• Journal of the Korean Association of Oral and Maxillofacial Surgeons
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• v.37 no.4
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• pp.272-277
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• 2011

Purpose: The aim of this study was to compare the estimated blood loss and determine the change in hemoglobin depending on the combination of each orthognathic surgery. Subjects and Methods: The subjects of this study were patients who underwent orthognathic surgery among those diagnosed with a dentofaical deformity in Mok-Dong hospital, Ewha Womans University from 2002 to 2009. One hundred patients (men - 36, women - 64, mean age of $24.5{\pm}4.6$) participated in the study and were divided into four groups (group 1 - bilateral sagittal ramus osteotomy [BSSRO], group 2 - BSSRO+Genioplasty, group 3 - Lefort 1+BSSRO+genioplasty, group 4 - anterior segmental osteotomy on maxilla and mandible). A comparative study on the estimated blood loss (EBL), operation time, peri-operative changes in hemoglobin was performed using anesthesia records. The results were analyzed statistically using a Mann-Whitney U-test and Spearman's Rho test - SPSS 12.0 (SPSS Inc. Chicago, IL, USA). Results: In group 1 (BSSRO), the mean EBL, operation time and change in hemoglobin was $394.43{\pm}52.69$ ml, $184{\pm}42.33$ minutes, and 1.43, respectively, In group 2 (BSSRO+genioplasty), it was $556.32{\pm}63.42$ ml, $231{\pm}37.45$ minutes, and 1.80, respectively. In group 3 (Lefort 1+BSSRO+Genioplasty), it was $820.55{\pm}105.54$ ml, $320{\pm}15.41$ minutes, and 2.73, respectively. In group 4 (segmental osteotomy), it was $1025.39{\pm}160.21$ ml, $355{\pm}20.10$ minutes, and 3.33, respectively. In particular, in group 3, significant differences were observed depending on the method of the orthognathic surgery. The mean EBL in a Lefort 1 osteotomy with advancement was only 687 ml, whereas Lefort 1 osteotomy with canting correction (992 ml), even impaction (764 ml), and posterior nasal spine impaction (100 ml) showed a much higher EBL. Conclusion: From these results, the EBL and peri-operation hemoglobin increased as treatment plans became more complicated and increasing operation time. Safe orthognathic surgery should be performed by applying proper autologous transfusion plans based on the average EBL of each orthognathic surgery type.

• Journal of the Korean Association of Oral and Maxillofacial Surgeons
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• v.33 no.1
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• pp.11-19
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• 2007

This study was to evaluate the expression of vascular endothelial growth factor receptors (VEGFRs) in tumor and stromal cells of tougue squamous cell carcinoma (SCC). We also wanted to characterize the differences, from the angiogenic aspect, between cancer-associated stromal cells and non-malignant stromal cells. Paraffin-embedded tumor specimens from eleven patients with tongue SCCs were studied. Immunohistochemical staining for VEGFR-1,-2, and -3 was performed on the tumor cells, stromal fibroblasts and tumor-associated macrophages of the specimens. The expression of all 3 receptors was detected in the tumor cells themselves of the biopsy specimens. All 3 receptors were also expressed on stromal cells, except that VEGFR-2 was not expressed in stromal fibroblasts. In radical excision specimens, the staining intensity for VEGFR-1, -2 in the tumor cells and VEGFR-1,-3 in the tumor-associated macrophages was significantly lower than that in the biopsy specimens (P < 0.05). By using the general marker of fibroblast and macrophage, 5B5 and CD68, respectively, we performed double immunofluorescence staining for 5B5 and each VEGFR in the stromal fibroblasts and for CD68 and each VEGFR in the tumor-associated macrophages of the radical excision specimens. We used 4 cases of fibroma and 4 cases of chronic inflammation tissue as the controls. It was found that only each marker was expressed in the control group, however, 5B5/VEGFR-1 and 5B5/VEGFR-3 in the stromal fibroblasts, and CD68/VEGFR-1 and CD68/VEGFR-3 in the tumor-associated macrophages were double stained in the radical excision specimens. Although our study used small number of specimens, the results of our study showed that in tongue SCC, in association with the angiogenesis, the stromal cells showed the activated phenotype and this was different from the nonmalignant stromal cells.

• Journal of the Korean Association of Oral and Maxillofacial Surgeons
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• v.33 no.1
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• pp.46-54
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• 2007

PURPOSE Osteosarcoma occurring in the head and neck region is known as a malignant tumor that shows a relatively poor prognosis and, despite various treatments, clinicians have often been confounded by it. The existence or non-existence of the mutation of the gene $p16^{INK4a}$ has been used in prognosis assessment. In this study, author have attempted to determine whether methylation of the gene $p16^{INK4a}$ could be applied to forecast the progress of osteosarcomas in the head and neck region having been given poor prognoses in the diagnostic process and the early stage of treatment. RESEARCH SUBJECT AND METHOD Clinicopathologic investigations, immunohistochemical examinations, a methylation specific polymerase reaction (MSP) analysis, and a survival analysis were conducted on the tissues of 20 patients with mandibulofacial osteosarcoma. RESULTS Neither age, sex, size, smoking or non-smoking, nor region have showed a statistical significance with methylation or unmethylation of the gene $p16^{INK4a}$ and expression rates demonstrated by immunohisto- chemical examinations. A chi-square test indicated that recurrence inclination has no relation with the expression rate of p16 protein (p=0.6615), but it showed a statistical significance with methylation of the gene $p16^{INK4a}$ (p=0.0033). With respect to investigations of the survival rates, a Kaplan-Meier survival analysis found that the manifestation rate of p16 protein did not have an impact on survival (p=0.8864), but that the methylation of the gene $p16^{INK4a}$ resulted in significant differences in survival rates (p=0.0105). CONCLUSIONS The above results show that methylation of the gene $p16^{INK4a}$ could be one of the major factors that help determine the recurrence inclination and prognosis of osteosarcomas occurring in the head and neck region.

• Journal of the Korean Association of Oral and Maxillofacial Surgeons
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• v.43 no.2
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• pp.77-82
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• 2017

Objectives: The aim of this study was to compare the mechanical resistance of four different osteosyntheses modeled in two different sagittal split ramus osteotomy (SSRO) designs and to determine the linear loading in a universal testing machine. Materials and Methods: An in vitro experiment was conducted with 40 polyurethane hemimandibles. The samples were divided into two groups based on osteotomy design; Group I, right angles between osteotomies and Group II, no right angles between osteotomies. In each group, the hemimandibles were distributed into four subgroups according to the osteosynthesis method, using one 4-hole 2.0 mm conventional or locking plate, with or without one bicortical screw with a length of 12.0 mm (hybrid technique). Each subgroup contained five samples and was subjected to a linear loading test in a universal testing machine. Results: The peak load and peak displacement were compared for statistical significance using PASW Statistics 18.0 (IBM Co., USA). In general, there was no difference between the peak load and peak displacement related to osteotomy design. However, when the subgroups were compared, the osteotomy without right angles offered higher mechanical resistance when one conventional or locking 2.0 mm plate was used. One locking plate with one bicortical screw showed higher mechanical resistance ($162.72{\pm}42.55N$), and these results were statistically significantly compared to one conventional plate with monocortical screws (P=0.016) and one locking plate with monocortical screws (P=0.012). The difference in peak displacement was not statistically significant based on osteotomy design or internal fixation system configuration. Conclusion: The placement of one bicortical screw in the distal region promoted better stabilization of SSRO. The osteotomy design did not influence the mechanical behavior of SSRO when the hybrid technique was applied.

• Journal of the Korean Association of Oral and Maxillofacial Surgeons
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• v.43 no.3
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• pp.152-159
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• 2017

Objectives: The aim of this study was to investigate the effects of advancement magnitude and changes in mandibular plane angle on the stability of mandibular advancement. Materials and Methods: This retrospective cohort study evaluated the postoperative stability of mandibular advancement in class II skeletal subjects who underwent bilateral sagittal split osteotomy. Radiographs taken preoperatively, immediately postoperatively and 1 year postoperatively were traced and analyzed using linear and angular measurements. To determine horizontal and vertical relapse, an X-Y coordinate system was established in which the X-axis was constructed by rotating S-N downward by $7^{\circ}$ (approximation of the Frankfort horizontal plane) and the Y-axis was defined as a line perpendicular to the X-axis and passing through the point Sella. For certain reference points including point A, point B, pogonion and menton, the perpendicular distance between each point and both axes was determined and cephalometric variables were recorded as X and Y coordinates. Results: Twenty-five subjects were studied. A significant correlation between the amount of mandibular advancement and relapse in the B point (vertical and horizontal) and the pogonion point was observed (vertical and horizontal, P<0.001). Evaluation of data demonstrated a positive correlation between the mandibular plane angle (SN/ML) change and vertical relapse in the B point (P<0.05). A simple regression model demonstrated that 74% of horizontal relapse and 42.3% of vertical relapse in the B point was related to the amount of mandibular advancement. The receiver operating characteristic test showed that 8.5 mm mandibular advancement is related to a relapse rate of 1 mm or more in the pogonion, vertically or horizontally. Conclusion: The magnitude of mandibular advancement is a stronger surgical predictor for horizontal rather than vertical relapse at the B point. Changes in mandibular plane angle (SN/ML) during surgery affect vertical, but not horizontal relapse at the B point.

• Maxillofacial Plastic and Reconstructive Surgery
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• v.21 no.2
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• pp.139-148
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• 1999

Oral cancer is a common neoplasm in humans and etiologic mechanism is not well known, so treatment and evaluation of oral cancer is difficult problem. Traditional TNM classification between prognosis of tumors and classification of histopathologic differentiation has problem like lack of objectivity through operators. In molecular biology, cancer is developed by alteration of activation of oncogene and/or inactivation of tumor suppressor gene. The p53 gene, one of the tumor suppresor genes, is believed to play an important role through mutation and overexpression in the progression of human cancers. The p53 mutation is most frequent genetic disorder in humans. The Cyclin D1 has tumor suppresion activity by regulation of cell cycle. The Cyclin D1 regulate activity of Rb tumor suppresor gene by stimulation of CDK4 The purpose of this study was to observe the expression of p53 protein and Cyclin D1 in oral squamous cell carcinoma, and to get expectation of the malignancy and prognosis of oral squamous cell carcinoma. Using the 15 cases of squamous cell carcinoma and the microscopic H&E and immunohistochemical stain. We divided it into 3 groups according to the stain extent, clinical stage and histologic differentiation. The results were as follows1.In the features of immunohistochemical stain of 15 cases of squamous cell carcinoma, positive reaction of p53 was identified in 8 cases (53.3%) and positive reaction of cyclin D1 was identified in 3 cases (20%). Both positive reaction of p53 protein and Cyclin D1 was show in only one case. 2.8 of p53 positive cases were linked in 87.5% of the end stage tumor, 62.5% of neck node involvement, 87.5% of poorly and moderately histopathplogic differentiation. 3. All 3 of Cyclin D1 positive cases were linked in the end stage tumor, neck node involvement, poorly and moderately histopathologic differentiation. From above results, expression of p53 protein was identified in 53.3% of 15 cases and these results mean oral squamous cell carcinoma was drived by mutation of p53 protein. Especially, highly positive reaction of p53 protein and Cyclin D1 was identified in cases that involvement of neck lymph node and the end stage tumors and it means that the evaluation of p53 protein and Cyclin D1 was useful for evaluation of malignant tumor as specific tumor marker.

• Maxillofacial Plastic and Reconstructive Surgery
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• v.27 no.2
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• pp.103-109
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• 2005

In spite of the ongoing advances, standard therapies for oral cancer still has some limitations in efficacy and in ability to prolong survival rate of advanced disease and result in significant functional defect and severe cosmetic deformity. Currently gene therapy using tumor suppressor gene is considered as a potent candidate for new therapeutic approaches that can improve efficacy and reduce complications. The purpose of this research is to identify the role of adenoviral vector to transfer HCCS-1 tumor suppressor gene in oral cancer cells and to find out whether there is a possibility for it to serve in the field of gene therapy. The human SCC-25 cell line was used for transfection. To determine the efficiency of the adenovirus as a gene delivery vector cell line was transduced with LacZ gene and analysed with X-gal staining. Northern blot was performed to confirm the tranfection with HSCC-1 gene and cell viability was assessed by cell cytotoxicity assay. We had successfully construct the recombinant HSCC-1 adenovirus(Ad5CMV-HCCS-1). DNA extracted from Ad5CMV-HCCS-1 revealed HCCS-1 gene is incorporated. The transduction efficiencies were over than 50% of SCC-25 cells with a MOI of 2 and over 95% with a MOI of 50. Northern blot analysis showed that a single 0.6kb mRNA transcript was expressed in Ad5CMV-HCCS-1 transduced SCC-25 cells. There was no or very low transcription HCCS-1 mRNA in wild and Ad5CMV-LacZ transduced SCC-25 cells. Cells transduced with Ad5CMV-HCCS-1 showed significant growth inhibition. By day 6, Ad5CMV-HCCS-1 treated cell count was decreased to 30% of mock-infected cells, while that of Ad5CMV-LacZ treated cells was 90% of mock-infected cells (p<0.05). Finally, these result suggest that the Ad5CMV-HCCS-1 has potential as a gene therapy tool for oral cancer.

• Journal of the korean academy of Pediatric Dentistry
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• v.29 no.3
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• pp.450-454
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• 2002

Laceration of soft palate and oropharynx is relatively common in children. Soft palate laceration has been reported patients of all ages, ranging from new born to geriatric patients. However, young children often place objects their mouth, they may fall on the object or receive a direct force on the object which then perforates the soft palate tissue. Most frequently affected site is the left supra-tonsillar area. Lesions are predominately in the soft palate with-out perforation. Linear and superficial wounds are frequent. A typical injury is the flat- U-, or V-shaped with apex directed anteriorly. In those cases without any through-and-through lacerations or any tissue loss, suture is not necessary. Furthermore, suture of the affected site may hinder wound healing. Healing of the wound should be complete by three weeks with minimal scarring. There have been reports of carotid artery injury due to soft palate laceration causing neurologic complications. For such reasons, traumatized child must be in close observation for 2-3days, and if symptoms of complication are noticed consultation with oromaxillofacial surgeons, E.N.T., or neurologist is required. These are two reports of boys 2 and 3 years of age who had soft palate laceration caused by a falling-down-in jury with an object in their mouth. They were treated non-surgically and neurologic evaluation was carried out for 1 week with complete healing.

• Maxillofacial Plastic and Reconstructive Surgery
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• v.27 no.6
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• pp.510-522
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• 2005

To assess the clinical applicability of bio-artificial mucosa which was made with autologous oral keratinocytes and human acellular dermal matrix, the formation of basement membrane and stratification of oral keratinocytes were evaluated. Six New Zealand white rabbits (around 2kg in weight) were anesthetized and its buccal mucosa was harvested (1.0 $\times$ 0.5cm size). Oral keratinicytes were extracted and cultured primarily with the feeder layer of pretreated NIH J2 3T3 fibroblast. These confluent cells were innoculated on the human acellular dermal matrix and cultured in multiple layer by air-rafting method. After 3, 5, 7, 10, 14 days of culture, each cultured bio-artificial mucosa was investigated the number of epthelial layer of by H&E stain and toluidine blue stain. The immuhohistochemical methods were used to evaluate the cell division capacity, the formation of basement membrane, and it's property of specific cells (PCNA, cytokeratin 14, laminin). Transmission electromicroscopy was used for the attachment between cells and matrix with the number of hemidesmosome. In result, the numbers of layer of stratified growth of oral keratinocyte cultured on the human acellular dermal matrix and the number of hemidesomal attachment between epithelial cells and human acellular dermal matrix were similar to the layers of normal oral mucosa after 10 days of culture. The cell division rate, basement membrane formation and proliferation rate increased as culture period increased. With these results, bio-artificial mucosa with autologous oral epithelial cells cultured on the acellular dermal matrix had clinically adaptable properties after 10 days' culture and this new bio-artificial mucosa model with relatively short culture time can be expected clinical applicability.

• Maxillofacial Plastic and Reconstructive Surgery
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• v.29 no.1
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• pp.85-90
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• 2007

Plasma cell neoplasms are generally categorized into four groups; multiple myeloma(MM), solitary plasmacytoma of the bone(SPB), plasma cell leukemias, and extramedullary plasmacytomas(EMP). These tumors may be further described as localized or diffuse in presentation. Localized plasma cell neoplasms are rare occurrences and include solitary plasmacytomas of the skeletal system, which account for 2-5% of all plasma cell neoplasms and extramedullary plasmacytomas of the soft tissue, which account for approximately 3% of all such neoplasms. A plasmacytoma is defined as any discrete, most likely solitary mass of neoplastic plasma cells either in the bone marrow or in various soft tissue sites. Diffuse lesions include the other two groups, multiple myeloma and plasma cell leukemia. The relationship between these processes has not yet been definitively characterized, but there appears to be a continuum in which both SPB and EMP often progress to MM. The patient was referred who had continuous deep throbbing bone pain and swelling on the left posterior gingival area of the mandible after extraction of the first and second molar. The result of intraoperative excisional biopsy of the lesion was confirmed as a plasmacytoma. And it revealed systemic multiple myeloma through the further diagnostic work-up. It is worth to report because of a rare case of multiple myeloma found in oral cavity as a form of plasmacytoma.