BACKGROUND: For normalization of displaced anatomical structure by large cyst, two-step procedure (decompression and enucleation afterward) has been recommended. However, the histological transformation after cystotomy for decompression was shown frequently in secondary enucleation. Therefore, analyses about effects and histological changes after decompression have been necessary. METHODS: 48 cases diagnosed as large odontogenic cyst in the jaw and treated by decompression and secondary enucleation were retrospectively analyzed in clinical, rediographical, and histological aspects. RESULTS: In dentigerous cyst, decompression was much useful. Impacted permanent teeth were erupted and reduction rate was higher than that of odontogenic keratocyst (OKC) and apical periodontal cyst. In OKC, among the 29 cases, 11 cases showed no-keratosis, proliferation and rete-ridge elongation after decompression. 4 cases showed no-keratosis, only. 7 cases showed orthokeratosis and rete-ridge elongation and 6 cases showed reteridge elongation, only. 1 case had no change. And the recurrence rate for OKCs was 10.3%. For all odontogenic cysts in this study, dysplasia was not found in cystic lining after decompression. CONCLUSIONS: This study implied that decompression for large odontogenic cyst was useful treatment modality because it was conservative treatment and recurrence rate was low although long treatment period was required.
Cystotomy ; Decompression* ; Dentigerous Cyst ; Jaw* ; Odontogenic Cysts* ; Radicular Cyst ; Recurrence ; Retrospective Studies ; Tooth

PURPOSE: In order to clarify the clinical utility of the vertical height augmentation (VHA) genioplasty using autogenous iliac bone graft (IBG), this study examined the postsurgical changes in hard and soft tissues of the chin and the stability of the grafted bone. PATIENTS AND METHODS: Twenty-three patients who had undergone VHA genioplasty using autogenous IBG were evaluated radiographically and clinically. A comparison study of the changes in hard to soft tissues after surgery in all 23 patients was performed with preoperative, 1-month, 3-months, 6-months, and/or 1-year postoperative lateral cephalograms by tracing. Stability, bone healing, and complication of the grafted bone was evaluated by follow-up roentgenograms and clinical observation. RESULTS: Between the preoperative and 6-month postoperative tracings, an average vertical augmentation of the osseous segment was 4.2 mm at menton and that of the soft tissue menton was 4.0 mm. There was a high predictability of 1: 0.94 between the amounts of hard versus soft tissue changes with surgery in the vertical plane. The position of the genial bone segment was stable immediately after surgery and soft tissue was not changed significantly from 1 month to 1 year after operation. Clinical and radiological follow-up results of the iliac bone graft showed normal bony union and were generally stable. CONCLUSIONS: VHA genioplasty using IBG is a reliable method for predicting hard and soft tissue changes and for maintaining postoperative soft tissue of the chin after surgery.
Chin ; Follow-Up Studies ; Genioplasty* ; Humans ; Transplants*

PURPOSE: Among the various surgical methods used for the effective treatment of cystic lesion in the jaws historically, decompression procedure has some of superior prognosis compare to direct enucleation. In order to propose the efficacy of decompression we performed this retrospective study to compare decompression procedure with one-stage enucleation in clinical results and prognosis. PATIENTS AND METHODS: We reviewed 175 patients who had been histopathologically diagnosed cystic lesions from 1996 to 2000 in our department. Patients who had been received decompression alone or secondary enucleation after decompression were 31 cases, and enucleation alone were 144 cases. The age and sex of the patients, the area, size, and histological type of the lesions, and detailed operation and complications including recurrence were investigated. The minimal follow-up period was 2 years. RESULTS: In 31cases of decompression, male patients were 22cases(71%) similar to male predilection(62.3%) in total 175 cases. Cystic lesions were developed evenly in all age groups totally. Decompression was mainly performed in teenagers but enucleation was used in elder decades. In decompression cases the lesions were located in mandibular posterior, maxillary posterior, mandibular anterior, and maxillary anterior in order, which had some differences in total and enucleation cases. In enucleation cases, less than 3cm in size was 77.1% but larger than 3cm was 93.5% in decompression cases. Histopathologically, dentigerous cysts(54.8%), unicystic ameloblastomas(16.1%), and odontogenic keratocysts(12.9%) were seen in decompression cases and no recurrence or metaplasia and infection was observed. On the other hand, permanent tooth loss, numbness, recurrence, and so on were accompanied after enucleation. CONCLUSION: Although decompression procedure has disadvantages such as many of visiting times and slow recovery of the surgical defect, decompression is the best choice of treatment for large cystic lesions of the jaws, because it prevents functional and cosmetic defect, allows bone regeneration, and makes easy secondary enucleation.
Adolescent ; Bone Regeneration ; Decompression* ; Follow-Up Studies ; Hand ; Humans ; Hypesthesia ; Jaw* ; Male ; Metaplasia ; Prognosis ; Recurrence ; Retrospective Studies ; Tooth Loss

The appropriate care to the dental emergency patients is much important in the aspect of community dental service. To attain such a purpose, the sacred duty of the training of oral and maxillofacial surgeons is required. So, a retrospective study on the characteristics of dental injuries and diseases in emergency care unit will be very meaningful. This study was carried by reviewing the charts and radiographic films of 3,394 patients, treated for dental emergency at Wonju Christian Hospital, Republic of Korea, from January 1, 1993 to December 31, 2002. All patients were classified to 6 groups including trauma, toothache, infection, hemorrhage, TMJ disorder and the others. The clinical characteristics of diseases and treatment modalities according to each group were analyzed. The trauma (73.9%) was the most frequent cause in dental emergency patients, and acute toothache, odontogenic infection, oral hemorrhage, and TMJ disorder were next in order. Gender prediction was male (68%), there were many patients on May and December in the monthly frequency, and the most frequent age group was from 0 to 9 years. In the trauma group, male (68.6%) was predominant, and soft tissue injuries and primary closures were the most frequent type of injury and treatment. In jaw fractures, traffic accidents were the most cause and the weakest site was mandibular symphysis area, and mandibular angle, condy le, and body area were next in order. In the acute toothache group, the cause was dental pulpitis mostly and treatment for that was drug administration mainly. Buccal space abscess in infection group had the largest incidence (24.5%), and common treatments were incision and drainage and medications. In the hemorrhage group, a major cause was postoperative bleeding (60.3%) and hemostasis was obtained by pressure dressing, curettage and suture. For the TMJ disorder group, the peak incidence (63.8%) was shown in the post-traumatic myofascial pain dysfunction syndrome and its primary care was medication such as analgesics and sedatives. In the other group, the various specific symptoms were complained due to acute sialadenitis, trigeminal neuralgia, acute stomatitis, chemical burn, terminal stage neuritis of head and neck cancer, and foreign body aspiration. In conclusion, for the rapid and proper care of the emergency dental diseases, well-trained education should be presented to the intern and resident course of oral and maxillofacial surgery. And it is demanded that oral and maxillofacial surgeons must be prepared in knowledge and skill for such emergency care.
Abscess ; Accidents, Traffic ; Analgesics ; Bandages ; Burns, Chemical ; Curettage ; Dental Pulp ; Drainage ; Education ; Emergencies* ; Emergency Medical Services ; Foreign Bodies ; Gangwon-do* ; Head and Neck Neoplasms ; Hemorrhage ; Hemostasis ; Humans ; Hypnotics and Sedatives ; Incidence ; Jaw Fractures ; Male ; Neuritis ; Oral Hemorrhage ; Primary Health Care ; Republic of Korea ; Retrospective Studies ; Sialadenitis ; Soft Tissue Injuries ; Stomatitis ; Stomatognathic Diseases ; Surgery, Oral ; Sutures ; Temporomandibular Joint Disorders ; Toothache ; Trigeminal Neuralgia ; X-Ray Film

BACKGROUND: Some clinical trials have reported that a new analgesic combination of tramadol and acetaminophen provides good efficacy in various pain models. For the more clinical uses of this agent, comparisons about the onset of analgesia and analgesic efficacy in the acute state of pain with the other drugs known as strong analgesics were needed. PURPOSE: The goal of this study was to compare the times to onset of analgesia and the other analgesic efficacy of 75 mg tramadol/650 mg acetaminophen and 20 mg codeine/500 mg acetaminophen/400 mg ibuprofen in the treatment of acute pain after oral surgery. PATIENTS AND METHODS: Using a randomized, single-dose, parallel-group, single-center, and active-controlled test design, this clinical study compared the times to onset of analgesia using a two-stopwatch technique and the other analgesic efficacy of the single-dose tramadol/ acetaminophen and odeine/acetaminophen/ibuprofen. These were assessed in 128 healthy subjects with pain from oral surgical procedures involving extraction of one or more impacted third molars requiring bone removal. From the time of pain development, the times to onset of perceptible and meaningful pain relief, pain intensity, pain relief, an overall assessment, and adverse events of the study medications were recorded for 6 hours. RESULTS: The demographic distribution and baseline pain data in the two groups were statistically similar. The median times to onset of perceptible pain relief were 21.0 and 24.4 minutes in the tramadol/acetaminophen and codeine/acetaminophen/ibuprofen groups respectively and those to onset of meaningful pain relief were 56.4 and 57.3 minutes, which were statistically similar. The other efficacy variables such as mean total pain relief (TOTPAR) and the sum of pain intensity differences (SPID) were also similar in the early period after pain development and drug dosing. The safety of tramadol/acetaminophen was well tolerated and very comparable to that of codeine/acetaminophen/ibuprofen. CONCLUSIONS: In this acute dental pain model, the onset of analgesia and analgesic efficacy of tramadol/acetaminophen was comparable to that of codeine/acetaminophen/ibuprofen. These results showed that tramadol/acetaminophen was recommendable for fast and effective treatment in the management of postoperative acute pain.
Acetaminophen ; Acute Pain* ; Analgesia* ; Analgesics ; Humans ; Ibuprofen ; Molar, Third ; Oral Surgical Procedures ; Pain, Postoperative ; Surgery, Oral ; Tramadol

Pleomorphic adenoma is the most common salivary neoplasm mainly occurring in the major salivary glands - especially in parotid gland, which is characterized by variable histopathologic appearances and high recurrence rate with malignant transformation according to surgical situations. And this benign mixed tumor occurring in minor salivary glands is believed to shows same clinicopathologic appearances and relatively low recurrent rate compared with the case in major salivary glands. But there are few comparative studies of large series of pleomorphic adenoma occurring in minor salivary glands which includes different histopathologic appearance, clinical characteristics, treatment methods, recurrence rate, and malignant transformation. We retrospectively studied the 54 patients who were pathologically confirmed with pleomorphic adenoma occurring in minor salivary glands, and analyzed the clinico-histopathological appearance, surgical methods, recurrent cases. The results obtained are as follows. 1. The incidence of the tumor was most frequent in 4th & 5th decade, and in female. 2. Palate(90%) including hard & soft palate was the most frequent site for pleomorphic adenoma in minor salivary glands. 3. The exact duration could not be known due to asymptomatic slow growth patterns of the tumor. 4. The mean tumor size was 2.3cm. 5. 28 (52%) pleomorphic adenomas were classified as Cellular type (cell-rich), 17 (31%) specimen as Intermediate type(equal cell to stroma ratio), and 9 (17%) as Myxoid type(stroma-rich). 6. Surgically 51 cases (94%) were showed well-encapsulated tumors, but histopathologically only 34 specimen (63%) were wellencapsulated. Therefore pleomorphic adenomas in minor salivary glands also have to be excised more widely, not enucleated. And in case of suspicious malignancy or large tumor, preoperative incisional biopsy can be applied in the center of the tumor for prevention of rupture of tumor cell, and total excision with use of frozen biopsy for detection of malignancy and confirming the excision m argin, and closed follow-up according to final histopathologic results is recommended.
Adenoma, Pleomorphic* ; Biopsy ; Female ; Humans ; Incidence ; Palate, Soft ; Parotid Gland ; Recurrence ; Retrospective Studies ; Rupture ; Salivary Glands ; Salivary Glands, Minor*

Ameloblastoma is cytologically a benign tumor, but is clinically characterized by infiltrative growth and high recurrency. The criteria for surgical treatment of ameloblastoma has not yet established and it is generally accepted that ameloblastoma be treated differently based on clinical types. The purpose of this paper is to consider effectiveness of enucleation in large-sized intraosseous ameloblastoma that has treated more frequently by radical treatment. 39 cases of the intraosseous ameloblastomas were treated by enucleation in the department of oral and maxillofacial surgery of Yonsei University, dental college from February 1990 to January 2001. 25 cases were selected because they were large in size that could produce facial disfigurement or pathologic fracture of jaws. They were radiographically characterized by the cortical bone that was expanded or eroded locally and histopathologically by 19 solid ameloblastomas and 6 intramural type of unicystic ameloblastomas. Among the 25 cases, 4 cases - 3 solid ameloblastomas and 1 intramural type of ameloblastoma - recurred. Recurrence rate was 16%. The compact bone which is not invaded by ameloblastoma was used as surgical margin of enucleation with accompanying chemical cauterization for killing the residual tumor cells. This may have been the reason for the low recurrence rate. So, it is considered that enucleation and long-term follow-up enable the large-sized intraosseous ameloblastomas that were characterized by almost destroyed cancellous bone and expanded or discontinued cortical bone to treat minimizing facial disfigurement and masticatory dysfunction and sociopsychological impact produced by radical treatment. I recommend that the large-sized intraosseous ameloblastomas without involvement to the surrounding soft tissues be first treated by enucleation.
Ameloblastoma* ; Cautery ; Cytochrome P-450 CYP1A1 ; Follow-Up Studies ; Fractures, Spontaneous ; Homicide ; Jaw ; Neoplasm, Residual ; Recurrence ; Surgery, Oral

Orthognathic surgery of the mandibular prognathism and the retrognathism is tend to be performed on the mandibular ramus to prevent inferor alveolar nerve injuries. The purpose of this study is to find a safe and accurate reference point on mandibular ramus for orthognathic surgery by comparative anatomical study of dentofacial deformity patients. We use 38 Korean Cadavers with normal occlusion(Group 1), 3-dimensional simulation of computerized tomogram of 23 patients with retrognathism (Group 2), 27 patients with mandibular prognathism (Group 3). Following results are obtained : 1. The maximum thickness of the mandibular ramus is 8.78+/-1.15mm for Group 2, 7.61+/-1.26mm for Group 1, 6.95+/-0.82mm for Group3 respectively (P=0001). The minimum thickness is 5.51+/-1.08mm for Group 1 , 5.06+/-0.40mm for Group 2, 4.56+/-0.78mm for Group3, respectively (p=0.0001). But, the thickness at the level of 5mm above the lingular is 0.78+/-0.65mm for Group 2, 5.63 +/-1.28mm for Group 1, 5.32+/-0.91mm for Group 3, respectively. There is no significant difference between these groups(P=0.0510). 2. The horizontal location from the midwaist point to lingular is 0.18+/-1.57mm for Group 1, 0.69+/-1.33mm for Group 2, 0.66+/-1.66mm for Group 3, and there is no significant difference between these groups(p=0.0835). But the vertical location from the midwaist point to lingular is 1.45+/-2.64mm for Group 1, 0.63+/-1.44mm for Group 2, 0.34+/-1.81mm for Group 3, and there is significant difference between these groups(p=0.0030). 3. The horizontal location from the midwaist point to mandibular foramen is 0.29+/-1.75mm for Group 1, 0.63+/-1.44mm for Group 2, 0.34+/-1.81mm for Group 3, and there is no significant difference between these groups(p=0.5403). But the vertical location from the midwaist point to mandibular foramen is -3.33+/-4.43mm for Group1, -4.79+/-2.26mm for Group 2, -6.06+/-2.99mm for Group 3, and there is significant difference between these groups(P=0.0001). 4. The horizontal length from the disto-buccal cusp tip of mandibular second molar to lingula is 30.97+/-4.17mm for Group 3, 28.29+/-2.65mm for Group 1, 25.48+/-0.77mm for Group 2 (p=0.0000), and also vertical length is 7.72+/-3.22mm for Group 3, 6.38+/-1.83mm for Group 1, 5.89+/-2.30mm for Group 2 (P=0.0014). 5. The location of lingular is 0.50 from anterior border of mandibular ramus in all groups, if it assumed the length from anterior border to posterior border is 1. And it is almost 0.33 from the sigmoid notch, if it assumed the length from sigmoid notch to antegonial notch is 1. 6. In Group 1, Antilingular prominence is located on (1.12+/-1.43mm, 4.01+/-2.36mm) from the midwaist point, and there is no correlation between antilingular prominence and lingular, mandibular foramen.
Cadaver ; Colon, Sigmoid ; Dentofacial Deformities* ; Humans ; Molar ; Orthognathic Surgery ; Prognathism ; Retrognathia

Two major salivary glands, submandibular duct, lingual nerve, and vessels are situated beneath the mouth floor. Among these, passing through the pterygomandibular space, lingual nerve is innervated to the lingual gingiva and the mucosa of mouth floor, and is responsible for the general sensation of the anterior two thirds of the tongue. So, the injury of the lingual nerve during an anesthesia or surgery in the retromolar area may cause complications such as a numbness, a loss of taste of the tongue and the other dysfunctions. Therefore, to find out the morphology and the course of lingual nerve and to clarify the topographical relationships of lingual nerve at the infratemporal fossa and paralingual space area, 32 Korean hemi-sectioned heads were dissected macroscopically and microscopically with a viewpoint of clinical aspect in this study. This study demonstrated various anatomical characteristics with relation to the course and topography of the lingual nerve in Koreans. And clinical significances based on the anatomical variations through the topography of the courses and communications between the mandibular nerve branches were described in details.
Anesthesia ; Chorda Tympani Nerve ; Gingiva ; Head ; Hypesthesia ; Lingual Nerve* ; Mandibular Nerve ; Mouth Floor ; Mucous Membrane ; Salivary Glands ; Sensation ; Tongue

A material of 48 patients with 60 avulsed and replanted permanent teeth were followed retrospectively in the period of 1996. 1 to 1998. 12 (mean observation period=1year 7months). The age of the patients at the time of replantation ranged from 9 to 63 years (mean=24 years). Clinical records of patients were reviewed to obtain valid data concerning the extent of injury and treatment provided. Pulpal and periodontal healing states were examined with periapical x-rays and clinical examination procedures (i.e. percussion test and mobility test) at their recall visit. Root ankylosis was found in fifty-two teeth (87%) and root resorption in twenty-four (40%). Only two of the replanted teeth (3%) showed partial regeneration of the periodontal ligament. Six teeth (10%) resulted in tooth loss, but the remaining fifty-four were clinically well functioning. Most of teeth have mild marginal bone loss accompanied by gingival retraction without pathological periodontal pockets. The incidence of root resorption was much higher in younger age group. However, it was not affected by the interval between avulsion and replantation, the condition of supporting tissues, the degree of root formation and the type of splinting, indicating that multiple factors involved in determining the prognosis of replanted teeth. Based on these findings, avulsed teeth in unfavorable conditions (i.e. long extra-alveolar periods, etc.) should be preserved if possible.
Ankylosis ; Humans ; Incidence ; Percussion ; Periodontal Ligament ; Periodontal Pocket ; Prognosis ; Regeneration ; Replantation* ; Retrospective Studies ; Root Resorption ; Splints ; Tooth Loss ; Tooth Replantation ; Tooth*