• Journal of Preventive Medicine and Public Health
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• 제23권3호
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• pp.358-368
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• 1990

1989년 11월부터 4개월간 대구시내 소재 일부, 6가 크롬(삼산화크롬)으로 피막처리하는 도금작업장의 남성근로자를 대상으로 비중격천공이 있는 근로자 12명과 비중격천공이 없는 근로자 12명을 폭로군으로 하고 크롬에 폭로된 적이 없는 정상인 20명을 대조군으로 하여 개별면담을 통해 연령, 직업력, 흡연습관을 파악하였으며, 정맥혈을 채취하여 원자화 무염광로를 부착한 원자흡광도계로 혈중 크롬농도를 측정하였으며 말초혈액 중 임파구의 자매염색분체교환의 발현빈도를 조사하고 연령, 흡연습관, 직업력 및 혈중 크롬농도 등이 임파구 자매염색분체교환의 발현빈도에 미치는 영향을 조사했다. 크롬 도금작업의 말초혈액 중 임파구 자매염색분체교환의 발현빈도는 비중격 천공이 있는 군이 $10.1{\pm}1.6$, 비중격천공이 없는 군이 $8.5{\pm}3.4$이었고 대조군 $6.1{\pm}2.1$으로 세군간에 유의한 차이가 있었으며 (p<0.01), 비중격천공 군에서 가장 높은 빈도를 보였으며, 대조군에 비해 1.7배의 높은 빈도를 나타냈다. 혈중 크롬농도는 대조군이 $0.060{\pm}0.043{\mu}g/ml$, 크롬도금 작업자 중 비중격천공이 있는 군 $0.114{\pm}0.030{\mu}g/ml$, 비중격천공이 없는 군 $0.090{\pm}0.050{\mu}g/ml$로 세군간의 차이는 유의하였다 (p<0.01). 크롬도금 작업자와 대조군 모두 연령군별, 흡연습관별 및 근속년수에 따른 자매염색분체교환의 발현빈도에는 유의한 차이가 없었다. 혈중 크롬농도와 자매염색분체교환 발현빈도의 상관성은 상관계수, r=0.007로서 상관관계가 없었다 (Y=0.638 X+0.191, r=0.007. p>0.05). SCE 평균 발현빈도를 $y=(sum\;SCE)^{\frac{1}{2}}+(sum\;SCE+1)^{\frac{1}{2}}$를 이용하여 변형한 변수 y에 대해 연령, 흡연습관, 직업 및 혈중 크롬농도의 요인들로서 설명력은 32.3%였으며 가장 중요한 변수는 직업으로 나타났다. 이상의 결과로 보아 직업적인 크롬폭로에 의한 유전적 손상의 위험성이 어느 정토 있을 것으로 추측되며 생물학적 독성검정 지표로서 유용성이 있을 것으로 생각된다.

• Journal of the Korean Association of Oral and Maxillofacial Surgeons
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• 제33권3호
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• pp.238-246
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• 2007

This study is aimed to elucidate the abnormal growth pattern of human fetal maxilla with cleft lip and palate (CLP). Total 71 fetal maxillae with CLP were obtained from aborted human fetuses. They were examined radiologically for the dimensional changes of maxillary trapezoid (MT) formed by maxillary primary growth centers (MxPGC)(Lee et al., 1992). In palatal radiogram of the CLP maxilla, the MT was traced by the anterior and posterior MxPGCs, and the dimensions of anterior and posterior maxillary widths, maxillary length, and MT length (MTL), and MT area were measured for evaluation of the basic growth pattern of the developing maxilla. The growth of anterior and posterior MxPGCs was severely retarded in the prenatal maxillae with CLPs, showing abnormal shape of MT. Cleft lip subjects without cleft palate also showed arrested growth of MT. Unilateral cleft lipalveolar cleft or cleft palate (UCL-AC/CP) and bilateral cleft lip-alveolar cleft or cleft palate (BCL-AC/CP) showed enhanced abnormal MT pattern. The abnormality of MT was most marked in BCL-AC/CP. It was also observed that the craniofacial malformations other than CLPs produced abnormal MT. In conclusion, the MT growth of prenatal CLP maxilla was severely arrested and resulting in abnormal MT shape on the palatal radiogram. BCL-AC/CP showed more protruded nasal septum than other types of CLPs, while UCL-AC/CP showed severe deviation of the protruded nasal septum towards the non-cleft side. Cleft lip only subjects also showed the abnormal growth of MT. These data suggest that the MT is primarily involved in CLPs, and MT shape could be utilized as a sensitive indicator for the analysis of maxillary malformation in different types of CLPs.

• Maxillofacial Plastic and Reconstructive Surgery
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• 제34권2호
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• pp.133-139
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• 2012

모든 환자들은 구순접합술을 시행 받았고 구순 및 구개열 유아들은 악정형장치인 Latham을 사용하였다. 수술의 기술적 변화들은 앞서 설명하였다. Columella 부위의 높은 rotation과 releasing incision은 내측 입술 부위를 충분히 길게 해주고, advancement flap이 phitral column 상방으로 최소로 침범되게 하여 균형적인 입술을 만들 수 있다. 또한 구륜근을 외번시켜 philtral ridge를 형성하고, 작은 unilimb Z-plasty을 구순측 Cupid's bow handle 높이에 맞게 시행 후, vermilion-cutaneous junction에서부터 상방으로 cutaneous closure 시행한다. 변위된 alar cartilage는 nostril rim incision을 통해 동측 upper lateral cartilage에 매달며, Alar base는 anterior-caudal septum의 위치, sill의 설정 그리고 외측 vestibular web 제거를 포함하여 3차원적으로 설계하여 치료해야 한다. 이번에 소개한 Mulliken의 치료법이 환자들과 외과의사들에게 많은 도움이 되기를 바란다.

• Maxillofacial Plastic and Reconstructive Surgery
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• 제40권
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• pp.40.1-40.8
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• 2018

Background: A 9-year-old male showed severe defects in midface structures, which resulted in maxillary hypoplasia, ocular hypertelorism, relative mandibular prognathism, and syndactyly. He had been diagnosed as having Apert syndrome and received a surgery of frontal calvaria distraction osteotomy to treat the steep forehead at 6 months old, and a surgery of digital separation to treat severe syndactyly of both hands at 6 years old. Nevertheless, he still showed a turribrachycephalic cranial profile with proptosis, a horizontal groove above supraorbital ridge, and a short nose with bulbous tip. Methods: Fundamental aberrant growth may be associated with the cranial base structure in radiological observation. Results: The Apert syndrome patient had a shorter and thinner nasal septum in panthomogram, PA view, and Waters' view; shorter zygomatico-maxillary width (83.5 mm) in Waters' view; shorter length between the sella and nasion (63.7 mm) on cephalogram; and bigger zygomatic axis angle of the cranial base (118.2°) in basal cranial view than a normal 9-year-old male (94.8 mm, 72.5 mm, 98.1°, respectively). On the other hand, the Apert syndrome patient showed interdigitating calcification of coronal suture similar to that of a normal 30-year-old male in a skull PA view. Conclusion: Taken together, the Apert syndrome patient, 9 years old, showed retarded growth of the anterior cranial base affecting severe midface hypoplasia, which resulted in a hypoplastic nasal septum axis, retruded zygomatic axes, and retarded growth of the maxilla and palate even after frontal calvaria distraction osteotomy 8 years ago. Therefore, it was suggested that the severe midface hypoplasia and dysostotic facial profile of the present Apert syndrome case are closely relevant to the aberrant growth of the anterior cranial base supporting the whole oro-facial and forebrain development.

• 대한구순구개열학회지
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• 제9권2호
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• pp.93-100
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• 2006

본 증례에서는 2명의 불완전, 그리고 완전구순열 환자를 Delaire의 개념에 의하여 수술을 시행 하였다. 불완전 구순열 교정은 코 교정 후 좌우 비대칭을 해소할 수 있었으나 완전구순구개열의 환아에서는 코의 비대칭성을 회복하기 위해 동시 수술을 시행하였으나 좌우 비대칭성은 수술 후에도 관찰할 수 있었다. 본 증례의 경우 환자의 경제적 그리고 사회적 이유로 인해 수술이 지연된 환자로 수술에 난이도는 비교적 높지 않았던 경우로 비강전정부위와 비익부위, 그리고 구륜근 등의 피부 하방에 비정상적으로 배열된 근육의 박리와 재위치를 이루어주었던 경우였다. 술 후 평가를 위한, 심미, 발음, 기능과 정서적 발달 정도를 검사하여야 하나 지리적 관계로 재평가가 어려운 점이 예상된다.

• Archives of Plastic Surgery
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• 제43권3호
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• pp.242-247
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• 2016

Background Median cleft lip is a rare anomaly consisting of a midline vertical cleft through the upper lip. It can also involve the premaxillary bone, the nasal septum, and the central nervous system. In our current report, we present the clinical features of 6 patients with a median cleft lip and their surgical management according to the accompanying anomalies. Methods From December 2010 to January 2014, 6 patients with a median cleft lip were reviewed. Five of these cases underwent surgical correction; alveolar bone grafting was performed in a patient with a median alveolar cleft. The surgical technique included inverted-U excision of the upper lip and repair of the orbicularis oris muscle. The mean follow-up period was 20.4 months (range, 7.4-44.0 months). Results The study patients presented various anomalous features. Five patients received surgical correction, 4 with repair of the median cleft lip, and one with iliac bone grafting for median alveolar cleft. A patient with basal sphenoethmoidal meningocele was managed with transoral endoscopic surgery for repair of the meningocele. Successful surgical repair was achieved in all cases with no postoperative complications. Conclusions Relatively mild forms of median cleft lip can be corrected with inverted-U excision with good aesthetic outcomes. In addition, there is a broad spectrum of clinical features and various anomalies, such as nasal deformity, alveolar cleft, and short upper frenulum, which require close evaluation. The timing of the operation should be decided considering the presence of other anomalies that can threaten patient survival.

• 대한두경부종양학회지
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• 제10권1호
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• pp.63-73
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• 1994

Chondrosarcomas are uncommon disease that are noted almostly in the pelvis, sternum, long bone. Chondrosarcoma in the head & neck was very rare. It can occur in nearly every bone in the head and neck. Lesion of the maxilla is most frequent site in head and neck region, but temporomandibular joint is rare site. In chondrosarcoma of temporomandibular joint, its danger lies in its local invasiveness and potential to seed into the meninges. Histologically, the tumor exhibits myxoid feature, which must be differentiated from chordoma and chondroid chordoma. The cranial nerve palsies frequently observed with the tumors are related to the anatomical location. Chondroma is a benign tumor that most frequently found in the hand, foot bone, but can be originated in any cartilagenous area of body. When it occurs in one site, it is named as solitary enchondroma, and when it occurs in multiple site, it is named as multiple enchondromatosis. In the head & neck, it may occur in the nasal cavity, nasopharynx, nasal septum, eustachian tube, palate. But chondroma that occur as neck mass is extremely rare. Recently, the authors experienced a case of chondrosarcoma confirmed pathology affecting 35-years-old female presenting mass in left temporomadibular joint and a case of chondroma confirmed pathology affecting 26-years-old female presenting neck mass, left.

• Journal of the Korean Association of Oral and Maxillofacial Surgeons
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• 제33권6호
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• pp.681-683
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• 2007

Kabuki(Niikawa-Kuroki) syndrome was first reported by Niikawa et al(1981). The faces of the patients are similar to the make-up of traditional Japanese Kabuki actors: long palpebral fissures, an ectropium of the lateral third of the eyelids, and arching eyebrows with sparse lateral halves. Craniofacial findings include a depressed nasal tip, short nasal septum, large and prominent ears, and micrognathia. Other main features area mild to moderate mental deficiency, short stature, skeletal and dermatoglyphic abnormalities, including prominent finger tip pads. Oral anomalies are common in KS(over 60%) and include abnormal dentition, widely spaced teeth, cleft palate or lip, high vault of palate, hypodontia, conical incisors, screw driver-shaped incisors and ectopic upper 6-year molars. The increased occurrence of cleft lip and palate or the development of a high vault of palate has been described by a number of authors. This condition is believed to be common in Japan, but has been reported from other parts of the world. The objective of this presentation is to report a case of this syndrome in six-year-old girl, with characteristic findings.

• Archives of Plastic Surgery
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• 제34권4호
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• pp.528-530
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• 2007

Purpose: Holoprosencephaly(HPE) is a rare developmental defect due to incomplete cleavages of the prosencephalon during the third week of fetal development. Chromosomal anomalies, genetic syndrome, teratogen, or genetic disorder of non-syndromic HPE are usually accepted as etiology. The consequences of prechordal mesoderm defect are varying degrees of deficit of midline facial development, especially the median nasal process(premaxilla), and incomplete morphogenesis of the forebrain. We experienced a case of lobar HPE with complete cleft lip and palate. Methods: A female newborn infant was born at $38^{+6}$ weeks' gestational age via NSVD. The infant's birth weight was 3.6 kg, height 52 cm, and head circumference 32.5 cm, showing microcephaly, flat nose, median complete cleft lip & palate, and hypotelorism, along with defects of midfacial development including losses of premaxilla, philtrum, nasal septum, and columella. Results: There were no specific findings noted from the head and neck X-ray and tests for endocrine and metabolic disorders, but clinical characteristics of midface and dysgenesis corpus callosum on brain MRI were seen, so that this case was diagnosed with HPE. Conclusion: HPE is divided into three categories of alobar, semilobar, and lobar prosencephaly according to the degree of cerebral hemisphere separation. Assesment of patient's brain abnormality and malformation is essential in determining the extent and benefit of surgical intervention. This case was included in the lobar type HPE which shows relatively good prognosis compared with other types and reconstruction of median complete cleft lip & palate and midfacial defects will be performed.

• 대한두개안면성형외과학회지
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• 제14권1호
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• pp.61-64
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• 2013

Schwannomas are well-differentiated solitary benign tumors that originate from the schwann cells of the nerve sheath. They can readily occur in the head and neck regions, but the schwannoma originating from the infraorbital nerve is extremely rare and usually painless, slow-growing, and without specific symptoms. The author experienced a rare case of infraorbital schwannoma, which was completely removed through the intraoral approach. A 20-year-old woman was admitted to our hospital for a painless, solid and circular mass located on the right infraorbital region. The eyeball movement and visual field were normal. There was no globe displacement or proptosis. Preoperative computed tomography demonstrated $13{\times}10{\times}5mm$-sized soft tissue mass. On March 2011, the mass was removed through an intraoral approach. On histopathological examination, the gross specimen consisted of a smooth, well-encapsulated and light yellowish solid mass, measuring $12{\times}7{\times}5mm$. Microscopically, it presented a typical manifestation of schwannoma with Antoni A area with Verocay body, and Antoni B area on H&E stain. The result of the immunohistochemical staining was positive for the S-100 protein. The patient had hypoesthesia of the nasal septum and vestibule in the postoperative period, and this finding confirmed that the internal nasal branch of infraorbital nerve was the nerve in which the schwannoma originated. Infraorbital schwannomas are very rare and must be included in the differential diagnosis of the orbital masses inferior to the eyeball. In the case of early diagnosis, the small-sized infraorbital schwannomas can be completely removed without any scar through an intraoral approach.