• Title/Summary/Keyword: Anterior approach

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Retrospective Analysis of Cerebellopontine Angle Meningiomas (소뇌교각부 수막종의 후향적 분석)

  • Kim, Sang Hyo;Kim, Suk Chul;Jung, Shin;Kang, Sam Suk;Kim, Tae Sun;Lee, Jung Kil;Kim, Jae Hyoo;Kim, Soo Han;Lee, Je Hyuk
    • Journal of Korean Neurosurgical Society
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    • v.30 no.sup1
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    • pp.30-36
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    • 2001
  • Objective : To investigate the postoperative result and prognostic factors in cerebellopontine meningioma. Materials & Methods : During the years 1990 through 1999, a retrospective study of 17 cerebellopontine angle meningiomas was performed. The retromastoid approach was used in all cases : 14 tumors were excised totally and 3 tumors subtotally. Results : Fourteen patents were females with a median age of 58.7 years. The most common presenting complaints were 8th cranial nerve dysfunction and headache. Most of the tumors were large(>4cm) and extended into the tentorial regions. Histological examination revealed benign meningiomas in 16 patients and atypical in one patient. Tumors were located posterior to the internal auditory meatus in 11 cases and anterior in three cases with three cases of en-plaque type. Two of three patients whose tumors were subtotally excised received radiation therapy. Tumor has recurred in one patient. Postoperative result was good in 16 cases with one mortality case. Conclusion : This results suggest that site of 7th-8th cranial nerves complex, en-plaque type meningioma, and petroclival meningioma extended into the clivus were significant prognostic factors. Postoperative radiation therapy is recommended for cases of subtotal resection.

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A Suture Bridge Transosseous-Equivalent Technique for Bankart Lesions with Deficient Bony Stability - Technical Note - (골안정성 결손을 가진 Bankart 병변에 대한 경 골-유사 교량형 봉합술식 - 술기 보고 -)

  • Choi, Chang-Hyuk;Kim, Shin-Kun;Chang, Il-Woong;Chae, Sung-Bum
    • Journal of the Korean Arthroscopy Society
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    • v.13 no.2
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    • pp.179-182
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    • 2009
  • Purpose: Point fixation at the margin of the glenoid is a limitation of conventional arthroscopic stabilization using suture anchors, and does not afford sufficient footprint healing, especially in glenoid bone deficiency. So, we introduce an arthroscopic suture bridge transosseous-equivalent technique for bony Bankart lesions to avoid the technical disadvantage of point contact with anchor fixation and to improve mechanical stability through cross compression of the labrum. Surgical approach: The technique was adapted from the transosseous-equivalent rotator cuff repair technique using suture bridges, which improved the pressurized contact area and mean pressure between the tendon and footprint. After preparation of the glenoid bed by removal, reshaping, or mobilization of the bony lesion, two anchors (3.0 mm Biofastak, $Arthrex^{(R)}$, Naples, FL) were inserted into the superior and inferior portion of the bony Bankart lesion. Using a suture hook, medial mattress sutures were applied around the capsulolabral portion of the IGHL complex to obtain sufficient depth of glenoid coverage. A 3.5 mm pushloc anchor ($Arthrex^{(R)}$, Naples, FL) hole was made in the articular edge of the anterior glenoid rim. distal, suture bridge was applied, and proximal was inserted to mobilize the labrum in the proximal direction. This avoided the technical disadvantage of point contact with anchor fixation and decreased the level of gap formation through cross-compression of the labrum.

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A noninvasive esthetic treatment of isolated microdontia using new high-translucent cubic-phase zirconia (5Y-PSZ) laminate veneers: A case report (고투명도 입방정상 지르코니아(5Y-PSZ) 라미네이트를 이용한 왜소치의 비침습적 심미 수복 증례)

  • Ahn, Min-Zin;Ahn, Do-Gwan;Pyo, Se-Wook;Kim, Hee-Kyung
    • The Journal of Korean Academy of Prosthodontics
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    • v.57 no.3
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    • pp.263-270
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    • 2019
  • Current trends in restorative dentistry focus on improving the esthetics and keeping the sound dental tissues as long as possible. The aims of this case report were to describe the successful outcome of cubic-phase zirconia laminate veneers for a patient with isolated microdontia by using a digital workflow, and to describe their clinical implications. A 15-year-old female who had isolated microdontia in combination with spacing visited Ajou University Dental Hospital for esthetic treatment. In this case, 6 maxillary anterior teeth were restored with cubic-phase zirconia laminate veneers without tooth structure removal by using a digital impression, computer-aided design (CAD) software, and computer-aided manufacturing (CAM) procedures. At 6-month follow-up, no distinct mechanical and biological complications were detected and the prostheses exhibited satisfactory esthetics and functions. Due to its favorable tissue responses and enhanced translucency, cubic-phase zirconia can be a suitable strategy for a noninvasive esthetic approach.

Effects of Dynamic Tubing Gait Training on Postural Alignment, Gait, and Quality of Life in Chronic Patients with Parkinson's Disease : Case Study (동적탄력튜빙 보행훈련 프로그램이 만성 파킨슨병 환자의 자세정렬과 보행능력과 삶의 질에 미치는 영향 : 사례연구)

  • Lee, Dong-Ryul
    • Journal of Korea Entertainment Industry Association
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    • v.15 no.8
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    • pp.363-377
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    • 2021
  • The present study investigated the effects of dynamic tubing gait training(I and II) on the postural alignment, gait, and quality of life in chronic patients with Parkinson's disease. This study is based on the case study that recruited a total of 3 patients with chronic Parkinson's disease (Hoehn and Yahr Stage of 1 to 3 each one person). Dynamic tubing gait training (I and II) applied to chronic patients with Parkinson's disease for 25 sessions, 30 minutes a day, 5 days a week, over 5 weeks period. To investigate the effects of this study, evaluating using the postural alignment test, muscle activity tests, gait analysis, and quality of life scale for patient with Parkinson's disease. After the intervention of Dynamic tubing gait training (I and II), Trunk flexion was decreased. Also, during walking from initial contact (IC) to mid stance (Mst), muscle activity of Quadriceps, Hamstring, and Tibialis Anterior (TA) was increased and muscle activity of Gastrocnemius was decreased. The muscle activation of Erector Spinae (ES T12, L3) was increased in the H&Y I and III stages and decreased in the H&Y II stage. Length of gait line, single support line, ant/post position and lateral symmetry of center of pressure (COP) parameters improved. The spatio-temporal gait parameters including of step length, stride length, and velocity was increased, and cadence decreased. Further the quality of life of patients with Parkinson's disease was improved. Based on these findings, Dynamic tubing gait training (I and II) could be applied as a new approach to improve posture, gait, quality of life in chronic patients with Parkinson's disease for more than 5 years, whose drug resistance is halved.

Alternative Fixation Technique for Bony Bankart Lesion with Using Suture Anchor (봉합나사와 골터널을 이용한 골성 반카르트 병변의 고정)

  • Kim, Byung-Kook;Lee, Ho-Jae;Kim, Go-Tak;Dan, Jinmyoung
    • Journal of the Korean Orthopaedic Association
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    • v.54 no.6
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    • pp.574-578
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    • 2019
  • For the treatment of a bony Bankart lesion accompanied by an acute traumatic shoulder dislocation, anatomical reduction and stable fixation of the bone fragment and glenohumeral ligament are essential to avoid chronic instability or degenerative changes. If the Bankart lesion has large bony pieces or comminuted fragments, it can be difficult to perform precise and secure fixation of the big intraarticular fragment to the fracture site because of the limited visualization of the arthroscopic procedure. In addition, in the case of the open procedure, it requires an extensive surgical dissection to access the fractured fragment, which may cause surgical approach-related morbidity, such as neurovascular complications, delayed subscapularis healing, and increased risk of stiffness. This paper describes an alternative open suture anchor technique for a large bony Bankart lesion, which was secured anatomically with squared knots after a shuttle relay through bony tunnels and adjacent soft tissue and labrum. This technique can achieve anatomical and firm fixation under direct vision, and reduce the number of surgery related morbidities.

Arthroscopic Iliopsoas Tenotomy of Iliopsoas Impingement after Total Hip Arthroplasty (고관절 전치환술 후 발생한 장요건 충돌의 관절경하 장요건 절단술)

  • Huh, Soon Ho;Choi, Byeong Yeol;Han, Sang Roc;Chung, Woo Chull
    • Journal of the Korean Orthopaedic Association
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    • v.56 no.2
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    • pp.125-133
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    • 2021
  • Purpose: The clinical outcomes were investigated to determine if arthroscopic management is a useful method for 19 hips with iliopsoas tendon impingement (IPI) after total hip arthroplasty (THA). Materials and Methods: Eighteen patients (19 hips), who complained of groin pain and flexion pain that persisted after THA from September 2013 to December 2019, were the subjects of this investigation. The mean time to manifestation after THA was four months (range, 1-9 months) in patients of an average age of 60 years (range, 50-69 years). Thirteen out of 18 patients underwent THA using the direct anterior approach and five by the lateral approach. IPI was diagnosed by the medical history, physical examination, blood test, radiographic examination using X-ray and computed tomography, and topical injection therapy. All patients underwent arthroscopic treatment and a dynamic arthroscopic physical examination after exposure to the iliopsoas tendon revealed impingement. Tenotomy was then performed on the muscle portion through the total tendon portion. Symptoms and pain levels of preoperative, postoperative and follow-up period were investigated and compared. Results: The Western Ontario and McMaster Universities Osteoarthritis Index score decreased from an average of 58.4 (range, 40-88) before surgery to an average of 35.0 (range, 15-76) after surgery. Similarly, the visual analogue scale decreased from an average of 4.0 (range, 2-6) before surgery to an average of 1.4 (range, 0-4) after surgery. Sixteen patients (88.9%) showed pain relief and improvement in the straight leg raise test, and two patients showed postoperative muscle weakness and sustained pain. In the follow-up period, muscle weakness improved. One patient underwent arthroscopic iliopsoas tenotomy at the lesser trochanteric level but the symptoms persisted. The clinical symptoms were improved after one more tenotomy at the joint level. Conclusion: Arthroscopic iliopsoas tenotomy performed in patients with IPI after THA showed good clinical results.

DOUBLE TEETH IN MAXILLARY PERMANENT INCISORS : CASE REPORTS (상악 전치부에 발생한 이중치: 증례보고)

  • Kim, Mi-Ni;Kim, Young-Jae;Kim, Jung-Wook;Jang, Ki-Taek;Kim, Chong-Chul;Hahn, Se-Hyun;Lee, Sang-Hoon
    • Journal of the korean academy of Pediatric Dentistry
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    • v.36 no.1
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    • pp.119-125
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    • 2009
  • Fusion and gemination are irregularities in tooth development. It is often difficult to differentiate between gemination and fusion and it is common to refer to these anomalies as 'double teeth'. The deciduous teeth are most commonly involved, but in 0.1% of cases permanent teeth are affected, in which case aesthetic, funtional and periodontal problems can result. Double teeth present great difficulties in management and required a multidisciplinary approach. The central groove on the labial and palatal surfaces of a double tooth is extremely prone to caries, therefore early 'fissure sealing' is essential. In permanent dentition, surgical separation of fused teeth may be possible with subsequent orthodontic alignment and restorative treatment as needed to reshape the crown. Reshaping or reduction of a double tooth with a single canal may be attempted by modifying the appearance of the labial groove and the use of composite tints but is often impossible and extraction may be the only alternative. Orthodontic treatment and prosthetic replacement is then required. Implants may be an option for adolescents. The present study describes three clinical cases of double teeth in the position of the maxillary permanent incisors. The first case demonstrates an example of multidisciplinary care including surgical intraoral hemisection, root canal therapy, restorative and orthodontic treatment. The second and third cases describe the external and internal morphology of the two fused teeth by means of three dimensional dental computer tomography.

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Clinical Outcome after Surgical Treatment of Intra-articular Comminuted Fracture of the Distal Humerus in the Elderly: Open Reduction and Internal Fixation Versus Total Elbow Arthroplasty (고령의 상완골 원위부 관절내 분쇄골절의 수술적 치료: 관혈적 정복술 및 내고정술과 일차적 주관절 전치환술의 임상적 결과)

  • Kim, Doo-Sup;Yoon, Yeu-Seung;Yi, Chang-Ho;Woo, Ju-Hyung;Rah, Jung-Ho
    • Clinics in Shoulder and Elbow
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    • v.15 no.2
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    • pp.130-137
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    • 2012
  • Purpose: To evaluate and report the clinical outcome after surgical treatment of intra-articular comminuted fracture of distal humerus in the elderly with osteoporosis. Materials and Methods: From January 2007 to October 2009, 24 patients aged older than 65 years with intra-articular comminuted fracture of distal humerus underwent surgical treatment. 18 patients (Group I) were managed using primary open reduction and internal fixation (OR IF) through the modified posterior approach and 6 patients (Group II) were taken primary total elbow arthroplasty. The average follow up period was 17.2 months. According to the AO classification, there were 8 C2, 16 C3 type fractures. All enrolled patients were evaluated radiographically and clinically. Clinical outcomes were assessed with the Mayo Elbow Performance, Disabilities of Arm and Shoulder and Hand, and Musculoskeletal Functional Assessment functional questionnaires. Results: The bony union was observed in 18 patients in group I at average 14 weeks. There were 2 patients with neurapraxia of whom the ulnar nerve symptom did not improve despite of anterior transposition. And non-union at osteotomy sites was seen in 2 patients. The mean Mayo Elbow Performance score was 87.0. The mean DASH score was 32.4. The average arc of elbow flexion was $121.0^{\circ}$ (range, $95{\sim}145^{\circ}$) with mean flexion-contracture of $12.0^{\circ}$ (range, 0 to 35). 6 patients in Group II showed no complication during follow up periods. The mean Mayo Elbow Performance score was 89.1. The mean DASH score was 44.3. The average arc of elbow flexion was $125.1^{\circ}$ (range, $100{\sim}145^{\circ}$) with mean flexion-contracture of $12.6^{\circ}$ (range, 0 to 30). Conclusions: With careful patient selection, Total elbow arthroplasty as well as OR IF could achieve good outcomes in elderly of comminuted intra-articular distal humerus fracture with osteoporosis.

Patellar Inferior Pole: New Landmark for the Anteromedial Instrument Portal for Arthroscopic Surgery of the Medial Meniscus Posterior Horn (슬개골 하극: 내측 반월상 연골판 후각부에 대한 관절경 수술을 위한 전내측 기구 삽입구의 새로운 표식)

  • Kim, Young-Mo;Hwang, Deuk-Soo;Lee, June-Kyu;Shin, Hyun-Dae;Kang, Tae-Hwan;Kim, Dong-Kyu;Kim, Pil-Sung
    • Journal of Korean Orthopaedic Sports Medicine
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    • v.7 no.2
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    • pp.128-134
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    • 2008
  • Purpose: We prospectively evaluated the clinical usefulness of the patellar inferior pole (PIP) as a landmark of the anteromedial (AM) portal for the arthroscopic surgery of the medial mensiscus posterior horn (MMPH). Materials and Methods: Group 1 (50 normal left knees of adults), Group 2 (10 normal knees under anesthesia), and Group 3 (50 consecutive knees undergoing elective arthroscopic surgery for relatively simple intraarticular pathologies, or diagnostic arthroscopy) were included. In Group 1 and 2, the true lateral (A) and valgus stress lateral radiographs (B) on $30^{\circ}$ flexion were obtained, and the lines (AM portal line) passing through the PIP and distal-most medial femoral condyle (MFC) were drawn under the condition without considering the thickness of articular cartilage of MFC (1, 2-A, B group), and considering it as 2.5mm on B (1, 2-C group). Then, we investigated the meeting point of the AM portal line with medial tibial plateau (C-D percentage), and measured the distance between the PIP and the anterior joint line (E-length), and medial tibial-femoral joint space (F-length). In Group 3, the AM portal was made at the PIP level and clinical usefulness of the approach to the MMPH and body of the lateral meniscus (LM) was analyzed. Results: The average C-D percentage came out as 85.8, 101.3, 69.1% for each Group 1-A, B, C, and 102.4, 144.6, 116.8% for each Group 2-A, B, C. Measured E-length was an average of 15.1 (Group 1-A), 15.5 (Group 1-B, C), 13.1 (Group 2-A), and 12.9 mm (Group 2-B, C) and the change by valgus stress had no statistical significance. The F-length increased about 1.2 (Group 1) and 3.6 mm (Group 2) when valgus stress was applied, which had statistical significance (p<0.001, p<0.001). In Group 3, 49, 48 knees were classified as good for the MMPH, and the body of LM in aspect of the clinical usefulness of AM portal made on the PIP level. Conclusion: We identified the clinical usefulness of the PIP as a skin landmark of AM portal for the arthroscopic surgery of the MMPH.

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INTRAOSSEOUS TOOTH MIGRATION OF IMPACTED MESIODENS IN THE INVERTED POSITION (상악 정중부에 역위 매복된 과잉치의 악골 내 이동)

  • Lee, Suk-Woo;Lee, Jae-Ho;Kim, Seong-Oh;Choi, Hyung-Jun;Sohn, Hyung-Kyu;Choi, Byung-Jai
    • Journal of the korean academy of Pediatric Dentistry
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    • v.35 no.4
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    • pp.750-756
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    • 2008
  • Supernumerary teeth are frequently found in the anterior portion of the maxilla and develop as a result of abnormal proliferation of the dental lamina during tooth germ formation, caused by genetic or environmental factors. They may result in various complications, such as eruption interference, displacement, rotation of adjacent teeth, diastema, eruption into the nasal cavity, and development of dentigerous cyst. The optimal time for surgical extraction of supernumerary teeth has been a controversial issue. Someone prefer early surgical extraction because supernumerary teeth can cause eruption interference and displacement of adjacent teeth, eventually altering occlusion. Others prefer to delay surgical extraction until $8{\sim}10$ years of age in consideration of root maturation of the adjacent teeth and also patient's behavior. When surgical extraction of supernumerary teeth is postponed, there is possibility that impacted supernumerary teeth in the inverted or horizontal position move toward the nasal cavity, hard palate, or premolar area. When such intraosseous tooth migration is combined with the vertical growth of the maxilla, surgical approach becomes even harder. Therefore, possibility of intraosseous tooth migration should be considered as an important factor when deciding appropriate time for surgical extraction. We are presenting cases of mesiodens which showed intraosseous migration during $6{\sim}7$ years of follow-up period since the first diagnosis had been made at the $2{\sim}3$ years of age.

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