Cavernous sinus thrombosis progression from trismus

In the Department of Oral and Maxillofacial Surgery, patients with trismus can be easily identified. If the cause of trismus is infection of the masticatory space near the pterygoid plexus, the possibility of cavernous sinus thrombosis should be considered. We report the case of a patient who presented with limited mouth opening and progressed to cavernous sinus thrombosis, along with a review of the relevant literature.

Simultaneous surgery for subcondylar fracture and prominent angle of the mandible / 대한악안면성형재건외과학회지

We experienced a patient of subcondylar fracture who had a squared contour of the lower face with prominent angle of the mandible and masseter hypertrophy. Our patient was increasingly seeking esthetic improvement of the lower third of the face. But she did not want multi-stage operations. Thus, we decided and performed a one-stage mandibular angle ostectomy with fracture management. We have a stable and esthetic result simultaneously despite fractures of the fixation plates during follow-up period, so report a case.

A simple method of intraoperative intubation tube change

Nasotracheal intubation should be performed in patients with jaw fractures because maxillomandibular fixation is required. However, when there are concomitant fractures of the nose and facial bones, an intubation tube positioned at the nose makes it difficult to perform an intricate surgery. In order to overcome these problems, a variety of ways to change the position of the tube have been introduced. We describe a simple technique of switching the tube from a nasal to oral position, which was easily executed in a patient with concomitant nasal and mandibular fractures, accompanied by a literature review.

Comparison of resorbable plates and titanium plates for fixation stability of combined mandibular symphysis and angle fractures

OBJECTIVES: We compared resorbable plates with titanium plates for treatment of combined mandibular angle and symphyseal fractures. MATERIALS AND METHODS: Patients with mandibular angle and symphysis fractures were divided into two groups. The control (T) group received titanium plates while the experimental (R) group received resorbable plates. All procedures were carried out under general anesthesia using standard surgical techniques. We compared the frequency of wound dehiscence, development of infection, malocclusion, malunion, screw breakage, and any other technical difficulties between the two groups. RESULTS: Thirteen patients were included in the R group, where 39 resorbable plates were applied. The T group consisted of 16 patients who received 48 titanium plates. The mean age in the R and T groups was 28.29 and 24.23 years, respectively. Primary healing of the fractured mandible was obtained in all patients in both groups. Postoperative complications were minor and transient. Moreover, there were no significant differences in the rates of various complications between the two groups. Breakage of 3 screws during the perioperative period was seen in the R group, while no screws or plates were broken in the T group. CONCLUSION: Resorbable plates can be used to stabilize combined mandibular angle and symphysis fractures.

Outcomes of open versus closed treatment in the management of mandibular subcondylar fractures

OBJECTIVES: To compare the clinical and radiological outcomes after closed reduction (CR) and open reduction and internal fixation (ORIF) in the management of subcondylar fractures. MATERIALS AND METHODS: Forty-eight patients presenting with subcondylar fracture between January 2010 and March 2013 were evaluated retrospectively. Fifteen patients were treated with CR and 33 patients with ORIF. The clinical and radiologic parameters were evaluated during follow-up (mean, 7.06 months; range, 3 to 36 months). RESULTS: In the CR group, no patients had any problems with regard to the clinical parameters. The average period of maxillomandibular fixation (MMF) was 5.47 days. The preoperative average tangential angulation of the fractured fragment was 3.67degrees, and loss of ramus height was 2.44 mm. In the ORIF group, no clinical problems were observed, and the average period of MMF was 6.33 days. The preoperative average tangential angulation of the subcondylar fragment was 8.66degrees, and loss of ramus height was 3.61 mm. CONCLUSION: CR provided satisfactory clinical results, though ORIF provided more accurate reduction of the fractured fragment. So there is no distinct displacement of fractured fragment, CR should be selected than ORIF because of no need for surgery.

Displacement of dental implants into the focal osteoporotic bone marrow defect: a report of three cases

Focal osteoporotic bone marrow defect (FOBMD) is a radiolucent area corresponding to the presence of hematopoietic tissue rarely found in the jaws. FOBMD is most commonly located in the mandibular edentulous posterior area of a middle-aged female. From November 2011 to November 2012, we experienced three cases involving removal of implants that had accidentally fallen into the FOBMD area. All patients happened to be female, with a mean age of 54 years (range: 51-60 years). One case involved hypoesthesia of the lower lip and chin, while two cases healed without any complication. Displacement of an implant into the FOBMD area is an unusual event, which occurs rarely during placement of a dental fixture. The purpose of this study was to report on three cases of FOBMD and to provide a review of related literature.

Healing patterns of the acellular dermal matrix depend on graft method in the rabbit ears

Usefulness of acellular dermal matrix graft on the tissue regeneration in rabbits

PURPOSE: The present study was aimed to examine the effect of acellular dermal matrix (AlloDerm(R)) grafted to the experimental tissue defect on tissue regeneration. MATERIALS AND METHODS: Male albino rabbits were used. Soft tissue defects were prepared in the external abdominal oblique muscle. The animals were then divided into 3 groups by the graft material used: no graft, autogenous dermis graft, and AlloDerm(R) graft. The healing sites were histologically examined at weeks 4 and 8 after the graft. In another series, critical sized defects with 8-mm diameter were prepared in the right and left iliac bones. The animals were then divided into 5 groups: no graft, grafted with autogenous iliac bone, AlloDerm(R) graft, AlloDerm(R) graft impregnated with rhBMP-2, and AlloDerm(R) graft with rhTGF-beta(1). The healing sites of bone defect were investigated with radiologic densitometry and histological evaluation at weeks 4 and 8 after the graft. RESULTS: In the soft tissue defect, normal healing was seen in the group of no graft. Inflammatory cells and foreign body reactions were observed in the group of autogenous dermis graft, and the migration of fibroblasts and the formation of vessels into the collagen fibers were observed in the group of AlloDerm(R) graft. In the bone defect, the site of bone defect was healed by fibrous tissues in the group of no graft. The marked radiopacity and good regeneration were seen in the group of autogenous bone graft. There remained the traces of AlloDerm(R) with no satisfactory results in the group of AlloDerm(R) graft. In the groups of the AlloDerm(R) graft with rhBMP-2 or rhTGF-beta(1), there were numerous osteoblasts in the boundary of the adjacent bone which was closely approximated to the AlloDerm(R) with regeneration features. However, the fibrous capsule also remained as in the group of AlloDerm(R) graft, which separated the AlloDerm(R) and the adjacent bone. CONCLUSIONS: These results suggest that AlloDerm(R) can be useful to substitute the autogenous dermis in the soft tissue defect. However, it may not be useful as a bone graft material or a carrier, since the bone defect was not completely healed by the bony tissue, regardless of the presence of osteogenic factors like rhBMP-2 or rhTGF-beta(1).

A recent 5-year retrospective study on nasal bone fracture

PURPOSE: This study was performed to investigate the incidence, types of fracture, treatment, associated fracture and complications in patients with nasal bone fracture. MATERIALS AND METHODS: Clinical examination, patient's records and radiographic images were evaluated in 230 cases of nasal bone fractures who were treated at the Department of Oral and Maxillofacial Surgery, Chonnam National University Hospital for recent 5 years; from January 2002 to December 2006. RESULTS: 1. The age of patient was ranged from 4 to 77 years (mean age=36.6 years); Males was 75.7% (n=174), and females 24.3% (n=56). 2. The cause of the nasal bone fracture in this study was a fall or slip down (28.8% , n=66), sports accident (26.0% , n=60), fighting (21.3% , n=49), traffic accident (9.6% , n=22), industrial trauma (7.8% , n=18), and the others (6.6% , n=15). 3. For the patterns of fracture, simple fracture without displacement occured in 10.4% (n=24). Simple fracture with displacement without septal bone fracture was found in 49.5% (n=114). Simple fracture with displacement in company with septal bone fracture showed in 32.6% (n=75). Comminuted fracture with severe depression was presented in 7.4% (n=17). 4. The reduction the displaced nasal bone was carried out in 2 to 10 days (mean 6.8 days) after the injury. 5. Nasal bone fracure associated with Le Fort I fracture (6.5% , n=6.5), Le Fort II fracture (7.4% , n=17), Le Fort III fracture (1.3% , n=3), NOE fracture (13.9% , n=32), ZMC fracture (17.4% , 40), maxillary bone fracture (8.3% , n=19), orbital blow-out fracture (15.7% , n=36), frontal bone fracture (1.3% , n=3) and alveolar bone fracture (10.9% , n=25). 6. The major type of treatment method was closed reduction in 90% (n=207), open reduction in 3% (n=7), and observation in 7% (n=16). 7. There were some complications such as ecchymosis, hyposmia, hypo esthesia and residual nasal deformity which are compatible. Open rhinoplasty was conducted for 3 patients who had residual nasal deformity. CONCLUSIONS: These results suggest that most of nasal bone fractures are occurred physically active aged groups(age 10-49 years) and could be treated successfully with closed reduction at 7 days after the injury.

Usefulness of acellular dermal matrix graft on the tissue regeneration in rabbits

PURPOSE: The present study was aimed to examine the effect of acellular dermal matrix (AlloDerm(R)) grafted to the experimental tissue defect on tissue regeneration. MATERIALS AND METHODS: Male albino rabbits were used. Soft tissue defects were prepared in the external abdominal oblique muscle. The animals were then divided into 3 groups by the graft material used: no graft, autogenous dermis graft, and AlloDerm(R) graft. The healing sites were histologically examined at weeks 4 and 8 after the graft. In another series, critical sized defects with 8-mm diameter were prepared in the right and left iliac bones. The animals were then divided into 5 groups: no graft, grafted with autogenous iliac bone, AlloDerm(R) graft, AlloDerm(R) graft impregnated with rhBMP-2, and AlloDerm(R) graft with rhTGF-beta(1). The healing sites of bone defect were investigated with radiologic densitometry and histological evaluation at weeks 4 and 8 after the graft. RESULTS: In the soft tissue defect, normal healing was seen in the group of no graft. Inflammatory cells and foreign body reactions were observed in the group of autogenous dermis graft, and the migration of fibroblasts and the formation of vessels into the collagen fibers were observed in the group of AlloDerm(R) graft. In the bone defect, the site of bone defect was healed by fibrous tissues in the group of no graft. The marked radiopacity and good regeneration were seen in the group of autogenous bone graft. There remained the traces of AlloDerm(R) with no satisfactory results in the group of AlloDerm(R) graft. In the groups of the AlloDerm(R) graft with rhBMP-2 or rhTGF-beta(1), there were numerous osteoblasts in the boundary of the adjacent bone which was closely approximated to the AlloDerm(R) with regeneration features. However, the fibrous capsule also remained as in the group of AlloDerm(R) graft, which separated the AlloDerm(R) and the adjacent bone. CONCLUSIONS: These results suggest that AlloDerm(R) can be useful to substitute the autogenous dermis in the soft tissue defect. However, it may not be useful as a bone graft material or a carrier, since the bone defect was not completely healed by the bony tissue, regardless of the presence of osteogenic factors like rhBMP-2 or rhTGF-beta(1).

A recent 5-year retrospective study on nasal bone fracture

PURPOSE: This study was performed to investigate the incidence, types of fracture, treatment, associated fracture and complications in patients with nasal bone fracture. MATERIALS AND METHODS: Clinical examination, patient's records and radiographic images were evaluated in 230 cases of nasal bone fractures who were treated at the Department of Oral and Maxillofacial Surgery, Chonnam National University Hospital for recent 5 years; from January 2002 to December 2006. RESULTS: 1. The age of patient was ranged from 4 to 77 years (mean age=36.6 years); Males was 75.7% (n=174), and females 24.3% (n=56). 2. The cause of the nasal bone fracture in this study was a fall or slip down (28.8% , n=66), sports accident (26.0% , n=60), fighting (21.3% , n=49), traffic accident (9.6% , n=22), industrial trauma (7.8% , n=18), and the others (6.6% , n=15). 3. For the patterns of fracture, simple fracture without displacement occured in 10.4% (n=24). Simple fracture with displacement without septal bone fracture was found in 49.5% (n=114). Simple fracture with displacement in company with septal bone fracture showed in 32.6% (n=75). Comminuted fracture with severe depression was presented in 7.4% (n=17). 4. The reduction the displaced nasal bone was carried out in 2 to 10 days (mean 6.8 days) after the injury. 5. Nasal bone fracure associated with Le Fort I fracture (6.5% , n=6.5), Le Fort II fracture (7.4% , n=17), Le Fort III fracture (1.3% , n=3), NOE fracture (13.9% , n=32), ZMC fracture (17.4% , 40), maxillary bone fracture (8.3% , n=19), orbital blow-out fracture (15.7% , n=36), frontal bone fracture (1.3% , n=3) and alveolar bone fracture (10.9% , n=25). 6. The major type of treatment method was closed reduction in 90% (n=207), open reduction in 3% (n=7), and observation in 7% (n=16). 7. There were some complications such as ecchymosis, hyposmia, hypo esthesia and residual nasal deformity which are compatible. Open rhinoplasty was conducted for 3 patients who had residual nasal deformity. CONCLUSIONS: These results suggest that most of nasal bone fractures are occurred physically active aged groups(age 10-49 years) and could be treated successfully with closed reduction at 7 days after the injury.

A retrospective clinical study of condylar fractures of the mandible in a 4-year period

The present study was performed to evaluate the function of the mandible according to the pattern of fracture and treatment methods of condylar fractures of the mandible and help operators in making a treatment plan. Sixty patients (average follow-up period was 7.8+/-9.4 months) who were treated for condylar fracture from June, 2002 to May, 2006 at the Department of Oral and Maxillofacial surgery, Chonnam National University Hospital were reviewed. The common causes of the condylar fracture were traffic accident and fall-down (35.0%). In concomitant injuries, laceration was 46.7% and the fracture of the mandibular symphysis was highest incidence (60.0%). The common site of the fracture was the condylar head (47.8%), followed by subcondyle (36.2%) and condylar neck (15.9%). Under 15 years old patients, the closed reduction was performed in 87.5% out of the patients. All of the condylar fragments were fixed to the mandible with titanium miniplates in cases of open reduction. The mean period of intermaxillary fixation (IMF) was 14.2+/-6.5 days in closed reduction and 10.0+/-4.2 days in open reduction. The old patient with bilateral condylar head fractures, who were treated by closed reduction with IMF for 3 weeks, showed the limitation of mandibular movements. But, there was no significant different results between open reduction and closed reduction with the respect of the Helkimo's mandibular mobility index and clinical dysfunction index (DI). Complications, such as fibrous ankylosis and resorption of the mandibular condyle, were not observed in all patients. These results suggest that the good results can be obtained by closed reduction with proper IMF periods and functional exercise in most condylar fractures of the mandible except severely displaced extracapsular fractures.

An experimental study and case analysis of acellular dermal matrix implantation for restoration of soft tissue defects

Surgical treatment of large cyst on the mandible by using saggital split ramus osteotomy

Clinical study of ameloblastoma on the jaw

Ameloblastoma, a benign tumor of odontogenic type, represents 10% of all tumors of the jaw. It is localized in the mandible (80%) and in the maxilla(20%). In every case, the selection of the surgical treatment must consider some fundamental elements, including the age and general state of health the clinicopathological variant, and the localization and extent of the tumor. This study was invested the clinicopathological findings of 23 patients with ameloblastoma which had been diagnosed by biopsy during the period of 1987 to 2005 at Chonnam National University Hospital. And it contained the statistical analysis according to the treatment methods and the clinicopathological findings such as sex, age, location, chief complaints, duration, radiographic findings, histologic findings, treatment methods. The results obtained are were follows. The age of patient ranged from 10 to 91 years(means, 35.9 years) at biopsy. Thirteen(57%) of the 23 subjects were males, and 10(43%) were females. Twenty(87%) of the 23 ameloblastomas were located in the mandible. Swelling was the most common symptom and was experienced by 20(87%) patients. Radiographically, 11(48%) of the 23 tumors were unilocular with a well-demarcated border and 12(52%) were multilocular. The most common histologic pattern was plexiform and acanthomatous rather then follicular. Conservative treatment was performed 7 cases(30%), radical treatment 11 cases(48%), and combined treatment 5 cases(22%). Follow-up period ranged from 2.1 years to 22 years(mean 5.1 years). Based on the above results, surgical excision after marsupialization was found to be useful as a preliminary treatment of the large cystic ameloblastoma in children and adolescents. On the contrary, the lesion with a soap bubble appearance, the one with ineffective marsupialization was subjected to extensive excision of the tumor with a wide margin of normal bone.

Radix augmentation using temporalis fascia graft

Correction of Caudal Septal Deformity via Open Approach / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Caudal septal deformities are surgically challenging disorders. A number of corrective programs have been described with variable success. Causes of frequent failure in correction of the caudal deformities have been conservatism and unrealistic dependence on incisional method such as cross hatching, and limited comprehension of the extrinsic and intrinsic forces causing caudal deformities. We reviewed and evaluated the surgical techniques for correction of the caudal septal deformities performed at our institution. SUBJECTS AND METHOD: A retrospective study was performed on 24 patients who underwent septal surgeries for severe caudal septal deformities between Feb 2001 to May 2004. With open approach, all deforming forces around the caudal septum were released and definite intraoperative correction was possible. RESULTS: All 24 patients showed definite improvement in terms of functional and anesthetic outcomes. Potential complications related with structural instability as well as other inherent complications of nasal surgery have not been encountered. CONCLUSION: For successful correction of the caudal septal deformities, completed exposure and releasing all the extrinsic forces around the caudal deformities via open rhinoplasty approach is desirable to avoid frequent recurrences.

A Case of MALT Lymphoma Showing Mikulicz Syndrome / 대한이비인후과학회지

Since Mikulicz's description of symptomless hypertrophy of the salivary gland and lacrimal gland, the term, Mikulicz syndrome, has been used to describe enlargement of the salivary gland with or without lacrimal gland involvement occurring in leukemia, lymphosarcoma, sarcoidosis, tuberculosis syphilis, etc. However, there are still a tremendous amount of confusion in the application of the term, Mikulicz syndrome. In Korea, there has been no reported case of Mikulicz syndrome to date. Internationally, it is also extremely rare to spot a reported case of the disease originating primarily from submandibular glands. We would like to report a case in which a 56 year old female patient was reported to have the disease ; she was diagnosed initially as benign lymphoepithelial lesion (BLL) by submandibular biopsy, but later confirmed by lacrimal gland biopsy to have mucosa associated lymphoid tissue (MALT).