important for life-saving in the medical emergency room. In spite of the bleeding control methods of the wound suture & direct pressure, the postoperative bleeding can be occurred, because of the presence of various bleeding disorders & postoperative delayed wound infections. The proper care of bleeding disorders & wound infections are very important for the control of the delayed postoperative rebleeding. In spite of these methods, active oral bleeding can be presented by the other causes of head injury. A rare but particularly dangerous sort of bleeding that may have an especial importance to the patient with severe basal skull fracture that damage large vessels and even the cavernous sinus. The occurrence of profuse nasal or oropharyngeal bleeding may arise from damage to the anterior and posterior ethmoidal vessels, but when mixed with brain tissue it is evidence of mortal damage. In this condition, rapid entire oropharyngeal packing is essential for the control of active oral bleeding. This is a case report of rapid rational bleeding control method by much amount of wet gauze packings, in a 44-years-old male patient with active oropharyngeal bleeding by basal skull fractures.
하악골 복합 골절시 구내 열창부 상에 추가 절개 배농술을 이용한 단기간 가변적 악간고정 관리: 증례보고
모동엽,유재하,최병호,김하랑,이천의,유미현,Mo, Dong-Yub,Yoo, Jae-Ha,Choi, Byung-Ho,Kim, Ha-Rang,Lee, Chun-Ui,Ryu, Mi-Heon 대한악안면성형재건외과학회 2010 Maxillofacial Plastic Reconstructive Surgery Vol.32 No.3
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.
국소마취하 상악 측절치 치근단 절제술 후 인식된 신경병성 비정형 치통 1예 -증례 보고-
모동엽,유재하,최병호,김하랑,이천의,김종배,Mo, Dong-Yub,Yoo, Jae-Ha,Choi, Byung-Ho,Kim, Ha-Rang,Lee, Chun-Ui,Kim, Jong-Bae 대한치과마취과학회 2010 Journal of Dental Anesthesia and Pain Medicine Vol.10 No.1
This type of neuropathic pain(atypical odontalgia) is seen most often in middle-aged women or men after dentoalveolar operation. Atypical odontalgia probably is caused by deafferentation leading to intraneural changes in the medullary dorsal horn. Treatment of this problem is difficult, but some success has been reported in uncontrolled, open-labeled studies using high doses of tricyclic antidepressants. This is the management report of a patient case, that had a neuropathic atypical odontalgia recognized with the right maxillary lateral incisor. The patient was consulted to the Department of Pain Clinics, ENT & Neurology and diagnosed the adenoid cystic carcinoma on left cerebellum and right paranasal sinus with extension to the cavernous sinus. In spite of the osteoplastic craniotomy, neurosurgical mass removal and radiation therapy were done with chemotherapy, atypical odontalgia was continued. In addition to the consultation to Psychology, stress management and antidepressant medication were done and improved slowly.
조기 치근관 배농술을 이용한 하악 골절선상 감염치아들의 보존적 관리:
모동엽(Dong-Yub Mo),유재하(Jae-Ha Yoo),최병호(Byung-Ho Choi),설성한(Sung-Han Sul),김하랑(Ha-Rang Kim),이천의(Chun-Ui Lee) 대한구강악안면외과학회 2010 대한구강악안면외과학회지 Vol.36 No.4
The management of teeth in the line of a mandibular fracture is controversial despite the general agreement that most of these teeth can be preserved. Teeth should be retained if bony attachments are adequate for survival, the tooth is sound and important in maintaining fixation of the fractured segment of bone. Teeth should be removed if they are loose and interfere with the reduction of fragments, are devitalized and potentially a source of wound infection, are damaged beyond their usefulness or may become devital and interfere with healing by becoming infected. However, tooth removal will increase the level of trauma, extend the severity of the wound and require expensive prosthetic treatment. Therefore, it is very important to conserve infected teeth in the line of a mandibular fracture through early primary endodontic treatment (pulp extirpation, canal enlargement and canal opening drainage) and splinting. The basic principles underlying the treatment of pulpless teeth are those underlying general surgery. Therefore, debridement of the infected wound(pulp extirpation and canal enlargement), drainage (canal opening) and gentle treatment of the tissues (occlusal reduction and teeth splinting) are the principles of surgery. This is a representative case report of conservative care by the early endodontic drainage of infected teeth in the line of a mandibular fracture.
중증 간경변증 환자에서 발치창 과도 출혈부의 지속적 배농술을 통한 지혈 :
모동엽(Dong-Yub Mo),유재하(Jae-Ha Yoo),최병호(Byung-Ho Choi),김하랑(Ha-Rang Kim),이천의(Chun-Ui Lee),유미현(Mi-Heon Ryu) 대한구강악안면외과학회 2009 대한구강악안면외과학회지 Vol.35 No.6
There are five principal causes for excessive bleeding in the immediate postextraction phase ; (1) Vascular wall alteration (wound infection, scurvy, chemicals, allergy) (2) Disorders of platelet function (genetic defect, drug-aspirin, autoimmune disease) (3) Thrombocytopenic purpuras (radiation, leukemia), (4) Inherited disorders of coagulation (hemophilia, Christmas disease, vitamin deficiency, anticoagulation drug-heparin, coumarin). If the hemorrhage from postextraction wound is unusually aggressive, and then dehydration and airway problem are occurred, the socket must be packed with gelatine sponge(Gelfoam) that was moistened with thrombin and wound closure & pressure dressing are applied. The thrombin clots fibrinogen to produce rapid hemostasis. Gelatine sponges moistened with thrombin provide effective coagulation of hemorrhage from small veins and capillaries. But, in dental alveoli, gelatine sponges may absorb oral microorganisms and cause alveolar osteitis (infection). This is a case report of bleeding control by continuous rubber strip & iodoform gauze drainage (without gelfoam packing) of active bleeding infection sites of three teeth extraction wounds in a 46-years-old female patient with advanced liver cirrhosis
다발성 경화증 노인환자에서 하악 전달마취 시행후 발생된 급성 요통치험 1예 -증례 보고-
이천의,모동엽,유재하,최병호,김종배,Lee, Chun-Ui,Mo, Dong-Yub,Yoo, Jae-Ha,Choi, Byung-Ho,Kim, Jong-Bae 대한치과마취과학회 2010 Journal of Dental Anesthesia and Pain Medicine Vol.10 No.2
Multiple sclerosis is a degenerative disease prevalent in northern climates, and its cause is unknown. The histopathological lesion in multiple sclerosis is the sclerotic "plague", a discrete focus of myelin loss with maintenance of axon segments and glial proliferation. The plaques may be seen in widely different brain and spinal tissues. The common causes of low back pain are psychosomatic disorder, myofascial pain dysfunction syndrome and herniation of nucleus pulposus. Local anesthetics cross the blood-brain barrier and the signs of CNS toxicity appear at a level between 4.5 and $7.0\;{\mu}g/ml$. This is a case report of acute back pain care after mandibular block anesthesia for the surgical extraction of mandibular root rests in an old aged woman with multiple sclerosis.
간경화증과 구강전이 간암환자에서 과도한 재발성 치은출혈과 치통조절: 증례보고
이천의,모동엽,유재하,최병호,김종배,Lee, Chun-Ui,Mo, Dong-Yub,Yoo, Jae-Ha,Choi, Byung-Ho,Kim, Jong-Bae 대한악안면성형재건외과학회 2010 Maxillofacial Plastic Reconstructive Surgery Vol.32 No.6
The common local causes of active gingival bleeding are the vessel engorgement and erosion by severe inflammation and injury to hypervascularity lesion. Abnormal gingival bleeding is also associated with systemic bleeding disorders (liver disease, leukemia etc.). There are many conventional methods for gingival bleeding control, such as, direct pressure, packing, electrocoagulation, tight suture and application of hemostatic agents. If the continuous gingival bleeding is not stopped in spite of the all local application methods, the medical consultation should be obtained for systemic condition care and the major feeding arterial embolization. This is a case report of severe gingival bleeding and periodontitis control in a patient with liver cirrhosis and oral metastatic lesion of hepatocellular carcinoma. The bleeding lesion was placed in left buccal mucosa and gingiva of the left mandibular molars. The control methods were dental crown removal, primary endodontic drainage, gingival sulcus drainage and maxillary arterial embolization with medical consultation.
Midazolam을 이용한 의식하진정법을 시행한 환자에서 나타난 선행성 및 후행성 기억상실
김영욱,금윤선,모동엽,이장렬,김현철,이상철,Kim, Yeong-Wook,Keum, Yoon-Seon,Mo, Dong-Yub,Lee, Jang-Yeol,Kim, Hyoun-Chull,Lee, Sang-Chul 대한치과마취과학회 2011 Journal of Dental Anesthesia and Pain Medicine Vol.11 No.2
Midazolam is known to produce sedation as well as amnesia. Many articles reported about anterograde amnesia, but it is rare that articles about retrograde amnesia. The 61-year-old female patient (64 kg, 154 cm, ASA physical status I) was administered 3.02 mg (0.047 mg/kg) of midazolam during 2 hours. The patient's Modified Observer's Assesment of Alertness/Sedation Scale was 4. The patient who had been consciously sedated with midazolam, exhibited profound amnesia, both anterograde and retrograde after implantation. The patient's memory restoration was begun after 6 hours.
장기간의 보존적 배농술로 치료된 하악 복합골절 관련 광범위 골수염 치험 : 증례보고
김하랑,유재하,최병호,설성한,모동엽,이천의,Kim, Ha-Rang,Yoo, Jae-Ha,Choi, Byung-Ho,Sul, Sung-Han,Mo, Dong-Yub,Lee, Chun-Ui 대한악안면성형재건외과학회 2009 Maxillofacial Plastic Reconstructive Surgery Vol.31 No.6
Failure to use effective methods of reduction, fixation and immobilization may lead to osteomyelitis with the exposed necrotic bone, as the overzealous use of transosseous wires & plates that devascularizes bone segments in the compound comminuted fractures of mandible. Once osteomyelitis secondary to fractures has become established, intermaxillary fixation should be instituted as early as possible. Fixation enhances patient comfort and hinders ingress of microorganisms and debris by movement of bone fragments. Teeth and foreign materials that are in the line of fracture should be removed and initial debridement performed at the earliest possible time. Grossly necrotic bone should be excised as early as possible ; no attempt should be made to create soft tissue flaps to achieve closure over exposed bone. The key to treatment of chronic osteomyelitis of the mandible is adequate and prolonged soft tissue drainage. If good soft tissue drainage is provided over a long period, sequestration of infected bone followed by regeneration or fibrous tissue replacement will occur so that appearance and function are not seriously altered. Localization and sequestration of infected mandible are far better performed by natural mechanism of homeostasis than by cutting across involved bone with a cosmetic or functional defect. As natural host defenses and conservative therapy begin to be effective, the process may become chronic, inflammation regresses, granulation tissue is formed, and new blood vessels cause lysis of bone, thus separating fragments of necrotic bone(sequestra) from viable bone. The sequestra may be isolated by a bed of granulation tissue, encased in a sheath of new bone(involucrum), and removed easily with pincettes. This is a case report of the long-term conservative drainage care in osteomyelitis associated with mandibular fractures.
설신경과 장협신경 전달마취 시행 후 발생된 설부와 협선반부의 장기간 이상감각증 관리 -증례보고-
김하랑,유재하,최병호,모동엽,이천의,김종배,Kim, Ha-Rang,Yoo, Jae-Ha,Choi, Byung-Ho,Mo, Dong-Yub,Lee, Chun-Ui,Kim, Jong-Bae 대한치과마취과학회 2009 Journal of Dental Anesthesia and Pain Medicine Vol.9 No.2
Trauma to any nerve may lead to persistent paresthesia. Trauma to the nerve sheath can be produced by the needle. The patient frequently reports the sensation of an electric shock throughout the distribution of the nerve involved. It is difficult for the type of needle used in dental practice to actually sever a nerve trunk or even its fibers. Trauma to the nerve produced by contact with the needle is all that is needed to produce paresthesia. Hemorrhage into or around the neural sheath is another cause. Bleeding increases pressure on the nerve, leading to paresthesia. Injection of local anesthetic solutions contaminated by alcohol or sterilizing solution near a nerve produces irritation; the resulting edema increases pressure in the region of the nerve, leading to paresthesia. Persistent paresthesia can lead to injury to adjacent tissues. Biting or thermal or chemical insult can occur without a patient's awareness, until the process has progressed to a serious degree. Most paresthesias resolve in approximately 8 weeks without treatment. In most situations paresthesia is only minimal, with the patient retaining most sensory function to the affected area. In these cases there is only a very slight possibility of self injury. But, the patient complaints the discomfort symptoms of paresthesia, such as causalgia, neuralgiaform pain and anesthesia dolorosa. Most paresthesias involve the lingual nerve, with the inferior alveolar nerve a close second. This is the report of a case, that had the persistent paresthesia care on left lingual & buccal shelf regions after the lingual and long buccal nerve block anesthesia.