• Journal of Korean Neurosurgical Society
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• 제56권1호
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• pp.66-70
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• 2014

Sympathetic dysfunction is one of the possible complications of anterior spine surgery; however, it has been underestimated as a cause of complications. We report two successful experiences of treating severe dysesthetic pain occurring after anterior spine surgery, by performing a sympathetic block. The first patient experienced a burning and stabbing pain in the contralateral upper extremity of approach side used in anterior cervical discectomy and fusion, and underwent a stellate ganglion block with a significant relief of his pain. The second patient complained of a cold sensation and severe unexpected pain in the lower extremity of the contralateral side after anterior lumbar interbody fusion and was treated with lumbar sympathetic block. We aimed to describe sympathetically maintained pain as one of the important causes of early postoperative pain and the treatment option chosen for these cases in detail.

• 대한두개안면성형외과학회지
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• 제18권4호
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• pp.230-237
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• 2017

Background: The traditional approach for reduction of frontal sinus fractures is coronal incision. Inherent complications of the coronal approach include long scar, hair loss, and long operation time. We describe a simple approach for the reduction of frontal sinus anterior wall fractures using a suprabrow incision that is commonly used for brow lift. Methods: From March 2007 to October 2016, the authors identified patients with anterior wall frontal sinus fractures treated by open reduction through a suprabrow incision. Only cases with photographic/radiographic documentation and a minimum follow-up of 6 months were included. The incision line was designed to be at the upper margin of the eyebrow. Medical records and radiographic data were retrospectively reviewed. Surgical outcomes, cosmetic results, and complication were assessed. The patient scale of the patient and observer scar assessment scale was used to assess patient satisfaction for incisional scar at the 6-month follow-up. Results: Thirty-one patients underwent fracture reduction through a suprabrow approach during the study period, with a mean follow-up of 41 months. No patients showed any recurrent displacement, eyebrow asymmetry, or infection during follow-up. Thirteen patients reported their forehead paresthesia postoperatively, and 12 of them had preoperative symptom. One patient complained of incisional scar and underwent scar revision. All patients were satisfied with their eyebrow and forehead contour. Conclusion: The suprabrow approach allowed for an accurate reduction of the fractures in the anterior wall frontal sinus by providing direct visualization of the fracture. This transcutaneous approach can effectively restore forehead contour with acceptable postoperative complications and patient satisfaction.

• 대한정형외과 초음파학회지
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• 제6권2호
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• pp.45-52
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• 2013

목적: 관절와상완 관절내 주사의 도달법에 있어서, 현재 임상에서 선호되고 있는 맹검 도달법에 의한 전방 도달법과 초음파 장비를 이용한 후방 도달법의 주사 정확도를 비교하고자 하였다. 대상 및 방법: 본원에서 견관절의 관절와상완 관절내 주사를 시행하였으며, 시술 전-후의 임상 경과에 관한 의무기록 및 초음파 영상의 확인이 가능한 연속적인 95예를 대상으로 하였다. 맹검법을 사용하여 전방 도달을 시행한 52예(I군), 초음파 장비를 이용하여 후방 도달을 시행한 43예(II군)였다. 후방 관절내에서 주사액의 존재가 초음파로 확인된 경우에 관절내 주사의 성공으로 판정하였다. 주사 주입전과 주사 후 2주의 견관절의 운동 범위를 측정하였다. 시술 후 2주 추시시 환자의 주관적인 증상 호전 정도를 기록하였다. 결과: 맹검 전방도달법(I군)에서의 관절내 주사의 정확도는 80.8%였으며, 초음파 유도하 후방 도달법(II군)에서의 성공률은 90.7%였다. 모든 환자에게서 관절와 상완 관절내 주사의 도달법에 상관 없이, 견관절의 운동 범위의 증가를 보였다. 시술 후 2주 추시 관찰 시, 양호 이상의 만족을 보인 환자는 73.7%(70/95)였다. 결론: 맹검법에 의한 전방 도달법을 이용한 관절와상완 관절내 주사의 성공률은 80.8%였다. 초음파 장비를 이용한 후방 도달법을 이용한 관절와상완 관절내 주사의 성공률은 90.7%였다. 동일한 시술자에 의한 두 가지 방법의 비교 연구에서, 초음파 유도하 후방 도달법이 보다 우월한 정확도를 보였다.

• Journal of Korean Neurosurgical Society
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• 제56권5호
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• pp.371-374
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• 2014

Neurosurgeons have been trying to reduce surgical invasiveness by applying minimally invasive keyhole approaches. Therefore, this paper clarifies the detailed surgical technique, its limitations, proper indications, and contraindications for a superciliary keyhole approach as a minimally invasive modification of a pterional approach. Successful superciliary keyhole surgery for unruptured aneurysms requires an understanding of the limitations and the use of special surgical techniques. Essentially, this means the effective selection of surgical indications, usage of the appropriate surgical instruments with a tubular shaft, and refined surgical techniques, including straightforward access to the aneurysm, clean surgical dissection, and the application of clips with an appropriate configuration. A superciliary keyhole approach allows unruptured anterior circulation aneurysms to be clipped safely, rapidly, and less invasively on the basis of appropriate surgical indications.

• Maxillofacial Plastic and Reconstructive Surgery
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• 제12권2호
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• pp.88-94
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• 1990

Because of it's accessibility and the quantity of bone available, the ilium is a common donor site for autogenous cancellous, cortical, and corticocancellous grafts to the facial skeleton. Especially, the anterior iliac crest has been the traditional source of pelvic bone for autogenous bone grafting in the maxillofacial skeleton. Recently the need for large amounts of bone in some reconstructive procedures of the facial skeleton has led to the evaluation of posterior ilium. The posterior approach to the ilium is superior to the anterior approach when large quantities of cancellous bone are required for facial reconstruction. The posterior approach has the advantages of more available bone, fewer complications, less postoperative pain, less disturbance in ambulation, and a possible reduction in the length of hospitalization. As the posterior approach affords an almost unlimited amount of bone for autogenous grafting in the maxillofacial region, we feel its use is indicated when very large amounts of bone are required.

• Archives of Plastic Surgery
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• 제45권2호
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• pp.165-170
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• 2018

Background To present the outcomes of the tarsal switch procedure using an anterior approach to correct severe ptosis with poor levator muscle function (<4 mm) with absent or poor Bell's phenomenon. Methods This retrospective case series included 11 patients with severe neurogenic or acquired myogenic palpebral ptosis. All patients underwent the tarsal switch procedure through an anterior approach from 2012 to 2015. Margin reflex distance (MRD1 and MRD2) and the palpebral fissure were evaluated preoperatively and postoperatively. Data were compared using the Wilcoxon signed-rank test. P-values <0.05 were considered to indicate statistical significance. Results Surgery was performed on 18 eyelids (11 patients). The median age at surgery was 57 years (range, 29-86 years). Four patients had unilateral ptosis and seven had bilateral ptosis. Nine patients had myogenic ptosis and two had neurogenic ptosis. Postoperatively, the chin-up position improved in all patients. The MRD1 increased statistically significantly, from 0 mm preoperatively to 1.0 mm postoperatively (P=0.001). The MRD2 decreased statistically significantly, from 4.5 mm preoperatively to 3.0 mm postoperatively (P=0.001). The palpebral fissure did not change (4.0 mm preoperatively to 4.0 mm postoperatively) (P=0.13). Conclusions The tarsal switch procedure through an anterior approach is an effective alternative for correcting severe ptosis, especially neurogenic or acquired myogenic ptosis. This procedure can be performed with minimal risk of ocular surface exposure and provides stable outcomes.

• 대한심미치과학회지
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• 제8권1호
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• pp.18-27
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• 1999

A tooth solely can not be an exclusive factor to attain our goal, esthetics. Other consideration, such a proportion of individual tooth, harmonized arrangement of the dentition and surrounding tissues including gingiva, lip and face should be taken into account. Esthetic gingival pattern and incisal level in the anterior area are the very important factors for esthetic restoration of the smile. We often propose adequate periodontal and prosthodontic approaches in order to improve the esthetics of the anterior area. Here, I would like to share some cases which include soft tissue management for ovate pontic placement, osteoplasty, resin filling for severe cervical caries, and bleaching approach to discolored root caused by endodontic treatment, and so on.

• Journal of Korean Neurosurgical Society
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• 제39권3호
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• pp.238-240
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• 2006

The incidence of distal anterior cerebral artery[ACA] aneurysm is relatively rare, and only a few cases of bilateral symmetrical distal ACA aneurysms which were adhered together have been reported. They are also called kissing aneurysms. We treated bilateral asymmetrical distal ACA kissing aneurysms in a 44-year-old woman. We successfully clipped the double aneurysmal sacs individually by interhemispheric approach in spite of intraoperative aneurysmal rupture. The patient was discharged without any neurological deficits two weeks after the operation.

• Maxillofacial Plastic and Reconstructive Surgery
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• 제27권2호
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• pp.183-187
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• 2005

관상접근법 후 발생한 측두부 함몰의 기전은 아직 명확하지는 않으나 중측두동맥의 손상에 의한 측두지방대의 소실과 변위, 측두근의 부피감소, 봉합시의 잘못된 위치에 의해 발생된다. 이에 저자등은 관상접근법 후 발생한 측두부 함몰을 빠른 혈관화와 골조직의 성장, 낮은 합병증을 보이는 $Medpor^{(R)}$를 이용하여 심미적인 개선을 얻을 수 있었고 이후 현재까지 양호한 경과를 보이기에 문헌고찰과 함께 보고하는 바 이다.

• Journal of Korean Neurosurgical Society
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• 제53권1호
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• pp.49-51
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• 2013

A case of traumatic spondyloptosis of the cervical spine at the C6-C7 level is reported. The patient was treated succesfully with a anterior-posterior combined approach and decompression. The patient had good neurological outcome after surgery. A-51-year-old female patient was transported to our hospital's emergency department after a vehicle accident. The patient was quadriparetic (Asia D, MRC power 4/5) with severe neck pain. Plain radiographs, computerize tomography and spinal magnetic resonance imaging (MRI) showed C6-7 spondyloptosis and C5, C6 posterior element fractures. Gardner-Wells skeleton traction was applied. Spinal alignment was reachived by traction and dislocation was decreased to a grade 1 spondylolisthesis. Then the patient was firstly operated by anterior approach. Anterior stabilization and fusion was firstly achieved. Seven days after first operation the patient was operated by a posterior approach. The posterior stabilization and fusion was achieved. Postoperative lateral X-rays and three-dimensional computed tomography showed the physiological realignment and the correct screw placements. The patient's quadriparesis was improved significantly. Subaxial cervical spondyloptosis is a relatively rare clinical entity. In this report we present a summary of the clinical presentation, the surgical technique and outcome of this rarely seen spinal disorder.