• Title/Summary/Keyword: Midline

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Determination of Adequate Entry Angle of Lumbar Sympathetic Ganglion Block in Korean

  • Kim, Won-Ho;Kim, Sang-Kwon;Lee, Chul-Joong;Kim, Tae-Hyeong;Sim, Woo-Seok
    • The Korean Journal of Pain
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    • v.23 no.1
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    • pp.11-17
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    • 2010
  • Background: The target of lumbar sympathetic ganglion block is the anterolateral surface of the L2, 3 and 4 vertebral bodies, where the lumbar sympathetic ganglion usually lies. In most cases, a block-needle is inserted approximately 5-8 cm lateral to spinous process on the skin and directed to the anterolateral surface of vertebral body obliquely. The purpose of this study is to determine the safe entry angle and entry point in Korean by using the abdominal CT scan images. Methods: The abdominal CT images of eighty five patients were recruited to this study. The minimal angle aimed at the lumbar sympathetic ganglion that can pass through the lateral aspect of body and maximal angle that avoids puncturing the kidney, ureter or retroperitoneal space were measured. The distance from midline to skin entry point was also measured. Results: There was no significant difference in entry angle among L2, 3, and 4 level. The entry angle was similar in the right and left side, and in males and females. The entry angle of old age group was significantly smaller than that of young age group. The calculated safe entry angle was $30.5{\pm}0.4^{\circ}$ and entry point was $7.7{\pm}0.2\;cm$ and $6.7{\pm}0.1\;cm$ lateral from midline in males and females respectively. Conclusions: These measurements can be used as a reference for lumbar sympathetic ganglion block and radiofrequency lesioning. Prior to performing the lumbar sympathetic ganglion block for cancer patients, the abdominal CT scan should be reviewed to prevent complications.

DIASTEMA CLOSURE TREATMENT DECISION FOR AN ADOLESCENT PATIENT WITH CEREBRAL PALSY (뇌성마비인 청소년의 치간이개 치료법 결정 : 증례보고)

  • Lee, Koeun;Lee, Jae-Ho;Kang, Chung-Min
    • The Journal of Korea Assosiation for Disability and Oral Health
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    • v.11 no.1
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    • pp.1-4
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    • 2015
  • Diastema is thought to be a problem related to aesthetics, pronunciation, or malocclusion. Due to its extent and patient conditions, orthodontic treatment, prosthodontic treatment, and conservative direct resin restoration are the treatment options for diastema closure. Additional factors need to be considered when deciding on the most appropriate treatment of diastema, particularly for patients with cerebral palsy. A 13-year-old girl visited the Department of Pediatric Dentistry at Yonsei University Dental Hospital with a chief complaint of the large gap between her upper front teeth. After clinical and radiographic examinations, midline diastema of 4.5 mm, protrusive maxilla incisors, congenital missing teeth, retained primary teeth, etc. were identified. Prosthodontic treatment with intentional root canal treatment was not appropriate because of the patient's age. Dental spaces can be closed effectively via orthodontic appliances. However, additional prosthodontic and restorative intervention is unavoidable, which incurs significant costs and requires more time. Instead of orthodontic and prosthodontic treatment, direct resin restoration can address the chief complaint; these restorations are reversible, less harmful to other oral structure and teeth, relatively easy to apply, less expensive than other treatments, and require shorter office visits. Midline diastema can be treated in several ways. For diastema closure in patients with cerebral palsy, conservative resin restorations are a short, simple, and appropriate treatment compared with orthodontic or prosthodontic treatments.

Reconstruction of Disharmonious Upper Anterior Dentition by Implant Supported Fixed Prosthesis (임플란트 지지 고정성 보철물로 상악 전치부를 수복한 증례)

  • Oh, Sang-Chun;Chee, Young-Deok
    • Journal of Dental Rehabilitation and Applied Science
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    • v.24 no.2
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    • pp.183-192
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    • 2008
  • Modern dental reconstructions do not only aim at restoring the patient's mastication, but rather at improving general well-being and quality of life, especially in terms of esthetics. The media, the internet, advertising, and many other facts of society contribute to an increased cosmetic awareness. A 35-year-old male patient presented with as follows: 1) the porcelain fracture of ceramo-metal restoration on #11 and #23, 2) the inclination of incisal plane to horizontal reference plane, 3) the dental midline deviation to facial midline, and 4) the lack of symmetry on upper anterior dentition. The patient requested an aesthetic improvement using fixed prosthodontics including implant-supported restorations. In the upper anterior region, one of the goals of the conventional as well as implant prosthesis is to achieve restorations with the dental attractiveness and beauty in the respect of dental, dentofacial, and facial compositions. This case report presents geometrically improvement of dental esthetics using conventional and implant prosthesis with soft and hard tissue augmentation.

A Case of Nasofrontal Dermoid Cyst Via Transcollumelar Approach (경비주 접근법으로 안면부 손상없이 제거한 비전두 유피낭종 1예)

  • Lee, Kang Hyun;Lee, Sung Min;Kim, Sang Wook;Park, Ki Joon;Kim, Dong-Kyu
    • Korean Journal of Head & Neck Oncology
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    • v.36 no.1
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    • pp.27-31
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    • 2020
  • The midline nasal dermoid cysts are rare congenital neoplasms, which are diagnosed frequently in childhood. Masses are often noticeable at birth gaining size over time with recurrent infections and usually arise from the nasal cavity or lower 1/3 of the nasal dorsum. CT scan as the primary investigation is helpful to determine accurately the size and extent of the lesion as well as the integrity of adjacent bony structures. MRI scan is recommended to rule out an intracranial extension or sinus tracts. Treatment of choice is the complete surgical excision preserving the cyst wall. Here in, we present an unusual case of nasofrontal dermoid cyst in a 19-year-old boy without radiographic evidence of transcranial extension. In this case, we surgically removed nasofrontal dermoid cyst via transcolumellar approach. We also corrected saddle nose deformity after mass removal. Therefore, in this case, we experienced a successful case in which the nasofrontal dermoid cyst was totally removed without facial scar and deformity.

Risk Factors Affecting Recurrence of Thyroglossal Duct Cyst in Children (소아에서 발생한 갑상설관낭종의 재발에 영향을 미치는 위험인자)

  • Jung, Hee-Kyung;Park, Jin-Young
    • Advances in pediatric surgery
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    • v.17 no.1
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    • pp.35-44
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    • 2011
  • Thyroglossal duct cysts (TGDC) are the most common type of congenital developmental anomaly encountered in the anterior midline of the neck in childhood. The aim of the study was to evaluate the clinical characteristics of TGDC and identify any factors that could be related to recurrence after surgery. This study consisted of a retrospective chart review of 45 patients treated at Kyungpook National University Hospital for TGDC between 1990 and 2008. All records were reviewed for age and sex, length of history, presentation, diagnostic methods, sizes and locations of cyst, surgical management, histopathology of the lesion and recurrences. The statistical analysis of risk factors for recurrence was made using the Fisher's exact test with a significance level of p (0.05. The male to female ratio was 2.2:1 with a male preponderance. The mean age at operation was 5 years and 2 months (4 months - 17 years). The most common presenting symptom was a nontender cervical mass (78 %). Most TGDC were found in the midline position. Twenty four were infrahyold, 17 were hyoid, and 4 were suprahyoid level. Forty one (91 %) patients received the Sistrunk operation, and 4(9 %) patients received Cyst excision. Postoperative a seroma developed in six patients in the early postoperative days. There were a total of 3(6.6 %) recurrences, 2 in patients who had excision only and in one patient who had the Sistrunk operation. Univariate analysis for risk factors with recurrence showed that there was no statistical relationship between the presence of preoperative infection and the development of recurrence. The removal of hyoid bone along with TGDC was a statistically significant risk factor for recurrent disease. This study suggests that the Sistrunk operation Is the treatment of choice for TGDC in order to reduce recurrence.

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Location of Back-shu Points of the Bladder Meridian in the Lumbar Region through Patient Measurement

  • Sim, Ho-Yun;Park, Sang Kyun;Lee, Kwang Ho
    • Journal of Acupuncture Research
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    • v.35 no.1
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    • pp.37-40
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    • 2018
  • Background: The purpose of this study was to compare the first branch of the bladder meridian (FBBM) as determined by the proportional bone measurement method (PBMM), to the line formed by the erector spinae muscle group, and to establish an academic basis for selection of acupuncture points and needling. Methods: Sixty participants were divided into 3 groups based on body mass index (BMI) and into 2 groups based on waist/height ratios. The distance from the midline of the spine to the first branch of the bladder meridian with PBMM (DFBBM), and the distance from the midline of the spine to the most elevated fleshy region of the erector spinae (DMEFR), at the same level as the inferior border of the spinous processes of L1-L5, were measured. The DFBBM and the 5 DMEFRs were then analyzed according to BMI and the waist/height ratio. Results: DFBBM was statistically different from DMEFR in all back-shu points in the lumbar region. DFBBM was not significantly different from DMEFR in the groups with a high BMI or waist/height ratio. However, there was a statistical difference in the groups with a low or moderate BMI or low waist/height ratio. Conclusion: Since the location of the most elevated fleshy region of the erector spinae does not coincide with the location of the FBBM, the selection of back-shu points in the lumbar region must be performed precisely by PBMM.

A CLINICAL STUDY ON THE CHANGE OF TMJ SYMPTOMS FOLLOWING IVRO IN THE MANDIBULAR PROGNATHISM (IVRO를 이용한 하악골 전돌증 환자의 수술전후 악관절 증상 변화에 대한 임상적 평가)

  • Kim, Jin-Kwon;Park, Kwang-Ho;Kim, Hyung-Gon;Kim, Sang-Soo;Kim, Ki-Young;Huh, Jong-Ki
    • Maxillofacial Plastic and Reconstructive Surgery
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    • v.19 no.1
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    • pp.1-13
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    • 1997
  • Preoperative and postoperative TMJ symptoms were observed in mandibular prognathism of 30 patients operated on by Le Fort I osteotomy and intraoral vertical ramus osteotomy. The alterations of TMJ symptoms were investigated and the relationship between changes of TMJ symptoms and some cephalometric values including occlusal plane angle, mandibular plane angle, posteior ramal height and a degree of deviation of mandibular incisor midline to facial midline were observed. The results are as follows. The incidence of patient with TMJ symptoms before orthognathic surgery was 40% and after orthognathic surgery was 20%. The most frequetly encountered symptoms in orthognathic TMJ dysfunction patients were TMJ pain and/or clicking. After surgery 66% of the preoperative symptomatic patients reported improvement TMJ symptoms. On the orther hand 2 patient (6%) of the preoperative asymptomatic patients developed TMJ symptoms after surgery. Preoperatively, 60% of the facial asymmetric patients with mandibular prognathism had TMJ symptomas. The more severe facial asymmetry was, the higher incidence of TMJ symptoms was. The alteration of occlusal plane angle and mandibular plane angle seems to be one of the contributing factors which make to change TMJ symptoms in orthognathic patients. But its amount seems to be low significance. Increase or decrease of posterior ramal height have influence on the change of TMJ symptoms.

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Minimally Invasive Multi-Level Posterior Lumbar Interbody Fusion Using a Percutaneously Inserted Spinal Fixation System : Technical Tips, Surgical Outcomes

  • Kim, Hyeun-Sung;Park, Keun-Ho;Ju, Chag-Il;Kim, Seok-Won;Lee, Seung-Myung;Shin, Ho
    • Journal of Korean Neurosurgical Society
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    • v.50 no.5
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    • pp.441-445
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    • 2011
  • Objective : There are technical limitations of multi-level posterior pedicle screw fixation performed by the percutaneous technique. The purpose of this study was to describe the surgical technique and outcome of minimally invasive multi-level posterior lumbar interbody fusion (PLIF) and to determine its efficacy. Methods : Forty-two patients who underwent mini-open PLIF using the percutaneous screw fixation system were studied. The mean age of the patients was 59.1 (range, 23 to 78 years). Two levels were involved in 32 cases and three levels in 10 cases. The clinical outcome was assessed using the visual analog scale (VAS) and Low Back Outcome Score (LBOS). Achievement of radiological fusion, intra-operative blood loss, the midline surgical scar and procedure related complications were also analyzed. Results : The mean follow-up period was 25.3 months. The mean LBOS prior to surgery was 34.5, which was improved to 49.1 at the final follow up. The mean pain score (VAS) prior to surgery was 7.5 and it was decreased to 2.9 at the last follow up. The mean estimated blood loss was 238 mL (140-350) for the two level procedures and 387 mL (278-458) for three levels. The midline surgical scar was 6.27 cm for two levels and 8.25 cm for three level procedures. Complications included two cases of asymptomatic medial penetration of the pedicle border. However, there were no signs of neurological deterioration or fusion failure. Conclusion : Multi-level, minimally invasive PLIF can be performed effectively using the percutaneous transpedicular screw fixation system. It can be an alternative to the traditional open procedures.

GEOMETRICAL ANALYSIS ON THE DENTOFACIAL COMPOSITION OF KOREAN BEAUTIFUL WOMAN (한국 미인의 치아안면구도에 대한 기하학적 분석)

  • Shin Young-Ho;Oh Sang-Chun
    • The Journal of Korean Academy of Prosthodontics
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    • v.42 no.5
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    • pp.524-534
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    • 2004
  • Statement of problem: The meaning of the beauty has a little different nature according to a time, culture, and nation. Purpose : This study was undertaken to estimate the geometric esthetic criteria for Korean woman by analysis of facial photograph in a smiling. Material and methods: The facial photographs of 678 Korean beautiful woman were collected from Miss Korea candidates(from 1971 to 2003 year). The dento-facial composition was measured and analyzed geometrically on computer monitor using $Adobe^{(R)}$ $Photoshop^{(R)}$ 7.0. The statistical significance of the differences among the 4 decade groups was estimated by a $x^2$ test. Result : The Korean beautiful woman skewed the geometric characteristics such as the 'coincidence' (83.0%) between facial midline and dental midline, the 'normal' (96.9%) alignment and arrangement of upper anterior teeth. the 'average' (79.1%) position and 'upward' (53.4%) curvature of upper lip, the 'parallel' (85.7%) relationship between the lower lip and upper anterior incisal curvature, the 'touching' (49.9%) and 'not-touching' (44.8%) relationship between upper anterior incisor and towel lip, the 'first premolar' (54.1%) and 'second premolar' (38.9%) displayed in a smile, and the 'symmetry' (89.4%) of smile. There was statistical significance among the 4 decades in the respect of the upper lip curvature, the relationship between upper anterior incisor and lower lip, and the most posterior teeth displayed in a smile (p<0.05). Conclusion : The Korean beautiful woman showed similar results to the western esthetic criteria in the some respects and the tendency that the Korean woman had more active smiling recently.

Primary Septoplasty In The Treatment of Nasal Bone Fractures (비골 골절 치료시 일차적 비중격 성형술)

  • Yoo, Yeon Sik;Yoon, Eul Sik;Lee, Byung Il;Dhong, Eun Sang
    • Archives of Plastic Surgery
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    • v.36 no.1
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    • pp.61-65
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    • 2009
  • Purpose: Most nasal bone fractures involve the septum; either or both of the ethmoidal perpendicular plate(EPP) and quadrangular cartilage(QC). Unlocked tension from the underlying quadrangular cartilage and poorly reducted bony septum are obstacles to the successful reduction of nasal bone. So we compared the preliminary outcome of septoplasty as a primary treatment with the untreated septum in nasal bone fractures. Methods: We performed a retrospective study of 215 patients underwent reduction of nasal fracture between January 2002 and February 2008. We graded patients into four groups according to the amount of deviation and direction of force by CT. Our indication for septoplasty and combined procedures was the deviation of EPP or QC over 50% from the midline. We interviewed part of the patients by telephone regarding the subjective esthetic and functional outcomes. Results: Forty five of 215 patients (21 percent) underwent septoplasty and combined procedures (cartilage graft, etc) after the informed consent. Patients who underwent septoplasty significantly satisfied with the outcome of esthetic appearance and nasal patency compared with patients who underwent simple closed reduction despite of having septal deviation over 50 percent from the midline. (p < 0.05) Conclusion: Septal surgery and esthetic consideration shoud be made even in simple nasal reductions. And if CT scans reveal severe deviation of septum, septoplasty should be considered as a primary treatment.