Distraction Osteogenesis of Maxillary Anterior Segment in Cleft Lip and Palate Patients (구순구개열 환자에서 상악전방골 신장술)
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- Korean Journal of Cleft Lip And Palate
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- v.15 no.2
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- pp.89-96
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- 2012
Le Fort 1 osteotomy or maxillary advancement with distraction osteogenesis (DO) is main treatment strategy for cleft palate patients with maxillary hypoplasia. Maxillary DO allows greater maxillary advancement within physiological limit than Le Fort 1 osteotomy. Moreover, it is better for velopharyngeal function. However, there is a greater tendency for an increase in nasal sound when maxilla is advanced excessively. Therefore, the advancement of anterior maxillary segment using DO has been utilized. It offers advantages such as an increase in the length of the palate, a prevention of the change in palatopharyngeal depth, and a preservation of the velopharyngeal function. Moreover, it will obliterate the necessity of bone graft, and it prevents the occurrence of oronasal or oroantral fistula. Finally, it stimulates the regeneration of the soft and hard tissue of alveolus, and subsequently makes possible to place implant.
Background: Free fibular flap is one of the most useful methods in the hard tissue reconstruction of the maxillamandible. Free fibular flap presents some advantages in which the reconstruction of both soft and hard tissues can be done at the same time. It also provides a safe and successful bone graft for the reconstruction, along with a low rate of complications. Despite these advantages and the rarity of a postoperative complication, particularly in oral and maxillofacial surgery procedures, a prolonged operation might exhibit some complications related with rhabdomyolysis. We experienced the rare event of rhabdomyolysis after oral cancer surgery. Case presentation: In this article, we report the case of a patient who developed rhabdomyolysis after undergoing free fibular flap surgery. Conclusions: Despite the advantages of the free fibular flap operation, clinicians must be aware of the risk of complications because there are multiple factors that could result in rhabdomyolysis, such as duration of operation, position of the subject, and pre-existing conditions of diabetes and hypertension. Once the diagnosis of rhabdomyolysis is confirmed, a prompt treatment plan should be made and applied as soon as possible. This will increase the chance of a full recovery for the patient who is exhibiting symptoms of rhabdomyolysis.
Purpose: Following tooth extraction caused by severe periodontitis, alveolar ridge dimension lose their original volume. To reduce the alveolar ridge dimension, the ridge preservation technique has been introduced and tested in many clinical studies with membrane alone or membrane plus graft, achieving reduced ridge loss compared to extraction only. The aim of the present clinical study was to compare the post-extraction dimensional changes in the membrane exposure group to non-exposure group during healing period following ridge preservation technique. Methods: Ridge preservation was performed in 44 extraction sites. After extraction, deproteinized bovine bone mineral coated with synthetic oligopeptide (Ossgen-
The flap considered at first for the reconstruction of large maxillary defect, especially mid-face defect, is scapular free flap, because it provides ample composite tissue which can be designed 3-dimensionally for orbital, facial and oral reconstruction. In case of maxillary defect involving hard palate, however, this flap has some limitations. First, its bulk prevents oral function and physio-anatomic reconstruction of nasal and oral cavity. Second, mobility and thickness of cutaneous paddle covering the alveolar area reduce retention of tissue-supported denture and give rise to peri-implantitis when implant is installed. Third, lateral border of scapula that is to reconstruct maxillary arch and hold implants is straight, not U-shaped maxillary arch form. To overcome these problems, new concept of step prefabrication technique was provided to a 27-year-old male patient who had been suffering from a complete hard palate and maxillary alveolar ridge defect. In the first stage, scapular osteomuscular flap was elevated, tailored to fit the maxillary defect, particulated autologous bone was placed subperiosteally to simulate U-shaped alveolar process, and then wrapped up with split thickness skin graft(STSG, 0.3mm thickness). Two months later, thus prefabricated new flap was elevated and microtransferred to the palato-maxillary defect. After 6 months, 10 implant fixtures were installed along the reconstructed maxillary alveolus, with following final prosthetic rehabilitation. The procedure was very successful and patient is enjoying normal rigid diet and speech.
Purpose: Heterotopic calcification is the abnormal deposition of calcium salts in tissues other than bone and enamel, and it occurs in the form of dystrophic calcification or metastatic calcification. This deposition can occur under many conditions, but in some rare cases, it may develop in burns and nonhealed scars. It is difficult to treat the combination of heterotopic calcification and ulceration in scar tissues by using conservative therapy and to determine the margin of excision in such cases. Our study proposes the use of intraoperative C-arm-guided mapping of lesions with heterotopic calcification, and adequate excision of ulcers in chronic scars where heterotopic calcification is also observed. Methods: This study included 2 patients and was conducted from January 2010 to July 2010. The first patient was a 63-year-old woman who presented with atypical calcium deposits and chronic ulceration in the lower one-third region of the right leg. The second patient was a 38-year-old man who presented with a nonhealing ulcer that had developed on the right leg 3 months earlier he had a history of 40% scalding burns on the entire body. Surgery is the most reliable method for treating heterotopic calcification therefore, both patients were treated using intraoperative C-arm-guided marginal mapping of heterotopic calcification, followed by release of contracture, and eventually split-thickness skin grafting. Results: Plain radiographs of the leg showed spotty radiopaque areas in the hard part of the scar well superficial to the underlying bones. Histopathological analysis revealed multiple foci of calcified deposits, increased fibrosis, and inflammation in the scar tissue. Surgery-related complications were not observed. Conclusion: C-arm guided excision of calcified scars and the release of contracture can cure nonhealing ulcers and may therefore prevent recalcification.
Introduction: Microsurgical replantation of amputated digit have become common procedure in recent years. However replantation of fingertip amputation, Zone I by Yamano classification, is still difficult because digital arteries branch into small arteries and also digital veins are hard to separate from the immobile soft tissue. So, fingertip amputation was covered by volar V-Y flap, composite graft, cross finger flap and groin flap. But patients who have been treated by these methods experience shortening of digit, nail deformity, excessive tenderness and persistent pain. Replantation could solve most of these problems. Material & Methods: In our department, from March 2004 to August 2007, 36 digits in 32 patients with complete amputation at distal to nail base were replanted using a microsurgical technique. Results: The overall survival rate of the replanted finger was 75%. Venous anastomosis was possible in 8 cases and impossible in 28 cases. In latter cases external bleeding technique was applied with medical leech. Conclusion: After replantation, a few patient complained decreased sensibility, nail deformity and cold intolerance. But most of patients were satisfied with the functional and cosmetic appearance of the viable replanted digits. We believe the replantation should be the first choice in fingertip amputation.
The maxillary anteriors play an important role in esthetics. Therefore after extraction, it is crucial to preserve the hard tissue and soft tissue in order to promote esthetics of restoration. There are several challenges when restoring the maxillary anteriors via implant. Some of the challenges are be maintaining consistency with neighboring teeth in terms of shade, form, and texture : as well as having harmonious emergency with the gingival margin. In this case, a traumatized patient with crown-root fracture of the maxillary central and lateral incisors is presented. The cracked teeth were extracted, and implants were inserted with bone grafts to compensate the volume of damaged area of the maxillary anterior. Cantilever implant prosthetics were planned while precise adjustments to the gingival area were made using customized impression coping to perform the esthetic restorations. The final outcome of the treatment was satisfying in both esthetic and utilitarian perspective.
The hemifacial microsomia is characterized by variable underdevelopment of the craniofacial skeleton, external ear, and facial soft tissues. So, patients with hemifacial microsomia have an occlusal plane canting and malocclusion with facial asymmetry. Distraction osteogenesis (DO) with an intraoral or extraoral device is a technique using tension to generate new bone with gradual bone movement and remodeling. DO has especially been used to correct craniofacial deformities such as a hemifacial microsomia, facial asymmetry, and mandible defect that could not adequately be treated by conventional reconstruction with osteotomies. It has a significant advantage to lengthen soft and hard tissue of underdeveloped site without bone graft and a few complication such as nerve injury or muscle contracture. A 13-years old girl visited our clinic for the chief complaint of facial asymmetry. She had a left hypoplastic maxilla and mandible, occlusal plane canting and malocclusion. We diagnosed hemifacial microsomia and lanned DO to lengthen the affected side. Le Fort I osteotomy, left mandibular ramus and symphysis osteotomy were performed. The internal distraction devices fixed with screw on maxillary and mandibular ramus osteotomy sites. External devices were adapted to lower jaw for DO on symphysis osteotomy site and to upper jaw for rapid maxillary expansion (RME). At 7days after surgery, distraction was started at the rate of 1mm per day for 13days, and after 4months consolidation periods, distraction devices were removed. Simultaneous multiple maxillo-mandibular distraction osteogenesis with RME resulted in a satisfactory success in correcting facial asymmetry as well as occlusal plane canting for our hemifacial microsomia.
The wall shear stress in the vicinity of end-to end anastomoses under steady flow conditions was measured using a flush-mounted hot-film anemometer(FMHFA) probe. The experimental measurements were in good agreement with numerical results except in flow with low Reynolds numbers. The wall shear stress increased proximal to the anastomosis in flow from the Penrose tubing (simulating an artery) to the PTFE: graft. In flow from the PTFE graft to the Penrose tubing, low wall shear stress was observed distal to the anastomosis. Abnormal distributions of wall shear stress in the vicinity of the anastomosis, resulting from the compliance mismatch between the graft and the host artery, might be an important factor of ANFH formation and the graft failure. The present study suggests a correlation between regions of the low wall shear stress and the development of anastomotic neointimal fibrous hyperplasia(ANPH) in end-to-end anastomoses. 30523 T00401030523 ^x Air pressure decay(APD) rate and ultrafiltration rate(UFR) tests were performed on new and saline rinsed dialyzers as well as those roused in patients several times. C-DAK 4000 (Cordis Dow) and CF IS-11 (Baxter Travenol) reused dialyzers obtained from the dialysis clinic were used in the present study. The new dialyzers exhibited a relatively flat APD, whereas saline rinsed and reused dialyzers showed considerable amount of decay. C-DAH dialyzers had a larger APD(11.70
The wall shear stress in the vicinity of end-to end anastomoses under steady flow conditions was measured using a flush-mounted hot-film anemometer(FMHFA) probe. The experimental measurements were in good agreement with numerical results except in flow with low Reynolds numbers. The wall shear stress increased proximal to the anastomosis in flow from the Penrose tubing (simulating an artery) to the PTFE: graft. In flow from the PTFE graft to the Penrose tubing, low wall shear stress was observed distal to the anastomosis. Abnormal distributions of wall shear stress in the vicinity of the anastomosis, resulting from the compliance mismatch between the graft and the host artery, might be an important factor of ANFH formation and the graft failure. The present study suggests a correlation between regions of the low wall shear stress and the development of anastomotic neointimal fibrous hyperplasia(ANPH) in end-to-end anastomoses. 30523 T00401030523 ^x Air pressure decay(APD) rate and ultrafiltration rate(UFR) tests were performed on new and saline rinsed dialyzers as well as those roused in patients several times. C-DAK 4000 (Cordis Dow) and CF IS-11 (Baxter Travenol) reused dialyzers obtained from the dialysis clinic were used in the present study. The new dialyzers exhibited a relatively flat APD, whereas saline rinsed and reused dialyzers showed considerable amount of decay. C-DAH dialyzers had a larger APD(11.70