• Maxillofacial Plastic and Reconstructive Surgery
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• v.31 no.1
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• pp.53-60
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• 2009

Maxillary deficiency, anterior cross bite, constriction of maxillary arch, malaligned teeth are frequently observed in patients with cleft lip and palate. Surgery and orthodontics, combined intervention are needed to correct maxillary deficiency. Distraction osteogenesis that currently used has many advantages like less relapse tendency, more advancement of maxilla, capable in growing patients. In case 1, 18 years old girl with BCLP had severe midfacial deficiency and multiple missing of teeth. LeFort I osteotomy, followed by maxillary distraction osteogenesis utilizing rigid external distraction device(RED) system, was performed. After a 6-day latency period, distraction proceeded at a rate of 1mm per day (at 1st week, 1.5mm/day). Total advancement was 19mm. The RED device left in place for the additional 4 weeks for consolidation. After the RED device was removed, face mask was applied with elastic traction for 5 weeks. After achieving acceptable facial appearance and occlusion, orthodontic appliance was removed. The results after 4 years follow-up was sustained pretty well without aggravation of velopharyngeal function. In case 2, 22 years old man with UCLP had severe midfacial deficiency and palatally erupted upper 2nd premolars due to arch length discrepancy, but the anterior segment of maxillary did not show constriction and crowding. patient had no arch width discrepancy, crowding was concentrated on premolar region. Segmental LeFort I osteotomy was performed. After a 6 - day latency period, using internal distraction device, distraction proceeded at a 0.5mm per day(at 1st week, 0.75 - 1 mm/day). Total advancement was 15mm. After internal distraction device was removed, face mask was applied with elastic traction for 4 weeks. After surgical-orthodontic treatment, facial appearance and occlusion was improved pretty good, and after 46 months follow-up the result was retained well.

• Maxillofacial Plastic and Reconstructive Surgery
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• v.31 no.4
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• pp.325-329
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• 2009

Objective : This is to report the effectiveness of intraoral distraction osteogenesis, iliac bone graft for alveolar augmentation in the extremely atrophied alveolar defects after infected allobone grafted area. Subjects and Methods : Anterior segmental osteotomy was performed and the trans-oral alveolar distractors (Martin, Germany) were applied in patient with the severe acquired anterior mandibular and mandibular defect after ameloblastoma enucleation. Iliac bone grafts were performed in defect sites and distraction osteogenesis were treated. After latent period for 1 week, the osteomized alveolar segments were distracted by 0.75 mm a day (0.25 mm/1 turn) for 10 days The consolidation period was about 12 weeks. Thereafter, 2 titanium threaded implants were simultaneously installed with removal of distractor. For oral rehabilitiation, The implants were installed in maxilla, mandible. It was tested with clinically and radiographically. Results : Amounts of acquired alveolar bone were 10 mm with the increased width of the ridge crests and soft tissue expansion. Dental implants installated on the augmented alveolar ridges in 12 weeks after distraction were confirmed as in good osseointegration and in good function without any complications. Conclusion : Intraoral distraction osteogenesis can be a good option for alveolar ridge augmentation of the severely atrophied ridges and soft-tissue defects.

• Journal of Korean Neurosurgical Society
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• v.55 no.1
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• pp.12-17
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• 2014

Objective : Anterior cervical discectomy and fusion (ACDF) is often complicated by subsidence, pseudoarthrosis, kyphosis, and graft donor site morbidities. To decrease the occurrence of these complications, various types of cages have been developed. We designed this retrospective study to analyze and compare the efficacy and outcomes of ACDF using double cylindrical cages (DCC) (BK Medical, Seoul, Korea) versus an anterior cervical plating system with autogenous iliac crest grafts. Methods : Forty-eight patients were treated with autograft and plating (plate group), and 48 with DCC group from October 2007 to October 2011. We analyzed construct length, cervical lordotic curvarture, the thickness of the prevertebral soft tissue, segmental instability, and clinical outcomes. Results : There were no significant differences between the two groups with regard to the decrease in construct length or cervical lodortic curvature at the 3-, 6-, and 12-month follow-ups. The prevertebral soft tissue was thinner in the DCC group than the plate group immediately after surgery and at the 3-, 6-, and 12-month follow-ups. The difference in interspinous distance on flexion-extension was shorter in the plate group than the DCC group at the 3- and 6-month follow-ups. However, there was no significant difference in this distance between the two groups at the 12-month follow-up. Conclusion : A double cylindrical cage is a good alternative for fusion in patients with cervical degenerative diseases; the surgical method is relatively simple, allows good synostosis, has less associated prevertebral soft tissue swelling, and complications associated with autografting can be avoided.

• Journal of Korean Neurosurgical Society
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• v.60 no.6
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• pp.755-762
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• 2017

Objective : The purpose of this study is to describe the detailed surgical technique and short-term clinical and radiological outcomes of lateral lumbar interbody fusion (LLIF) and in situ lateral screw fixation using a conventional minimally invasive screw fixation system (MISF) for revision surgery to treat rostral lumbar adjacent segment disease. Methods : The medical and radiological records were retrospectively reviewed. The surgery was indicated in 10 consecutive patients with rostral adjacent segment stenosis and instability. After the insertion of the interbody cage, lateral screws were inserted into the cranial and caudal vertebra using the MISF through the same LLIF trajectory. The radiological and clinical outcomes were assessed preoperatively and at 1, 3, 6, and 12 months postoperatively. Results : The median follow-up period was 13 months (range, 3-48 months). Transient sensory changes in the left anterior thigh occurred in 3 patients, and 1 patient experienced subjective weakness; however, these symptoms normalized within 1 week. Back and leg pain were significantly improved (p<0.05). In the radiological analysis, both the segmental angle at the operated segment and anterior disc height were significantly increased. At 6 months postoperatively, solid bony fusion was confirmed in 7 patients. Subsidence and mechanical failure did not occur in any patients. Conclusion : This study demonstrates that LLIF and in situ lateral screw fixation may be an alternative surgical option for rostral lumbar adjacent segment disease.

• Journal of Chest Surgery
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• v.29 no.3
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• pp.346-349
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• 1996

This 32 year old female patient underwent left radical mastectomy due to ductal carcinoma on May 1990, and treated with FAM (5-fluorouracil, Adriamycin and Mitomycin C) regimen postoperatively. However, right cervical Iymph node enlargement and facial edema progressively developed since December 199). On April 1994, operation was performed, and findings were as followes; x4$\times$5$\times$7 to 1 : 1 $\times$ 1 cm sized multiple enlarged and hyperemic Iymph nodes were scatterred throughout submandibular area to the junction of superior vents cave and pericardium, and partially invaded both anterior segmental lobe, sternum and both distal tip of clavicles. After radical dissection of the nodes of neck and mediastinal nodes, and wedge resection of both anterior segments of lung, and partial resection of both clavicle tips and total sternum. The both innominate veins and superior vena cava were partially obstructed by invaded cancer SVC reconstruction was done with preclotted 10$\times$ 10$\times$ 18mm Y shap d woven Dacron graft, which was anastomosed to the point of the junction of subclavian vein and jugular vein after cross clamping both veins and 2cm above the pericardial junction with one arm clamp. After maintaining blood drainage to the SVC from the right side, left innominate vein was anastomosed with 4-0 Prolene continuous running suture. Bone cement was used for resected sternal portion and clavicular ends were fixed to postal portion with 18 Gauge wires. The patient was treated with radiation and chemotherapy after discharge, and there were no evidence of regrowing of the mass nor obstruction of the graft inspite of no antithrombotic therapy.

• The Journal of the Korean dental association
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• v.55 no.6
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• pp.400-410
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• 2017

Approximately 30% of adult patients who want orthodontic treatment have transverse discrepancy with insufficient width of the maxilla. Particularly, in Class III patients requiring orthognathic surgery, the frequency of insufficient width of the maxillary arch related to respiratory problems is high. We report a case of non-surgical maxillary expansion using a Hyrax type expander with an orthognathic surgery, based on the reports that the ratio of non-fused midpalatal suture is not high in adults. A 30 years and 2 months old woman with a long face showed an Angle Class III with a vertical growth pattern. Class III molar and canine relation, anterior edge bite, and mandibular incisor compensatory lingual inclination were observed. The posterior buccal overjet seemed to be appropriate, but I diagnosed that there was a transverse discrepancy, for the following reasons. The inter-canine and inter-molar widths were sufficient but excessive lingual inclination of the mandibular molars was observed when assessing the bucco-lingual inclination based on the center of resistance of the maxillary and mandibular first molar. For this reason, it was expected that intercuspal interference would occur during orthodontic decompensation. Therefore, slow maxillary expansion using Hyrax type expander was performed and 2-jaw rotation surgery was performed to improve aesthetic and occlusion. Adults can also improve width discrepancy by non-surgical methods, which can avoid SARPE requiring additional surgery or segmental surgery lacking stability and predictability.

• Journal of Korean Neurosurgical Society
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• v.62 no.4
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• pp.450-457
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• 2019

Objective : Anterior cervical discectomy and fusion (ACDF) is commonly used surgical procedure for cervical degenerative disease. Among the various intervertebral spacers, the use of allografts is increasing due to its advantages such as no harvest site complications and low rate of subsidence. Although subsidence is a rare complication, graft collapse is often observed in the follow-up period. Graft collapse is defined as a significant graft height loss without subsidence, which can lead to clinical deterioration due to foraminal re-stenosis or segmental kyphosis. However, studies about the collapse of allografts are very limited. In this study, we evaluated risk factors associated with graft collapse. Methods : We retrospectively reviewed 33 patients who underwent two level ACDF with anterior plating using allogenous bone graft from January 2013 to June 2017. Various factors related to cervical sagittal alignment were measured preoperatively (PRE), postoperatively (POST), and last follow-up. The collapse was defined as the ratio of decrement from POST disc height to follow-up disc height. We also defined significant collapses as disc heights that were decreased by 30% or more after surgery. The intraoperative distraction was defined as the ratio of increment from PRE disc height to POST disc height. Results : The subsidence rate was 4.5% and graft collapse rate was 28.8%. The pseudarthrosis rate was 16.7% and there was no association between pseudarthrosis and graft collapse. Among the collapse-related risk factors, pre-operative segmental angle (p=0.047) and intra-operative distraction (p=0.003) were significantly related to allograft collapse. The cut-off value of intraoperative distraction ${\geq}37.3%$ was significantly associated with collapse (p=0.009; odds ratio, 4.622; 95% confidence interval, 1.470-14.531). The average time of events were as follows: collapse, $5.8{\pm}5.7months$; subsidence, $0.99{\pm}0.50months$; and instrument failure, $9.13{\pm}0.50months$. Conclusion : We experienced a higher frequency rate of collapse than subsidence in ACDF using an allograft. Of the various preoperative factors, intra-operative distraction was the most predictable factor of the allograft collapse. This was especially true when the intraoperative distraction was more than 37%, in which case the occurrence of graft collapse increased 4.6 times. We also found that instrument failure occurs only after the allograft collapse.

• Journal of Korean Neurosurgical Society
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• v.64 no.6
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• pp.913-921
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• 2021

Objective : Accurate measurement of T1 slope (a component of T1s minus cervical lordosis [CL]) is often constrained by anatomical limitations. In this situation, efforts should be made to find the exact meaning of T1s-CL and whether there are any alternatives to it. Methods : We enrolled 117 patients who received two-level anterior cervical discectomy and fusion (ACDF). Occipital slope, C2 slope (C2s), C7 slope (C7s), T1, O-C2 angle (O-C2A), C2-7 angle (C2-7A), O-C7 angle (O-C7A), T1s-CL, C7-T1 angle (C7-T1A), and C2-7 sagittal vertical axis were measured. We determined 16° (T1s-CL) as the reference point for dividing subjects into the mismatch group and the balance group, and a comparative analysis was performed. Results : The mean value of C7-T1A was constantly maintained within 2.6° peri-operatively. In addition, C2s and T1s-CL showed the same absolute change (Δ|0.8|°). The mean values of T1s-CL of the mismatch and balance groups were 23.0° and 7.6°, respectively. The five factors with the largest differences between the two groups were as follows : C2s (Δ13.3°), T1s-CL (Δ15.4°), O-C2A (Δ8.7°), C2-7A (Δ14.7°), and segmental angle (Δ7.9°) before surgery. Only four factors showed statistically significant change between the two groups after ACDF : T1s-CL (Δ4.0° vs. Δ0.2°), C2s (Δ3.2° vs. Δ0.7°), O-C2A (Δ2.6° vs. Δ1.3°), C2-7A (Δ6.3° vs. Δ1.3°). A very strong correlation between T1s-CL and C2s was also found (r=|0.88-0.96|). Conclusion : C2s itself may be the essential key to represent T1s-CL. The amounts and directions of change of these two factors (T1s-CL and C2s) were also almost identical. The above phenomenon was re-confirmed once again through the correlation analysis.

• Journal of Korean Neurosurgical Society
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• v.66 no.6
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• pp.716-725
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• 2023

Objective : Anterior cervical spine surgery (ACSS) is a common surgical procedure used to treat cervical spinal degenerative diseases. One of the complications associated with ACSS is prevertebral soft tissue swelling (PSTS), which can result in airway obstruction, dysphagia, and other adverse outcomes. This study aims to investigate the correlation between various cervical sagittal parameters and PSTS following single-level ACSS, as well as to identify independent risk factors for PSTS. Methods : A retrospective study conducted at a single institution. The study population included all patients who underwent single-level ACSS between January 2014 and December 2022. Patients with a history of cervical spine surgery or trauma were excluded from the study. The presence and severity of PSTS was assessed by reviewing pre- and postoperative imaging studies. The potential risk factors for PSTS that were examined include patient age, sex, body mass index, tobacco use, comorbidities, serum albumin levels, operative time, implant type, implanted level, and various cervical spine sagittal parameters. Multivariate linear regression analysis was performed to identify the independent risk factors for PSTS. Results : A total of 62 consecutive patients who underwent single-level ACSS over a 8-year period at a single institution were enrolled in this study. Only preoperative segmental angle showed positive correlation with PSTS among various cervical spine sagittal parameters (r=0.36, p=0.005). Artificial disc replacement showed a negative correlation with PSTS (β=-0.38, p=0.002), whereas the use of demineralized bone matrix (DBM) had a positive impact on PSTS (β=0.33, p=0.009). We found that male sex, lower preoperative serum albumin, and implantation of upper cervical level (above C5) were independent predictors for PSTS after single-level ACSS (β=1.21; 95% confidence interval [CI], 0.27 to 2.15; p=0.012; β=-1.63; 95% CI, -2.91 to -0.34; p=0.014; β=1.44; 95% CI, 0.38 to 2.49; p=0.008, respectively). Conclusion : Our study identified male sex, lower preoperative serum albumin levels, and upper cervical level involvement as independent risk factors for PSTS after single-level ACSS. These findings can help clinicians monitor high-risk patients and take preventive measures to reduce complications. Further research with larger sample sizes and prospective designs is needed to validate these findings.

• Journal of Korean Neurosurgical Society
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• v.64 no.5
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• pp.776-783
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• 2021

Objective : The purpose of this study was to identify risk factors for distal adding on (AO) or distal junctional kyphosis (DJK) in adolescent idiopathic scoliosis (AIS) treated by posterior spinal fusion (PSF) to L3 with a minimum 2-year follow-up. Methods : AIS patients undergoing PSF to L3 by two senior surgeons from 2000-2010 were analyzed. Distal AO and DJK were deemed poor radiographic results and defined as >3 cm of deviation from L3 to the center sacral vertical line (CSVL), or >10° angle at L3-4 on the posterior anterior- or lateral X-ray at ultimate follow-up. New stable vertebra (SV) and neutral vertebra (NV) scores were defined for this study. The total stability (TS) score was the sum of the SV and NV scores. Results : Ten of 76 patients (13.1%) were included in the poor radiographic outcome group. The other 66 patients were included in the good radiographic outcome group. Lower Risser grade, more SV-3 (CSVL doesn't touch the lowest instrumented vertebra [LIV]) on standing and side bending films, lesser NV and TS score, rigid L3-4 disc, more rotation and deviation of L3 were identified risk factors for AO or DJK. Age, number of fused vertebrae, curve correction, preoperative coronal/sagittal L3-4 disc angle did not differ significantly between the two groups. Multiple logistic regression results indicated that preoperative Risser grade 0, 1 (odds ratio [OR], 1.8), SV-3 at L3 in standing and side benders (OR, 2.1 and 2.8, respectively), TS score -5, -6 at L3 (OR, 4.4), rigid disc at L3-4 (OR, 3.1), LIV rotation >15° (OR, 2.9), and LIV deviation >2 cm from CSVL (OR, 2.2) were independent predictive factors. Although there was significant improvement of the of Scoliosis Research Society-22 average scores only in the good radiographic outcome group, there was no significant difference in the scores between the groups. Conclusion : The prevalence of AO or DJK at ultimate follow-up for AIS with LIV at L3 was 13.1%. To prevent AO or DJK following fusion to L3, we recommend that the CSVL touch L3 in both standing and side bending, TS score is -4 or less, the L3/4 disc is flexible, L3 is neutral (<15°) and ≤2 cm from the midline and the patient is ≥ Risser 2.