• Archives of Plastic Surgery
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• 제42권6호
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• pp.704-708
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• 2015

Background Various techniques for lengthening short columellae have been used for bilateral cleft nose repair. However, previous methods have not yielded satisfactory results. We performed a full-thickness skin graft to lengthen short columellae during secondary cleft nose repair in adult patients. Methods Ten bilateral cleft lip and nose patients underwent secondary cheiloplasty with open rhinoplasty between July 2008 and August 2014. The patients underwent a full-thickness skin graft on the medial crura to elongate the columella. The average age of the patients at the time of surgery was 22.2 years. Nasal profiles were evaluated before and after the operation using the photogrammetric method. Results The nasal profiles were improved in all patients, and all skin grafts were well taken, with the exception of one patient. Columellar height, nostril height, and columella-lip angle increased, and nasal width decreased significantly. The ratios of columellar height to nasal height, columellar height to nasal width, and nasal height to nasal width increased to a statistically significant extent. Conclusions Columella lengthening with a full-thickness skin graft is a simple and effective method for the repair of severely short columellae in bilateral cleft nose patients. We had satisfactory outcomes, with good color matching and aesthetically pleasing contours.

• 대한구순구개열학회지
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• 제9권2호
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• pp.93-100
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• 2006

본 증례에서는 2명의 불완전, 그리고 완전구순열 환자를 Delaire의 개념에 의하여 수술을 시행 하였다. 불완전 구순열 교정은 코 교정 후 좌우 비대칭을 해소할 수 있었으나 완전구순구개열의 환아에서는 코의 비대칭성을 회복하기 위해 동시 수술을 시행하였으나 좌우 비대칭성은 수술 후에도 관찰할 수 있었다. 본 증례의 경우 환자의 경제적 그리고 사회적 이유로 인해 수술이 지연된 환자로 수술에 난이도는 비교적 높지 않았던 경우로 비강전정부위와 비익부위, 그리고 구륜근 등의 피부 하방에 비정상적으로 배열된 근육의 박리와 재위치를 이루어주었던 경우였다. 술 후 평가를 위한, 심미, 발음, 기능과 정서적 발달 정도를 검사하여야 하나 지리적 관계로 재평가가 어려운 점이 예상된다.

• 대한구순구개열학회지
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• 제13권1호
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• pp.35-42
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• 2010

한국얼굴기형환자 후원회 의료봉사팀은 2010년 2월 6일에서 12일까지 라오스의 수도인 Vientiane을 방문하여 구순구개열 무료수술을 무사히 마쳤다. 의료봉사팀은 총 11명으로 구성되었다. 구강악안면외과의 6명과 간호사 2명, 학생 3명이었다. 수술은 라오스 비엔찬의 Mahosot 병원에서 수술장 한개에 수술 침대를 두개 놓고, 두팀을 구성하여 수술을 진행하였다. 당시 서울대학교 치과대학 예방치학교실 백대일 교수님께서 안식년을 맞아 라오스에서 라오스인 구강건강에 관한 national survey를 수행하고 계셨는데 수술팀에게 많은 도움을 주셨다. 2월 7일 토요일 예진 때는 한국국제협력단에서 파견한 국제협력의사 박병원 선생님(내과 전문의)께서 통역으로 도와 주셨다. 총 30명의 환자가(남:여=14:16) 수술을 받았으며, 환자들의 평균 나이는 9.7세였다. 수술 종류는 cheiloplasty, palatoplasty, rhinoplasty, scar revision, lip reconstruction로 구분 지을 수 있었으며, 모든 수술은 합병증 없이 마무리되었다. 이번 자선수술을 통해 30명의 환자를 수술하였고, 라오스 의사들에게 구순구개열 진료에 대한 기술을 교육할 수 있었다. 또 라오스 치과대학과 자매결연을 맺는 등 한국-라오스 우호증진에 많은 기여를 한바 이를 보고한다.

• Archives of Plastic Surgery
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• 제37권4호
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• pp.427-432
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• 2010

Purpose: The purpose of this study is to estimate muscle defect by ultrasonography in the patients with secondary deformities of the lip. We investigated the association between the muscle defect in the repaired cleft lip and the philtral appearance not only at resting state but also maximal puckering. Methods: From December 2006 to November 2007, 52 children were evaluated after primary or secondary cheiloplasty. Digital photographs were taken both from the front and both three quarter views in repose and at maximal pucker. Video clips were also taken in repose and at maximal pucker. A panel of four, scored the philtral ridge and dimple seen on these photographs and videos by using two visual analog scales. Eminence of the philtral ridge was scored by a 5 point grading scale, from "conspicuous groove" to "normal philtral ridge" and the philtral dimple was scored by 3 point grading scale, from "no dimple" to "prominent dimple". Ultrasound images of the upper lip were made using a linear array transducer at the resting position of the lip and evaluated by a single radiologist. Results: The philtral ridge eminence scored $2.79{\pm}0.54$ and $1.40{\pm}0.53$ at resting and maximal pucker, correlating with "flat" and "conspicous groove". The philtral dimpling scored $1.44{\pm}0.53$ and $2.27{\pm}0.66$ at resting and maximal pucker, correlating with "no dimple" and "slight dimple". Ultrasound imaging showed the average muscle dehiscence to be $3.78{\pm}2.14$ mm at resting position. Correlation between the muscle defect in ultrasound imaging and philtral ridge eminence at rest was statistically significant (p<0.050), but was not significant (p=0.756) at maximal pucker using Spearman's rank correlation. Correlation between the muscle defect in ultrasound imaging and philtral dimpling was not statistically significant both at rest (p=0.920) and at maximal pucker (p=0.815) using Spearman's rank correlation. Conclusion: Quantitative assessment of the muscle defect using ultrasonography correlates with the static philtral appearance, but does not correlate with the dynamic appearance. Also, the size of the muscle defect does not show any correlation with the philtral dimpling. Our findings reveal that ultrasound imaging partially reflect static appearance of philtrum but cannot reflect dynamic appearance and suggest the need for further research to evaluate dynamic appearance.

• 대한두개안면성형외과학회지
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• 제24권3호
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• pp.111-116
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• 2023

Background: In Indonesia, the prevalence of cleft lip and palate increased from 0.08% to 0.12% between 2013 and 2018. Children with cleft deformities typically undergo staged surgery. However, the coronavirus disease 2019 (COVID-19) pandemic has had negative impacts on the healthcare sector, including the suspension of elective procedures; this has raised concerns about the safety of performing surgery and the functional consequences of delaying treatment, the latter of which is associated with poor prognosis. The purpose of this study was to report the characteristics of clefts treated by the Bandung Cleft Lip and Palate Center team during the pandemic period. Methods: This brief comparative study based on a chart review was conducted at the Bandung Cleft Lip and Palate Center. We statistically evaluated data from all patients treated between September 2018 and August 2021. Frequency analysis was performed to analyze the average number of each procedure by age before and during the COVID-19 pandemic. Results: Data from 18-month periods before (n= 460) and during (n= 423) the pandemic were compared. Cheiloplasty procedures were examined (pre-pandemic, n= 230; pandemic, n= 248); before the pandemic, 86.1% were performed according to the treatment protocol (patient < 1 year old), and this proportion non-significantly dropped to 80.6% during the pandemic (p= 0.904). Palatoplasty procedures were also compared (pre-pandemic, n= 160; pandemic, n= 139); the treatment protocol (patient 0.5-2 years old) was followed for 65.5% of procedures before the pandemic and 75.5% during the pandemic (p= 0.509). Additionally, 70 (mean age, 7.94 years) revision and other procedures were performed before the pandemic and 36 (mean age, 8.52 years) during the pandemic. Conclusion: The cleft procedures performed at the Bandung Cleft Lip and Palate Center did not significantly change during the COVID-19 pandemic.

• 대한치과교정학회지
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• 제29권6호
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• pp.649-661
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• 1999

본 연구의 목적은 1) 양측성 순구개열 신생아에 대한 수술전 비치조정형 장치 (Pre-surgical nasoalveolar molding appliance, PNAM) 치료를 소개하고, 2) 이 장치의 치조골 조형 (molding) 효과를 평가하는 것이다. 서울대학교병원 교정과에 내원하여 PNAM 장치를 사용하여 치료받은 8명의 양측성 순구개열 환자 (남자 7명, 여자 1명, 평균 초진 연령:61.6일)를 연구대상으로 하였으며, 치조골에서 전상악골의 치조능 좌우측 말단부와 양측 분절 치조능 최전방점까지의 파열부간 평균거리는 $8.09{\pm}5.03mm$였고 치조골 정형치료의 평균 기간은 $8.8{\pm}3.1$주였다. 초진시 (T0)와 성공적인 치조골 정형술이 완료된 시기(T1)에 인상을 채득하여 모형을 제작한 후, 사진 촬영과 digital caliper를 사용하여 20개의 길이항목과 14개의 각도항목을 계측하였다. Microsoft사의 Excel 97 program을 사용하여 각 항목의 계측치들을 통계 처리하였고, 치조골 정형술에 의한 치료전후의 차이를 비교하기 위하여 paired t-test를 사용하였다. PNAM 장치에 의한 치조골 조형 효과에 대한 결론은 다음과 같다. 1. 양측성 순구개열 파열부의 폐쇄가 성공적으로 이루어졌다. 2. 양측 분절의 측방 성장이 억제되어 내측 굴곡이 발생하였다. 3. 전상악골 후방부에 위치한 서골(vomer) 전방부의 굴곡에 의하여 전상악골의 후방이동과 회전이 발생하였다. 구순성형술을 시행하기 전에 PNAM장치를 사용하여 양측성 순구개열 신생아 환자의 파열부 폐쇄에 대한 좋은 결과를 얻을 수 있었다.