• Maxillofacial Plastic and Reconstructive Surgery
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• 제38권
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• pp.25.1-25.4
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• 2016

Background: Bilateral sagittal split ramus osteotomy (BSSRO) is the most widely used mandibular surgical technique in orthognathic surgery and is easy to relocate the distal segments, accelerating bone repair by the large surface of bone contact. However, it can cause neurosensory dysfunction (NSD) or sensory loss by injury of the inferior alveolar nerve. The purpose of the present study was to evaluate NSD after BSSRO and modifiers at NSD recovery. Methods: In this study, NSD characteristics after BSSRO from 2009 to 2014 at the Kyung Hee University Dental Hospital were evaluated. The pattern of sensory recovery over time was also evaluated based on factors such as field of sensory dysfunction, surgical procedure, presence of pre-operative facial asymmetry, and postoperative medications. Results: Most of the patients had shown NSD immediately after orthognathic surgery. Among the 1192 sides of 596 patients, NSD was observed in 953 sides and 544 patients. Sexual predilection was shown in males (p value = 0.0062). In the asymmetric group of 132 patients, NSD was observed in 128 patients (96.97 %). In the symmetric group of 464 patients, NSD was observed in 416 patients (89.45 %); on the other hand, NSD was observed significantly higher in the asymmetric group (p = 0.025). NSD-associated factors were analyzed, and vitamin B12 may be beneficial for NSD recovery. Conclusions: There was a difference between the symmetric group and the asymmetric group in NSD recovery. Vitamin B12 can be regarded as an effective method to nerve recovery. However, a further prospective study is needed.

• Journal of the Korean Association of Oral and Maxillofacial Surgeons
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• 제32권2호
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• pp.138-141
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• 2006

Introduction : In recent years, vascularized, i.e., living bone grafts, have been widely applied in the field of oral and maxillofacial surgery, as a method of treatment of congenital or acquired non-unions, and a large defects in mandible. The vascularized fibular graft has been especially used for this purpose because of its shape and mechanical strength. The postoperative hypertrophy of grafted fibula is of particular interest to us. Material and methods : This study was undertaken to determine the volume change(indirect methods) and radiographic appearance of a free vascularized fibular graft as it responds to the mechanical and physiologic features of its new environment. In order to elucidate the long term effect on fibular mass after mandibular reconstruction, change in various method of volume change was utilized as indirect measure of change in long-term. Results : The younger the patient, the more prominent and rapid the hypertrophy of the graft. the hypertrophy of the graft never exceeded the diameter of the recipient bone, except for callus enlargement after stress fracture of the grafted bone. Conclusion : Etiologic explanations for this phenomenon have not been clarified in the previeous literature. some of the factors implicated include a periosteal reaction or new bone formation, as seen at the onset of bone union after a fracture in a child, a reaction to the mechanical loading on the graft and a reaction to the circulatory changes resulting from the grafting procedure.

• Maxillofacial Plastic and Reconstructive Surgery
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• 제34권6호
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• pp.473-479
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• 2012

Warthintumor (WT), also known as adenolymphoma or papillary cystadenoma lymphomatosum, was described in 1895 for the first time. It is a common benign tumor of the parotid glands and the second most common neoplasm of the salivary gland, accounting for 5% to 14% of all parotid neoplasm. A 63-year-old man visited our clinic with the complaint of swelling on the right parotid gland. Physical examination showed a 3 cm, firm, well-circumscribed, painless mass on the right mandibular angle. Computed tomography imaging showed a $3.5{\times}2.0{\times}1.6$ cm well-defined cystic mass. WT is histologically characterized by bilayered, oncocystic cell, lymphoid stroma, and cystic space. With these typical cytomorphologic characteristics, the fine-needle aspiration cytology was performed as diagnostic tool before the surgery. The lymphocytes and oncocystic cell were not observed. The lesion was completely excised under general anesthesia. We diagnosed the case as WT, from the surgically excised specimen. We report on the case with a review of the literatures.

• Maxillofacial Plastic and Reconstructive Surgery
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• 제31권5호
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• pp.401-407
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• 2009

Purpose : This study was designed to evaluate the clinical aspect of cysts which arised in the oral and maxillofacial region. Patients and Methods : We reviewed clinical record, radiograph, histopathologic and operative report of 155 patients who had been diagnosed as cysts and treated at the department of oral and maxillofacial surgery in Chonnam National University Hospital from January 2003 to December 2008. Gender, age, classifiaction, anatomic distribution, clinical sign and symptoms, treatment, complications and recurrence rate were studied. Results : 1. Among 155 patients, the male patients(64.5%) were more than the female(35.5%). 2. The average age ofthe patients was 37.2 years(ranging from 5 to 79 years). 3. In pathologic classification, radicular cyst and dentigerous cyst were most common cysts, irrespective of 73 cases(48.3%) and 35 cases(23.2%). 4. The frequently involved cystic regions were followed as mandibular molars(38.1%), and maxillary incisors(30.2%). 5. The frequent sequence of clinical symptoms was edema(29.9%), no symptom(18.9%), tenderness(13.9%), pain(11.5%) and abscess(9.4%). 6. The most prevalent treatment was the combination operation, such as cyst enucleation with extraction or endodontic treatment of the causative tooth(76.8%) 7. Among 155 cases, 2 cases that were treated using enucleation method were recurred(1.3%).

• 구강회복응용과학지
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• 제26권3호
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• pp.359-371
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• 2010

안면 비대칭 중 가장 흔히 나타나는 하악 비대칭은 성장 중 골격성장의 비대칭을 유발하는 다양한 원인에 의해 발생한다. 안면 비대칭이 있을 경우 외모 뿐 아니라 저작과 기능에 지장을 줄 수 있다. 심한 골격성 악간관계 부조화가 있는 경우 보철치료만으로는 이상적인 교합관계를 형성하기 어려우며, 힘의 분산이 적절히 이루어지지 않아 자연치와 수복물의 수명이 단축될 수 있다. 악간관계 부조화로 인한 부정교합이 존재하여 치아의 수복 시 예후가 불량할 것으로 예상되는 경우 먼저 교정치료를 통한 악간관계의 개선을 위한 교합안정이 우선되어야 한다. 부조화가 심한 경우 기능적 및 심미적인 치료 결과를 위해 악교정 수술이 필요하며, 진단결과에 따라 편악 또는 양악수술이 시행된다. 상 하악 또는 안면 비대칭증의 악교정 수술시 이부 성형술이 동반될 수 있으며, 이는 하악골의 이부의 수직적, 횡적, 전후방적 위치를 외과적으로 변화시킴으로써 더욱 심미적인 안모개선을 얻기 위해 시행된다. 본 증례의 환자는 안모의 비대칭과 돌출된 하악 및 불량 보철물을 개선하고자 술전 교정을 시행한 뒤 상악 Le-Fort I 골절단술, 하악 시상분할골절단술, 이부 성형술(전방 4 mm), 우측 하악각 증대술을 시행하였다. 술후 교정치료를 진행하고 치관연장술 및 완전구강회복을 진행하였다. 보철 수복 완료 후, 환자의 평가와 객관적 결과로 만족할만한 결과를 얻었기에 이를 보고하고자 한다.

• Maxillofacial Plastic and Reconstructive Surgery
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• 제28권5호
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• pp.404-416
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• 2006

Purpose : This study was to clarify the changes in mandibular condyle after unilateral mandibular distraction osteogenesis throughout histological changes and expression of matrix metalloproteinase-2 (MMP-2) and tissue inhibitor of matrix metalloproteinase-2 (TIMP-2). Materials & Methods : Intraoral distractors were placed via submandibular incision in 8 dogs. Two unoperated animals served as controls. Distraction was performed five days after osteotomy as a rate of 0.5 mm twice per day for 10 days. Two animals were sacrificed on 7, 14, 28, and 56 days after completion of distraction, respectively. Ipsilateral condyles were harvested and processed for histological and immunohistochemical examinations. Results : The condyle cartilage is separated into four layers: fibrous layer, proliferative layer, hypertrophic layer, and calcified layer. At 7 days and 14 days after distraction, the condylar cartilage showed the decreased thickness of the articular cartilage and reduced cellularity. At 28 days after distraction, there was an increase in cellularity of fibrous, proliferative, and hypertrophic layer. However, it demonstrated reduced cellularity compared to the control. At 56 days of after distraction, the articular cartilage was an almost normal histologic structure. Positive Safranin-O staining, indicative of sulfated proteoglycans, was examined in the condylar cartilge of nonloaded control. At 7 days and 14 days after distraction, the sulfated proteoglycans is almost completely depleted from the noncalcified part of the condylar cartilage. At 28 days after distraction, there was an increase in Safranin-O staining intensity. However, the staining intensity of the experimental condyle was weaker than that of the control. At 56 days of after distraction, the condylar cartilage showed almost normal Safranin-O staining pattern. In control condyle, MMP-2 immunostaining was seen in fibrous, proliferative, and hypertrophic layer of condylar cartilage, however, it demonstrated lack of staining in fibrous and proliferative layer. At 7 days and 14 days after distraction, strong MMP-2 immunoreactivity was seen in the fibrous, proliferative and hypertrophic layer of the condylar cartilage. At 28 days after distraction, MMP-2 immunostaining was seen in the fibrous and hypertrophic layer of condylar cartilage, however, their immunoactivity was reduced. At 56 days after distraction, MMP-2 immunoreactivity showed almost normal immunostaining pattern. In control condyle, TIMP-2 immunostaining was primarily seen in fibrous and hypertrophic layer of condylar cartilage, however, it demonstrated lack of staining in proliferative layer. At 7 days after distraction, very weak TIMP-2 immunoreactivity appeared in fibrous, proliferative and hypertrophic layer of the condylar cartilage. At 14 days after distraction, weak TIMP-2 immunoreactivity was seen in the fibrous, proliferative and hypertrophic layer of the condylar cartilage. At 28 days after distraction, TIMP-2 immunoreactivity was increased in the fibrous and hypertrophic layer of condylar cartilage. At 56 days after completion of distraction, TIMP-2 immunoreactivity showed almost normal immunostaining pattern. Conclusions : The results show that short-term outcome of physiologic distraction osteogenesis may lead to degenerative changes in the condylar cartilage. These alterations in the condylar cartilage may be considered as a pressure-related degeneration of the cartilage tissue. However, the long-term results suggest that the condylar cartilage display repair activity after mandibular distraction osteogenesis.

• Maxillofacial Plastic and Reconstructive Surgery
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• 제31권3호
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• pp.207-215
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• 2009

Purpose: The aim of the present study is to evaluate the long term bone healing after horizontal ridge augmentation using auto block bone graft for implant installation timing. Materials and Methods: Five Beagle dogs(which were 14 months old and weighted approximately 10kg). In surgery 1(extraction & bone defect), premolars(P2, P3,P4) were extracted and the buccal bone plate was removed to create a horizontally defected ridge. After three months healing, in surgery 2(ridge augmentation). Auto block bone grafts from the mandibular ramus were used in filling the bone defects were fixed with stabilizing screws. The following fluorochrome labels were given intravenously to the beagle dogs: oxytetracycline 1week after the surgery, alizarin red 4 weeks after the surgery, calcein blue 8 weeks after the surgery. The tissue samples were obtained from the sacrificed dogs of 1, 4, 8, 12, 16 weeks after the surgery. Non-decalcified sections were prepared by resin embedding and microsection to find thickness of $10{\mu}m$ for the histologic examination and analysis. Results: 1. We could achieve the successful reconstruction of the horizontal bone defect by auto block bone graft. The grafted bone block remained stable morohologically after 16 weeks of the surgery. 2. In the histologic view. We observed osteoid tissue from the sample $4^{th}$ week sample and active capillary reconstruction in the grafted bone from the $12^{th}$ week sample. Healing procedures of auto bone grafts were compared to that of the host bone. 3. Bone mineralization could be detected from the $8^{th}$ week sample. 4. Fluorochrome labeling showed active bony changes and formation at the interface of the host bone and the block graft mainly. Bony activation in the grafted bone could be seen from the $4^{th}$ week samples. Conclusions: Active bone formation and remodeling between the grafted bone and host bone can be seen through the revascularization. After the perfect adhesion to host bone, Timing of successful implant installation can be detected through the ideal ridge formation by horizontal ridge augmentation.

• 대한치과교정학회지
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• 제38권2호
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• pp.121-132
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• 2008

양악 수술 시 상악골의 상방이동을 시행하였을 경우에 상기도의 공간적 구조변화를 평가하기 위하여, 술전, 술후, 술후 6개월 후의 간격으로 두부규격방사선사진을 촬영하여 그 변화량을 분석해 보았다. 술전 교정치료를 시행하여 상악은 Le Fort I 골절단술로 상방이동 시행하였고 동시에 하악은 후방이동 시키는 수술을 시행 받은 24명을 대상으로 하였다 (평균 연령22세 1개월, 남자 9명 여자 15명). 상악골 상방이동에 대한 상기도 공간의 변화와 그에 따른 관련성을 조사한 결과, PAS (R)부위는 술후 (T1) 감소하였으나 (p<0.01) 술후 6개월 후(T2)에는 다시 증가하여 술전과 비교 시, 크기 변화를 관찰할 수 없었고, PAS (NL) 부위는 술후(T1)와 술후 6개월 후(T2)에서 유의성 있는 크기 증가를 보였다. PAS (OL)의 경우, 술후 (T1)증가를 보이다가 술후 6개월 이후(T2)에서 감소하였다. 연구개의 두께는 술후 (T1) 증가를 보이다가 6개월 이후 (T2) 처음과 같거나 약간 감소하는 것으로 나타났으며 FH-uvular 각도는 술후 6개월 이후 증가하였다. 또한 상악골 상방이동에 대한 상기도 공간의 변화를 회귀분석 시행한 결과 양악수술 시 평균 $4.40{\pm}1.14mm$의 상악골 상방이동은 양악 수술 후 상기도 공간의 변화에 큰 영향을 미치지 않는 것으로 나타났다.

• Imaging Science in Dentistry
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• 제50권3호
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• pp.199-208
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• 2020

Purpose: This study was performed to introduce an in vivo hybrid multimodality technique involving the coregistration of micro-computed tomography (micro-CT) and high-resolution magnetic resonance imaging (HR-MRI) to concomitantly visualize and quantify mineralization and vascularization at follow-up in a rat model. Materials and Methods: Three adult female rats were randomly assigned as test subjects, with 1 rat serving as a control subject. For 20 weeks, the test rats received a weekly intravenous injection of 30 ㎍/kg zoledronic acid, and the control rat was administered a similar dose of normal saline. Bilateral extraction of the lower first and second molars was performed after 10 weeks. All rats were scanned once every 4 weeks with both micro-CT and HR-MRI. Micro-CT and HR-MRI images were registered and fused in the same 3-dimensional region to quantify blood flow velocity and trabecular bone thickness at T0 (baseline), T4 (4 weeks), T8 (8 weeks), T12 (12 weeks), T16 (16 weeks), and T20 (20 weeks). Histological assessment was the gold standard with which the findings were compared. Results: The histomorphometric images at T20 aligned with the HR-MRI findings, with both test and control rats demonstrating reduced trabecular bone vasculature and blood vessel density. The micro-CT findings were also consistent with the histomorphometric changes, which revealed that the test rats had thicker trabecular bone and smaller marrow spaces than the control rat. Conclusion: The combination of micro-CT and HR-MRI may be considered a powerful non-invasive novel technique for the longitudinal quantification of localized mineralization and vascularization.

• Journal of the Korean Association of Oral and Maxillofacial Surgeons
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• 제29권1호
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• pp.56-59
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• 2003

구강악안면 영역에서의 외상에 의한 내악 동맥의 가성 동맥류는 극히 드문 병변으로 저자들은 서울 대학교 치과병원 구강악안면외과에서 1례를 치험하였다. 그 원인은 외상에 의한 하악 과두 골절, 관혈적 정복술시의 의원적 외상 또는 둘 다를 고려해 볼 수 있었으며 임상적으로 박동성 잡음,촉진 가능한 맥동이 있었고 술중 과다 출혈의 양상을 보였다. 병소는 혈관 조영술에 의해 확진되었으며, 색전술로 치료하였다. 가성 동맥류는 생명을 위협할 정도의 과다 출혈을 일으킬 수 있으므로 그 진단과 치료는 중요하다. 혈관 조영술은 임상적 증상에 대한 확실한 진단을 가능케 해 주며 이를 이용한 색전술은 관혈적 결찰법에 비해 장점을 가지므로 좋은 치료법이 될 수 있다.