A Study of Different Aspects of Blowout Fracture Between Preoperative CT and Intraoperative Images

PURPOSE: To analyze the morphologic differences in blowout fracture seen on preoperative CT images compared to intraoperative images. METHODS: The present study included 63 patients (63 eyes) with orbital fractures that were repaired by orbital reconstruction between January 2009 and April 2010. We assessed the medial, inferior, and inferomedial orbital fractures and excluded superior and lateral wall fractures. We captured intraoperative blowout fracture images using a camera or endoscope and compared the fracture type (fracture size, fracture surface) seen on intraoperative images with that observed on the preoperative CT images. RESULTS: The study consisted of patients between 20 and 50 years of age with a mean age of 27.76 years (men: 49 eyes, women: 14 eyes). The proportions of small fractures and medium fractures were similar on the preoperative CT images; however, large fractures were observed more frequently on the intraoperative images. The proportions of mono-fragment fractures and multi-fragment fractures were similar on the preoperative CT images, but multi-fragment fractures, especially inferior orbital fractures, were more frequent on the intraoperative images. Features of the trapdoor fracture differed most between images in terms of fracture size and surface. CONCLUSIONS: The morphology of blowout fractures, especially trapdoor fractures, differed between preoperative CT images and intraoperative images.

Oral cancer resection and reconstruction without blood transfusion by using recombinant human erythropoietin

Recently, the population of patients who refuse transfusion has increased for both religious and non-religious reasons, even in life threatening emergency situations. Their refusal has highlighted the need to develop nonblood transfusion surgery techniques to decrease the risk from blood transfusions. A 57-year woman with an ulcerative lesion on the gingiva of the right upper molar area visited the department of oral and maxillofacial surgery in Dankook University Dental Hospital. After a preliminary evaluation, the patient was diagnosed with squamous cell carcinoma. As she refused blood transfusion during surgery for religious reasons, surgery was planned using recombinant human erythropoietin (rHuEPO) without a blood transfusion. The patient underwent a partial maxillectomy, supraomohyoid neck dissection, free radial forearm flap and split thickness skin graft under general anesthesia. rHuEPO and iron were used before and after surgery. The hemoglobin/hematocrit (Hb/Hct) level, iron (Fe) and total iron-binding capacity (TIBC) were assessed. The patient recovered completely without any blood transfusions. rHuEPO is a viable alternative for patients with religious objections to receiving blood transfusions.

Clinical study of diagnosis and treatment of bisphosphonate-related osteonecrosis of the jaws

INTRODUCTION: Bisphosphonates is used widely for the treatment of the Paget's disease, multiple myeloma, bone metastases of malignant tumors with the prevention of pain and their pathological fracture. However, it was recently suggested that bisphosphonates related osteonecrosis of the jaw (BRONJ) is a side effect of bisphosphonate use. MATERIALS AND METHODS: Twenty-four individuals, who were referred to the Department of Oral and Maxillofacial surgery, Dankook University Dental Hospital, were selected from those who had exposed bone associated with bisphosphonates from January, 2005 to December, 2009 according to the criteria of American Association of Oral and Maxillofacial Surgeons (AAOMS) for BRONJ. The patients group consisted of 7 males and 17 females between the age of 46 to 78 years (average 61.8 years). Each patient had panoramic imaging, computed tomography (CT), whole body bone scanning performed for a diagnosis and biopsy sampling from the necrotizing tissue. C-terminal cross-linking telopeptide of type I collagen (CTX) level of patients who had undergone surgical intervention was measured 7 days before surgery. RESULTS: The main cause of bone exposure was post-extraction (15), chronic periodontitis (4), persistent irritation of the denture (3). Twenty people had undergone BRONJ treatment for two to eight months except for 4 people who had to maintain the bisphosphonates treatment to prevent a metastasis and bone trabecular pain with medical treatment. When the bisphosphonate treatment was suspended at least for 3 months and followed up according to the AAOMS protocols, the exposed necrotizing bones were found to be covered by soft tissue. CONCLUSION: Prevention therapy, interruption of bisphophonates for at least 3 months and cooperation with the physician for conservative treatment are the essential for treating BRONJ patient with high risk factors. The CTX level of BRONJ patients should be checked before undergoing surgical intervention. Surgical treatments should be delayed in the case of a CTX level <150 pg/mL.

Open reduction of mandibular fracture without maxillomandibular fixation: retrospective study

INTRODUCTION: Maxillomandibular fixation (MMF) is essential before surgery under general anesthesia in maxillofacial trauma patients. MMF is used basically to reconstruct the occlusion and occlusal stability to recover the facial shape and oral functions. The arch bar and wire is a traditional method for MMF, but it can not only bring pressure to the periodontal ligaments and teeth but also cause a penetrating injury to the surgeons. MATERIALS AND METHODS: In this study, 198 patients with an open reduction using a manual reduction without MMF from September 2005 to May 2010 in Dankook University Dental Hospital were subjected to a follow-up evaluation during the postoperative 4 months periods. This study evaluated the incidence of complications according to the condition of the patient (gender, age), the state of bony union of the fracture sites and a numeric rating scale evaluation for postoperative pain scoring. RESULTS: 1. The complications were classified into major and minor according to the seriousness, and the major complication rate was as low as 2.02%. Only 2 cases of re-operations (1.01%) were encountered. In the classification according to the fracture line, plate fracture was observed in both cases of mandibular symphysis fracture, and angle fractures and loosening of two screws were noted in the case of mandibular angle fracture. CONCLUSION: The use of MMF is not always necessary if a skilled assistant is provided to help manually reduce the fracture site. Compared to other studies of mandibular fracture surgery using MMF, the complication rate was similar using only manual reduction and the patients' discomfort was reduced without MMF.

Comparison of Secondary Surgical Methods in Congenital Nasolacrimal Duct Obstruction after Failed Primary Probing

PURPOSE: Evaluate the surgical results and clinical value of monocanalicular stenting (Monaka(R))(FCI Ophthalmics, Marshfield Hills, MA, U.S.A) and balloon catheter dacryoplasty (DCP) using PTCA balloon (Stormer(R)) for congenital nasolacrimal duct (NLD) obstruction in children. METHODS: The authors performed monocanalicular stenting (Monaka(R)) and balloon catheter (Stormer(R)) DCP as a secondary treatment of 25 children (27 lacrimal systems) over 12 months of age who had undergone ineffective probing treatment. The patients were followed up over 3 months and the postoperative outcome was assessed by fluorescein dye test. RESULTS: Nine of eleven children (nine of eleven lacrimal systems, 81.8%) and seven of nine children (seven of nine lacrimal systems, 77.7%) showed objective and subjective improvement, respectively. CONCLUSIONS: Monocanalicular stenting and balloon dacryoplasty are excellent secondary treatments for congenital nasolacrimal duct obstruction after initial probing and irrigation surgery have been failed. Balloon dacryoplasty is a new procedure in improve the life-quality and reduce the complications rather than monocanalicular stenting.

Clinical Effects of Phototherapeutic Keratectomy on Terminal Bullous Keratopathy

PURPOSE: Although the treatment of choice for bullous keratopathy is typically penetrating keratoplasty (PKP), not all patients are suited for this treatment. Thus, we evaluated the clinical effects of phototherapeutic keratectomy (PTK) on pain relief and on the improvement of photophobia and visual acuity in patients suffering from bullous keratopathy. METHODS: Twenty-three patients with bullous keratopathy who were awaiting PKP and suffering from ocular pain, photophobia, and cosmetic problems, were assessed. Twelve eyes were treated with PTK using the excimer laser (VISX STAR S3, Irvine, CA, U.S.A). Another 11 eyes were treated with eye drops or other conservative modalities. Statistically significant differences in pain relief, photophobia improvement, and cosmetic improvement between two groups were assessed by Fisher's exact test. RESULTS: Twelve eyes with bullous keratopathy underwent PTK. At post-operative 1 month, 83% of patients showed relief of pain, 75% of patients showed improvements in photophobia, and 58% of patients had increased visual acuity of one or more line. The overall satisfaction rate of PTK was 91%, but 67% of patients showed recurrence of corneal opacity and bullae formation at 6 months after the procedure. CONCLUSIONS: Phototherapeutic keratectomy (PTK) reduced pain and improved visual acuity slightly in patients with bullous keratopathy. This procedure could be considered a valuable alternative treatment modality while awaitng PKP.

Influencing factors for the results of ESWL for lower ureteral stone / 대한비뇨기과학회지

We had treated the 331 patients with lower ureter stone with EDAP-LT01 lithotriptor, Surveying 231 patients of them. whose retrospective study (or prospective) was possible, we have analyzed the factors that influenced on the treatment effect. So we got the following results. Most of stone size was ranged from 0.61 to 0.90 cm (38.6%). Stone clearance was achieved in 220 cases at 15 month and treatment failure was 11 cases (4.7%). Of the 220 patients, location of stone was more than 3.1 cm above ischial spine(IS) on KUB in 5 cases. Between 1.1-3.0 cm above it in 35 cases, +/-1. 0 cm of IS were 170 cases, and more than 1.1-3.0 cm below of it in 10 cases. There was no difference in the amount of total storage of shockwave in stone clearance according to location of stones, but high storage of shock wave required on cases of 3.1 cm above IS group. The 220 patients were grouped by in situ lower ureter stone at the time of the first visit to the hospital (158 cases), migration from upper stone (55 cases) and steinstrasse from upper tract stone (7 cases). The amount of shock wave consumption was 216.4, 301.2, 407.7 respectively, so initially lower ureter stone were treated with more effectiveness. Of the 220 cases, there were 184 cases of mild ureteral dilation, 34 cases of moderate ureteral dilation and 2 cases of severe ureteral dilation. The amount of shock wave consumption was 224, 295, 795 respectively. So treatment of these cases also showed significant difference (p=0.021). From these results, we concluded that effectiveness of ESWL against lower ureteral stone was related to the degree of ureteral dilatation, location of stone and situation of the stone migration within the ureter.