• Maxillofacial Plastic and Reconstructive Surgery
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• v.42
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• pp.21.1-21.6
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• 2020

Background: Fibula free flap mandible reconstruction is the standard procedure after wide resection of the mandible. Establishment and maintenance of normal occlusion are important in mandible reconstruction both intraoperatively and after surgery. However, scar formation on the surgical site can cause severe fibrosis and atrophy of soft tissue in the head and neck region. Case presentation: Here, we report a case of severe soft tissue atrophy that appeared along with scar formation after mandibular reconstruction through the fibular free flap procedure. This led to normal occlusion collapse after it was established, and the midline of the mandible became severely deviated to the affected side that was replaced with the fibula free flap, leading to facial asymmetry. We corrected the malocclusion with a secondary operation: a sagittal split ramus osteotomy on the unaffected side and a sliding osteotomy on the previous fibula graft. After a healing time of 3 months, implants were placed on the fibula graft for additional occlusal stability. Conclusion: We report satisfactory results from the correction of malocclusion after fibula reconstruction using sliding fibula osteotomy and sagittal split ramus osteotomy. The midline of the mandible returned to its original position and the degree of facial asymmetry was reduced. The implants reduced difficulties that the patient experienced with masticatory function.

• Journal of the Korean Association of Oral and Maxillofacial Surgeons
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• v.46 no.6
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• pp.379-384
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• 2020

Objectives: We sought to identify a clinically useful method of analyzing orbital dystopia to aid in diagnosis and treatment planning and to quantify vertical discrepancies in eye level and variations in canthal tilt in Koreans. Patients and Methods: In 76 Korean patients with a mean age of 23.12 years, mean differences in the level of the pupils, lateral canthi, medial canthi, and canthal tilt were measured. The difference in pupil level was calculated from the perpendicular lines drawn from the midpupil area of each eye to the midline of the face to determine the amount of skeletal discrepancy of the eye. Soft tissue discrepancies were determined according to the vertical difference between the lines drawn from the lateral or medial canthus of each eye perpendicular to the midline of the face. The canthal tilt was determined from the inclination of a line connecting the lateral and medial canthi, then classified as class I, II, or III. Results: Mean differences in pupil level, medial canthi, and lateral canthi were 1.57±1.10 mm, 1.14±1.07 mm, and 2.03±1.64 mm, respectively. The mean degree of canthal tilt were 8.45°±3.53° for the right side and 8.42°±3.81° for the left side. No study participants presented with class III canthal tilt. The mean canthal tilt values for those with class I tilt were 3.21°±1.68° for the right side and 3.18°±1.63° for the left side, while, for those who had class II tilt, the values were 9.60°±3.66° for the right side and 9.54°±2.99° for the left side. Conclusion: The presented diagnostic method of orbital dystopia can be used to effectively establish a treatment plan that takes into consideration the patient's skeletal and soft-tissue discrepancies.

• Journal of the Korean Society of Physical Medicine
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• v.16 no.4
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• pp.55-65
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• 2021

PURPOSE: This study compared the effects of sit-to-stand training with various foot positions combined with visual feedback on the postural alignment and balance. METHODS: Thirty stroke patients were assigned randomly into three groups of standing with a symmetrical foot position (SSF) (n = 10), asymmetrical foot position with the affected foot at the rear (SAF) (n = 10), and visual feedback and asymmetrical foot position (SVAF) (n = 10). Sit-to-stand training with different foot positions was performed for 30 minutes a day, five times a week, for a total of four weeks, and the effects on postural alignment and balance were assessed. RESULTS: The angle between the midline and scapula peak of the affected side was decreased significantly at sitting and thigh-off in the SAF group and at sitting, thigh-off, and standing in the SVAF group (p < .05). The angle between the midline and scapula peak of the non-affected side was increased significantly at sitting and thigh-off in the SAF group and at sitting, thigh-off, and standing in the SVAF group, the difference in the angle between the scapular peaks of the left and right sides was decreased significantly at sitting and thigh-off in SSF group, and at sitting in SAF group (p < .05). In the SVAF group, the angle at sitting, thigh-off, and standing was decreased significantly (p < .05). A comparison of the balance ability showed that BSS in the SVAF group was improved significantly (p < .05). CONCLUSION: Based on these results, the postural alignment and balance ability were improved in stroke patients who participated in sit-to-stand with visual feedback and asymmetrical foot position training.

• Journal of Korean Neurosurgical Society
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• v.65 no.3
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• pp.457-468
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• 2022

Objective : The clinical management paradigm of skull base chordomas is still challenging. Surgical resection plays an important role of affecting the prognosis. Endonasal endoscopic approach (EEA) has gradually become the preferred surgical approach in most cases, but traditional transcranial surgery cannot be completely replaced. This study presents a comparison of the results of the two surgical strategies and a summary of the treatment algorithms for skull base chordomas. Methods : We retrospectively analyzed the surgical outcomes and follow-up data of 48 patients with skull base chordomas diagnosed pathologically who received transnasal midline approaches (TMA) and transcranial lateral approaches (TLA) from 2010 to 2020. Results : Among the 48 patients, 36 cases were adopted TMA and 12 cases were performed with TLA. In terms of gross total resection (GTR) rate, 27.8% in TMA and 16.7% in TLA and with EEA alone it was increased to 38.9%, while 29.7% in primary surgery. In TMA, the cerebrospinal fluid (CSF) leak remains the most common complication (13 cases, 36.1%), other main complications included death, cranial nerve palsy, hypopituitarism, all the comparisons were no statistical significance. The Karnofsky Performance Scale scores in TMA were all better than those in TLA at different time, and the overall survival (OS) and recurrence free survival/progression free survival was just the reverse. Conclusion : The EEA for skull base chordomas resection has improved the GTR rate, but transcranial approach is still an alternative approach. It is necessary to select an appropriate surgical approach based on the location and the pattern of tumor growth in order to obtain the best surgical outcomes.

• Korean Journal of Radiology
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• v.22 no.10
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• pp.1690-1696
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• 2021

Objective: To describe the anatomic locations and imaging features of posterior lung herniation in unilateral pulmonary agenesis and aplasia, focusing on radiograph-CT/MRI correlation. Materials and Methods: A total of 10 patients (seven with pulmonary agenesis and three with pulmonary aplasia, male: female = 1:9, mean age 7.3 years, age range from 1 month to 20 years) were included. Chest radiographs (n = 9), CT (n = 9), and MRI (n = 1) were reviewed to assess the type of lung underdevelopment, presence of anterior and posterior lung herniation, bronchus origin, supplying artery, and draining vein of the herniated lung. Results: Pulmonary agenesis/aplasia more commonly affected the left lung (n = 7) than the right lung (n = 3). Anterior lung herniation was observed in nine of the 10 patients. Posterior lung herniation was observed in seven patients with left pulmonary agenesis/aplasia. Two patients showed posterior lung herniation crossing the midline but not beyond the aorta, and five patients showed the posteriorly herniated right lower lobe crossing the midline to extend into the left hemithorax farther beyond the descending thoracic aorta through the space between the esophagus and the aorta. This anatomical configuration resulted in a characteristic radiographic finding of a radiolucent area with a convex lateral border and a vertical medial border in the left lower lung zone, revealing a tongue-like projection on CT and MRI. Conclusion: Posterior lung herniation occurs in unilateral left lung agenesis/aplasia. Approximately 70% of the cases of posterior lung herniation reveal a unique radiolucent tongue-like projection in the left lower lung zone on imaging studies, which is caused by the extension of the posteriorly herniated right lung farther beyond the descending aorta.

• Imaging Science in Dentistry
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• v.54 no.1
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• pp.33-41
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• 2024

Purpose: The aims of this study were to create a deep learning model to distinguish between nasopalatine duct cysts (NDCs), radicular cysts, and no-lesions (normal) in the midline region of the anterior maxilla on panoramic radiographs and to compare its performance with that of dental residents. Materials and Methods: One hundred patients with a confirmed diagnosis of NDC (53 men, 47 women; average age, 44.6±16.5 years), 100 with radicular cysts (49 men, 51 women; average age, 47.5±16.4 years), and 100 with normal groups (56 men, 44 women; average age, 34.4±14.6 years) were enrolled in this study. Cases were randomly assigned to the training datasets (80%) and the test dataset (20%). Then, 20% of the training data were randomly assigned as validation data. A learning model was created using a customized DetectNet built in Digits version 5.0 (NVIDIA, Santa Clara, USA). The performance of the deep learning system was assessed and compared with that of two dental residents. Results: The performance of the deep learning system was superior to that of the dental residents except for the recall of radicular cysts. The areas under the curve (AUCs) for NDCs and radicular cysts in the deep learning system were significantly higher than those of the dental residents. The results for the dental residents revealed a significant difference in AUC between NDCs and normal groups. Conclusion: This study showed superior performance in detecting NDCs and radicular cysts and in distinguishing between these lesions and normal groups.

• The korean journal of orthodontics
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• v.54 no.4
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• pp.229-238
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• 2024

Objective: The study aimed to assess the prevalence of dental malocclusion, orthodontic parameters, and parafunctional habits in children with developmental dyslexia (DD). Methods: Forty pediatric patients (67.5% boys and 32.5% girls, mean age: 11.02 ± 2.53 years, range: 6-15 years) with DD were compared with 40 age- and sex-matched healthy participants for prevalence of dental malocclusion, orthodontic parameters, and parafunctional habits. Dental examinations were performed by an orthodontist. Results: Pediatric patients with DD exhibited a significantly higher prevalence of Angle Class III malocclusion (22.5% vs. 5.0%, P = 0.024), deep bite (27.5% vs. 7.5%, P = 0.019), midline deviation (55.0% vs. 7.5%, P < 0.0001), midline diastemas (32.5% vs. 7.5%, P = 0.010), wear facets (92.5% vs. 15.0%, P < 0.0001), self-reported nocturnal teeth grinding (82.5% vs. 7.5%, P < 0.0001), nail biting (35.0% vs. 0.0%, P < 0.0001), and atypical swallowing (85.0% vs. 17.5%, P < 0.0001) compared to that in healthy controls. Conclusions: Pediatric patients with DD showed a higher prevalence of Class III malocclusion, greater orthodontic vertical and transverse discrepancies, and incidence of parafunctional activities. Clinicians and dentists should be aware of the vulnerability of children with dyslexia for exhibiting malocclusion and encourage early assessment and multidisciplinary intervention.

• Journal of the korean academy of Pediatric Dentistry
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• v.35 no.2
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• pp.268-277
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• 2008

Authors evaluated 1171 patients at the department of Pediatric Dentistry in Kyoungpook National University Hospital through clinical records and radiographs. And the following features were studied ; age, sex distribution, number of mesiodens per patients, cause of discovery of mesiodens, location, status of eruption, shape and orientation of crown, complication, dental age of adjacent upper incisor tooth at the time of surgical extraction of mesiodens and the relationship between the resolution rate of complication after extraction of mesiodens and the dental age of adjacent upper incisor tooth, length of diastema, the eruption status of lateral incisor and the crowding status of premaxilla. The followings are the results : 1. The cause of discovery of mesiodens were as follows ; delayed eruption of the permanent incisors in 13.8%, midline diastema in 11.6%, radiographs taken for other reasons in 23.4% and for caries treatment in 15.1%. 2. Complication due to the presence of mesiodens did not occur in 36.8%, delayed eruption of adjacent teeth was observed in 16.1%, midline diastema in 34.4%, rotation in 8.8%, displacement in 2.4%, and crowding in 1.0% of all evaluated patients. 3. As for the dental age of adjacent upper incisor tooth at the time of surgical extraction of mesiodens, below 1/3 of total root length were observed in 3.5%, $1/3{\sim}1/2$ of total root length in 19.9%, $1/2{\sim}2/3$ of total root length in 54.7% and over 2/3 in 21.9% of all evaluated patients. 4. Resolution rate of delayed eruption after the extraction of mesiodens was significant higher in the group with the root length below 1/2. Resolution rate of midline diastema was significant higher in the group with diastema width below 3mm and with non-crowding of adjacent upper incisor teeth.

• Radiation Oncology Journal
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• v.14 no.3
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• pp.201-209
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• 1996

Purpose : To assess the efficacy of high dose rate - intracavitary radio-therapy (HDR-ICR) in the radiotherapy of FIGO stage IB squamous cell carcinoma of uterine cervix and to determine the optimum dose combination scheme of external radiotherapy and ICR to achieve acceptable local control without severe complication. Materials and Methods : One hundred and sixty two patients with FIGO stage Ib squamous cell carcinoma of uterine cervix who received definitive radiotherapy between May 1979 and December 1990 were retrospectively analyzed. All the patients received external radiotherapy combined with HDR-ICR. External dose of 40-46 Gy in 4.5-5 weeks was given to whole pelvis(median 45 Gy) and ICR dose of 30-39 Gy in 10-13 times was given to the point A. Midline shielding was done after 20-45 Gy of external radiotherapy(median 40 Gy) Summation of external dose Plus ICR dose to the point A range were 64.20-95.00 Gy. and mean was 83.94 Gy. We analyzed the local control rate, survival rate, and late complication rate. Rusults : Initial complete response rate was $99.4\%$ for all patients. Overall 5-year survival rate was $91.1\%$ and 5-year disease free survival rate was $90.9\%$. Local failure rate was $4.9\%$ and distant failure rate was $4.3\%$. Tumor size was the only significant prognostic factor. When tumor size greater than 3cm, 5-rear survival rate was $92.6\%$ and less than 3cm, that was $79.6\%$. Late complication rate was $23.5\%$ with $18.5\%$ of rectal complication and $4.9\%$ of bladder complication. Mean rectal dose summation of external midline dose plus ICR rectal point dose was lower in the patients without rectal complication(74.88 Gr) than those with rectal complication (78.87 Gy). Complication rate was increased with low rate of improvement of survival rate when summation of external midline dose plus point A or point R dose by ICR was greater than 70-75 Gy. Conclusion : The definitive radiation therapy using high dose rate ICR in FIGO stage IB uterine cervical cancer is effective treatment modality with good local control and survival rate without severe complication.

• Animal cells and systems
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• v.1 no.2
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• pp.381-388
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• 1997

Glutamate is a putative excitatory neurotransmitter in the central nervous system. The present study utilizing monoclonal antibodies against fixative-modified glutamate analyzed the distribution of glutamate-immunoreactive neuronal elements in the dog basilar pons. The glutamatergic neurons were present throughout the rostrocaudal extent of the basilar pons, predominantly to the medial and ventral subdivisions. Labelled cells were relatively sparse in the midline region of the medial nucleus and most lateral area of the lateral nucleus. The majority of glutamate-immunoreactive neuronal somata in the basilar pons was multipolar-shaped, and the size was in the range of 15-25 ${\mu}$m in diameter. Glutamate-immunoreactive axons and terminals were also observed at specific regions of the basilar pons. These observations provide evidence that this excitatory neural element functions in a multisynaptic pathway involving glutamatergic afferents to the basilar pons, pontocerebellar projection neurons, and the granule cells of the cerebellar cortex.