The experienced surgeon can be surprised & challenged by the hazards of active bleeding during oral & maxillofacial surgical procedure, because of alterations in the surgical anatomy, bleeding disorders and surgical intervention of infected tissues. This is a report of two cases of active bleeding during surgical extraction of mandibular third molar, that had the pericoronitis, osteitis and adjacent neurovascular bundle in its apex. When the abrupt active bleeding was occurred during surgical extraction of mandibular third molar, pressure packing by hemostatic agent(bone wax) & wet gauze biting were applied into the extraction socket during 30 minutes. After 30 minutes, the wound was explored about the bleeding and active bleeding was then continued. In spite of repeated bleeding control method of the pressure dressing, the marked hemorrhage was generated continuously. Therefore, the author decised the bleeding as immediately uncontrollable hemorrhage and the pressure dressing was again applied for the more longer duration without wound closure. After 3 days, the pressure dressing was removed and iodoform gauze drainge was then established without the bleeding. The drain was changed as the interval of 3~5 days for prevention of infection & secondary hemorrhage and relatively good wound healing was then resulted in 6 weeks.
Bandages ; Hemorrhage* ; Molar, Third* ; Osteitis ; Pericoronitis ; Wound Healing ; Wounds and Injuries

In the unconscious patient with general muscle rigidity, the natural teeth can be luxated and then bite wounds may be occurred around lip, owing to the pathologic involuntary self-biting habit. If the forceful biting is generated continuously, the teeth may be avulsed and aspirated into the aerodigestive tract with the infection of biting wound. For the prevention of pulmonary aspiration of the teeth and wound infection, the biting teeth should be cared before the fact. The authors treated the teeth as endodontic drainage with removal of the crown or iodoform gauze drainage into the socket with extraction of the teeth. The prognosis was more favorable without biting wounds.
Crowns ; Dental Pulp Cavity* ; Drainage* ; Humans ; Lip ; Muscle Rigidity ; Prognosis ; Tooth ; Wound Infection ; Wounds and Injuries*

No abstract available.
Emergencies ; Humans

Crouzon syndrome, an autosomal dominant disorder, has characteristic features of craniosynostosis, hypertelorism, exophthalmos, maxillary hypoplasia and relative mandibular prognathism. Mutations of fibroblast growth factor receptor 2 (FGFR2) gene are associated with craniosynostotic conditions, such as Crouzon syndrome, Jackson-Weiss syndrome, Pfeiffer syndrome, Apert syndrome and Beare-Stevenson cutis gyrata. We found one child with common morphological features of Crouzon syndrome. Interestingly, she was found to have Cys342Ser mutation in FGFR2 exon lllc which has been previously observed in Jackson-Weiss syndrome. This finding supports the variable expression of FGFR2 in human and allelic heterogeneity in these apparently clinically distinct craniosynostotic conditions.
Acrocephalosyndactylia ; Child ; Craniofacial Dysostosis* ; Craniosynostoses ; Exons* ; Exophthalmos ; Humans ; Hypertelorism ; Population Characteristics ; Prognathism ; Receptor, Fibroblast Growth Factor, Type 2

STUDY DESIGN: Six patients with the lumbar kyphosis who underwent the circumferential fusion by posterior-anterior-posterior method were reviewed retrospectively from January 1998 to June 1999. OBJECTIVES: To determine whether patients with lumbar kyphosis can be successfully treated by circumferential fusion by posterior-anterior-posterior method. SUMMARY OF LITERATURE REVIEW: In the lumbar kyphosis, many procedures have been reported to correct the deformity, including multiple osteotomy, transpedicular vertebral resection, posterior interbody fusion, etc. Circumferential fusion by posterior-anterior-posterior method is suggested in this report as a valuable technique for excellent deformity correction and maintenance. MATERIAL AND METHODS: The surgery consists of posterior structural release with decompression followed by anterior structural release with interbody fusion by use of bone graft and posterior fixation. Clinical and radiologic results of the lumbar lordosis, sacral inclination and C7 plumb-line were assessed. RESULT: The mean segments of anterior and posterior fusion were 2.8 and 3.5 respectively. All clinical symptoms of patients had been improved in more than good. The average angle of lumbar lordosis was corrected from kyphosis 2.8degree preoperatively to lordosis 31.2degree postoperatively. At the last follow-up, the average loss of correction was 2.3degree . The average angle of sacral inclination was corrected from 6.7degree to 50.8degree . The distance from supero-posterior corner of S1 to C7 plumb line was reduced from 11.0 cm to 2.75 cm. CONCLUSION: The circumferential fusion by posterior-anterior-posterior method offer an effective surgical treatment, which produce excellent deformity correction, fusion rate, maintenance of the correction and good clinical outcome.
Animals ; Congenital Abnormalities ; Decompression ; Follow-Up Studies ; Humans ; Kyphosis* ; Lordosis ; Osteotomy ; Retrospective Studies ; Transplants

Purpose: We analyzed changes in mini-scleral lens parameters after repetitive ethylene oxide (EO) sterilization. Methods: We measured the base curve radius (BCR), the optical power, the central lens thickness (CLT), and the overall lens diameter (OLD) of 67 basic, oblate-type mini-scleral lenses (Onefit A; BIUMTEC, Seoul, Korea) before and after three repeats of EO sterilization at 2-week intervals. The sterilization process (15 hours in duration) included a core step featuring exposure to gaseous EO for 180 minutes at 1.5 bar and 56°C. Results: The BCR changes in the basic type of mini-scleral lens after EO sterilization were -0.011 ± 0.004 mm, -0.024 ± 0.005 mm, and -0.021 ± 0.005 mm for the first, second, and third sterilizations, respectively; all changes were significant. None of optical power, CLT, or OLD were affected by EO sterilization. We found no significant correlation between any baseline value and the change thereof after sterilization. Conclusions Repeated EO sterilization of mini-scleral lenses did not change the optical power, CLT, or OLD, but significantly reduced the BCR. EO should not be used to sterilize mini-scleral lenses.

Purpose: We describe a patient with Stevens-Johnson syndrome who exhibited recurrent anterior corneal granulomas after corneal perforation (despite multiple amniotic membrane [AM] transplantations); the patient was successfully treated by lamellar grafting of an acellular, preserved human cornea.Case summary: Corneal granulomas developed four times in a 46-year-old man who had been diagnosed with Stevens-Johnson syndrome 17 years priorly and who had undergone multiple AM transplantations after corneal perforation. A corneal granulomatous mass recurred 2 months prior to presentation in our clinic; it rapidly increased in size. With the patient under general anesthesia, the corneal mass was excised and a 4.0-mm-diameter, acellular preserved human cornea (Halo; Eversight Inc., Palo Alto, CA, USA) was grafted. A similarly sized AM was placed over the grafted cornea. Although the engrafted cornea exhibited stromal infiltration 1 month after surgery, the keratitis improved following brief antibiotic treatment. At 8 months postoperatively, the wound was stable; no granuloma recurrence, no graft melting, and no suspected microbial keratitis were observed in the region of the graft. Conclusions In patients with Stevens-Johnson syndrome and recurrent anterior granulomas (despite multiple AM transplantations), a lamellar graft of acellular, preserved human cornea may be a good therapeutic choice.

Purpose: To report two cases of atypical conjunctival lesions that differ from the well-known typical papillary or follicular conjunctivitis after the use of brimonidine.Case summary: In the first case, a 46-year-old female patient diagnosed with binocular normal tension glaucoma visited our hospital. After topical application of 1% brinzolamide/0.2% brimonidine fixed-combination eye drops for 7 months, a number of yellow follicles confined to the left upper bulbar conjunctiva with mild conjunctival injection and conjunctival edema were observed under slit lamp microscopy examination. After stopping brimonidine for 2 weeks, conjunctival injection and follicles decreased and, 1 month later, bulbar conjunctival follicles had disappeared completely. Since changing the eye drops to a brinzolamide/timolol fixed combination, there was no recurrence of the condition. In the second case, a 70-year-old female patient who had been diagnosed with binocular normal tension glaucoma a year ago had been using 0.15% brimonidine. On slit lamp examination, bilateral eyelid edema and overall diffuse conjunctival tissue hypertrophy and multiple follicles appeared on the upper and lower palpebral conjunctiva, the bulbar conjunctiva, the conjunctival fornix, and the lacrimal caruncle. Bilateral conjunctival biopsy was performed to differentiate conjunctival lymphoma, and granulomatous inflammation was confirmed by biopsy. After stopping 0.15% brimonidine treatment and changing to latanoprost, conjunctival lesions improved and there was no recurrence. Conclusions If atypical conjunctival lesions are observed in patients using topical brimonidine, side effects related to brimonidine should be considered. Our results indicated marked improvement within 2 weeks of stopping brimonidine treatment.

Purpose: We analyzed changes in mini-scleral lens parameters after repetitive ethylene oxide (EO) sterilization. Methods: We measured the base curve radius (BCR), the optical power, the central lens thickness (CLT), and the overall lens diameter (OLD) of 67 basic, oblate-type mini-scleral lenses (Onefit A; BIUMTEC, Seoul, Korea) before and after three repeats of EO sterilization at 2-week intervals. The sterilization process (15 hours in duration) included a core step featuring exposure to gaseous EO for 180 minutes at 1.5 bar and 56°C. Results: The BCR changes in the basic type of mini-scleral lens after EO sterilization were -0.011 ± 0.004 mm, -0.024 ± 0.005 mm, and -0.021 ± 0.005 mm for the first, second, and third sterilizations, respectively; all changes were significant. None of optical power, CLT, or OLD were affected by EO sterilization. We found no significant correlation between any baseline value and the change thereof after sterilization. Conclusions Repeated EO sterilization of mini-scleral lenses did not change the optical power, CLT, or OLD, but significantly reduced the BCR. EO should not be used to sterilize mini-scleral lenses.

Purpose: We describe a patient with Stevens-Johnson syndrome who exhibited recurrent anterior corneal granulomas after corneal perforation (despite multiple amniotic membrane [AM] transplantations); the patient was successfully treated by lamellar grafting of an acellular, preserved human cornea.Case summary: Corneal granulomas developed four times in a 46-year-old man who had been diagnosed with Stevens-Johnson syndrome 17 years priorly and who had undergone multiple AM transplantations after corneal perforation. A corneal granulomatous mass recurred 2 months prior to presentation in our clinic; it rapidly increased in size. With the patient under general anesthesia, the corneal mass was excised and a 4.0-mm-diameter, acellular preserved human cornea (Halo; Eversight Inc., Palo Alto, CA, USA) was grafted. A similarly sized AM was placed over the grafted cornea. Although the engrafted cornea exhibited stromal infiltration 1 month after surgery, the keratitis improved following brief antibiotic treatment. At 8 months postoperatively, the wound was stable; no granuloma recurrence, no graft melting, and no suspected microbial keratitis were observed in the region of the graft. Conclusions In patients with Stevens-Johnson syndrome and recurrent anterior granulomas (despite multiple AM transplantations), a lamellar graft of acellular, preserved human cornea may be a good therapeutic choice.