• Maxillofacial Plastic and Reconstructive Surgery
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• v.21 no.4
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• pp.407-413
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• 1999

Maxillary duplication is a kind of proliferative neurocristopathy and considered to arise from bifurcation of neural crest elements soon after migration into mandibular arch. Sometimes this malformation is accompanied with oblique facial cleft. Usually this type of maxillofacial malformation requires multiple surgical intervention and the results are far from ideal. It became more troublesome if it had not been properly corrected on time, because secondary deformities could be developed from growth and development of abnormal tissues. This is a case of a 25-year-old-female patient who showed severe facial asymmetry thought to secondary deformity of maxillary duplication and masticatory disturbance due to multiple supernumerary teeth on posterior part right maxilla. We successully treated these deformities through four times of surgery of bone resection, orthodontic treatment, zygomatic and orbital reconstruction, orthognathic surgery and scar revision... ect. So we reported this rare case with review of literatures.

• Maxillofacial Plastic and Reconstructive Surgery
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• v.34 no.2
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• pp.140-147
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• 2012

Microvascular reconstruction, in the oral and maxillofacial regions, is a widely accepted as the best way to overcome the complex oral cavity defects. Many patients requiring composite reconstructions have been treated previously with radiation therapy, chemotherapy, selective and/or functional neck dissection or any of these combinations. In many cases of these patients, inadequate neck vessels for the microanastomosis of free flap are available, due to a lack of recipient vessels in the neck, poor vessel quality or vessel caliber mismatch. To achieve a tension-free anastomosis, vein grafting must be considered to span the vessel gap between the free flap pedicle and the recipient neck vessels. Although most microsurgeons believed that interpositional grafts are to be avoided due to vessel thrombosis and increased number of necessary microanastomosis, we, authors have some confidence of equivalency between reconstruction with and without interpositional saphenous vein graft. The great saphenous vein, also known as the long saphenous vein, is the large subcutaneous superficial vein of the leg and thigh. It joins with the femoral vein in the region of femoral triangle at the saphenofemoral junction, and coursed medially to lie on the anterior surface of the thigh before entering an opening in the fascia lata, called the saphenous opening. For a better understanding of the great saphenous vein graft for the interpositional vessel graft in the oral cavity reconstructions, and an avoidance of any uneventful complications during these procedures, the related surgical anatomies with their harvesting tips are summarized in this review article in the Korean language.

• Journal of the Korean Association of Oral and Maxillofacial Surgeons
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• v.28 no.6
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• pp.456-463
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• 2002

Distraction osteogenesis is a well-established clinical treatment for limb length discrepancy and skeletal deformities. Appropriate mechanical tension-stress is believed not to break the callus but rather to stimulate osteogenesis. In contrast to fracture healing, the mode of bone formation in distraction osteogenesis is primarily intramembranous ossification. Although the biomechanical, histological, and ultrastructural changes associated with distraction osteogenesis have been widely described, the basic biology of the process is still not well known. Moreover, the molecular mechanisms in distraction osteogenesis remain largely unclear. Recent studies have implicated the growth factor cascade is likely to play an important role in distraction. And current reserch suggested that mechanical tension-stress modulates cell shape and phenotype, and stimulates the expression of the mRNA for bone matrix proteins. This article presents the hypotheses and current research that have furthered knowledge of the molecular biology that govern distraction osteogenesis. The gene regulation of growth factors and extracellular matrix proteins during distraction osteogenesis are discussed in this article. It is believed that understanding the biomolecular mechanisms that mediate distraction osteogenesis may guide the development of targeted strategies designed to improve distraction osteogenesis and accelerate bone healing.

• Journal of the Korean Association of Oral and Maxillofacial Surgeons
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• v.28 no.6
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• pp.472-479
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• 2002

Since $Br^{\circ}anemark$ introduced the osseointegrated implants, they have been granted for useful methods for the restoration of oral function. The original $Br^{\circ}anemark$ protocol recommended long stress-free healing periods to achieve the osseointegration of dental implants. However, many clinical and experimental studies have shown that the osseointegration is no wonder in almost cases and that early and immediate loading may lead to predictable osseointegration. So we are willing to introduce the Satellite Abutment newly invented for immediate loading. We think that it will make the occlusal forces dispersed to surrounding bone and that we can restore the oral function immediately after implant installation not disturbing osseointegration. In case of using Satellite abutment, stress concentrated to bone contact area of implant was distributed not only fixation plate and screws but also superior, middle portion of implant and cortical layer of jaw bone. It was clearly decreased on the bone contact surfaces around dental implants. 1. Stress was decreased more than 76.5% when satellite straight abutment was used. 2. Stress was decreased more than 50% when satellite angled abutment was used. 3. The stress around dental implant was well distributed along the cortical bone surface and the fixation plate and screw. This study concludes that satellite abutment can be used as all immediate loading implant prothesis because it was possible to distribute periimplant occlusal stress through implant contact bone surface and cortical layer of jaw bone.

• Journal of the Korean Association of Oral and Maxillofacial Surgeons
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• v.28 no.6
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• pp.464-471
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• 2002

The purpose of this study was to evaluate the stress patterns within fractured mandibles generated by reduction forceps and to determine the optimal position of the reduction forcep. Twenty-seven mandibular models were fabricated using a photoelastic resin. Each of the three sets of mandible models prepared was osteotomized according to one of three different fracture types(symphysis, parasymphysis and body fractures). After reducing the cut segments, a reduction forcep was placed into different engagement holes to compress the segments. Photoelastic stress analysis was used to visualize the stress patterns within the fractured mandiblular models generated by the reduction forcep. In the case of symphysis or parasymphysis fractures, an optimum distribution of stress over the fracture site was achieved when placing the reduction forcep more than 12.5mm on either side of the fracture line between the midway level bisecting the mandible and 5mm below the level. In the case of body fractures, optimum stress distribution was achieved when the reduction forcep was placed more than 15mm from the fracture line on the midway level. In conclusion, a correct use of reduction forceps helps to provide a precise threedimensional reduction for mandibular fractures.

• Journal of the Korean Association of Oral and Maxillofacial Surgeons
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• v.28 no.6
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• pp.440-455
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• 2002

The final goal for an orthognathic surgery is a functional and esthetic achievement based on occlusion theory. All the dental treatment should be done with the occlusion in mind, though, they tend to be ignored with no good reason. We cannot think of occlusion without temporomandibular joint because it is the first clue to define an occlusion. As normal occlusion comes from the central tendency of distribution of population, we can get it by examining the population that closely meet the criteria of ideal occlusion. To perform proper occlusal function and to maintain the stability after treatment, the case must be finished in normal occlusion closer to ideal one. Our aim is to achieve the ideal occlusal scheme like the mutually protected occlusion with the best masticatory efficiency and the stability. The facial esthetics are influened by culture, race and the time in which human live. While the occlusal function rarely changes as time goes by, esthetics tend to do from one country to another. Orthodontists and maxillofacial surgeons should have solid sets of treatment goals to achieve the best facial esthetics and the ideal occlusion dictated by the joint. Doing orthognathic surgery, two factors aforementioned should be taken into account to establish the Surgical Treatment Objectives(STO). The doctors who are planning orthognathic surgery need to have a very logical and systematic thought process to make STO. The author examined 28 selected beautiful Korean female adults with normal skeleton with normal occlusion and analyzed the hard and the soft tissue relationship into five parts : dentomaxillary relationship, intermaxillary relationship, posture to hard tissue relationship, facial balance, and posture to soft tissue relationship. This study presents a sequential flow of diagnosis and treatment planning especially for surgical patients and it also can be applied to the nonsurgical patients.

• Journal of the Korean Association of Oral and Maxillofacial Surgeons
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• v.28 no.6
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• pp.413-420
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• 2002

Mercury is one of the most frequently used heavy metal in dental clinic. Mercury poisoning rises up when someone is exposed to mercury chronically. In 1818, Amalgam was used for dental restorative procedure, and after then study about mercury toxicity has begun. Clinical signs of mercury toxicity in oral & maxillofacial area were increases of salivation, metallic taste, swelling and pain of tongue, redness and ulceration of oral mucosa, and increased mobility and loss of teeth. After we injected mercury($HgCl_{2}$) into intraperitoneum of rat, studied about histopathological changes of submandibular gland cell. Experimental group was divided into two groups by amount of mercury. (Group 1 was 0.5mg/Kg of mercury injection, group 2 was 1.0mg/Kg of mercury injection.) 1. After 3days of intraperitoneal injection, black granules were observed at macrophage cell in both group. In group 2, author found hyperchromatism of nucleus, and vacuolization of cellular matrix and nucleus of acinar cell. 2. After 1week of intraperitoneal injection, author found severe vacuolization of nucleus and cellular matrix, and irregular granules around nuclear membrane at mucous cell and serous cell in both group. Vacuolization of nucleus and cellular matrix was seen at duct cell in group 2. 3. After 2weeks of intraperitoneal injection, author could found severe vacuolization of cellular matrix, and sometimes nucleus was positioned in central area of cellular matrix at mucous and serous cell in both group. Vacuolization of nucleus and cellular matrix was found at vascular endothelial cell in group 2. 4. After 4weeks of intraperitoneal injection, destruction and distortion of gland cells were distinct. Vacuolization and destruction of nucleus and cellular matrix was found at duct cell in group 2. After intraperitoneal injection of mercury, we found equanimity of mercury and destruction of cellular matrix at serous cell, mucous cell, and duct cell of submandibular gland. So, we thought that metallic taste of mercury poisoning patient would be due to excretion of saliva containing mercury.

• Journal of the Korean Association of Oral and Maxillofacial Surgeons
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• v.28 no.6
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• pp.421-433
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• 2002

In order to elucidate the pathogenesis of cleft lip and palate, first of all, it is necessary to understand the developmental mechanisms of growth factors and extracellular matrix proteins in the tissues of cleft lip and palate. We have performed immunohistochemical studies on human cleft lip and palate tissues to elucidate the pathogenetic implications of cleft lip and palate. 16 specimens from postnatal human cleft lip and palate subjects and 17 specimens from autopsy of prenatal human cleft lip and palate were fixed in 10% buffered formalin, embedded in paraffin. The sections were routinely stained by hematoxylin and eosin, also stained by PAS, and followed by immunohistochemical stainings using the antiseras of growth factors and extracellular matrix proteins such as PCNA, S-100, c-erb-B2, MMP-3, MMP-10, HSP-70, transglutaninase-C, E-cadherin, VEGF, vWF. Both the prenatal and postnatal specimens of cleft lip and palate showed dysplastic proliferation of the basal cell layer, increased infiltration of melanocytes into mucosal epithelium, sebaceous gland hyperplasia ingrowing into the muscular tissue of lip and palate, and fatty infiltration into the submucosal deep connective tissue. The strong reactions of MMP-3 and HSP-70 were detected in the tissues of cleft lip and palate, especially increased in degenerating muscle bundles, while the immunostainings of PCNA and c-erb-B2 were weakly positive in the tissues of cleft lip and palate. These data suggest that the retrogressive tissue degeneration around the cleft areas persistently exist during the prenatal and postnatal period after cleft formation, and the sebaceous gland hyperplasia and fatty infiltration with the intense expression of MMP-3 and HSP-70 is closely related to the muscular degeneration around the cleft area.

• Journal of the Korean Association of Oral and Maxillofacial Surgeons
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• v.31 no.3
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• pp.266-273
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• 2005

Purpose: To assess the relationship between soft tissue reference line and hard tissue reference line using the standardized photographs and the posteroanterior cephalometric radiographs(P-A)in facial asymmetric patients and to compare the differences of angular measurement between normal group and asymmetry group. Methods: Normal group consisted of 44 persons with normal occlusion and normal facial morphology. Asymmetry group consisted of 90 patients with facial asymmetry. Standardized facial photographs and P-A were taken in all subjects. The horizontal reference lines were bipupillary line in photographs and latero-orbitale line in P-A respectively. The vertical reference line were the line from the midpoint of horizontal reference line perpendicularly. Angular measurement of otobasion canting, lip canting, nose deviation, chin deviation, and maxillary deviation were compared and analyzed in photographs. And angular measurement of mastoid canting, mandibular canting, nose deviation, chin deviation, and maxillary deviation were compared and analyzed in P-A. Results: 1. The variables of photographs and P-A were significantly related in the asymmetry group. 2. Significant differences between all variables except for PT2 and PA2 were shown in the asymmetry group and between PT1 and PA1, PT3 and PA3 in the normal group respectively. 3. Comparison measurement scores of angular difference between control group and experimental group concerning each variable showed significant difference except for PA1. Conclusions: Soft tissue components may not compensate for underlying skeletal imbalance in nose deviation and chin deviation. The horizontal reference lines in photographs were significant related with the P-A, but angular variables between the two studies show significant differences. Therefore, we do not recommend use photography in the assessment the facial asymmetry as complemented in the P-A.

• Journal of the Korean Association of Oral and Maxillofacial Surgeons
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• v.31 no.3
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• pp.260-265
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• 2005

Patient-controlled analgesia (PCA) has been widely used for postoperative pain control in medical surgery parts. Conventional intramuscular analgesia (IMA) is also effective in postoperative pain control, but it has some disadvantages that depend on patients' perception of pain and the anxiety that they endure caused by the delay of the injection time. This study was conducted to assess the efficacy and postoperative outcomes of intravenous PCA compared to IMA injections in 36 patients (BSSRO). Three factors were compared: amount of pain in PCA and IMA group ; amount of pain according to the sex in PCA and IMA group and the amount of pain according to the analgesia use. Results of this study did not demonstrate a statistically significant difference in any of these, using a p value of 0.05. The results of this study were as follows. : 1. There was no statistically significant difference in VAS pain score between IMA group and PCA group. 2. There was no statistically significant difference according to the sex. 3. There was no statistically significant difference according to the amount of PCA. The history of PCA is about 30 years and many literatures have reported about its effects, complications, methods, advantages and disadvantages. So, this study has some limitations of small sample size to conclude the effects of PCA. But when the decision about the method for postoperative pain control has to be made, it should be made based on patient or physician preference and cost factors rather than on the trend.