• Archives of Plastic Surgery
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• 제38권1호
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• pp.35-42
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• 2011

Purpose: Blow-out fractures can be reduced using various methods. The orbital reconstruction technique using a balloon under endoscopic control has advantages over other methods. However, this method has some problems too, such as postoperative follow-up, management of the balloon catheter, and reduction of the posterior orbital floor. Thus, we developed a simple, effective method for orbital floor reduction that involves molding and shaping the antral balloon catheter. Methods: A 0, 30, or $70^{\circ}$, 4-mm endoscope was placed though a two-point, 5-mm maxillary antrostomy. The balloon catheter is placed directly at the orbital apex to reconstruct the anterior shelf (spherical shape), while it is turned in a U-shape towards the anterior maxilla for the posterior shelf (elliptical shape). Orbital floor defects, compound or comminuted fractures are reconstructed with alloplastic materials through an open lid incision under the endoscopic control. Results: This technique was applied to ten patients with orbital floor fractures: five anterior shelf and five posterior shelf fracture, respectively. Four of the patients had zygomatico-orbital fractures, while the rest had isolated orbital floor fractures. Two patients were given porous polyethylene implants Synpor$^{(R)}$) and three underwent reconstruction with a resorbable mesh plate. No complication associated with this technique was identified. Conclusion: The freestyle placement and selection of a urinary balloon catheter under endoscopic control and the preoperative estimation of the volume enhanced the stabilization of the orbital contour. This method improves the adaptation of the orbital floor without the risk of injuring the surrounding orbital contents, dissecting blindly, or using sharp traction. One drawback of this method is the patient's discomfort from the catheter during treatment.

• Journal of the Korean Association of Oral and Maxillofacial Surgeons
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• 제25권4호
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• pp.356-360
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• 1999

PURPOSE : This is to review the complicated jaw fractures that had been referred for revision of the unsatisfactory results, and to provide proper managements for the easily complicated jaw fractures. MATERIALS & METHODS : Twenty-nine patients who had been revised due to malunion or complicated fractures of facial bones for last 3 years were reviewed. The main problems required for revision, type of fractures complicated, the primary managements to be reclaimed, the specialties to be involved, the management to be reclaimed, time elapsed to seek reoperation, type of revision surgeries, residual complication were analysed with medical records, radiographs and final examinations. RESULTS: The major complaints were malocclusion(79.3%), facial disfigurement(41.3%), TMJ problems (13.7%), neurologic problems(10.3%), non-union(10.3%), and infection(6.8%). Unsatisfactory results were occurred most frequently after improper management of the multiple fractures of the mandible (62.2%), combined fractures of maxilla and mandible (20.6%), fracture of zygomatico-maxillary complex and midpalate (17.2%). The complications to be corrected were widened or collapsed dental arches (79.3%), improperly reduced condyles (41.3%), painful TMJ (34.4%), limited jaw excursion (31.0%), over-reduction of zygoma (13.7%), and nonunion with infection(13.7%). and dysesthesia (10.3%). The primary managements were nendereet by plastic surgeons in 82.7%(24/29) and by oral surgeons in 7.6%(2/29). Main causes of malunion are inadequate ORIF in 76%, unawareness & delay in 17%, and delayed due to systemic cares in 17%. 76% of 29 patients had been in state of intermaxillary fixation for over 4 weeks. Revision were done by means of "refracture and ORIF"in 48.2%(14/29), orthognathic osteotomies with bone grafts in 55.1%(16/29), and camouflage countering & alloplastic implantations in 37.9%(11/29), TMJ surgeries in 17.2%, micro-neurosurgeries in 11.6%. Residual complications were limited mouth opening in 24.1% (7/29), paresthesia in 13.7%, resorption of reduced condyle in 10.3%. CONCLUSIONS : Failure of initial treatment of jaw fractures is due to improper diagnosis and inadequate treatment with lack of sufficient knowledge of stomatognathic system. It is crucial to judge jaw fracture and patients accurately, moreover, the best way of treatments has to be selected. Consideration of these factors in treatment could minimize the complication of jaw fractures.

• 치과방사선
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• 제22권2호
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• pp.259-269
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• 1992

The author has examined the abnormalities in panoramic radiographs of 668 edentulous patients. The distribution, type, incidence, and location of all abnormalities were analized, and the distances between alveolar crest and anatomical structures were measures. (Maxillary measurements were performed between alveolar crest and lower margin of the maxillary sinus and mandibular measurements between alveolar crest and upper edge of the mental foramen.) The obtained results were as follows: 1. Of the 668 panoramic radiographs examined, 103(15.4%) showed one or more abnormalities. 2. The incidence of abnormalities was decreased by years, which was 22.0% in 1970's and 16.8% in 1980's and 12.1 % in 1990's. 3. The distribution of abnormalities as follows; 43 (40.2%) superficial root fragments, 24(22.4%) impacted teeth, 9(8.4%) imbedded root fragments, 7 (6.5%) cysts, 7(6.5%) fractures, 5(4.7%) foreign bodies, 5(4.7%) abnormal radiolucencies, 4(3.7%) abnormal radiopacities, 2(1.9%) bony defects, 1(0.9%) tumor. 4. In the location of abnormalities, 42 cases (35.3%) were in the maxillary posterior region, 26 cases(21.8%) were in the maxillary anterior region, 20 cases(24.4%) were in the mandibular posterior region and 18 cases(15.1%) were in the mandibular anterior region. 5. In the distance between alveolar crest and maxillary sinus, 109 cases(9.7%) were below 0.5㎜, 757 cases(67.6%) were between 0.5㎜ and 10㎜, 254 cases(22.7%) were above 10㎜. In the distance between alveolar crest and mental foramen, 73 cases (8.8%) were below 0.5㎜, 501 cases (60.7%) were between 0.5㎜ and l0㎜ and 252 cases(30.5%) were above 100㎜.

• Journal of the Korean Association of Oral and Maxillofacial Surgeons
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• 제41권6호
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• pp.306-316
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• 2015

Objectives: The facial bones are the most noticeable area in the human body, and facial injuries can cause significant functional, aesthetic, and psychological complications. Continuous study of the patterns of facial bone fractures and changes in trends is helpful in the prevention and treatment of maxillofacial fractures. The purpose of the current clinico-statistical study is to investigate the pattern of facial fractures over a 4-year period. Materials and Methods: A retrospective analysis of 1,824 fracture sites was carried out in 1,284 patients admitted to SMG-SNU Boramae Medical Center for facial bone fracture from January 2010 to December 2013. We evaluated the distributions of age/gender/season, fracture site, cause of injury, duration from injury to treatment, hospitalization period, and postoperative complications. Results: The ratio of men to women was 3.2:1. Most fractures occurred in individuals aged between teens to 40s and were most prevalent at the middle and end of the month. Fractures occurred in the nasal bone (65.0%), orbital wall (29.2%), maxillary wall (15.3%), zygomatic arch (13.2%), zygomaticomaxillary complex (9.8%), mandibular symphysis (6.5%), mandibular angle (5.9%), mandibular condyle (4.9%), and mandibular body (1.9%). The most common etiologies were fall (32.5%) and assault (26.0%). The average duration of injury to treatment was 6 days, and the average hospitalization period was 5 days. Eighteen postoperative complications were observed in 17 patients, mainly infection and malocclusion in the mandible. Conclusion: This study reflects the tendency for trauma in the Seoul metropolitan region because it analyzes all facial fracture patients who visited our hospital regardless of the specific department. Distinctively, in this study, midfacial fractures had a much higher incidence than mandible fractures.

• 대한소아치과학회지
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• 제43권1호
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• pp.60-69
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• 2016

영구 전치의 복합 치관-치근 파절은 심미적, 기능적 문제 뿐 아니라 심리적 문제도 발생시킨다. 그러므로 파절에 대한 치료는 매우 중요하며, 여러 분야에 걸친 종합적 치료가 요구된다. 본 증례는 두 환자에서의 외상으로 인한 상악 전치의 복합 치관-치근 파절에 대한 임상적 치료 과정을 서술하였다. 근관치료와 근첨형성술이 각 환자에게 시행되었으며, 파절선을 치은 상방으로 노출시키고 생물학적 폭경을 재확립하기 위해 교정적 정출을 시행하였다. 이후 유지기간을 두었고, 그 기간 동안 치아에 임시수복을 시행하였다. 최종적으로 CAD/CAM을 이용한 세라믹 크라운 수복을 시행하였다. 이후 정기 검진 때에도 해당 치아들은 만족스러운 기능적, 심미적 결과를 보였으며, 두 환자 모두에서 재발은 나타나지 않았다. 치주조직 또한 건강한 상태를 보였다.

• Archives of Plastic Surgery
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• 제40권4호
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• pp.330-334
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• 2013

Background Ultrasound-aided fixation is a recently developed alternative method of treatment of zygomatico-maxillary (ZM) fracture, and it can resolve the problems of excessive torsion force and subsequent fractures of screws. We conducted this study to evaluate the clinical usefulness of ultrasound-aided fixation as compared with the conventional fixation method using a drill and an expander in patients with ZM fracture. Methods We conducted a retrospective study in 35 patients with ZM fracture who had been treated at our hospital during a period ranging from March of 2008 to December of 2010. We divided them into two groups: an ultrasound-aided fixation group, comprising 13 patients who underwent ultrasound-aided fixation (SonicWeld Rx, KLS Martin), and a conventional group, comprising 22 patients who underwent conventional fixation (Biosorb FX, Linvatec Biomaterials Ltd.). We compared such variables as sex, direction, age at operation, follow-up period, operation duration, number of fixed holes, and time to discharge between the two groups. Results The ultrasound-aided fixation reduced the operation duration by about 30 minutes as compared with that of conventional fixation. There was no significant difference in follow-up period, number of fixed holes, or time to discharge between the two groups. Furthermore, there were no complications in either group. Conclusions The ultrasound-aided fixation of fractured ZM bone using an absorbable implant system is safe and effective in promptly reducing the bone fracture and providing satisfactory cosmetic outcomes over time.

• Archives of Plastic Surgery
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• 제40권5호
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• pp.546-552
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• 2013

Background The zygoma is a major portion of the midfacial contour. When deformity occurs in this area, a reduction should be conducted to correct it. If a sagittal fracture at the temporal root of the zygomatic arch occurs, this also requires reduction, but it is difficult to approach due to its anatomical location, and the possibility of fixation is also limited. Thus, the authors attempted the reduction of sagittal fracture by two- or three-point fixation and the Gillies approach without direct manipulation. The preoperative and postoperative results of the patients were evaluated. Follow-up was performed to establish a treatment guideline. Methods A retrospective study was done with 40 patients who had sagittal fractures at the temporal root of the zygomatic arch from March 2009 to June 2012. Only two- or three-point fixation was performed for the accompanying zygomatic-orbital-maxillary fracture. The Gillies approach was used for complex fractures of the zygomatic arch, while the temporal root of the zygomatic arch was only observed without reduction. Preoperative and postoperative computed tomography and X-ray scans were performed to examine the results. Results The result of the paired t-test on preoperative and postoperative bone gap differences, the depression level, and the degree of temporal protrusion showed a marked decrease in the mean difference at a 95% confidence interval. The results were acceptable. Conclusions In the treatment of sagittal fractures at the temporal root of the zygomatic arch, it is acceptable to use indirect reduction and non-fixation methods. This leads to a satisfactory aesthetic and functional outcome.

• 대한두개안면성형외과학회지
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• 제19권4호
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• pp.264-269
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• 2018

Background: Orbital resorbable mesh plates are adequate to use for isolated floor and medial wall fractures with an intact bony buttress, but are not recommended to use for large orbital wall fractures that need load bearing support. The author previously reported an orbital wall restoring surgery that restored the orbital floor to its prior position through the transnasal approach and maintained temporary extraorbital support with a balloon in the maxillary sinus. Extraorbital support could reduce the load applied on the orbital implants in orbital wall restoring surgery and the use of resorbable implants was considered appropriate for the author's orbital wall restoring technique. Methods: A retrospective review was conducted of 31 patients with pure unilateral orbital floor fractures between May 2014 and May 2018. The patients underwent transnasal restoration of the orbital floor through insertion of a resorbable mesh plate and maintenance of temporary balloon support. The surgical results were evaluated by the Hertel scale and a comparison of preoperative and postoperative orbital volume ratio (OVR) values. Results: The OVR decreased significantly, by an average of 6.01% (p<0.05) and the preoperative and postoperative Hertel scale measurements decreased by an average of 0.34 mm with statistical significance (p<0.05). No complications such as buckling or sagging of the implant occurred among the 31 patients. Conclusion: The use of resorbable mesh plate in orbital floor restoration surgery is an effective and safe technique that can reduce implant deformation or complications deriving from the residual permanent implant.

• Journal of the Korean Association of Oral and Maxillofacial Surgeons
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• 제49권6호
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• pp.332-338
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• 2023

Objectives: This study aimed to compare the effectiveness of a hybrid arch bar (hAB) with the conventional Erich arch bar (EAB) for the management of jaw fractures, focusing on their use for temporary fixation in patients undergoing open reduction and internal fixation (ORIF). Materials and Methods: Patients presenting with maxillary and mandibular fractures at our institution were included in this prospective, comparative study. Placement time and ease of occlusal reproducibility were recorded intraoperatively for Group A (hAB patients) and Group B (EAB patients). The primary outcome was comparison of the postoperative stability of the two arch bars. Postoperative measurements also included mucosal overgrowth, screw loosening or wire retightening, and replacement rates. The data were tabulated and computed with a P<0.05 considered statistically significant. Results: The study included 41 patients. A statistically significant difference was observed in postoperative stability scores (3) between Group A and Group B (85.0% vs 9.5%, P=0.001). The mean placement time in Group A (23.3 minutes) significantly differed from that in Group B (86.4 minutes) (P<0.001). The ease of intraoperative occlusion was not different between the two groups (P=0.413). Mucosal overgrowth was observed in 75.0% of patients (15 of 20) in Group A. Conclusion: The hAB was superior to EAB in clinical efficiency, maxillomandibular fixation time reduction, stability, versatility, and safety. Despite temporary mucosal overgrowth, the benefits of hAB outweigh the disadvantages. The choice between hAB and EAB should be based on specific clinical requirements.

• 구강회복응용과학지
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• 제35권3호
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• pp.153-159
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• 2019

목적: 구개측 굴곡파절이 있는 상악 구치의 교합면 마모 양상을 분석하여, 교합력과 굴곡파절의 연관성에 대해 연구해보고자 한다. 연구 재료 및 방법: 상악 구치에서 구개측 굴곡파절을 가지고 있는 148명의 환자, 총 308개의 치아를 대상으로 조사를 진행하였다. 구개측 굴곡파절을 가지고 있는 상악 소구치와 대구치의 교합면 마모를 분류 및 기록하였다. 치아별, 연령별, 성별에 따라 분류를 진행하였고, 그룹간의 통계적 유의성을 평가하기 위해 Chi-square test를 시행하였다(${\alpha}=0.05$). 결과: 상악 구치에서 구개측 굴곡파절은 제1대구치에서 가장 높은 빈도로 관찰되었고, 구개측 굴곡파절이 있는 모든 치아에서 하나 이상의 교합면 마모가 관찰되었다. 치아별, 연령별, 성별 모두에서 구개측 굴곡파절이 있는 치아의 교합면 마모는 교두 내사면과 중심와 및 변연융선에서 높은 빈도로 관찰되었으며 통계적으로 유의성이 있었다(P < 0.05). 결론: 구개측 굴곡파절은 상악 제1대구치에서 가장 많은 빈도로 관찰되었고, 구개측 굴곡파절이 관찰된 상악 구치 모두에서 교합면 마모가 관찰되었다. 그리고 교합면 마모는 교두 내사면과 중심와 및 변연융선에서 많은 빈도로 관찰되었다. 이와 같은 결과는 굴곡파절이 교합력과 연관이 있음을 보여준다.