• Archives of Plastic Surgery
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• 제32권6호
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• pp.791-795
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• 2005

A symmetric approach, using external rhinoplasty, is presented to aid the plastic surgeon in obtaining improved aesthetic and functional results in patients with postoperative nasal deformities. The external approach yields a full visualization of the underlying nasal framework and intraoperative evaluation of the deformities to be corrected subsequently. The nasal septal cartilage is unequivocally one of the best graft sources for reconstruction of the dorsum, columella or tip. It has fairly even surface and pliability in carving and shaping the graft. The graft can be obtained during the surgery with less morbidity and prepared easily for need of the shape. The only real disadvantage is the limited amount of cartilage that can be obtained from the septum. The dorsal and caudal rims, one or more cm in width, of the nasal septum should not be disturbed to maintain the nasal frame during harvesting the septal graft. Authors invented novel instruments, J & D knife and Flat (Spatula) suction tip, and have employed the devices for harvesting the septal cartilage. We were unable to gain enough amount of the cartilage by using a swivel knife or cartilage scissors. The septal cartilage can be resected as much as needed with newly invented instruments which facilitate a separation(method) technique.

• 대한의용생체공학회:의공학회지
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• 제32권3호
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• pp.270-277
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• 2011

Laser cartilage reshaping(LCR) is a promising method for reshaping cartilage by using laser irradiation to maintain permanently modifies its shape. However this method has not been fully understood due to the limited scientific researches. The purpose of this study is to analyze optical and thermal characteristics of cartilage during laser irradiation. After analyzing Monte Carlo simulation for the comparison of laser fluence distributions with different laser wavelengths the characterization of the spectral changes during Nd:YAG laser(${\lambda}$ = 1444 nm) irradiation was investigated in the ranges of 900-1700 nm with double integrating spheres. The surface temperature distribution changes during laser irradiation were investigated with an infrared camera. The quantitative measurements of optical and thermal characteristics in cartilage after laser irradiation were correlated with the transition of water flux(from bound to free water) and this study may be useful for better understanding of biophysical transformation phenomena in cartilage after laser heating.

• Medical Lasers
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• 제10권2호
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• pp.90-95
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• 2021

Background and Objectives Surgery for harvesting costal cartilage is often required for revision septorhinoplasty due to a lack of septal cartilage in patients with a severely contracted nose, and postoperative scarring on the anterolateral rib cage commonly requires additional treatment. This study aimed to evaluate the therapeutic efficacy and safety of combined polydeoxyribonucleotide (PDRN) and microlens array (MLA)-type nanosecond-domain neodymium (Nd):yttrium-aluminum-garnet (YAG) laser treatment for postoperative scars after costal cartilage harvest surgery. Materials and Methods Nine Korean patients with scars after costal cartilage harvest surgery treated with PDRN injections and MLA-type Nd:YAG laser treatments were retrospectively reviewed. Results Most of the scar lesions exhibited clinical improvement at 2 weeks after PDRN and MLA-type nanosecond-domain laser treatments, and the lesions further improved after adding more treatment sessions. The median Vancouver Scar Scale (VSS) score decreased from 6 (interquartile range [IQR]: 6-7) before combined intralesional PDRN injection and MLA-type, nanosecond-domain Nd:YAG laser treatments to 3 (IQR: 2-4) thereafter. Patient satisfaction after the combination treatments was rated as satisfactory. None of our patients reported major adverse events. Conclusion This case series study demonstrated that combined PDRN and MLA-type, nanosecond-domain Nd:YAG laser treatments are effective and safe for treating scars from costal cartilage harvest surgery.

• Maxillofacial Plastic and Reconstructive Surgery
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• 제28권5호
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• pp.404-416
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• 2006

Purpose : This study was to clarify the changes in mandibular condyle after unilateral mandibular distraction osteogenesis throughout histological changes and expression of matrix metalloproteinase-2 (MMP-2) and tissue inhibitor of matrix metalloproteinase-2 (TIMP-2). Materials & Methods : Intraoral distractors were placed via submandibular incision in 8 dogs. Two unoperated animals served as controls. Distraction was performed five days after osteotomy as a rate of 0.5 mm twice per day for 10 days. Two animals were sacrificed on 7, 14, 28, and 56 days after completion of distraction, respectively. Ipsilateral condyles were harvested and processed for histological and immunohistochemical examinations. Results : The condyle cartilage is separated into four layers: fibrous layer, proliferative layer, hypertrophic layer, and calcified layer. At 7 days and 14 days after distraction, the condylar cartilage showed the decreased thickness of the articular cartilage and reduced cellularity. At 28 days after distraction, there was an increase in cellularity of fibrous, proliferative, and hypertrophic layer. However, it demonstrated reduced cellularity compared to the control. At 56 days of after distraction, the articular cartilage was an almost normal histologic structure. Positive Safranin-O staining, indicative of sulfated proteoglycans, was examined in the condylar cartilge of nonloaded control. At 7 days and 14 days after distraction, the sulfated proteoglycans is almost completely depleted from the noncalcified part of the condylar cartilage. At 28 days after distraction, there was an increase in Safranin-O staining intensity. However, the staining intensity of the experimental condyle was weaker than that of the control. At 56 days of after distraction, the condylar cartilage showed almost normal Safranin-O staining pattern. In control condyle, MMP-2 immunostaining was seen in fibrous, proliferative, and hypertrophic layer of condylar cartilage, however, it demonstrated lack of staining in fibrous and proliferative layer. At 7 days and 14 days after distraction, strong MMP-2 immunoreactivity was seen in the fibrous, proliferative and hypertrophic layer of the condylar cartilage. At 28 days after distraction, MMP-2 immunostaining was seen in the fibrous and hypertrophic layer of condylar cartilage, however, their immunoactivity was reduced. At 56 days after distraction, MMP-2 immunoreactivity showed almost normal immunostaining pattern. In control condyle, TIMP-2 immunostaining was primarily seen in fibrous and hypertrophic layer of condylar cartilage, however, it demonstrated lack of staining in proliferative layer. At 7 days after distraction, very weak TIMP-2 immunoreactivity appeared in fibrous, proliferative and hypertrophic layer of the condylar cartilage. At 14 days after distraction, weak TIMP-2 immunoreactivity was seen in the fibrous, proliferative and hypertrophic layer of the condylar cartilage. At 28 days after distraction, TIMP-2 immunoreactivity was increased in the fibrous and hypertrophic layer of condylar cartilage. At 56 days after completion of distraction, TIMP-2 immunoreactivity showed almost normal immunostaining pattern. Conclusions : The results show that short-term outcome of physiologic distraction osteogenesis may lead to degenerative changes in the condylar cartilage. These alterations in the condylar cartilage may be considered as a pressure-related degeneration of the cartilage tissue. However, the long-term results suggest that the condylar cartilage display repair activity after mandibular distraction osteogenesis.

• 대한정형외과학회지
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• 제56권5호
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• pp.404-412
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• 2021

목적: 슬관절 내측 구획 골관절염으로 근위 경골 절골술 및 미세 골절술을 함께 시행한 환자 군에서 이차적 관절경 검사를 시행하여 연골 재생 정도를 평가하고 연골 재생에 영향을 미치는 요인을 규명하고자 한다. 또한 연골 재생의 정도와 기능적 결과가 연관성이 있는지 분석하고자 한다. 대상 및 방법: 2007년부터 2015년까지 근위 경골 절골술 및 미세 골절술을 함께 시행하였고, 최소 2년이 지나 금속판 제거술 및 이차 관절경 검사까지 시행 받은 81예를 대상으로 하였다. 술 전 대퇴부 연골 손상의 정도는 ICRS (International Cartilage Research Society) 분류를 이용하였고, 모두 grade III, IV 였다. 이차적 관절경 검사 이후에는 연골 재생이 양호한 그룹(grade I, II)과 불량한 그룹(grade III, IV)으로 분류하였다. 다변량 로지스틱 회기 분석을 통하여 연골 재생에 영향을 미치는 독립적인 요인을 파악하였다. 또한 두 그룹간의 수술 전후에 Knee Society score (KSS)와 Western Ontario and McMaster Universities Osteoarthritis Index score (WOMAC)를 이용하여 기능적 결과를 비교하였다. 결과: 연령, 성별, 체질량 지수, 술 전후 방사선학적 요인, 술 전 관절의 상태는 연골 재생의 정도에 유의한 영향을 끼치지 않았으며, 큰 연골 병변 범위(≥2.0 cm²) (p=0.011)와 키스 병변(kissing lesion)의 존재(p=0.027)는 불량한 연골 재생과 연관성이 있었다. KSS와 WOMAC 점수상에서는 연골의 재생이 양호한 그룹과 불량한 그룹 간의 유의한 차이는 없었다. 결론: 큰 연골 병변과 키스 병변의 존재는 근위 경골 절골술 및 미세 골절술 후 불량한 연골 재생과 관계가 있었다. 하지만 재생된 연골의 상태는 기능적 결과와 연관성을 보이지 않았다.

• 대한치과교정학회지
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• 제34권2호
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• pp.143-152
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• 2004

하악과두 연골이 발생하고 분화하는 과정에서 나타내는 특성을 규명하기 위하여, 발생 16, 18일과 출생 1일, 5일, 10일, 20일 및 30일 후의 ICR생쥐의 하악과두를 형태학적으로 분석하고, 생쥐 I형, II형, X형 교원질, Indian hedgehog (IHH) 및 BMP-4 등의 mRNA 발현을 in-situ hybridization 방법으로 연구하였다. 1. 생쥐 I형 및 II형 교원질 mRNA는 하악과두의 발생 및 성장과정에서 모두 발현되었다. I형 교원질 mRNA는 휴지층과 증식층의 상부에서 관찰된 반면 II형 교원질은 휴지층과 증식층 그리고 비대연골층의 상부에서 관찰되었다. 2. 하악과두 연골은 성장에 따라 비대연골층이 계속 증가하는 소견을 보였으며, 비대 연골층의 세포들은 특징적으로 X형 교원질 mRNA의 발현을 보였다. 3. BMP-4 mRNA는 하악과두 연골 원기와 골화중인 하악골체에서 모두 발현되었다. 4. IHH mRNA는 하악과두의 발생과정에서 증식 연골층의 하부와 비대연골층의 상부에서 선택적으로 관찰되었다.

• Maxillofacial Plastic and Reconstructive Surgery
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• 제15권1호
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• pp.49-61
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• 1993

The transplantation of cartilage, especially auricular cartilage, has assumed a role of importance in the field of plastic and reconstructive surgery. From long years ago, many reports have appeared in the literature describing the experimental and clinical results of the use of cartilage. At present, the evidence for survival of autograft of cartilage is admitted, But, the results for interrelationship between the bone and cartilage grafts with or without perichondrium is not so conclusive. The purpose of this study were observed as to whether autogenous cartilage grafts were fixed by means of tie with 4-0 vicryl and fibrin adhesive on the femur or microscopic findings of union state in 16 rabbits. We sacrified the experimental animals after 1, 2, 4, 6 weeks postoperatively and made the specimens as a routine laboratory procedures and stained with Hematoxylin-Eosin stain, Verhoeff-van Gieson elastic fiber stain, and alcian blue periodic acid-Schiff(AB-PAS) for mucopolysaccharide. Histologic evaluation was performed under microscope. The obtaind results were as follows : 1. Fibrous union was formed between the grafting cartilage and the femur, nor any findings of calcification and formation of new bone. 2. Partial fibrous adhesion was observed in fibrin adhesive groups on 6 weeks postoperatively. 3. Appositional growth has performed more in fibrin adhesive groups than tie groups. 4. There are little difference in both for new copillary proliferation and fibroblast activations. 5. Degenerative changes have apperared more in tie groups than adhesive groups, but not related to the healing periods.

• Maxillofacial Plastic and Reconstructive Surgery
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• 제15권4호
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• pp.303-316
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• 1993

The auricular cartilage grafts have been widely used in replacement of the temporomandibular joint disk. Cartilage grafts itself have a low metabolism and high survival rate after grafting. In processing the grafting materials, it was important to preserve the properties of chondrocyte proper. We used 15% glycerol and 10% DMSO (Dimethyl Sulfoxide) solutions for cartilage fixation before deep freezing. We have performed the allogenic auricular cartilage graft in the temporomandibular joint of 20 rabbits which 10 specimen was treated with 15% glycerol and the other 10 specimen was treated with 10% DMSO respectively and examined in 1, 2, 4, 6 and 8 weeks after operation histopathologically. The result were : 1. Inflammatory cell infiltration around the grafted material appeared more glycerol groups than DMSO groups at 1 week, but each group has no differences after 2 weeks. 2. Degenerative changes of grafted auricular chondrocytes were more deveolped in glycerol group than DMSO groups till 4 weeks, but there were no differences between two groups after 6 weeks. 3. Fibrous union between grafted fragment and mandibular condyle was prominent in DMSO group. 4. Vascular proliferation of the grafted auricualr cartilage was more developed in DMSO groups than glycerol group in early stage. 5. Amount of the additional growth of grafted auricular cartilage was more existed in DMSO groups than glycerol group. 6. General survival rate after grafting was more prominent in DMSO group. In summary, allogenic auricular cartilage grafts treated with 15% glycerol and 10% DMSO solution have supported to survivalbility as a cryopreservative agents, especially DMSO groups have little inflammatory cell infiltration in early stages and degenerative changes and additional growth are more prominent than glycerol groups.

• Archives of Plastic Surgery
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• 제33권6호
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• pp.723-731
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• 2006

Purpose: Collagen is the principal structural biomolecule in cartilage extracellular matrix, which makes it a logical target for cartilage engineering. In this study, porous type I collagen scaffolds were cross-linked using dehydrothermal(DHT) treatment and/or 1-ethyl-3-(3-dimethyl aminopropyl) carbodiimide(EDC), in the presence and absence of chondroitin-6-sulfate(CS) for cartilage regeneration. Methods: Cartilage defects were created in the proximal part of the ear of New Zealand rabbits. Four types of scaffolds(n=4) were inserted. The types included DHT cross-linked(Group 1), DHT and EDC cross- linked(Group 2), CS added DHT cross-linked(Group 3), and CS added DHT and EDC cross-linked(Group 4). Histomorphometric analysis and cartilage-specific gene expression of the reconstructed tissues were evaluated respectively 4, 8, and 12 weeks after implantation. Results: The largest quantity of regenerated cartilage was found in DHT cross-linked groups 1 and 3 in the 8th week and then decreased in the 12th week, while calcification increased. Calcification was observed from the 8th week and the area increased in the 12th week. Group 4 was treated with EDC cross-linking and CS, and the matrix did not degrade in the 12th week. Cartilage-specific type II collagen mRNA expression increased with time in all groups. Conclusion: CS did not increase chondrogenesis in all groups. EDC cross-linking may prevent chondrocyte infiltration from the perichondrium into the collagen scaffold.

• The Korean Journal of Pain
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• 제24권3호
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• pp.141-145
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• 2011

Background: Stellate ganglion block is usually performed at the transverse process of C6, because the vertebral artery is located anterior to the transverse process of C7. The purpose of this study is to estimate the location of the transverse process of C6 using the cricoid cartilage in the performance of stellate ganglion block. Methods: We reviewed cervical lateral neutral-flexion-extension views of 48 patients who visited our pain clinic between January and June of 2010. We drew a horizontal line at the surface of the cricoid cartilage in the neutral and extension views of cervical lateral x-rays. We then measured the change in the shortest distance from this horizontal line to the lowest point of the transverse process of C6 between the neutral and extension views. Results: There was a statistically significant difference in the shortest distance from the horizontal line at the surface of the cricoid cartilage to the lowest point of transverse process of C6 between neutral position and neck extension position in both males and females, and between males and females in both neutral position and neck extension position. The cricoid cartilage level was 4.8 mm lower in males and 14.4 mm higher in females than the lowest point of transverse process of C6 in neck extension position. Conclusions: Practitioners should recognize that the cricoid cartilage has cephalad movement in neck extension. In this way, the cricoid cartilage can be still useful as a landmark for stellate ganglion block.