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

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

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

Purpose: To report the successful rehabilitation of a patient with anomalous head posture by using a virtual reality low vision aid (VRLVA).Case summary: A 75-year-old male diagnosed with age-related macular degeneration 15 years prior presented with an anomalous head posture for eccentric viewing. He had central scotoma within the central 10 degrees, and the preferred retinal locus (PRL) was localized to the inferonasal retina. The patient underwent a training session on the use of the VRLVA, which has a remapping function to remap distorted images, and those falling on the scotoma, to another location on the screen. After explaining the purpose of the VRLVA, the patient was given the device to use at home for two weeks. At two weeks after training, the patient could look straight ahead when using the VRLVA, without anomalous head posture. In addition, reading performance, including speed and accuracy, improved; moreover, he experienced no device-related adverse events. Conclusions By using the VRLVA, low-vision patients with anomalous head posture can shift images falling on the central scotoma to the PRL, thereby minimizing their anomalous head posture and improving reading performance. We expect that future technological advances, such as a wearable design and the use of lightweight material, will further improve the performance and acceptability of the VRLVA.

Purpose: We describe the clinical aspects of allergy to a brinzolamide 1.0%/brimonidine 0.2% fixed combination (BBFC) in Korean patients with glaucoma. Methods: The medical records of 117 glaucoma patients treated with BBFC were retrospectively analyzed in terms of sex, age, glaucoma type, follow-up period after prescription of eyedrops, number of eyedrop preparations used, allergy onset, and clinical characteristics. Results: The incidence of ocular allergy during BBFC use was 12.8%. Allergy developed after an average of 8.58 months (range, 0.93-25.80 months); half of all allergies were evident within the first 5 months. The most common type of allergy was follicular conjunctivitis (53.4%), followed by papillary conjunctivitis and blepharoconjunctivitis. Systemic side-effects and eye discomfort (0.09%) were largely confined to non-allergic patients. Conclusions An understanding of the clinical pattern of BBFC allergy in Korean glaucoma patients could facilitate treatment compliance and patients’ education.

PURPOSE: We used a questionnaire to explore perceptions and clinical practice patterns of Korean pediatric ophthalmologists in terms of amblyopia.METHODS: From September to November 2018, we conducted a web-based questionnaire survey of 99 specialists of the Korean Association for Pediatric Ophthalmology and Strabismus who operated ophthalmology clinics in Korea. We received 56 responses (56.57%) and retrospectively analyzed the data.RESULTS: The average specialist age was 44.0 ± 9.7 years. The mean age of treated amblyopia patients was 3 to 5 years (69.6%); the most common amblyopia was refractive anisometropic amblyopia (75.0%). On average, treatment commenced at 4 years of age (53.6%); child and parent co-operation most significantly influenced treatment success (46.4%). The preferred test was cycloplegic refraction (96.4%) and the preferred treatment occlusion therapy (100%) with glasses correction (98.2%). Occlusion therapy was most commonly performed for 2 hours/day (69.6%); the minimum age for eyeglasses prescription was 2.10 ± 1.18 years. Only three respondents (5.36%) prescribed contact lenses and only one (1.79%) performed refractive surgery.CONCLUSIONS: In Korea, amblyopia treatment is based on occlusion therapy and glasses correction. However, the time of treatment commencement, the duration of occlusion therapy, and the glasses used for correction varied. It is necessary to develop guidelines for amblyopia treatment; these should reflect current medical conditions.
Amblyopia ; Child ; Contact Lenses ; Eyeglasses ; Glass ; Humans ; Korea ; Ophthalmology ; Parents ; Practice Patterns, Physicians' ; Prescriptions ; Refractive Surgical Procedures ; Retrospective Studies ; Specialization ; Strabismus ; Surveys and Questionnaires

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.