본문 바로가기
HOME> 논문 > 논문 검색상세

논문 상세정보

장기간의 보존적 배농술로 치료된 하악 복합골절 관련 광범위 골수염 치험 : 증례보고
THE LONG-TERM CONSERVATIVE DRAINAGE CARE OF EXTENSIVE OSTEOMYELITIS ASSOCIATED WITH MANDIBULAR COMPOUND FRACTURE : REPORT OF A CASE

김하랑    (연세대학교 치과대학 구강악안면외과학교실 (원주기독병원)   ); 유재하    (연세대학교 치과대학 구강악안면외과학교실 (원주기독병원)   ); 최병호    (연세대학교 치과대학 구강악안면외과학교실 (원주기독병원)   ); 설성한    (연세대학교 치과대학 구강악안면외과학교실 (원주기독병원)   ); 모동엽    (연세대학교 치과대학 구강악안면외과학교실 (원주기독병원)   ); 이천의    (연세대학교 치과대학 구강악안면외과학교실 (원주기독병원)  );
  • 초록

    Failure to use effective methods of reduction, fixation and immobilization may lead to osteomyelitis with the exposed necrotic bone, as the overzealous use of transosseous wires & plates that devascularizes bone segments in the compound comminuted fractures of mandible. Once osteomyelitis secondary to fractures has become established, intermaxillary fixation should be instituted as early as possible. Fixation enhances patient comfort and hinders ingress of microorganisms and debris by movement of bone fragments. Teeth and foreign materials that are in the line of fracture should be removed and initial debridement performed at the earliest possible time. Grossly necrotic bone should be excised as early as possible ; no attempt should be made to create soft tissue flaps to achieve closure over exposed bone. The key to treatment of chronic osteomyelitis of the mandible is adequate and prolonged soft tissue drainage. If good soft tissue drainage is provided over a long period, sequestration of infected bone followed by regeneration or fibrous tissue replacement will occur so that appearance and function are not seriously altered. Localization and sequestration of infected mandible are far better performed by natural mechanism of homeostasis than by cutting across involved bone with a cosmetic or functional defect. As natural host defenses and conservative therapy begin to be effective, the process may become chronic, inflammation regresses, granulation tissue is formed, and new blood vessels cause lysis of bone, thus separating fragments of necrotic bone(sequestra) from viable bone. The sequestra may be isolated by a bed of granulation tissue, encased in a sheath of new bone(involucrum), and removed easily with pincettes. This is a case report of the long-term conservative drainage care in osteomyelitis associated with mandibular fractures.


  • 주제어

    Fracture osteomyelitis .   Post-operative infected wound .   Long-term conservative drainage.  

  • 참고문헌 (22)

    1. Kaban LB, Pogrel MA, Perrott DH : Complications in oral and maxillofacial surgery. WB Saunders, 1997, p121 
    2. Kim J, Yoo JH, Yoon JH et al : Clinical guide in dental management of the medically compromised patients. Kunja Publishing Co, 2005, p11 
    3. Park TW, Lee SR, Kim JD et al : Oral and maxillofacial radiology. Narae Publishing Co, 2001, p516 
    4. Koury M, Ellis E : Rigid internal fixation of infected mandibular fractures . Journal of Oral and Maxillofacial Surgery 50 : 434, 1993 
    5. Koury ME, Perrott DH, Kaban LB : The use of rigid internal fixation in mandibular fractures complicated by osteomyelitis. Journal of Oral and Maxillofacial Surgery 52 : 1114, 1994 
    6. Sabiston DC : Textbook of surgery, Vol 1. 13th ed. WB Saunders, 1986, p23 
    7. Iizuka T, Lindqvist C, Hallihainen D et al : Infection after rigid internal fixation of mandibular fractures : A clinical and radiographic study. Journal of Oral and Maxillofacial Surgery 49 : 585, 1991 
    8. William JL : Rowe and Williams' maxillofacial injuries, Vol II. Second ed. Churchill Livingstone, 1994, p845 
    9. Stone I, Dodson TB, Bays RA : Risk factors for infection following operative treatment of mandibular fractures. Plastic Reconstructive Surgery 91 : 64, 1993 
    10. Fonseca RJ and Walker RV : Oral and maxillofacial trauma, Vol II. WB Saunders, 1991, p1150 
    11. Topazian RG, Goldberg MH : Management of infections of the oral and maxillofacial regions. WB Saunders, 329, 1981, p247 
    12. Conley JJ : Complications of head and neck surgery. WB Saunders, 1979, p358 
    13. Prein J, Beyer M : Management of infection and nonunion in mandibular fractures. Oral and Maxillofacial Clinics of North America 2 : 187, 1990 
    14. Peacock EE, Winkle WV : Wound repair, Second ed. WB Saunders, 1976, p624 
    15. Yoo JH, Lee JW : The care of infected orocutaneous open wounds after open reduction in compound comminuted fracture of mandible, report of cases. The Journal of Korean Association of Maxillofacial Plastic and Reconstructive Surgeons 11 : 267, 1989 
    16. Kim JB, Yoo JH, Choi BH : Conservative care of nonunion owing to osteomyelitis associated with fracture of mandible, report of 3 cases. Journal of the Korean Association of Oral and Maxillofacial Surgeons. 23(5) : 471, 2001 
    17. Dingman RO, Natvig P : Surgery of facial fractures. WB Saunders, 1984, p339 
    18. Schultz RC : Facial injuries, Second ed. Year Book Medical Publishers, 1988, p450 
    19. Kruger GO : Textbook of oral and maxillofacial surgery, Sixth ed. CV Mosby, p333-356, 1984 
    20. Roitt IM, Lehner T : Immunology of oral disease, Second edition. Blackwell Scientific Publications, 1983, p279 
    21. Kim GS, Lee DK : Oral and maxillofacial infections. Kunja Publishing Co, 1992, p171 
    22. Kruger E, Schilli W : Oral and maxillofacial traumatology, Vol I. Quintessence book, 1982, p134 

 저자의 다른 논문

  • 김하랑 (10)

    1. 2008 "전신질환자에서 과도한 감염치아부 국소마취시 스트레스 감소법 : 문헌적 고찰 및 증례보고" 대한치과마취과학회지 = Journal of the Korean Dental Society of Anesthesiology 8 (1): 1~9    
    2. 2009 "설신경과 장협신경 전달마취 시행 후 발생된 설부와 협선반부의 장기간 이상감각증 관리 -증례보고-" 대한치과마취과학회지 = Journal of the Korean Dental Society of Anesthesiology 9 (2): 108~115    
    3. 2009 "중증 간경변증 환자에서 발치창 과도 출혈부의 지속적 배농술을 통한 지혈 : 증례보고" 大韓口腔顎顔面外科學會誌 = Journal of the Korean Association of Oral and Maxillofacial Surgeons 35 (6): 431~436    
    4. 2010 "교도소에서 의뢰된 급성 하악 지치 주위염의 보존적 감염관리: 증례보고" 大韓口腔顎顔面外科學會誌 = Journal of the Korean Association of Oral and Maxillofacial Surgeons 36 (1): 57~61    
    5. 2010 "어린이에서 상악 정중부 매복 과잉치 발치 시 즉시 배액술의 효과: 증례보고" 대한악안면성형재건외과학회지 = The journal of Korean association of maxillogacial plastic and reconstructive surgeons 32 (3): 256~259    
    6. 2010 "하악골 복합 골절시 구내 열창부 상에 추가 절개 배농술을 이용한 단기간 가변적 악간고정 관리: 증례보고" 대한악안면성형재건외과학회지 = The journal of Korean association of maxillogacial plastic and reconstructive surgeons 32 (3): 260~264    
    7. 2010 "국소마취하 상악 측절치 치근단 절제술 후 인식된 신경병성 비정형 치통 1예 -증례 보고-" 대한치과마취과학회지 = Journal of the Korean Dental Society of Anesthesiology 10 (1): 20~26    
    8. 2010 "구강악안면 손상 후 과도한 출혈을 보인 정신지체 응급환자에서 신속지혈 예: 증례보고" 大韓口腔顎顔面外科學會誌 = Journal of the Korean Association of Oral and Maxillofacial Surgeons 36 (4): 303~308    
    9. 2010 "조기 치근관 배농술을 이용한 하악 골절선상 감염치아들의 보존적 관리: 증례보고" 大韓口腔顎顔面外科學會誌 = Journal of the Korean Association of Oral and Maxillofacial Surgeons 36 (4): 309~313    
    10. 2010 "뇌기저부 골절후 발생된 과도한 구인두 출혈의 구인두 전체 신속압박에 의한 응급지혈: 증례보고" 대한악안면성형재건외과학회지 = The journal of Korean association of maxillogacial plastic and reconstructive surgeons 32 (2): 189~195    
  • 유재하 (72)

  • 최병호 (57)

  • 설성한 (6)

  • 모동엽 (12)

  • 이천의 (20)

 활용도 분석

  • 상세보기

    amChart 영역
  • 원문보기

    amChart 영역

원문보기

무료다운로드
  • NDSL :
  • 대한악안면성형재건외과학회 : 저널
유료다운로드

유료 다운로드의 경우 해당 사이트의 정책에 따라 신규 회원가입, 로그인, 유료 구매 등이 필요할 수 있습니다. 해당 사이트에서 발생하는 귀하의 모든 정보활동은 NDSL의 서비스 정책과 무관합니다.

원문복사신청을 하시면, 일부 해외 인쇄학술지의 경우 외국학술지지원센터(FRIC)에서
무료 원문복사 서비스를 제공합니다.

NDSL에서는 해당 원문을 복사서비스하고 있습니다. 위의 원문복사신청 또는 장바구니 담기를 통하여 원문복사서비스 이용이 가능합니다.

이 논문과 함께 출판된 논문 + 더보기