• Journal of the Korean Association of Oral and Maxillofacial Surgeons
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• 제30권5호
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• pp.380-390
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• 2004

Bone healing plays an important role in orthognathic and craniofacial surgery. Bone tissue repair and regeneration are regulated by an array of growth and morphogenetic factors. Bone formation and remodeling require continuous generation of osteoprogenitor cells from bone marrow stromal cells, which generate and respond to a variety of growth factors with putative roles in hematopoiesis and mesenchymal differentiation. In this study, the efficacy of a single application of hepatocyte growth factor to promote bone regeneration in 5-mm experimental calvarial defects of adult male rats was assessed histologically and immunohistochemically. The result of the experimental site were compared with those of the contralateral contral side. None of the control and experimental bone defects demonstrated complete bone closure. Bone regeneration was found close th the margine and central part of the defects. At 1, 2 weeks, there were found much significant cellural mitotic activity and many inflammatory cells and osteoblasts on the experimental site than control site. At 4, 6 weeks, new bone apposition was founded in both site but, more apposition was seen at experimental site. At 8, 12 weeks, also, some differences was found that more apposition of new bone and collagen fiber was seen on experimental site. Our results have some possibility that HGF do a early positive role to repair the bone defect. More study will be needed.

• 대한구순구개열학회지
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• 제4권1호
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• pp.45-53
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• 2001

악골유합증은 두경부의 매우 드문 선천적 기형으로, 상악과 하악간의 골성 유합이 그 특징이다. 저자들은 좌측 상악, 하악 및 관골궁의 골성 유합을 보이는 1 예를 경험하였고, 골성 유합의 분리를 위한 수술을 시행하였으며, 이후 장기 예후 관찰기간중 개구제한의 점차적인 재발을 관찰하였기에 이에 보고하는 바이다.

• 대한치과마취과학회지
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• 제7권1호
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• pp.22-26
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• 2007

상악과 하악이 선천적으로 붙어서 태어나는 선천성 유합증은 드문 선천성 기형으로 단순히 점막이 붙은 점막유합증에서 악골이 붙은 골유합증까지 다양하게 나타난다. 이중 상악골과 하악골의 골자체가 붙는 골유합증은 아주 드물어서 현재까지 26증례만 보고되고 있는데, 보고된 대부분의 증례는 편측에만 발생하는 불완전형으로 알려져 있다. 7세 된 여아환자가 인디아의 GSR 병원에 입이 벌어지지 않는다는 주소로 내원하였는데 환아의 턱은 완전히 움직이지 않았으며, 2-3 mm 정도 벌어지는 앞니부위에서는 2.5 cm 폭경의 3.0 mm 두께의 단단한 치조점막이 관찰되었다. 전기메스로 전방부의 부착성 섬유밴드를 잘라준 후 즉각적인 개구정도는 16 mm 정도까지 가능하여 구강으로의 기관삽관이 가능하였다. 삽관후 양쪽 후방부 협측점막의 두꺼운 밴드들을 모두 제거하여 개구량을 33 mm까지 증진시킨 후 수술을 종결하였다. 환아의 보호자에게 거즈 블록과 설압자를 이용하여 개구 연습을 능동적으로 시키도록 강조하여 교육하였으며 술후 16개월 경과시까지 특별한 합병증이나 개구량 감소는 관찰되지 않았다. 독립적으로 발생한 선천성 치조점막 유합증 환자에서 비정상적으로 커져있는 과두와 설골이 관찰되었는데, 설-하악 구조의 비정상적인 발육에 기인하여 지속적인 비정상적 운동으로 인한 이차적인 치은과 협점막의 섬유성 부착이 생긴 것으로 추측되었다. 이에 마취과와의 효율적인 협진으로 기관절개술 등의 부가적인 마취방법 없이 효과적으로 치료할 수 있었다.

• Archives of Plastic Surgery
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• 제33권2호
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• pp.237-240
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• 2006

The simultaneous correction of the hypertelorism and exophthalmos combined with craniosynostosis is very rarely performed operative procedures in the world. The craniosynostosis is the congenital anomaly that designates premature fusion of one or more sutures in either cranial vault or cranial base. Hypertelorism is not a distinct clinical syndrome in itself, but is a physical finding secondary to facial and cranial maldevelopment and it is defined as a increase in the distance between the medial orbital walls. Exophthalmos can occur following the decrease in the size of the orbit in patients with developmental skeletal disorders such as craniofacial synostosis. The authors experienced 9-year-old male patient, who has complex cranio-facial abnormality. The craniosynostosis was oxycephaly type and primary fronto-orbital advancement surgery had been performed in other hospital. The abnormal cranial vault combined with hypertelorism and exophthalmos due to maldeveloped both orbital walls. Surgical correction was obtained by various cranio-fronto-orbital remodeling technique such as calvarial bone craniotomy, fronto-orbital advancement, paramedian resection, medial canthopexy, Tessier-Wolfe three wall orbital expansions. We achieved a quite satisfactory result both functionally and aesthetically in a complex cranio-facial deformity patient by combination and modification of previously developed various cranio-facial plasty technique and hereby report the case with brief discussion and review of literature.

• Maxillofacial Plastic and Reconstructive Surgery
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• 제18권1호
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• pp.69-77
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• 1996

저자등은 중안면 발육부전으로 인한 심미적 및 기능적 장애를 주소로 경희대학교 치과대학 구강악안면외과에 내원한 23세 남자에 대해 관상절개술만을 통하여 두개하 Le Fort III 골절단술을 시행하여 중안면부의 심미성을 증진시키고 안구돌출증의 해소 및 반대교합의 개선등 양호한 결과를 얻었기에 이에 대한 문헌고찰과 함께 보고하는 바이다.

• Archives of Plastic Surgery
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• 제49권1호
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• pp.43-49
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• 2022

Background Cleft lip and cleft palate are the most frequent congenital craniofacial deformities, with an incidence of approximately 1 per 700 people. Postoperative palatal fistula is one of the most significant long-term complications. This study investigated the incidence of postoperative palatal fistula and its predictive factors based on 25 years of experience at our hospital. Methods We retrospectively reviewed 636 consecutive palatal repairs performed between January 1996 and October 2020 by a single surgeon. Data from patients' medical records regarding cleft palate repair were analyzed. The preoperative extent of the cleft was evaluated using the Veau classification system, and the cleft palate repair technique was chosen according to the extent of the cleft. SPSS version 25.0 was used for all statistical analyses, and exploratory univariate associations were investigated using the t-test. Results Fistulas occurred in 20 of the 636 patients; thus, the incidence of palatal fistula was 3.1%. The most common fistula location was the hard palate (9/20, 45%), followed by the junction of the hard and soft palate (6/20, 30%) and the soft palate (5/20, 25%). The cleft palate repair technique significantly predicted the incidence of palatal fistula following cleft palate repair (P=0.042). Fistula incidence was significantly higher in patients who underwent surgery using the Furlow double-opposing Z-plasty technique (12.1%) than in cases where the Busan modification (3.0%) or two-flap technique (2.0%) was used. Conclusions The overall incidence of palatal fistulas was 3.1% in this study. Moreover, the technique of cleft palate repair predicted fistula incidence.

• Maxillofacial Plastic and Reconstructive Surgery
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• 제27권4호
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• pp.334-345
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• 2005

The purpose of this study was to compare the postoperative stability and relapse according to 2 different fixation methods after bilateral sagittal split ramus osteotomies in mandibular prognathic patients. Tweenty one patients with Class III dental and skeletal malocclusion who were treated with bilateral sagittal split ramus osteotomy were selected for this retrospective study. We classfied the patients into two groups according to the fixation methods of bony segments after osteotomies. Group W (n = 10) had the bone segments fixed with nonrigid wire and Group S (n = 11) had bicortical screws inserted in the gonial area through a transcutaneous approach. Cephalometric radiographs were taken preoperatively, immediate postoperatively and more than six months postoperatively in each patient. After tracing the cephalometric radiographs, various parameters were measured. Before surgery, both groups were balanced with respect to linear and angular measurements of craniofacial morphology. Mean posterior sagittal setback amounts of the mandibular symphysis was 8.6 mm in the wire group and 6.79 mm in the rigid group, Six months postoperatively, the wire group had 33.1% relapse of the mandibular symphysis and 22.8% in the rigid group relapse. Both groups experienced changes in the orientation and configuration of the mandible. It is thought that Rigid screw fixation is a more stable method than nonrigid wire fixation for maintaining mandibular setback after sagittal split ramus osteotomy.

• Journal of the Korean Association of Oral and Maxillofacial Surgeons
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• 제30권1호
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• pp.69-73
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• 2004

뮤코르 진균증은 드물게 발생하지만 종종 치명적일 수 있으며, Phycomycetes종의 기회 감염에 의해 발생한다. 이 미생물은 부생의 호기성 진균(saprophytic aerobial fungus)이며 구강 점막, 부비동과 목에 통상적으로 존재하며 부패해 가는 식물, 거름, 고당 함유 음식 등에 나타난다. 뮤코르 진균증은 다양한 유형의 임상 형태로 면역결핍환자들에서 빠른 진행과 높은 치사율로 나타난다. 그러나 건강한 사람에서 두경부 영역에 감염된 예는 거의 없다. 본 교실에서는 58세 당뇨병이 있는 남자 환자에서 상악에 발생한 뮤코르 진균증의 증례에서 외과적 절제술과 ampotericin B의 정맥내 투여로 치료 되었으며, 현재까지 특별한 재발 소견 없이 양호한 결과를 얻었기에 이를 문헌 고찰과 함께 보고하는 바이다.

• Archives of Plastic Surgery
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• 제32권2호
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• pp.175-182
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• 2005

Skull base tumors have been determined inoperable because it is difficult to accurately diagnose the extent of the involvement and to approach and excise the tumor safely. However, recently, the advent of sophisticated diagnostic tools such as computed tomography and magnetic resonance imaging as well as the craniofacial and neurosurgical advanced techniques enabled an accurate determination of operative plans and safe approach for tumor excision. Resection of these tumors may sometimes result in massive and complex extirpation defects that are not amenable to local tissue closure. The purpose of this study is to analyze experiences of skull base reconstruction and to evaluate long term survival rate and complications. All cranial base reconstructions performed from July 1993 to September 2000 at Department of Plastic and Reconstructive Surgery of the Seoul National University Hospital were observed. The medical records were reviewed and analysed to assess the location of defects, reconstruction method, existence of the dural repair, history of preoperative radiotherapy and chemotherapy, complications and causes of death of the expired patients. There were 12 cases in region II, 8 cases in region I and 1 case in region III according to the Irish classification of skull base. Cranioplasty was performed in 4 patients with a bone graft and microvascular free tissue transfer was selected in 17 patients to reconstruct the cranial base and/or mid-facial defects. Among them, 11 cases were reconstructed with a rectus abdominis musculocutaneous free flap, 2 with a latissimus dorsi muscluocutaneous free flap, 1 with a fibular osteocutaneous free flap, 2 with a scapular osteocutaneous free flap, and 1 with a forearm fasciocutaneous free flap, respectively. During over 3 years follow-up, 5 patients were expired and 8 lesions were relapsed. Infection(3 cases) and partial flap loss(2 cases) were the main complications and multiorgan failure(3 cases) by cancer metastasis and sepsis(2 cases) were causes of death. Statistically 4-years survival rate was 68%. A large complex defects were successfully reconstructed by one-stage operation and, the functional results were also satisfactory with acceptable survival rates.

• Archives of Plastic Surgery
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• 제43권2호
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• pp.153-159
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• 2016

Background The prenatal ultrasound detection of cleft lip with or without cleft palate (CL/P) and its continuous management in the prenatal, perinatal, and postnatal periods using a multidisciplinary team approach can be beneficial for parents and their infants. In this report, we share our experiences with the prenatal detection of CL/P and the multidisciplinary management of this malformation in our institution's Congenital Disease Center. Methods The multidisciplinary team of the Congenital Disease Center for mothers of children with CL/P is composed of obstetricians, plastic and reconstructive surgeons, pediatricians, and psychiatrists. A total of 11 fetuses were diagnosed with CL/P from March 2009 to December 2013, and their mothers were referred to the Congenital Disease Center of our hospital. When CL/P is suspected in the prenatal ultrasound screening examination, the pregnant woman is referred to our center for further evaluation. Results The abortion rate was 28% (3/11). The concordance rate of the sonographic and final diagnoses was 100%. Ten women (91%) reported that they were satisfied with the multidisciplinary management in our center. Conclusions Although a child with a birth defect is unlikely to be received well, the women whose fetuses were diagnosed with CL/P on prenatal ultrasound screening and who underwent multidisciplinary team management were more likely to decide to continue their pregnancy.