Jae-Ha Yoo

Open reduction of condylar neck fractures with exposure of the facial nerve

OBJECTIVE The purpose of this study was to evaluate the clinical and radiologic results in patients whose condylar neck fractures were reduced and stabilized through use of a standard preauricular approach involving systematic exposure of the facial nerve. STUDY DESIGN We performed open reductions of high condylar neck fractures with exposure of the facial nerve in a prospective series of 34 patients. In this article, we describe clinical and radiologic results in 25 patients with follow-up longer than 6 months. RESULTS Immediate postoperative radiographs showed excellent reduction of the fractures in 24 patients. The postoperative course was uneventful in most patients. The incidence of complications was low; there were 5 patients with temporary facial nerve palsies, 3 patients with plate fractures or screw loosenings, 5 patients with transitory auricular hypoesthesia, 1 patient with inadequate reduction, and 1 patient with limited mouth opening. CONCLUSIONS The results of this study showed that accurate reduction and rigid fixation of high condylar neck fractures were possible through use of an approach in which the facial nerve was exposed.

The efficacy of postoperative prophylactic antibiotics in orthognathic surgery: a prospective study in Le Fort I osteotomy and bilateral intraoral vertical ramus osteotomy.

Purpose This study examined the efficacy of the postoperative prophylactic antibiotics used in orthognathic surgery. The prevalence of surgical site infections (SSIs) was determined according to the use of postoperative prophylactic antibiotics. Patients and Methods Fifty-six patients were divided into 2 groups. Each patient intravenously received 1.0 g of a third-generation cephalosporin (Cefpiramide) 30 minutes before surgery. Among them, 28 patients in the control group received 1.0 g Cefpiramide twice daily until the third day after surgery. The postoperative wounds were examined regularly for the presence of infectious signs. Results There was no significant difference in the incidence of postoperative wound infections between patients who had received postoperative prophylactic antibiotic administration and those who had not (p = 0.639). Conclusion Prolonged prophylactic antibiotic use after orthognathic surgery may not be necessary, provided that there are no other significant factors for wound infections.

ORAL HEMORRHAGE CONTROL AS TREATMENT PRIORITY IN A MENTALLY RETARDED PATIENT WITH MULTIPLE TRAUMA

Sympathetic reaction to grotesque facial injuries with oral bleeding can trigger confusion and generate inefficiency among emergency room personnel. Regardless of the extent of the injury, or of the sympathy elicated, the victim must be evaluated and treated as a whole patient with multiple trauma. There must be no confusion as to order of importance in the steps of evaluation : 1. airway 2. hemorrhage 3. shock 4. associated injuries 5. local injury 6. triage of facial injuries. The most dangerous aspect of oral hemorrhage is the possibility of its obstructing the upper airway. Swallowing large amounts of blood will usually cause gastric irritation and lead to vomiting, thus further complicating the management of the patient. Once a clear airway is assured and hemorrhage have been controlled, consideration is given to possible associated injuries before undertaking treatment of the facial injuries themselves. Status of the cardiopulmonary, gastrointestinal and neuromuscular systems all have a bearing on decisions concerning facial injury treatment. In this light, treatment priority becomes exceeding important. On the other hand, the importance of facial injuries should never be minimized, especially in a mentally retarded patient with oral hemorrhage. This is a case report about oral hemorrhage control as treatment priority in a mentally retarded patient. [J Korean Dis Oral Health Vol.12, No.1: 20-26, June 2016]

CARE OF RECURRENT TEMPOROMANDIBULAR JOINT DISLOCATION IN CEREBROVASCULAR ACCIDENT PATIENT : REPORT OF A CASE

Temporomandibular joint dislocation causes considerable pain, discomfort, and swelling. The anatomic construction of the articular fossa and the eminentia articularis may predispose to dislocation, and weakness of the connective tissue forming the capsule is believed to be a predisposing factor. The capsule may be stretched and, more rarely, torn. Dislocation may be unilateral or bilateral and may occur spontaneously after stretching of the mouth to its extreme open position, such as during a yawn or during a routine dental operation. Manual reduction with the patient under muscle-relaxing condition or anesthesia is recommended method. After the reduction of an acute dislocation, immobilization of the jaw is recommended to allow the stretched and sometimes torn capsule to heal, thus preventing recurrence. A Bartons bandage may be applied for 2 to 3 weeks to prevent the patient from opening the jaw too wide. But, it results in recurrent dislocation in the neurologically disabled patient, because of loose intermaxillary fixation. This is a case report about management of recurrent temporomandibular joint dislocation by multiple loop wirings and intermaxillary elastics in cerebrovascular accident patient.

CARE OF ANXIETY DISORDER AND HYPERVENTILATION DURING REFRACTORY TOOTH EXTRACTION IN A PSYCHOLOGIC DISABLED PATIENT

Hyperventilation is produced by several distinct causes: anxiety, respiratory alkalosis, increased blood catecholamine levels, and a decrease in the level of the ionized calcium in the blood. The dental fears about acute pain, bleeding, needle, drill and dental surgery lead to the severe anxiety and increased blood catecholamine level. Therefore, the most dental patient should be cared gently as the stress reduction protocol. In spite of the gentle care, a hyperventilation were occurred during the surgical extraction of impacted third molar with pericoronitis. We suggest that the dental patients with anxiety disorder must be attention for the manifestation of hyperventilation, especially in the psychologic disabled patient. [J Korean Dis Oral Health Vol.10, No.2: 106113, December 2014]