• Archives of Plastic Surgery
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• 제39권2호
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• pp.113-117
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• 2012

Background : Nasal pyramid fractures accompanied by saddle nose deformities are not easily corrected by closed reduction. We used an absorbable plate as a perpendicular strut to support the collapsed "keystone area" and obtained good results. Methods : Between September 2008 and June 2011, 18 patients who had nasal pyramid fractures with saddle nose deformities underwent surgery. Pre- and postoperative facial computed tomographic images and photographs were taken to estimate outcomes. The operative technique included the mucoperichondrial dissection of the nasal septum, insertion of an absorbable plate prepared to an appropriate length to support the "keystone area", and fixation of the absorbable plate strut to the cartilaginous septum. Results : Functional and esthetic outcomes were satisfactory in all patients. Eleven patients assessed the postoperative appearance of the external nose as 'markedly improved' and 7 patients as 'improved'. The 5 surgeons scored the results as a mean of 4.5 on a 5-point scale. Conclusions : The use of an absorbable plate as a perpendicular strut requires no additional procedures because the plate is gradually absorbed. The mechanical strength provided by a buttress between the "keystone area" and the maxillary crest lasts for a long time before the strut is absorbed.

• Maxillofacial Plastic and Reconstructive Surgery
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• 제12권2호
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• pp.9-20
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• 1990

A series of 19 cases with maxillary hyperplasia and mandibular retrognathia were operated on by simultaneous superior repositioning of the maxilla after Le Fort I osteotomy and anterior repositioning of the mandible after bilateral sagittal split ramus osteotomies with or without osteotomy of the inferior border of the mandible. These were evaluated by retrospective cephalometric and computer analysis for the longitudinal skeletal and dental changes for an average of 17.1 months after surgery. For stabilization of the osteotomized segments, the authors used wire osteosynthesis by means of bilateral infraorbital and zygomatic buttress suspension wire at the maxilla, and direct interosseous wire at the split segments of the mandibular rami. Results show generally good stability after simultaneous maxillary and mandibular surgery with wire osteosynthesis, and a minimal to moderate tendency toward skeletal and dental relapse. This article is a preliminary study to defy the efficiency of the wire osteosynthesis (wo)compared with rigid internal fixation (RIF) for simultaneous maxillary and mandibular surgery. 1. The vertical relapse rate of the A point after superior repositioning of the maxilla is 2.2%. 2. The horizontal relapse rate of the B point after advancement of the mandible is 18.3%. 3. The condyle is distracted inferiorly and slightly posteriorly at the immediate postoperative period. 4. At the long term follow up examination, the condyle presents tendency of return to the preoperative position. 5. Condylar segment angle is decreased at the immediate postoperative period, and at the long term follow up evaluation, the angle is increased. 6. Gonial angle is increased at the immediate postoperative period, and then is decreased at the long term follow up evaluation. 7. The dentition is satisfactory with acceptable movement at the long term follow up evaluation. 8. At the mandibular free body analysis, genioplasty shows good stability. 9. Wire osteosynthesis provides excellent stabilization for the simultaneous maxillary and mandibular surgery.

• Archives of Plastic Surgery
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• 제44권2호
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• pp.95-100
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• 2017

Background Intima-to-intima microanastomotic vascular remodeling was explored, utilizing a polylactide-caprolactone absorbable vein coupler model (PAVCM), which was designed to simulate a non-absorbable counterpart system with the sole exception of being absorbable. Methods Six New Zealand white rabbits were used. After transection of the jugular vein, 2 PAVCMs were placed, 1 at each transected end. The stumps were slipped through the PAVCMs, and the venous wall was everted $90^{\circ}$ to achieve intima-to-intima contact. Reanastomosis of the transected jugular vein was performed bilaterally in 3 rabbits. In the other 3 rabbits, the jugular vein (20 mm) harvested from one side was interpositionally grafted to the jugular vein on the opposite side to ease the anastomotic tension. Patency testing, ultrasonography, and histologic assessments were conducted postoperatively at weeks 2, 4, 12, 16, 22, and 26. Results All anastomotic sites were patent, without stenosis, occlusion, or dilatation. In the histologic sections, immature endothelial regeneration was observed at week 2, which was completed by week 4. Regeneration of the tunica media was noted at week 12. Between week 22 and week 26, the tunica media fully regenerated and the coupler dissipated entirely. Conclusions Despite the absence of a coupler to act as an anastomotic buttress, the structure and function of all the vessels appeared normal, even histologically. These outcomes are true milestones in the development of an absorbable vein coupler.

• 한국건축시공학회지
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• 제9권6호
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• pp.189-195
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• 2009

최근 인구의 도심 집중화 현상이 심화됨에 따라 토지이용의 극대화를 위해 지하공간의 활용이 매우 활발하게 진행되고 있다. 또한 최근 건축물의 지하심도가 깊고 인접건물과 근접시공 되는 경우가 많으므로 건축물의 지하외벽은 슬러리 월 또는 흙막이가시설을 외벽 거푸집으로 사용하고 내측에만 거푸집을 시공하는 방식인 합벽으로 시공되고 있다. 그러나 지하층 합벽 거푸집공사에 대한 원가분석이 건축공사 표준품셈 등에 없는 실정이다. 따라서 본 연구는 지하층 합벽 거푸집 공사의 원가분석을 시행하여 시공단계별 투입원가에 대한 자료를 제공하고자 하였다. 연구결과는 수평목 설치 및 해체는 3%, 거푸집 설치 및 해체는 26%, 보강재 설치 및 해체는 12%, 지지대 설치 및 해체는 42%, 기타 작업은 17% 이다. 정확한 투입원가를 프로세스별 구분하여 정리함으로서 신기술 및 신공법 개발 시 중점을 두어야 하는 포인트를 제시할 것으로 판단된다.

• Archives of Plastic Surgery
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• 제36권1호
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• pp.56-60
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• 2009

Purpose: Palatal fracture and mandible fracture result in instability of dental arch. Because they divide the maxillary and mandibular alveolus sagittally and / or transversely and comminute the dentition, they permit rotation of dental alveolar segments and significantly increase the potential for fracture malalignment, complicating fracture treatment. Previous treatment of palatal fracture consisted of palatal splint application and rigid palatal vault stabilization. This procedure result in patient's oral discomfort and removal of palate and screw. Mandible fracture often results in malocclusion due to widening of posterior aspect of dental arch. So we introduce more simple method using intermolar traction wiring, which can protect the widening of dental arch and rotation of dental alveolar segment. Methods: Arch bar and intermolar traction wiring with wire 1 - 0, or 2 - 0 was applied. After exposure of fracture line, neutrooclusion was maintained with intermaxillary fixation. And then open reduction & internal fixation on maxillary fracture line, commonly maxillary buttress, alveolar ridge, pyriform aperture except palatal vault or mandibular fracture line. After 1 week, intermolar traction wiring was removed. We checked occlusion and postoperative radiologic finding. Results: From June of 2007 to October of 2007, 10 patient, who have maxillary fracture with palatal fracture and mandible fracture, underwent open reduction & internal fixation with intermolar traction wiring. All have satisfactory occlusion and there were no complication, like gingiva disease, mouth opening impairment and nonunion. Conclusion: The intermolar traction wiring accompany open reduction and internal fixation can be alternative method for restoration of dental arch in facial bone fracture.

• Archives of Plastic Surgery
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• 제41권5호
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• pp.493-499
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• 2014

Background Maintaining stability and restoring the aesthetic appearance are the fundamental goals when managing zygomatic fractures. We aimed to evaluate the stability and anthropometric outcomes of zygomatic fracture patients who underwent two-point fixation involving the infraorbital rim and zygomaticomaxillary buttress via the transconjunctival and gingivobuccal approaches without any skin incisions. Methods We examined 15 zygomatic fracture patients who underwent two-point fixation during a 3-year period. Stability was evaluated using three-dimensional facial bone computed tomography. Superoinferior and anteroposterior displacement of the zygoma was quantified. The aesthetic appearance of the periorbital region was evaluated using indirect anthropometry with standardized clinical photographs. The ratios between the eye fissure height and width, and lower iris coverage ratio were used to evaluate aesthetical changes. The bony displacement and aesthetic ratios were analyzed using Wilcoxon or Friedman tests. The correlation between the preoperative zygoma position and anthropometric values was analyzed. Results The positions of the zygoma were similar to those on the contralateral side at the long-term follow-up. The preoperative anthropometric measurements on the fractured side differed from those on the contralateral side, although these values were close to the normal values at the long-term follow-up. Furthermore, we noted that the anteroposterior displacement strongly positively correlated with the lower iris coverage rate (Spearman's coefficient=0.678, P=0.005). Conclusions Two-point fixation of zygomatic fractures achieved stable outcomes on long-term follow-up, and also appeared to be reliable in restoring the aesthetic appearance of the periorbital region.

• 대한치과의사협회지
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• 제54권10호
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• pp.811-819
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• 2016

범안면골 골절은 안면부 손상 그 자체로도 치료가 까다롭고 어렵지만, 동반된 다른 신체 중요 장기의 손상 등과 함께 치료 후 에도 남을 수 있는 안면의 심미적, 기능적 문제들 때문에 더욱 치료가 힘들어 질 수 있다. 뇌손상 등의 중요 장기 손상으로 인해 수술이 빠른 시일 내에 시행되지 못할 때에는 관련 의학분과와의 긴밀한 협진 하에 수술 전 처치가 이루어질 수 있도록 하여야 하며, 연조직을 포함한 골절편 등 안면 구조물들이 손상되지 않고 전체적인 형태를 유지할 수 있도록 응급 처치가 되어야 한다. 3D CT 등의 영상진단을 통해 안면골 골절을 치료하기 위한 전체적인 계획을 수립해야 한다. 이 계획에는 수술을 위한 기도확보 방법, 골절의 정복 고정 순서, 접근 방법, 안구, 코 등의 재건 방법 그리고 연조직에 손상에 대한 처치가 포함된다. 수술 시에는 환자 개개인의 상황에 맞춰 되도록 정확한 정복과 고정이 가능한 안면구조물에서 부터 시작하여 교합을 형성하고, 안면골의 유기적인 관계에 유의하여 삼차원적인 구조를 재위치 시킬 수 있도록 해야 한다. 연조직 봉합 시에는 얼굴 피부의 처짐 등을 방지하기 위해 골막, 근막 및 중요 안면 인대들을 고려하여 시행하여야 한다.

• 지질공학
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• 제12권4호
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• pp.367-378
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• 2002

최근 국도가 4차선 선형 개량화 되는 과정에서 일반국도 내 터널 수가 증대되고 있으며 터널 갱구부의 사면 붕괴도 적지 않게 보고되고 있다. 운용중 터널 갱구부 사면 붕괴는 절토사면과는 달리 시공성 및 대책공법 선정의 한계성을 가지고 있다. 본 연구에서는 2002년 4월 발생한 수안보 온천 1, 2터널붕괴 현장을 대상으로 정밀 현장조사를 실시, 안정성 해석에 따른 효율적인 보강공법에 대해 검토한 것이다. 연구방법으로는 붕괴 현장의 정밀 지질조사를 통하여 붕괴 원인 분석 및 지반강도정수 산정을 위하여 현장 조사 및 붕괴 현장에 대한 역해석을 실시 지반강도정수를 추정하였다. 암반사떤의 안정성 해석을 위하여 불연속면의 영향을 고려하여 평사투영법을 실시하였으며, 안전율을 산정을 위하여 Tarlen을 이용한계평형해석을 실시하였다. 연구결과, 수안보 온천 1터널의 경우, 사면경사완화공법을 2터널의 경우는 3개의 영역으로 구분 콘크리트 버트리스 및 보강공법으로 록앵커 시공, 결착식 낙석방 지망을 설치하는 방안이 제시되었다.

• 한국산학기술학회논문지
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• 제16권5호
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• pp.3619-3626
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• 2015

본 연구대상인 화력발전소 석탄저장고는 우리나라 발전 산업 현장 중에서 원자력, 화력 등을 포함한 건축물 중 그 규모면에서 가장 크다. 이 옥내형 석탄저장고는 축구장 6개 크기의 평면에 높이가 73m인 mass volume이다. 또한 구조 및 기능적 요소가 미적요소보다 우선이므로 구조적 안전성과 기능적 석탄저장을 위해 중앙 옹벽과 부벽 합산이 $75,000m^3$에 달하는 콘크리트와 11,744ton의 PEB시스템을 이용한 철골을 사용하여 장대한 공간을 창출할 수 있게 설계되었다. 따라서 옥내형 석탄저장고에 적용된 옹벽과 철골구조에 대한 설계조건과 PEB 시스템의 특징 및 시공에 따른 주요 공정 특이사항을 조사하고, 아울러 이들 주요 공정상에 요구되는 시험 사항에 대해서 조사함으로써 이와 유사하게 지어질 옥내형 석탄저장고에 대한 설계조건과 기준 등을 제시하는 것이 본 연구의 목적이다.

• Archives of Plastic Surgery
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• 제34권4호
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• pp.448-454
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• 2007

Purpose: The objective of this study was to evaluate the outcomes of using the free flap in the reconstruction of maxillary defects. Methods: 27 consecutive cases of maxillary reconstruction with free flap were reviewed. All clinical data were analyzed, including ideal selection of flap, time of reconstruction, recurrence of cancer, postoperative complications, flap design, and follow-up results. The main operative functional items, including speech, oral diet, mastication, eye globe position and function, respiration, and aesthetic results were evaluated. Results: Among the 24 patients who underwent maxillary reconstruction with the free flap, 14 patients underwent immediate reconstruction after maxillary cancer ablation, and 10 patients underwent delayed reconstruction. There occurred 1 flap loss. Recurrences of the cancer after the reconstruction happened in 2 cases. Postoperative complications were 3 cases of gravitational ptosis of the flap, 2 cases of the nasal obstruction, and 1 case of fistula formation. Out of 27 free flaps, there were 15 latissimus dorsi myocutaneous flaps, 5 radial forearm, 4 rectus abdominis myocutaneous flaps, 1 scapular flap, 2 fibula osteocutaneous flap, respectively. Flaps were designed such as 1 lobe in 9 cases, 2 lobes in 9 cases, and 3 lobes in 5 cases. Among the 14 patients who had intraoral defect or who had palatal resection surgery, 2 patients complained the inaccuracy of the pronunciation due to the ptosis of the flap. It was corrected by the reconstruction of the maxillary buttress and hung the sling to the upper direction. All of the 14 patients were able to take unrestricted diets. In 6 patients who had reconstruction of inferior orbital wall with rib bone graft, they preserved normal vision. Aesthetically, most of the patients were satisfied with the result. Conclusion: LD free flap is suggested in uni-maxilla defect as the 1st choice, and fibular osteocutaneous flap and calvarial bone graft to cover the larger defect in bi-maxilla defect.