Application of Monitored Anesthesia Care Using Dexmedetomidine to Common Oral and Maxillofacial Trauma Cases

Oral and maxillofacial surgery (OMFS) trauma cases are commonly treated under general anesthesia. The purpose of this case report is to introduce an alternative method of anesthesia in patients who refuse general anesthesia. A combination of dexmedetomidine and ketamine for sedation anesthesia in 3 frequent fracture types in the field of OMFS—Le Fort I fracture, mandibular fracture, and alveolar bone fracture—was used. Dexmedetomidine as the single agent has not shown stable success rates for invasive procedures. To overcome some of the pitfalls with dexmedetomidine, combination sedation using ketamine was performed. Visual analogue scale scores were recorded postoperatively. Dexmedetomidine combined with ketamine administration provided safe and effective sedation and anxiolysis for surgical reduction and internal fixation of OMFS fractures. It showed advantages of decreased admission time, reduced expenses, minimal pain, and reduced anesthetic burden for the patient thus ultimately increasing overall satisfaction.

Comparison of Choroidal Thickness in Patients with Diabetes by Spectral-domain Optical Coherence Tomography

PURPOSE: To evaluate choroidal thickness in diabetes patients using spectral-domain optical coherence tomography. METHODS: We examined 203 eyes of 203 diabetic participants and 48 eyes of 48 healthy controls. The choroidal thickness at the foveal lesion was measured by enhanced-depth imaging optical coherence tomography. The participants were grouped according to diabetic retinopathy grade: no diabetic change, mild-to-moderate or severe non-proliferative, or proliferative diabetic retinopathy. The study parameters included history, age, axial length, intraocular pressure, central retinal thickness, fasting glucose, and blood pressure. RESULTS: The subfoveal choroidal thickness was thinner in eyes with non-proliferative or proliferative diabetic retinopathy than in normal eyes (p < 0.01). However, there was no difference between eyes with non-proliferative and proliferative diabetic retinopathy or between eyes with no diabetic change and the controls. Eyes exhibiting macular edema showed no significant difference in choroidal thickness compared with eyes having normal macular contours. CONCLUSIONS: The central choroid is thinner when eyes show diabetic changes on the retina. However, the presence of diabetic macular edema or proliferative change is not associated with more pronounced choroidal thinning.

The Effect of Intravitreal Bevacizumab in Patients with Acute Central Serous Chorioretinopathy

PURPOSE: To evaluate the effect of intravitreal bevacizumab injection (IVBI) in acute central serous chorioretinopathy (CSC) patients. METHODS: Patients with acute CSC received IVBI (1.25 mg/0.05 mL) or observation by randomization. Twelve eyes in each group completed 6 months of regular follow-up and were ultimately included in this study. Each patient was assessed using best corrected visual acuity measurements, fluorescein angiography, and optical coherence tomography at baseline and had regular follow-ups after treatment. RESULTS: All patients showed improvements in visual acuity and fluorescein angiographic leakage and had resolution of their neurosensory detachment following treatment. There were no significant differences in visual acuity, central retinal thickness, or remission duration between the IVBI group and the control group at baseline or after treatment (p>0.05). CONCLUSIONS: Intravitreal bevacizumab showed no positive effect in acute CSC patients compared to the observation group, and there were no adverse effects of treatment. Further investigation will be helpful to understand this therapy in patients with CSC.

Two Cases of Klebsiella Pneumoniae Endogenous Endophthalmitis Treated with Sulperazone

PURPOSE: To report and review 2 cases of Klebsiella Pneumoniae endogenous endophthalmitis showing multi drug resistance that were treated with sulperazone. METHODS: Sulperazone was administered to two patients with Klebsiella Pneumoniae endogenous endophthalmitis: a 51-year-old male with orbital cellulitis who showed no response to vancomycin, ceftazidime, and amikacin for 6days; and a 67-year-old female who showed no response to cefotaxime, and amikacin. RESULTS: Proptosis and inflammation began to improve after changing to sulperazone. Therefore, enucleation and debridement could be avoided. CONCLUSIONS: Good results were obtained by use of Sulperazone which inactivates beta-lactamase irreversibly and which showed bactericidal effect to multi drug resistant Klebsiella Pneumoniae endogenous endophthalmitis.

A Clinical Study of Serous Retinal Detachment in Pregnancy-induced Hypertension

PURPOSE: This study was designed to determine the clinical progression of serous retinal detachment(RD) due to hypertensive choroidopathy in toxemia of pregnancy. METHODS: We diagnosed 437 preeclampsia and eclampsia patients in 9, 689 consecutive deliveries at the Chunchon Sacred Heart Hospital from January 1996 to December 2000, and found 35 cases of serous RD among them. We retrospectively studied the incidence, clinical characteristics of the patients, location, and shape of retinal pigment epithelium (RPE) lesions. RESULTS: Among the 9, 689 pregnant women, there were 429 cases (4.4%) of preeclampsia and 8 (0.08%) of eclampsia. Serous RD occurred in 32 cases of preeclampsia (7.5%), and 3 of eclampsia (38%). In the preeclampsia cases, there were 26 cases (81%) of severe type, and 6 (19%) of mild type. The mean age of serous RD patients was 29.53yrs. Twenty-two cases (63%) in the 35 cases of serous RD were primipara patients, and 13 (37%) were multipara. Twenty-two cases (63%) in 35 the serous RD patients featured binocular involvement. Reattachment of retina was attained in all cases of serous RD, with a mean recovery interval of 18 days. CONCLUSIONS: Serous retinal detachment induced by toxemia of pregnancy can occur in mild preeclampsia patients. Reattachment of retina was attained in all serous RD cases. These study results will provide assurance for the treatment of serous retinal detachment patients.

A Case of Kimura's Disease of the Eyelid

PURPOSE: Kimura's disease is an uncommon, chronic inflammatory disorder of unknown etiology which occurs predominantly in Orientals and presents with tumor-like swellings mainly in the head and neck region. Orbital and ocular adnexal cases are rare. We report a case of Kimura's disease of the eyelid. METHODS: A 52-year-old male presented with a 10-year history of intermittently recurrent swelling and a painless mass of the left upper eyelid. The mass was resected and biopsied for histological examination. RESULTS: The case was diagnosed with Kimura's disease by the clinical and histopathologic findings.

Effect of Botulinum Toxin Type a Chemodenervation in Esotropia

PURPOSE: To investigate the efficacy of botulinum toxin type A chemodenervation in various types of esotropia(ET). METHODS: Enrolled eleven esotropic patients treated with botulinum toxin type A and examined the amount of esotropic correction and success rate of less than 10 PD (prism diopter) of postinjection deviation at 5 months after injection. RESULTS: Among the eleven esotropic patients, there were 7 cases of infantile ET, 2 cases of partially accommodative ET and 2 cases of basic ET. The mean preinjection deviation was 30.5 +/- 7.3 PD. The amount of correction was 17.7 +/- 4.3 PD and correction rate of deviation was 57.5%. In 6 of 11 cases, the postinjection deviation was within 10 PD and therefore success rate was 54.5%. In 5 patients (45.5%), their ET was undercorrected. In patients with under 20 PD of preinjection deviation, success rate was 75% (3/4) and those with over 20PD, the rate was 42.9% (3/7). In partially accommodative ET, 2 (100%) of 2 cases were aligned within 10PD. CONCLUSIONS: In comitant ET, botulinum toxin chemodenervation shows high undercorrection rate. The effects of botulinum toxin type A chemodenervation were better for relatively small angle and in partially accommodative ET than nonaccommodative one. But further study with more cases is needed.

Amniotic Membrane Transplantation in the Management of Shield Ulcers of Vernal Keratoconjunctivitis

PURPOSE: Human amniotic membrane has been used to variable ocular surface disorder. We report a case of the usefulness of amniotic membrane transplantation (AMT) for vernal keratoconjunctivitis "Shield ulcer". METHODS: A 12-year-old male patient was diagnosed to have vernal keratoconjunctivitis "Shield ulcer" and treated with medical therapy for four weeks. But he showed severe itiching, foreign body sensation, decreased visual acuity and continued to corneoconjunctival lesion and then, Amniotic membrane transplantation with stromal side down was performed after debridement of the ulcer bed and therapeutic contact lens was applied. RESULTS: At tenth day after AMT, ulcer size was decreased and corneal state was generally improved with restoration of visual acuity. One month after, he has been comfortable with improved visual acuity, giant papillae of upper tarsal conjunctiva was nearly complete remission. CONCLUSIONS: AMT is an effective method for managing vernal keratoconjunctivitis "Shield ulcer", that are refractory to conventional medical treatment.

A study of the effects of several bone-enhancing agents

Several agents are in use to promote new bone formation during bone graft procedures in maxillofacial region. Among them, we have used crude BMP, PRP, and P-15 for experimentally created defects with accompanying graft materials in the rabbit model. The aim of this study is to analyze the effect of above mentioned agents on bone formation using histologic and histomorphometrical methods, thus to provide experimental support for clinical application of these agents. Six rabbits were used as experimental animals. Four surgical defects were created on the distal femoral heads of each animal using trephine drill. The defects were filled with each agents with accompaning graft materials as experimental groups and particulate cortico- cancellous autogenous graft as control. For histomorphometric analysis, fluorescent dye was injected at 2week and 1week before sacrifice. Then, the animals were sacrificed at 2, 4 and 8weeks after surgery and histologic and histomorphometric examinations were achieved. At two weeks after bone graft, bone formation and active remodeling process were examined in all experimental groups and the control. But the intensity of such activities of the experiments were somewhat weaker than that of the control. In BMP group, the amount of newly formed osteoid was increased constantly and the amount was preserved constantly in PRP group. But in P-15 group, the amount of newly formed osteoid was decreased with time to 8week after surgery. Histologic findings showed superior bony quantity and quality in PRP group than that of P-15 group. MAR(Mineralization Apposition Rate) of all experimental groups were slower than that of control group. In P-15 group, constant foreign body reaction was observed at all periods and the graft material showed inwardly destroyed characteristics rather to mature. The data from this study provide the basis for future studies for evaluating the long-term remodeling process and foreign body reactions observed in P-15 group and clinical study for predictable use of these agents.

A Case of Pneumocephalus Following Facial Trauma Pneumocephalus

PURPOSE: To describe a patient who developed left subconjunctival air and pneumocephalus without definite finding of skull fracture after facial trauma. METHODS: A 16-year-old man developed headache, upper eyelid swelling and decreased visual acuity after facial trauma. Ophthalmic examinations revealed left subconjunctival hemorrhage, air and corneal abrasion. Computed tomography and simple X-ray showed huge orbital emphsema. It extends into the left posterior sclera, around the optic nerve and optic canal. Diagnosis of pneumocephalus of basal cistern with no bony fracture of face, orbits and skull was made. RESULTS: In clinical practice, physician should be kept in mind that the possibility of pneumocephalus resulted from orbital or subconjunctival emphysema through optic nerve sheath in case of no definite evidence of basal skull fractures.

The Change in Deviation Angle with Time Course after Surgical Correction of Intermittent Exotropia

PURPOSE: To evaluate the amount and pattern of change in deviation angle with time course after surgical correction of intermittent exotropia and to evaluate the effect of pre-operative deviation and operation age on post-operative deviation change. METHODS: 54 patients who followed more than 60 months (60~120 months, mean 71.7 months) after surgical correction of intermittent exotropia were selected. We defined 'satisfactory results' that alignment of orthotropia, under 10delta esotropia and under 10delta exotropia. RESULTS: Of 54 patients, satisfactory results obtained in 96.2%(52 patients), immediate post-operation day and decreas with time course to 35.1% (19 patients) at post-operative 5 years. To quantification of change of deviation, author defined exotropic drift as +, esotropic drift as -, and no change as 0. The change of deviation between immediate post-operation and 2 years after operation is +14.55delta, between 2 years after and 5 years is +2.70delta. The change of deviation developed between immediate post-operation and 2 years after operation has statistical significance in comparison with change of deviation developed between after 2 years and 5 years after operation (P=0.0001). Pre-operative deviation has no effect on post-operative deviation change (P=0.4472) and operation age was same (P=0.3461). CONCLUSIONS: The results of surgical correction of intermittent exotropia is significantly deteriorated with time course. Exotropic drift was more pronounced between immediate post-operation and 2 years after operation and then decreased. Therefore we recommend that after surgery of intermittent exotropia patients should be followed by schedule more than 2 years and thereafter the tendency for exotropic drift will more stable. After 2 years, however, small amount exotropic drift can be possible.

The Analysis of Corneal Topography after Laser in Situ Keratomileusis(LASIK) for Myopic Correction

PURPOSE: To investigate the patterns of corneal topography after LASIK METHODS: The author have performed LASIK to correct the myopia of 21 male and 34 female patients. The corneal topography was performed at preoperative state and 2 days, 1, 3, 6, 12months after operation. RESULTS: Differential maps were classified using a standard eight-category classification scheme which were divided into a combined regular group(toric-with-axis, toric-against-axis, homogeneous, focal topographic variant) and a combined irregular group(semicircular, irregularly irregular, central island, keyhole). At 2 days, the distribution of corneal topographic patterns was 61.8% in a combined regular group and 38.2% in a combined irregular group. Of all patterns, the homogeneous pattern was predominant. The best corrected visual acuity was better in a combined regular group than in a combined irregular group which was statistically significant. After postoperative 1 month, most irregular patterns had a change in topography, generally to an optically smoother pattern. CONCLUSIONS: Corneal topography has been established as an invaluable tool for refractive surgery and this analysis allows the recognition of normal and abnormal patterns of ablation following excimer laser surgery.

Optic Nerve Evulsion: 1 case report

Optic nerve evulsion is a visually devastating and rare manifestation resulting in sudden visual loss after ocular trauma. The several hypothesis of mechanism include penetrating orbital injury causing a backward pull on the optic nerve, extreme rotation and forward displacement of the globe, and sudden increase in intraocular pressure causing rupture of the lamina cribrosa. The authors report a case of optic nerve evulsion in a 25- year old man who was struck in the right eye with a umbrella. The diagnosis was made by fundoscopic findings, fluorescein angiography, visual evoked potential, electroretinography, orbit computed tomography and magnetic resonance image.

Central Fusion Disruption

There are several causes developing diplopia after cataract surgery. Among these causes, central fusion disruption may be developed in longstanding unilateral traumatic cataract and uncorrected aphakia. The pathophysiology is unknown, but time interval between sensory deprivation and optical correction is an important factor. The characteristic signs and symptoms are exotropic, hypotropic or excyclotropic deviation, and intractable diplopia with vertical bobbing movement of non-fixing eye, particularly near the angle of superimposition with prism or haploscopic device. The authors report two cases of central fusion disruption in longstanding unilateral traumatic cataract and uncorrected aphakia.

Orbital Abscess in a 2-month-old Neonate: 1 Case Report

Although orbital abscess may originate from a number of sources, acute paranasal sinus disease is the most common source of infection. The clinical presentation is eyelid swelling, proptosis, conjunctival chemosis, diplopia, and decreased visual acuity. Diagnostic methods available for evaluating orbital abscess include sinus X-ray, ultrasound, computed tomography(CT), and bacterial culture of abscess content. Orbital abscess is treated with systemic antibiotics, or surgical draining followed by intravenous antibiotic therapy. Prompt diagnosis and treatment are necessary to prevent meningitis, subdural abscess, cavernous sinus thrombosis, frontal sinus thrombosis, visual loss from increased intraorbital pressure, even death. The authors exprienced a 2-month-old female neonate who presented with eyelid swelling, erythema, propotsis, eyeball deviation on right eye. Her orbital CT disclosed orbital abscess and only systemic intravenous antibiotics and topical antibiotic eyedrop instillation improved the symptoms.

Subperiosteal Abscess Secondary to Dentoalveolar Abscess: 1 Case Report

Suppuaration between the orbital bone and the periorbita produces a subperiosteal abscess. Subperiosteal abscess is a rare condition, which usually developes as a complication of the infection of paranasal sinuses. While the case originated from dentoalveolar infection have been reported. The clinical presentation is eyelid swelling, erythema, proptosis, conjunctival chemosis, ocular motility limitation, decreased visual acuity. Diagnostic methods available for evalulating subperiosteal abscess include sinus X-ray, ultrasound, computed tomography(CT), and bacterial culture of abscess content. Subperiosteal abscess is treated with intravenous antibiotics and surgical drainage. Prompt diagnosis and treatement are necessory ot prevent visual loss, cavernous sinus thrombosis, subdural abscess, even death. The authors experienced a sixty one year old male who complianed of right buccal swelling and tenderness, eyelid swelling, erythema, proptosis, conjunctival chemosis, eyeball motility limitation on right eye. His facial computed tomography disclosed subperiosteal abscess with infratemporal and parapharyngeal inflammation. An intravenous antibiotics injection and surgical drainage improve the symptom and sign, So we present our case with a brief review of the literature related to subperiosteal abscess secondary to dentoalveolar inflammation.

MALIGNANT FIBROUS HISTIOCYTOMA OF THE MAXILLA : REPORT OF TWO CASES

A STUDY ON CHANGE OF THE SOFT TISSUE FACIAL PROFILE AFTER ORTHOGNATHIC SORCERY IN PATIENTS WITH THE MANDIBULAR PROGNATHISM

Changes of Transient and Steady VEP by Checkboard Contrast

We measured the changes of each component of YEP by increase in contrast 8%, 30%, 60%, 90%, 98% in small checkerboard pattern stimuli and large checkerboard pattern stimuli in 10 normal subjects (20 eyes) in order to get basic data for utilizing YEP according to changes of contrast in clinical diseases group, N1 latency and P1 latency were notably shortened from 30% to 60%. N2 latency was extremely shortened from 60% to 90%. N1-P1 amplitude and P1-N2 amplitude were remarkably increased from 30% to 60%. The amplitude of steady YEP generally increased as the contrast was increased. Immatured YEP wave was turned to matured YEP wave between contrast 30% and 60%. Threfore, when we apply YEP with to lower contrast of stimuli clinical cases, the appropriate range of contrast is from 30% to 60%.