• Maxillofacial Plastic and Reconstructive Surgery
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• 제19권4호
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• pp.351-361
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• 1997

This study was performed to evaluate the change of the soft tissue facial profile after mandibular set back surgery during time intervals. For this study, 33 patient, 8 males and 25 females, were selected and their lateral cephalograms were taken and analyzed periodically. Hard and soft tissue changes during postoperative time intervals, correlation between surgical skeletal changes and postoperative soft tissue changes, and prediction for long-term soft tissue changes were established through varying statistical methods. The results were as follow : 1. There were meaningful changes of anteroposterior skeletal position at 6 months and 2 years after mandibular set back by mandibular ramus osteotomy. Two years postoperatively, there was 30%, 32%, 29% relapse on B point, pogonion, menton each. 2. Two years after the mandibular ramus osteotomy, the relative changes of the soft tissue to their osseous counterparts showed 76% on the lower lip and 91% on the pogonion. 3. The movements of the mandibular landmarks in correlation to anteroposterior position of the lower lip and soft tissue of the chin showed to be effective on a long-term basis. 4. Using surgical changes of pogonion, prediction of changes in soft and hard tissue pogonion was useful and the coefficient of determination was 0.46 each and their reliability decreased 2 years postoperatively. 5. The upper lip position after the mandibular set back surgery was somewhat anterior 2 years postoperatively, but that has no statistical meanings.

• Maxillofacial Plastic and Reconstructive Surgery
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• 제23권1호
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• pp.21-30
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• 2001

The purpose of this study was to evaluate the skeletal relapse pattern of the mandibular prognathic patients after mandibular set back surgery by sagittal split ramus osteotomy. The horizontal and vertical position of the cephalometric points were measured before, after surgery and after one-year follow up period. The next, the positional change of the proximal and distal mandibular segment were evaluated respectively. The obtained results were as follows; 1. The horizontal and vertical position of Cd was not changed before and after surgery, and it was maintained its original position during the observation periods. 2. As the mandibular prognathism of the patients was severe before surgery, the more skeletal relapse tendency was observed during follow-up period(p<0.05). 3. As the horizontal positional change of the mandible which was obtained by mandibular set-back surgery was large, the more horizontal relapse tendency was observed during follow-up period(p<0.05). 4. The corpus axis angle decreased by sagittal split ramus osteotomy(p<0.01), but it was kept its reoriented position during follow-up period. 5. During the follow-up period after mandibular set-back by sagittal split ramus osteotomy, the forward relapse of mandible correlated with not only the forward rotation of the proximal segment but also the forward movement of the distal segment(p<0.05).

• The Korean Journal of Pain
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• 제14권1호
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• pp.104-109
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• 2001

We describe the accidental injection of local anesthetics containing steroid into the subdural space during an attempted lumbar epidural injection for intractable radiculopathy in a patient with failed back surgery syndrome. A 24-year-old man complained of severe radiating pain to left lower extremity and showed a walking disturbance and severe lumbar scoliosis. The MRI finding was a left paramedian recurred disc herniation on L4-5 in a laminectomy state. Several therapeutic modalities such as epidural steroid injection, transforaminal injection, L2 root block, medication, and exercise therapy, etc failed. Initially, during epidural block at L4-5 under fluoroscopic guidance, a railroad track appearance appeared on epidurogram suggesting the presence of a subdural space. A second epidural block was tried at L5-S1. Following confirmation of epidural space upon epidurogram, 6 ml of 0.5% lidocaine including triamcinolone 40 mg was injected. The patient showed signs of the subdural injection including an unexpectedly high sensory block (T2) and a motor weakness of both lower extremities. Following this event, the severe radiculopathy and lumbar scoliosis were improved. Therefore, we conclude that subdural injection of steroid could be helpful in intractable radiculopathy, especially in the failed back surgery syndrome. However, it must be used cautiously with careful patient selection.

• The Korean Journal of Pain
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• 제25권2호
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• pp.94-98
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• 2012

Background: An intravenous infusion of lidocaine has been used on numerous occasions to produce analgesia in neuropathic pain. In the cases of failed back surgery syndrom, the pain generated as result of abnormal impulse from the dorsal root ganglion and spinal cord, for instance as a result of nerve injury may be particularly sensitive to lidocaine. The aim of the present study was to identify the effects of IV lidocaine on neuropathic pain items of FBSS. Methods: The study was a randomized, prospective, double-blinded, crossover study involving eighteen patients with failed back surgery syndrome. The treatments were: 0.9% normal saline, lidocaine 1 mg/kg in 500 ml normal saline, and lidocaine 5 mg/kg in 500 ml normal saline over 60 minutes. The patients underwent infusions on three different appointments, at least two weeks apart. Thus all patients received all 3 treatments. Pain measurement was taken by visual analogue scale (VAS), and neuropathic pain questionnaire. Results: Both lidocaine (1 mg/kg, 5 mg/kg) and placebo significantly reduced the intense, sharp, hot, dull, cold, sensitivity, itchy, unpleasant, deep and superficial of pain. The amount of change was not significantly different among either of the lidocaine and placebo, or among the lidocaine treatments themselves, for any of the pain responses, except sharp, dull, cold, unpleasant, and deep pain. And VAS was decreased during infusion in all 3 group and there were no difference among groups. Conclusions: This study shows that 1 mg/kg, or 5 mg/kg of IV lidocaine, and palcebo was effective in patients with neuropathic pain attributable to FBSS, but effect of licoaine did not differ from placebo saline.

• 대한한방내과학회지
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• 제40권1호
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• pp.126-135
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• 2019

Background: Because of fear of reoperation and low efficiency, some patients with failed back surgery syndrome (FBSS) opt for Korean medicine treatment. Gold standard treatment is not present for FBSS, therefore both surgical and non-surgical treatment are possible. Studies of Korean conservative medicine for FBSS had a short duration of treatment and mainly pre- and post-treatment comparisons. And case of female patients who have worsened after childbirth is rare. The purpose of this study was to report long-term follow-up and rare cases of FBSS. Case summary: A 33-year-old female patient diagnosed with lumbar disc herniation complained with low back pain and radicular pain in the left leg after surgery in 2011. Acupuncture and decoction (Cheongpa-jeon, GCSB-5) were administered to her twice a day for about 6 years and 6 months. The patient's complaints improved with each hospitalization, and Magnetic Resonance Imaging (MRI) showed a slight decrease in the size of the recurrent disc (L4/5) and a newly developed disc (L5/S1) that had deteriorated after delivery. Conclusion: Korean medicine could be used to manage the pain of lumbar spine FBSS patients for 6-7 years and to alleviate lumbago after delivery.

• 대한두개안면성형외과학회지
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• 제10권1호
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• pp.19-22
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• 2009

Purpose: There are various approaches for open reduction surgery for orbitozygomatic fractures. After the incisions are performed, patients might have various complications. In this point of view, we conducted a retrospective study of the usability of infraorbital incision on elderly patients, generally more vulnerable to scleral show and ectropion. Methods: In this study, 20 patients who are relatively more vulnerable to scleral show and ectropion through snap-back test having infraorbital incision were reviewed. We monitored the duration of the surgery, and complications resulted from the incision. We evaluated the scars with the researcher's observations and with the patient's level of satisfaction on a scale of 1 to 5. Results: On average, 5 minutes was spent between the skin incision and the fracture exposure. No case of scleral show and ectropion occurred. One year follow-up observation revealed 4 cases of visible scars, 9 cases of barely visible scars, and 7 cases of invisible scars. The subjective satisfaction level of the patients' scar is an average of 4.0. Conclusion: Infraorbital incision has many advantages. First, it can reduce the complications such as scleral show and ectropion. Second, it can shorten the operation time. Third, it can diminish incision-related scars.

• 임상간호연구
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• 제17권3호
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• pp.388-398
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• 2011

Purpose: This study was to develop a post-operative exercise program, apply it to patients undergone lumbar spinal fusion surgery, and evaluate the effectiveness of the program on pain and disability activities of daily living. Methods: Fifty six patients who had lumbar spinal fusion were enrolled in this study. The patients were divided into two groups; 28 patients in the intervention group completed post-operative lumbar exercise program including walking for four weeks and 28 patients in the control group only did walking exercises. The degrees of pain on low back and leg were evaluated using visual analog scale (VAS) and the functional outcome was evaluated using the Korean version of Oswestry Disability Index (KODI) before surgery and 5 weeks after surgery. The data were analyzed using descriptive statistics, Chi-square test, t-test with SPSS 18.0 program. Results: Low back and leg pain of the participants in both experimental and control groups were improved after surgery compared to pre-surgery pain. However, there was no statistically significant difference between the groups. KODI score in the intervention group was significantly lower than that of the control group (p=.014). Conclusion: The developed post-operative exercise program in patients with lumbar spinal fusion surgery seems to be a useful intervention to reduce disability in activities of daily living.

• Archives of Plastic Surgery
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• 제50권5호
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• pp.463-467
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• 2023

Madelung's disease (MD) is a rare disease characterized by diffuse, nonencapsulated, multiple fat masses in different areas of the body. In this case report, we present a case of MD in Asia and its management. A 66-year-old man with a history of hypertension presented with massive growth of soft tissue around the neck, breasts, upper back, and lower abdomen. Preoperative magnetic resonance imaging revealed remarkably hypertrophic fat tissue around the neck and anterior chest was wall, which consistent with the diagnosis of MD. Multiple linear incisions were made on the neck and 763, 186, 635 g of posterior, right, and left fat tissues were excised, respectively. A single wide, transverse incision was done to excise 1,072 g of fat from the upper back. Masses of both breasts were excised, preserving the inferior pedicle, weighing 1,086 (right) and 1,164 g (left). The recovery was optimal and the patient was discharged without complications. In this case, we excised the adipose masses as much as possible and improved contour and symmetry. However, the fat infiltrations in the patient were diffusely distributed, making total fat excision difficult. This rare case report may help in managing patients with MD.

• 대한미세수술학회:학술대회논문집
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• 대한미세수술학회 1992년도 제12차 학술대회
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• pp.67-67
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• 1992

• 척추신경추나의학회지
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• 제17권2호
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• pp.1-15
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• 2022

Objectives This study aimed to assess the efficacy and safety of manual therapy in patients with failed back surgery syndrome (FBSS). Methods We searched eight electronic databases from October 2022 and only selected randomized controlled trials (RCTs) reporting outcomes for manual therapy in FBSS patients. Included studies were analyzed qualitatively. Results A total of twelve RCTs were included and three studies were meta-analyzed. Manual therapy combined with exercise demonstrated more favorable outcomes in terms of pain reduction compared to exercise therapy only (P<0.01). Some studies reported that manual therapy resulted in low efficacy, while some studies reported that specific manual techniques have a significant effect in pain relief. We, therefore, conclude that several studies have a high risk of bias. Conclusions Findings suggest that manual therapy is a safe and non-invasive, promising option for managing FBSS. However, manual therapy is not the best option in all circumstances; thus, this should be selectively applied by a well-trained practitioner. Further studies such as well-designed, risk-controlled RCTs are required to gain stronger evidence.