• 대한치과보철학회지
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• 제55권3호
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• pp.319-324
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• 2017

상악골 부분 절제술을 시행한 많은 환자에서 안모의 변형으로 심리적 우울감에 취약할 뿐만 아니라 연하, 저작 기능이 저하되며 발음 장애가 발생한다. 폐색장치를 통한 악안면 보철적 치료는 저작, 연하, 발음 기능의 회복뿐 아니라 적절한 안모로 회복시켜주며 장치를 사용하는 환자들의 삶의 질을 향상해준다. 본 증례는 상악골 부분 절제술 시행한 환자에서 수술 부위 안정화 기간 사용한 임시 폐색장치로 적절한 안면 지지의 정도를 예측할 수 있었고 이를 반영하여 artificial palate를 제작하였다. 이는 적절한 안면 지지를 재현하여 최종 폐색장치를 제작하는 간단한 접근법을 제시하였고 기능적, 심미적 부분에서 만족할 만한 결과를 얻어 이를 보고하고자 한다.

• 지역사회간호학회지
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• 제31권2호
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• pp.166-178
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• 2020

Purpose: This study was conducted to examine the effects of the oral care program for improving swallowing function of the elderly using welfare centers on depression, self efficacy, subjective oral health status and swallowing related quality of life. Methods: The intervention in this study was systematically developed through the six stages of Intervention Mapping Protocol (IMP) and was based on Mead's symbolic interaction theory and Bandura's self efficacy theory. A non equivalent control group pre and post-test design was conducted on a total of 37 elderly people (experimental group: 19, control group: 18) from D city. The oral care program was administered to the experimental group once a week for five weeks, totaling five times, and the exact program ran for 50 minutes. The collected data were analyzed using the SPSS/WIN 25.0 program. Results: Following the intervention, subjective oral health score, and swallowing related quality of life were significantly improved in the experimental group. Conclusion: The oral care program presented in this study was found to be effective in increasing subjective oral health status, and swallowing related quality of life for the elderly using welfare centers.

• 근관절건강학회지
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• 제21권2호
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• pp.85-96
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• 2014

Purpose: The purpose of this study was to develop a training program for swallowing and to test its effect on swallowing capacity and nutritional status among nursing home residents with stroke. Methods: A swallowing training program was developed by literature review, expert validation and a pilot test. A pretest and posttest quasi-experimental study design with nonequivalent control group was used to evaluate the effectiveness of the program. Swallowing training was conducted for thirty minutes, three times a week for 8 weeks. Swallowing capacity including dysphagia screening score, swallowing symptom questionnaire and tongue pressure, and nutritional status including body mass index and mid arm muscle circumference were measured at the baseline and at 8 weeks. Results: The exercised-based swallowing training program consisted of oromotor exercise, expiratory muscle strength exercise and effortful swallow. The participants were 77.2 years old on average. At the completion of 8-week program, the experimental group showed better scores in dysphagia screening (p=.039) and swallowing symptom questionnaire (p=.004) and a significant increase in tongue pressure (p=.003). Conclusion: The exercised-based swallowing training program was safely applied to nursing home residents with stroke and showed a significant improvement of swallowing capacity. Further studies are needed to identify its effect on the nutritional status.

• Annals of Rehabilitation Medicine
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• 제42권6호
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• pp.798-803
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• 2018

Objective To investigate the relationship between peak cough flow (PCF), pulmonary function tests (PFT), and severity of dysphagia in patients with ischemic stroke. Methods This study included patients diagnosed with ischemic stroke, who underwent videofluoroscopic swallowing study (VFSS), PCF and PFT from March 2016 to February 2017. The dysphagia severity was assessed using the videofluoroscopic dysphagia scale (VDS). Correlation analysis of VDS, PFT and PCF was performed. Patients were divided into three groups based on VDS score. One-way ANOVA of VDS was performed to analyze PCF, forced vital capacity (FVC), forced expiratory volume in one second (FEV1), and age among the different groups. Results The correlation coefficients of VDS and PCF, VDS and FVC, and VDS and FEV1 were -0.836, -0.508, and -0.430, respectively, all of which were statistically significant at the level of p<0.001. The one-way ANOVA indicated statistically significant differences in PCF, FVC, FEV1, and age among the VDS groups. Statistically significant differences in VDS and age were observed between aspiration pneumoia and non-aspiration pneumonia groups. Conclusion Coughing is a useful factor in evaluating the risk of aspiration in dysphagia patients. Evaluation of respiratory and coughing function should be conducted during the swallowing assessment of patients with ischemic stroke.

• 대한후두음성언어의학회지
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• 제32권1호
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• pp.39-42
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• 2021

Granuloma is an uncommon benign disease that develops in the process of wound healing. Pharyngeal or laryngeal granuloma can be associated with gastric reflux, mechanical injury or trauma including intubation, voice abuse, or foreign body. 50-year-old female was transferred to our institute with a huge mass occupying the upper aerodigestive tract causing dysphagia. The patient has been suffering from a brain hemorrhage for several months and was kept in bed due to the quadriplegia with stuporous mental status, and was tracheotomized. On examination, the whole oropharynx and hypopharynx was covered by a smooth-surfaced soft big diffuse granular mass, which extended down to the upper trachea through the larynx. The huge granuloma was successfully removed with surgery and was found to have a pedunculating stalk on the oropharyngeal posterior wall with a small mucosal defect, suggestive of the origin of the mass. The defect was closed primarily after the cauterization. The patient is now followed up regularly without any recurrence of the disease.

• Archives of Plastic Surgery
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• 제49권3호
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• pp.378-396
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• 2022

Several reconstructive methods have been reported to restore the continuity of the aerodigestive tract following resection of pharyngeal and hypopharyngeal cancers. However, high complication rates have been reported after voice prosthesis insertion. In this setting, the ileocolon free flap (ICFF) offers a tubularized flap for reconstruction of the hypopharynx while providing a natural phonation tube. Herein, we systematically reviewed the current evidence on the use of the ICFF for reconstruction of the aerodigestive tract. A systematic literature search was conducted across PubMed MEDLINE, Web of Science, ScienceDirect, Scopus, and Ovid MEDLINE(R). Data on the technical considerations and surgical and functional outcomes were extracted. Twenty-one studies were included. The mean age and follow-up were 54.65 years and 24.72 months, respectively. An isoperistaltic or antiperistaltic standard ICFF, patch flap, or chimeric seromuscular-ICFF can be used depending on the patients' needs. The seromuscular chimeric flap is useful to augment the closure of the distal anastomotic site. The maximum phonation time, frequency, and sound pressure level (dB) were higher with ileal segments of 7 to 15 cm. The incidence of postoperative leakage ranged from 0 to 13.3%, and the majority was occurring at the coloesophageal junction. The revision rate of the microanastomosis ranged from 0 to 16.6%. The ICFF provides a reliable and versatile alternative for reconstruction of middle-size defects of the aerodigestive tract. Its three-dimensional configuration and functional anatomy encourage early speech and deglutition without a prosthetic valve and minimal donor-site morbidity.

• 치위생과학회지
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• 제23권2호
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• pp.69-87
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• 2023

Background: Swallowing function deterioration is a common problem experienced by older adults worldwide. Many studies have been conducted to improve swallowing function in older adults; however, due to differences in intervention methods and study designs, it is difficult to draw a common conclusion. This study aimed to analyze trends and intervention methods in studies of swallowing function intervention for older adults conducted from 2010 to 2022, to establish a systematic approach for developing interventions to improve swallowing function in older adults and to provide evidence for this approach. Methods: Literature research was conducted for studies published between 2010 and 2022 that applied to swallow function interventions to adults aged 60 years or older. Databases including PubMed, Medline, RISS, Science On, KISS, and KCI were used. From a total of 1,164 articles searched using keywords, 20 articles were selected for final analysis. Results: The number of published articles steadily increased over time, and the intervention period was most commonly 6 or 8 weeks. The types of interventions included focused exercises to improve oral muscle strength in 12 articles and programs incorporating education, practice, and expert management in 8 articles. Among the focused exercises, tongue-strengthening exercises were most common in 4 articles. The evaluation variables for intervention effects were muscle strength evaluation, oral function evaluation, quality of life, and oral health and hygiene status. Muscle strength and oral function evaluations were statistically significant in focused exercise interventions, while the quality of life and oral health and hygiene status was significant in program interventions. Conclusion: This literature review is meaningful as a study that can be used to select the intervention period and program contents when planning an elderly swallowing intervention program.

• Nutrition Research and Practice
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• 제17권5호
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• pp.934-944
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• 2023

BACKGROUND/OBJECTIVES: Maintaining total muscle mass in the older adults with swallowing difficulty (dysphagia) is important for preserving swallowing function. Increasing protein intake can help sustain lean body mass in the older adults. The aim of this study was to evaluate the effect of various high-protein texture-modified foods (HPTMFs) on muscle mass and perform dietary assessment in ≥ 65-yrs-old patients with dysphagia. SUBJECTS/METHODS: Participants (n = 10) received the newly developed HPTMFs (average 595.23 ± 66.75 kcal/day of energy, 54.22 ± 6.32 g/day of protein) for 10 days. Relative handgrip strength (RHS), mid-upper arm circumference (MUAC), body composition, mini nutritional assessment (MNA), mini dietary assessment (MDA), and Euro Quality-of-Life questionnaire 5-dimensional classification (EQ-5D) were assessed. RESULTS: After 10 days, an increase in MUAC (26.36 ± 2.35 cm to 28.50 ± 3.17 cm, P = 0.013) and RHS (0.38 ± 0.24 kg/kg body weight to 0.42 ± 0.22 kg/kg body weight, P = 0.046) was observed. Although MNA, MDA, EQ-5D, subjective health status, muscle mass, and calf circumference showed a tendency to increase after intervention, no significant differences were found. CONCLUSIONS: These results suggest that the HPTMFs can be used for improving the nutritional and health status in patients with dysphagia.

• 한국식품과학회지
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• 제47권6호
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• pp.698-703
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• 2015

식물 소재 식품인 우엉을 코팅 및 비코팅 헤미셀룰라아제 효소액으로 침지한 후 시간에 따른 식품의 이화학적 특성 변화를 관찰한 결과, 색도에서는 모든 처리구에서 명도가 감소하는 경향을 나타냈지만, 적색도와 황색도는 감소하는 경향을 나타냈다. 또한 비코팅 효소와 코팅 효소 침지한 우엉 시료에서 공통적으로 본연의 색을 잃어가는 경향을 나타냈다. 경도는 시간에 따라 모든 처리구에서 감소하였고 증류수 침지 처리 시료에 비해 비코팅 효소와 코팅 효소 침지 처리한 시료의 경도 값이 유의적으로 낮았지만 코팅/비코팅 효소 처리한 시료간에는 유의적인 차이를 나타내지 않았다. 효소 활성은 우엉을 침지했던 함침액에 있는 생성물인 포도당의 함량 측정을 통해 진행한 결과 초반에는 비코팅 효소의 활성이 코팅 효소보다 높게 나타났지만 이후 시간의 경과에 따라 코팅 효소의 활성이 증가하며 비코팅 효소액 처리구의 활성보다 높은 함량을 나타냈다. 즉, 코팅막을 이용하여 효소를 포집하면 비코팅 효소에 비해 상대적으로 꾸준하게 효소의 활성을 유지 및 증가시킬 수 있으므로 식품의 연화 효과 및 효소의 활성을 장기간 적용할 수 있었다. 또한 리포좀 코팅은 수용성 및 지용성 성분의 포집이 가능하다. 즉, 본 실험을 통해 코팅된 가수분해효소의 고정화로 음식 재료의 연화 작용을 기대할 수 있으면서 효소 외에 다른 수용성 및 지용성의 영양 성분 및 기능성 성분 등을 함께 포집하여 비파괴 노인식 개발에 응용할 수 있으리라 사료된다.

• Journal of the Korean Association of Oral and Maxillofacial Surgeons
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• 제31권5호
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• pp.409-416
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• 2005

Purpose of study: The temporomandibular joint (TMJ) occupies a key functional role in mastication and contributes to normal deglutition, speech as well as cosmesis. When a large amount of mandible including the condyle head is resected, it is very difficult to reconstruct it as a functional unit. In this retrospective study, we present the functional, radiographic and cosmetic results of reconstructed temporomandibular joint using free fibular flap. Patients and Methods: Total 12 patients (M:F = 6:6) who underwent condylar reconstruction with the fibular flap were interviewed and examined by radiographs and Bio-PAK$^{(R)}$. Mean follow up periods was $47.7{\pm}20.0$ months and the average age was $38.7{\pm}15.3$ years. Remodeling of condyle and function of TMJ were evaluated and facial contour was judged subjectively. Results: All flaps were viable and no immediate postoperative complication had happened. One patient showed decreased mouth opening, so interpositional gap arthroplasty was performed. The resorption rates of reconstructed fibular were minimal and the condyle heads were changed into domeshaped neocondyle after 2 years. All patients had normal diet and no speech difficulty was reported. Nine patients were satisfied with their facial contour but three patients complained about the depression of cheek. Conclusion: The reconstruction of TMJ with free fibular flap was reliable methods and very effective means of restoring mandibular function. The functional and morphologic results were excellent and showed little complications.