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구강악안면 손상 후 과도한 출혈을 보인 정신지체 응급환자에서 신속지혈 예:
모동엽,유재하,최병호,설성한,김하랑,이천의 대한구강악안면외과학회 2010 대한구강악안면외과학회지 Vol.36 No.4
Excessive oral and maxillofacial bleeding causes upper airway obstruction, bronchotracheal and gastric aspiration and hypovolemic shock. Therefore, the rapid and correct bleeding control is very important for saving lives in the emergency room. Despite the conventional bleeding control methods of wiring (jaw fracture, wound suture and direct pressure), continuous bleeding can occur due to the presence of various bleeding disorders. There are five main causes for excessive bleeding disorders in the clinical phase; (1) vascular wall alteration (infection, scurvy etc.), (2) disorders of platelet function (3) thrombocytopenic purpura (4) inherited disorders of coagulation, and (5) acquired disorders of coagulation (liver disease, anticoagulant drug etc.). In particular, infections can alter the structure and function of the vascular wall to a point at which the patient may have a clinical bleeding problem due to vessel engorgement and erosion. Wound infection is a frequent cause of postoperative active bleeding. To prevent postoperative bleeding, early infection control using a wound suture with proper drainage establishment is very important, particularly in the active bleeding sites in a contaminated emergency room. This is a case report of a rational bleeding control method by rapid wiring, wound suture with drainage of a rubber strip & iodoform gauze and wet gauze packing, in a 26-year-old male cerebral palsy patient with active oral and maxillofacial bleeding injuries caused by a traffic accident.
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.
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
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.
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.