• 대한두개안면성형외과학회지
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• 제23권6호
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• pp.256-261
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• 2022

Background: Treating panfacial fractures (PFFs) can be extremely difficult even for experienced surgeons. Although several authors have attempted to systemize the surgical approach, performing surgery by applying a unidirectional sequence is much more difficult in practice. The purpose of this study was to review the literature on PFF surgery sequence and to understand how different surgical specialists-plastic reconstructive surgery (PRS) and oral maxillofacial surgery (OMS)-chose sequence and review PFFs fixation sequence in clinical cases. Methods: The PubMed and Google Scholar databases were scoured for publications published up until May 2020. Data extracted from the studies using standard templates included fracture part, fixation sequence, originating specialist, and the countries. Bibliographic details like author and year of publication were also extracted. Also, we reviewed the data for PFFs patients in the Trauma Registry System of Dankook University Hospital from 2011 to 2021. Results: In total, 240 articles were identified. This study comprised 22 studies after screening and full-text analysis. Sixteen studies (12 OMS specialists and 4 PRS specialists) used a "bottom-top" approach, whereas three studies (1 OMS specialist and 2 PRS specialists) used a "top-bottom" method. However, three studies (only OMS specialists) reported on both sequences. In our hospital, there were a total of 124 patients with PFF who were treated during 2011 to 2021; 64 (51.6%) were in upper-middle parts, 52 (41.9%) were in mid-lower parts, and eight (6.5%) were in three parts. Conclusion: Bottom-top sequencing was mainly used in OMS specialists, and top-bottom sequencing was used at a similar rate by two specialists in literature review. In our experience, however, it was hard to consistently implement unidirectional sequence suggested by a literature review. We realigned the reliable and stable buttresses first with tailoring individually for each patient, rather than proceeding in the unidirectional sequence like bottom-top or top-bottom.

• 동의생리병리학회지
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• 제26권1호
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• pp.128-132
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• 2012

In this paper, we performed a quantitative analysis of face color according to the health status of four constitution types. 205 Korean male in age from 65 to 80 were participated in this study and 85 subjects were finally selected for the analysis. Imaging process techniques were employed to extract feature variables associated with face color from a frontal facial image. Using the extracted feature variables, the correlations between face color and health status, face color and health status in each constitution type, and face color and four constitution types in heath status group were investigated. As the result, it was observed that the face color of healthy group contained more red component and less blue component than unhealthy group. For each constitution type, the face parts showing a significant difference according to health status were different. This is the first work which reports the correlation between the face color and health status of four constitution types with a objective method, and the numerical data for the face color according to the health status of four constitution types will be an objective standard to diagnose a patient's health status.

• Journal of the Korean Association of Oral and Maxillofacial Surgeons
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• 제44권1호
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• pp.18-24
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• 2018

Objectives: Foreign bodies (FBs) account for 3.8% of all pathologies of the head and neck region, and approximately one third of them are missed on initial examination. Thus, FBs represent diagnostic challenges to maxillofacial surgeons, rendering it necessary to employ an appropriate imaging modality in suspected cases. Materials and Methods: In this cross-sectional study, five different materials, including wood, metal, glass, tooth and stone, were prepared in three sizes (0.5, 1, and 2 mm) and placed in three locations (soft tissue, air-filled space and bone surface) within a sheep's head (one day after death) and scanned by panoramic radiography, cone-beam computed tomography (CBCT), and ultrasonography (US) devices. The images were reviewed, and accuracy of the detection modalities was recorded. The data were analyzed statistically using the Kruskal-Wallis, Mann-Whitney U-test, Friedman, Wilcoxon signed-rank and kappa tests (P<0.05). Results: CBCT was more accurate in detection of FBs than panoramic radiography and US (P<0.001). Metal was the most visible FB in all of modalities. US was the most accurate technique for detecting wooden materials, and CBCT was the best modality for detecting all other materials, regardless of size or location (P<0.05). The detection accuracy of US was greater in soft tissue, while both CBCT and panoramic radiography had minimal accuracy in detection of FBs in soft tissue. Conclusion: CBCT was the most accurate detection modality for all the sizes, locations and compositions of FBs, except for the wooden materials. Therefore, we recommend CBCT as the gold standard of imaging for detecting FBs in the maxillofacial region.

• Archives of Plastic Surgery
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• 제32권4호
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• pp.467-473
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• 2005

Calvarial bone grafting in craniomaxillofacial trauma and facial reconstructive surgery is now widely recognized and accepted as a standard procedure. One of the commonly reported problems of calvarial bone graft is the contour defect caused by partial resorption of the graft. But, there are few reports that discuss the fate of the calvarial bone graft based on the quantitative data. In this article, the changes of grafted calvarial bone were evaluated using 3-dimensional computed tomography(CT). 9 patients were observed with the CT scans at 2mm thickness immediately after operation and at the time of last follow-up. The area of the bone defect was segmented on the 3-dimensional CT image and calculated by AnalyzeDirect 5.0 software. The immediate postoperative bone defect area of the recipient site and the donor site were $612.9mm^2$ and $441.5mm^2$, respectively, which became $1028.1mm^2$ and $268.8mm^2$, respectively at the last follow-up. In conclusion, the bone defect area was less increased on the donor site of calvarial bone graft than on the recipient site. And the CT scan is a valuable imaging method to assess and follow-up the clinical outcome of calvarial bone grafting.

• 대한치과교정학회지
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• 제40권2호
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• pp.77-86
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• 2010

두부방사선 사진 채득 시 발생가능한 두부의 수직회전은 계측점 선정 및 계측치의 재현성에 영향을 줄 수 있으므로 진단자료의 객관화 및 중첩의 용이성을 위해 두부 회전을 최소화해야 한다. 본 연구에서는 연조직 계측점인 외안각(outer canthus)을 지표로 두부 자세를 기록하고 재현하는 방법의 신뢰도를 평가하고자 하였다. 정상 안모의 성인 남녀 21명에서 두부고정기에 부착한 Outer Canthus Indicator (OCI)를 이용하여 벽면응시를 통한 두부자세에서의 외안각의 위치를 계측하였다. 초진 시 두부자세에서 측모 광학 사진을 촬영하고 이틀 후 같은 계측치로 두부자세를 재현하여 얻은 두 장의 사진을 중첩하여 두부의 수직 회전과 외이도의 변위를 측정하였다. 두 명의 술자가 동일 과정을 반복했을 때 두부의 수직 회전은 각각 평균 $0.69\;{\pm}\;0.43^{\circ}$, $0.98\;{\pm}\;0.65^{\circ}$, 표준오차 0.09, 0.14로 나타났다. 외이도의 수평변위는 각각 평균 $0.90\;{\pm}\;0.72\;mm$, $0.72\;{\pm}\;0.55\;mm$, 표준오차 0.16, 0.12이고 외이도의 수직변위는 평균 $0.81\;{\pm}\;0.68\;mm$, $1.17\;{\pm}\;0.67\;mm$, 표준오차 0.15, 0.15이었다. 술자간 신뢰도를 평가하기 위한 paired t-test에서 변수들간 통계적으로 유의한 차이가 발견되지 않았다. Pearson 상관분석에서 외이도의 수평 변위와 수직 변위 사이에 통계적으로 유의성 있는 상관관계는 나타나지 않았다. 이상의 결과에 따라 OCI가 두부의 수직 회전에 의한 오차를 줄임으로써 규격화되고 상호 중첩 가능한 방사선 사진 및 광학 사진 자료를 채득하는 데 도움을 줄 것으로 사료된다.

• Journal of Korean Neurosurgical Society
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• 제59권6호
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• pp.564-569
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• 2016

Objective : This study used the intradural procedural time to assess the overall technical difficulty involved in surgically clipping an unruptured middle cerebral artery (MCA) aneurysm via a pterional or superciliary approach. The clinical and radiological variables affecting the intradural procedural time were investigated, and the intradural procedural time compared between a superciliary keyhole approach and a pterional approach. Methods : During a 5.5-year period, patients with a single MCA aneurysm were enrolled in this retrospective study. The selection criteria for a superciliary keyhole approach included : 1) maximum diameter of the unruptured MCA aneurysm <15 mm, 2) neck diameter of the MCA aneurysm <10 mm, and 3) aneurysm location involving the sphenoidal or horizontal segment of MCA (M1) segment and MCA bifurcation, excluding aneurysms distal to the MCA genu. Meanwhile, the control comparison group included patients with the same selection criteria as for a superciliary approach, yet who preferred a pterional approach to avoid a postoperative facial wound or due to preoperative skin trouble in the supraorbital area. To determine the variables affecting the intradural procedural time, a multiple regression analysis was performed using such data as the patient age and gender, maximum aneurysm diameter, aneurysm neck diameter, and length of the pre-aneurysm M1 segment. In addition, the intradural procedural times were compared between the superciliary and pterional patient groups, along with the other variables. Results : A total of 160 patients underwent a superciliary (n=124) or pterional (n=36) approach for an unruptured MCA aneurysm. In the multiple regression analysis, an increase in the diameter of the aneurysm neck (p<0.001) was identified as a statistically significant factor increasing the intradural procedural time. A Pearson correlation analysis also showed a positive correlation (r=0.340) between the neck diameter and the intradural procedural time. When comparing the superciliary and pterional groups, no statistically significant between-group difference was found in terms of the intradural procedural time reflecting the technical difficulty (mean${\pm}$standard deviation : $29.8{\pm}13.0min$ versus $27.7{\pm}9.6min$). Conclusion : A superciliary keyhole approach can be a useful alternative to a pterional approach for an unruptured MCA aneurysm with a maximum diameter <15 mm and neck diameter <10 mm, representing no more of a technical challenge. For both surgical approaches, the technical difficulty increases along with the neck diameter of the MCA aneurysm.

• Journal of the Korean Association of Oral and Maxillofacial Surgeons
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• 제44권3호
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• pp.112-119
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• 2018

Objectives: Temporomandibular joint ankylosis (TMJA) is a joint pathology caused by bony and/or fibrous adhesion of the joint apparatus, resulting in partial or total loss of function. Materials and Methods: This is a retrospective study conducted between 2012 and 2016 in the northwest region of Nigeria. The data retrieved includes gender, age, etiology of ankylosis, duration of ankylosis, laterality of ankylosis, type of imaging technique, type of airway management, types of incision, surgical procedure, mouth opening, interpositional materials used, and complications. Results were presented as simple frequencies and descriptive statistics. Results: Thirty-six patients with TMJA were evaluated during the study period. There were 21 males (58.3%) and 15 females (41.7%), yielding a male:female ratio of 1.4:1. The patients' age ranged from 5 to 33 years with $mean{\pm}standard$ deviation ($13.8{\pm}6.6years$). Thirty-five cases (97.2%) were determined to be true/bony ankylosis, while only 1 case (2.8%) was false/fibrous ankylosis. Most of the TMJA cases (16 cases, 44.4%) were secondary to a fall. In our series, the most commonly utilized incision was the Bramley-Al-Kayat (15 cases, 41.7%). The mostly commonly performed procedures were condylectomies and upper ramus ostectomies (12 cases each, 33.3%), while the most commonly used interpositional material was temporalis fascia (14 cases, 38.9%). The complications that developed included 4 cases (11.1%) of severe hemorrhage, 1 case (2.8%) of facial nerve palsy, and 1 case (2.8%) of re-ankylosis. Conclusion: Plain radiographs, with their shortcomings, still have significant roles in investigating TMJA. Aggressive postoperative physiotherapy for a minimum of 6 months is paramount for successful treatment.

• 대한치과교정학회지
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• 제27권2호
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• pp.209-219
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• 1997

본 연구는 골격성 III급 부정교합자에서 상하악절치의 치성보상 양상과 골격형태 사이의 상관관계를 규명하기 위해 시행되었다. 정상교합자 59명, 미약한 골격성 III급 부정교합자 91명 그리고 심한 골격성 III급 부정교합자 58명을 연구대상으로 선정하였으며 특히 미약한 골격성 III급 부정교합자는 전치부 반대교합의 유무에 따라 반대교합이 없는 군과 반대교합군으로 세분하여 연구하였다. 측모두부방사선규격사진을 15개의 골격 형태 계측항목과 16개의 상하악절치 경사도 및 위치 계측항목으로 분석한 뒤 통계 처리하여 다음과 같은 결과를 얻었다. 1. 각 군의 상하악 전치부 치성보상 양상을 보면 II-B군에 비해 II-A군과 III군의 상악 중절치는 순측경사 되어 있으며 II-A군이 III군 보다 크게 순측경사 되어 있었다. 하악절치는 II-A군과 II-B군에 비해 III군이 설측경사 되었으며 II-A군과 II-B군의 차이는 없었다. 2. II-A군과 II-B군 사이의 수직적인 골격형태 차이는 크지 않았고 하악절치 보다는 상악절치 위치 및 경사도에서 큰 차이를 보였다. 3. II- A군의 하악절치와 II-B군의 상악절치 계측항목이 골격형태와 상관성이 높았으며 특히 하악절치 계측항목중에서는 ∠IMPA, ∠FMIA, 상악절치 계측항목중에서는 ∠U1-FH, ∠U1-SN이 높은 상관성을 보였다. 4. 하악절치 계측항목중 ∠IMPA, ∠FMIA는 모든 군에서 골격형태와 높은 상관성을 보였다. 상악절치 계측항목중에서는 ∠U1-SN, ∠U1-FH, U1-facial plane(mm)이 다른 계측 항목에 비해 상관성이 높았다.

• 대한유전성대사질환학회지
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• 제17권3호
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• pp.85-91
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• 2017

뮤코지방증 2형과 3형은 GlcNAc-1-phosphotransferase 효소의 기능 이상으로 인해 발생하는 상염색체 열성 유전질환이다. GlcNAc-1-phosphotransferase 효소의 기능 이상은 리소좀 효소의 세포 내 이동에 관여하는mannose-6-phosphate와 리소좀 효소간의 결합을 저해하여 리소좀 효소들이 세포 안으로 들어오지 못하게 된다. 리소좀 효소의 부족으로 인해 리소좀 기능 이상 및 뮤코지질의 축적으로 인해 다양한 임상을 보이게 된다. 본 연구는 새롭게 진단된 뮤코지방증 환자의 임상 및 생화학, 분자유전학적 양상을 기술하고 본원에서 치료받은 11명의 뮤코지방증 2, 3형 환자들의 임상 양상을 비교하여 분석하였다. 본 저자들은 17개월에 특징적 얼굴 모양 및 관절 구축을 주소로 내원한 환자에서 효소 검사를 통해 리조솜 효소의 혈장 내 증가를 확인하였으며 GNPTAB 유전자의 직접염기 서열분석을 통해 복합이형접합자 돌연변이 (c.3428 dupA [pAsn1143Lysfs*3], c.673C>T [p.Gln225*])를 발견하였다. 새로 진단된 환자를 포함하여 총 11명의 환자(뮤코지방증 2형: 7명, 3형: 4명)들을 대상으로 임상 양상을 분석하였고 진단 시 나이는 뮤코지방증 2형은 2세 1개월, 3형은 6세 9개월이었으며 진단 시 신장 표준편차지수는 각각 -3.2 (${\pm}1.5$), -1.3 (${\pm}1.1$)였다. 심초음파 결과에서 뮤코지방증 3형 환자들은 심장 판막의 이상만을 보였으나 2형 환자들에서는 비후성 심근증(n=3), 좌심비대(n=1)이 동반되었다. 간비비대(n=4)는 뮤코지방증 2형 환자에서만 확인되었다. 뮤코지방증 2형의 경우, 3명의 환자가 호흡 곤란으로 기관 절개 및 호흡기 보조를 받았으며 2 명의 환자가 호흡기 문제로 사망하였다. Pamidronate 치료는 4명의 뮤코지방증 3형 환자와 4명의 2형 환자에서 시행하고 있으며 유효성 및 안정성에 대한 추가적인 평가가 필요하다.