This study discusses laryngospasm following orthognathic surgery and requiring emergency intubation, followed by systemic complications due to a hypoxic event. A 34-year-old male patient underwent orthognathic surgery due to facial asymmetry. When emerging from general anesthesia, blood pressure elevated suddenly, and severe agitation occurred. After extubation, desaturation occurred immediately, resulting in cyanosis and loss of consciousness. An emergency cricothyroidotomy was performed, and oral intubation was required to maintain the airway. The patient was sent to the intensive care unit on a ventilator. On postoperative day 2, the red blood cell count and hemoglobin level decreased significantly. Electrocardiogram showed abnormalities, although vital signs were stable and no bleeding was observed. Laryngospasm often occurs under general anesthesia, resulting in sustained closure of the vocal cords and obstruction of the airway. This condition can be life-threatening, and awareness of the various precipitating factors is important. Orthognathic surgery is a risk factor for laryngospasm because its surgical site affects the airway, and it involves discharge of blood via intraoral wounds. It is important to understand systemic changes occurring after a hypoxic event, and consultation with specialists from various departments should be actively pursued.

This study discusses laryngospasm following orthognathic surgery and requiring emergency intubation, followed by systemic complications due to a hypoxic event. A 34-year-old male patient underwent orthognathic surgery due to facial asymmetry. When emerging from general anesthesia, blood pressure elevated suddenly, and severe agitation occurred. After extubation, desaturation occurred immediately, resulting in cyanosis and loss of consciousness. An emergency cricothyroidotomy was performed, and oral intubation was required to maintain the airway. The patient was sent to the intensive care unit on a ventilator. On postoperative day 2, the red blood cell count and hemoglobin level decreased significantly. Electrocardiogram showed abnormalities, although vital signs were stable and no bleeding was observed. Laryngospasm often occurs under general anesthesia, resulting in sustained closure of the vocal cords and obstruction of the airway. This condition can be life-threatening, and awareness of the various precipitating factors is important. Orthognathic surgery is a risk factor for laryngospasm because its surgical site affects the airway, and it involves discharge of blood via intraoral wounds. It is important to understand systemic changes occurring after a hypoxic event, and consultation with specialists from various departments should be actively pursued.

This study discusses laryngospasm following orthognathic surgery and requiring emergency intubation, followed by systemic complications due to a hypoxic event. A 34-year-old male patient underwent orthognathic surgery due to facial asymmetry. When emerging from general anesthesia, blood pressure elevated suddenly, and severe agitation occurred. After extubation, desaturation occurred immediately, resulting in cyanosis and loss of consciousness. An emergency cricothyroidotomy was performed, and oral intubation was required to maintain the airway. The patient was sent to the intensive care unit on a ventilator. On postoperative day 2, the red blood cell count and hemoglobin level decreased significantly. Electrocardiogram showed abnormalities, although vital signs were stable and no bleeding was observed. Laryngospasm often occurs under general anesthesia, resulting in sustained closure of the vocal cords and obstruction of the airway. This condition can be life-threatening, and awareness of the various precipitating factors is important. Orthognathic surgery is a risk factor for laryngospasm because its surgical site affects the airway, and it involves discharge of blood via intraoral wounds. It is important to understand systemic changes occurring after a hypoxic event, and consultation with specialists from various departments should be actively pursued.

Background: Risk factors for developing medication-related osteonecrosis of the jaw (MRONJ) include the gen‑ eral condition of the patient, smoking habit, poor oral hygiene, and the type, duration, and administration route of the drug, dentoalveolar surgery, such as implant placement. This study aimed to discuss whether implants may induce osteonecrosis in older patients receiving long-term medication and to analyze the radiological pattern of the bone necrosis. Methods: This study included 33 patients diagnosed with dental implant-associated medication-related osteonecro‑ sis of the jaw. Data regarding the medical history, type of medication used, durations of administration, laboratory test results, onset of bone necrosis since implant placement, type of opposing teeth, and radiological pattern of the bone necrosis on cone-beam computed tomography were recorded in patients with and without implants. Results: The most commonly used drug was bisphosphonate, with an average duration of use of 61.37 (± 53.72) months. The laboratory results showed average serum C-terminal cross-linking telopeptide (CTX) level of 0.23 ng/ mL, vitamin D, 23.42 ng/mL, and osteocalcin, 4.92 ng/mL. Osteonecrosis occurred after an average of 51.03 (± 39.75) months following implant placement. Radiological evaluation revealed obvious sequestration in the implant-absent group, and the formation of a unit sequestration with an implant fixture (en bloc) was observed in the implant-pre‑ sent group. The patients underwent surgical treatment of sequestrectomy and explantation. Conclusion Implant placement, especially loading, may be considered a potential risk factor for the development of osteonecrosis in patients undergoing antiresorptive treatment.

Purpose: This clinical study presented the effectiveness of 2-stage posterior maxillary segmental osteotomy (PMSO) under local anesthesia in gaining interarch space to restore the posterior mandibular segment with dental implants. Materials and Methods: Nine patients who received two-stage PMSO for mandibular implant placement from 2003 to 2011 were included in the study. Of the 9 patients, 7 were female and 2 were male. Ages ranged form 28 to 72 (mean 46.6). Potential complications were investigated such as sinus infection, survival of bone segment, inflammatory root resorption of adjacent teeth, relapse of bone segment and timing of implant placement, delivery of implant prosthesis and stability of bone segment.Result: None of the patients showed relapse or complication. Bone segments were stabilized by opposed implant prosthesis. Conclusion Office-based 2-stage PMSO under local anesthesia can be considered a stable and predictable procedure. Also pedicle damage can be avoided by allowing favor of blood supply to the bone segments. From these advantages, it can be concluded that this surgical procedure can decrease post-operative complications.

OBJECTIVE: Red cell distribution width (RDW) is associated with mortality in patients with community- acquired pneumonia (CAP). However, little is known about the effect of changes in RDW during treatment on mortality. Thus, the objective of this study was to evaluate the association between RDW changes and mortality in hospitalized patients with CAP. METHODS: Retrospective analyses were performed using medical records of patients hospitalized for CAP from April 2008 to February 2014. The abstracted laboratory values included RDW (from days one to four), clinical variables, and pneumonia severity index (PSI) scores. The ΔRDW(n-1) was defined as the change in RDW calculated as: (RDW(day1)-RDW(day-n))/RDW(day1)×100 (%), where ‘day n’ refers to hospital day. RESULTS: During the study period, a total of 1,069 patients were hospitalized for CAP. The 30-day mortality was 100/1,069 (9.4%). The median RDW at baseline was 14.1% (range, 11.1 to 30.2) and differed significantly between survivors and non-survivors (P<0.05). There were 470 patients with available serial RDW data (30-day mortality 58/470 [12.3%]). Of those, age, PSI score, blood urea nitrogen level, total protein concentration, albumin level, RDW at day 1, and the ΔRDW₄₋₁ differed significantly between survivors and non-survivors. Multivariate Cox regression analysis showed that the significance of the relationship between ΔRDW₄₋₁ and 30-day mortality risk remained after adjusting for age, PSI score, RDW at day 1, total protein concentration, and initial albumin level. CONCLUSION: RDW change from day 1 to day 4 was an independent predictor of mortality in patients with CAP.
Blood Urea Nitrogen ; Erythrocyte Indices ; Erythrocytes* ; Humans ; Medical Records ; Mortality ; Pneumonia* ; Retrospective Studies ; Survivors