LUDWIG's angina in patient with cushing's syndrome: report of a case

Ludwig's angina is a serous and potentially life threatening infectious disease involving all of the submental, submandibular, and sublingual space bilaterally. It is characterized by severe swelling and broad-like induration of the tissues in the submandibular region and elevation of the tongue and flood of mouth with partial immobilization of these structures. A common cause of Cushing's disease is an iatrogenic problem related to chronic administration of either ACTH or glucocorticoids. Patients who administrated glucocorticoids altered responese infection and wound healing. More important, many patients who are taking or have been taken glucocorticoids have risk of developing acute adrenal insuffciency (adrenal crisis) when place in stressful situation. The treatment of infections in Cushing's syndrome are reduction of number of microbes through the use of appropriated antimicrobial agents and proper surgical drainage and appropriated airway management and prorer steroids therapy that increased administration of glucocorticoids. In this paper, we report a rare case of Ludwig's angina with Cushing's syndrome. A 45-years old women was referred to our clinic in November 1996 for treatment of infetious disease. Clinical examination of this patient showed a painful swelling of submental space, elevation of tongue and difficulty of respiration or 'Moon Face', 'Bufallo hump', striae of abdomen and ecchymosis of extrmities. We treated through the quickly airway management using blind oroendotracheal intubation, antimicrobial injection of large quantity, increased adminstration of glucocorticoids and proper surgical drainage. And We aquired satisfactory result.

THE CLINICOSTATISTICAL STUDY OF FACIAL BONE FRACTURE IN RECENT FIVE YEARS

This study was aimed to furnish the data of facial bone fracture which was related regional and social environment and to aid diagnosis and treatment of the fracture. This is the retrospective and clinicostatical study on 625 patients with facial bone fracture. The patients were treated in the Dept. of Oral and Maxillofacial Surgery of Wonkwang University Hospital from Jan. 1, 1993 to Dec. 31, 1997. The result were as follows : The facial bone fractures occured most frequently in the twenties(32.3%) and male were predominent(77.4%) than female. The most frequent etiologic factor of facial bone fracture was fall down(42.8%) and midface fracture was traffic accident(63.4%). The most common site of fracture was symphysis(51.1%) and angle(29.7%), condyle(27.5%), ZMC(13.4%) were next in order of frequency. Of the 626 patients, 590 patients(89.5%) were treated with open reduction and only 36 patients(10.5%) were treated with closed reduction. In the blow, the ratio of angle fracture(50%) is especially high(the overall ratio 29.7%) and in the Out car TA, the ratio of ZMC fracture(34.6%) is especially high(the overall ratio 13.4%). In the fall-down, the ratio of symphysis(58.4%) and condyle fracture(33.6%) is especially high(the overall ratio 51.1%, 27.5%). Postoperatives complication were found in 35(5.6%) of 626 patients, in which mouth opening limitation(3%) was the most common. Above results suggest that early diagnosis and treatment of fracture site, systemic condition and associated injuries are nessary, and cooperative treatment with medical department should be performed.

MANDIBULAR RECONSTRUCTION WITH ALLOGENEIC MANDIBLE AND AUTOGENOUS ILIAC CNACELLOUS BONE

To repair bony defects with transplanted bone in the body, fresh autogenous bone is undoubtly. A retrospective study was made of a consecutive patient who underwent mandibular reconstruction with PMCB and allogeneic mandibular crib in November 1996. Free autogenous iliac bone in the form of particulate cancellous bone and marrow was densely packed into the allogenous mandibular crib that was adapted to bridge the mandibular discontinuity defect. Freeze dried allogenous mandibular bone was traded by Wonkwang bone bank. Freeze dried allogenous mandibular bone was used as allogeneic crib carrying the PMCB. This case was undergone successful healing with the formation of a continuous bony union with the remaining mandible. The rate of resorption was assessed by sequeal panoramic radiographs, that is, a day of postoperative period, 3 months of postoperative period, 6 months of postoperative period, 12 months of postoperative period. The mean horizontal dimension of the mandibular defect was 58mm and the mean vertical dimension of the reconstructed segments was 30mm. The bony height reconstructed segments retained about 78% of the bony height of a 1-year period. We estimated that autogenous PMCB grafts and allogenous crib grafts were the most successful and esthetic grafts in mandibular discontinuity reconstruction.