• Journal of Yeungnam Medical Science
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• 제40권1호
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• pp.96-101
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• 2023

The endoscopic endonasal approach (EEA) to the craniovertebral junction (CVJ) has recently been considered a safer alternative and less invasive approach than the traditional transoral approach because the complications associated with the latter are avoided or minimized. Here, we present two challenging cases of CVJ pathologies. The first case involved os odontoideum associated with anterior displacement of the occipitocervical junction where the EEA was used, followed by C0-C1-C2 fusion using a posterior approach to decompress the CVJ, and was complicated by rhinorrhea and Candida albicans meningitis. The second case involved basilar invagination with syringomyelia previously treated using a posterior approach, where aggravation of neuropathic symptoms required combined treatment with EEA and occipitocervical fusion of C0-C2-C3-C4, with the postoperative course challenged by operative site infection requiring drainage with debridement and antibiotic therapy. The EEA is an alternative approach for accessing the CVJ in well-selected patients. Knowledge of EEA complications is crucial for the optimal care of patients.

• Journal of Korean Neurosurgical Society
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• 제37권3호
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• pp.201-206
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• 2005

Objective: To evaluate the accuracy and safety of C1-C2 transarticular screw insertion, we retrospectively review surgical records and postoperative radiological findings. Methods: From January 2001 to October 2003, the C1-C2 transarticular screw fixation and posterior wiring with iliac bone grafts was performed in 16 patients. 6 patients had rheumatoid arthritis which caused cervical instability, 3 patients had os odontoideum, 3 patients had type 2 odontoid process fracture, 3 patients had traumatic transverse ligament injury and 1 patients who had been managed with C1-C2 wire fixation had psoriatic arthritis. Results: Osseous fusion was documented in 15 patients(93.8%). Only one patient was recorded screw loosening because of postoperative infection. One patient had only one screw placed because of abnormal anatomical structure, one patients was breakage of a Kirschner wire, and one screw was medial location to lateral mass of C1, but clinical results was excellent and radiological instability was not noted. Conclusion: The author's experience demonstrates that C1-C2 transarticular screw fixation with wired bone graft is a safe procedure with higher fusion rate but precaution is needed to avoid the neural damage, vertebral artery injury, and hardware failure.

• 치과방사선
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• 제20권2호
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• pp.201-210
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• 1990

The purpose of this study was to observe the relationship between mandibular asymmetry and Temporomandibular Disorders by means of the cephalometry using the posteroanterior cephalogram and the submentovertex cephalogram which were taken in 35 Temporomandibular Disorder patients and 35 normal persons ranged from 20S to 30S. The results were as follows: 1. The angulation which was formed by the median line with the ANS-Menton line (MAP) was greater in patients group and there was statistically significant difference. 2. The angulation which was formed to the median line with the Menton-Odontoid process tip line (MES), the difference of the distances from the center of the posterior surface of the both condyles to the most anterior point of the chin (DD), the difference of the distances from the center of the both condyles to the horizontal reference line (DE), the difference of the angulations which were formed by the both condyles axes with the horizontal reference line (DCE), the difference of the lengths of the both condyles (CL) and the difference of the widths of the both condyles (DW) were greater in patients group and there were statistically significant differences. There was reversed correlation between MAP and the difference of the distances from the 3. bilateral points of the lateral margin of the both zygomaticofrontal sutures to the at the lateral inferior margin of the both antegonial protuberances in mandible (DH). There was reversed correlation between MES and DD, DE, DCE. 5. There was correlation between MAP and MES.

• 척추신경추나의학회지
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• 제3권1호
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• pp.1-7
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• 2008

Objectives : The os odontoideum is an uncommon abnormality which is due to non fusion of axis and odontoid process that exists as a separate ossicle apart from a hypoplastic dens. Its clinical significance lies in its potential to produce serious neurologic symptoms after cervical Chuna Manipulation Treatment. We experienced a patient diagnosed as os odontoideum which corresponds to absolute contra-indications of chuna manipulation treatment and report it. Methods : The patient was diagnosed as os odontoideum through cervical spine CT and MRI. Results and Conclusion : During cervical physical examination, we encountered L'hermitte's phenomenon from the patient and suspected one of contra-indications of chuna manipulation treatment. We could diagnose the patient as os odontoideum through cervical spine CT, MRI and prevent him from severe sequelae caused by chuna manipulation treatment.

• Asian Spine Journal
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• 제12권6호
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• pp.1117-1122
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• 2018

Study Design: Prospective study. Purpose: To assess the prevalence of periodontoid calcification and its associations with acute cervical pain. Overview of Literature: Calcium pyrophosphate dihydrate (CPPD) deposition disease is a common rheumatological disorder that occurs especially in elderly patients. Although CPPD crystals induce acute arthritis, these crystals are not usually symptomatic. Calcification surrounding the odontoid process (periodontoid calcification) has been reported to induce inflammation, resulting in acute neck pain. This disease is called crowned dens syndrome. Whether calcification induces inflammation or whether the crystals are symptomatic remains unclear. Methods: The prevalence of periodontoid calcification at the atlas transverse ligament was examined by computed tomography of the upper cervical spine in patients suspected of brain disease but no cervical pain (control group, n=296), patients with pseudogout of the peripheral joints but no cervical pain (arthritis group, n=41), and patients with acute neck pain (neck pain group, n=22). Next, the correlation between the prevalence of periodontoid calcification and symptoms was analyzed. Results: In the control group, 40 patients (13.5%) showed periodontoid calcification with no significant difference in the prevalence with gender. The prevalence of calcification increased significantly with age (p=0.002). In the arthritis group, 26 patients (63.4%) reported periodontoid calcification. In the neck pain group, 14 patients (63.6%) reported periodontoid calcification. Multiple logistic regression analysis by age and group revealed that higher age, inclusion in the arthritis group, and inclusion in the neck pain group significantly affected the prevalence of calcification. Conclusions: Our results cumulatively suggest that periodontoid calcification is an aging-related reaction and that calcification per se does not always cause neck pain. Periodontoid calcification was observed more frequently in patients with pseudogout of the peripheral joints and in those with acute neck pain than in asymptomatic control patients.

• Clinical Pain
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• 제18권2호
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• pp.92-96
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• 2019

Torticollis is an abnormal, asymmetric head or neck position which usually caused by imbalance of paracervical muscles. The traumatic torticollis can be caused by following events; atlantoaxial rotatory subluxation, atlantoaxial dislocation, cervical vertebral fractures, and injury to the cervical musculature. Especially, acute traumatic atlantoaxial rotatory subluxation usually presents limitation of cervical range of motion without pain or neurologic deficit. We report a case of a 58 year-old man who developed the acute atlantoaxial rotatory subluxation right after the chiropractic therapy, which induced the limitation of cervical range of motion to 52.5% of normal range. The magnetic resonance image revealed the facture of the odontoid process and the partial injury in transverse ligaments of the atlas. He underwent intramuscular botulinum toxin injection and 10 days of continuous cervical traction 15 hours a day using a 5 kg weight. The range of the cervical motion restored up to 90.2% of normal range.

• Journal of Yeungnam Medical Science
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• 제10권1호
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• pp.114-126
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• 1993

최근 6년간 영남대학교 의과대학병원에서 경추골절로 진단받은 100명의 환자를 대상으로 임상 및 수술소견과 방사선학적 소견을 조사하여 다음과 같은 결과를 얻었다. 1. 가장 흔히 침범되는 곳은 하부 경추중 $C_5$와 $C_6$, 상부경추중 $C_2$였다. 2. 가장 흔히 침범되는 부위는 몸체, 추궁판, 치상돌기의 순으로 나타났다. 3. 경추골절을 일으키는 손상의 기전으로는 과굴곡 손상에 의한 경우가 53%로 가장 많았고 부위별로는 과굴곡 손상때는 몸체, 골극돌기, 부횡돌기의 골절이 많았고 과신전 손상때는 상대적으로 추궁근의 골절이 많았다. 4. 과신전(1.68 fractures/patients)때보다는 과굴곡(2.26 fractures/patients) 때 좀더 심한 손상을 입는 것으로 나타났다. 5. 추궁판만의 단독골절은 드물었고 대부분이 다른 부위의 골절과 동반되어 나타났으며 이중 70%는 과굴곡 손상때 나타났다. 6. 몸체골절은 50% 이상에서 다른 부위의 골절을 동반하고 있었는데 이들 다른 부위의 골절 중에서는 추궁판골절이 가장 많았다. 7. 두개 이상의 여러 경추를 동시에 침범한 경우의 40%가 인접하지 않은 다른 부위의 골절을 보여 어떤 한 부위의 골절이 발견되었다 하더라도 반드시 전 경추에 대한 세심한 관찰로 또 다른 골절의 유무를 살펴야겠다. 8. 골전과 동반된 전위는 대부분 과굴곡 손상에서 나타났으며 약 70%가 전방전위를 보였으며 $C_{5-6}$과 $C_{6-7}$ 사이에 가장 많았다.

• 대한치과교정학회지
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• 제23권1호
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• pp.1-15
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• 1993

This study was undertaken to investigate the midline having the least difference between the right and left structures among the lines that had been used in the study of the craniomaxillofacial asymmetry. The sample of this study consisted of twenty six Korean girls(average 18.9 years old) having normal facial appearance and occlusion. On the frontal cephalometric films of the sample, we divided the whole craniomaxillofacial area into four portions, i.e., cranial, upper facial, lower facial, and dental portion. So, we have found the midlines having the least difference in the whole craniomaxillofacial area itself, and in the each divided four portions, furtherly in the other portions from aimed portion. The findings were as follow: 1. In the whole craniomaxillofacial area, the connecting line between crista galli and anterior nasal spine and the perpendicular bisecting line between right and left foramen rotundums were suitable for the midline. 2. In the cranial portion, established all six lines were suitable for midlines. In the other portions, the perpendicular bisection line between both condylion, the line passing the contact point between right and left mandibular central insisiors among the perpendicular lines between right and left mandibular central incisial tips were suitable midlines fer evaluating the asymmetry of cranial portion. 3. In the upper facial portion, the perpendicular bisecting line between right and left zygions was the most suitable midline. In the other portions, the line between the crista galli and the most superior point of the odontoid process, the perpendicular bisecting line between right and left gonions, the perpendicular bisecting line between right and left condylions, and perpendicular bisecting line between right and left foramens rotundum were suitable midlines for evaluating the asymmetry of the upper facial portion 4. In the dental portion, the perpendicular bisecting lines between right and left buccal cusps of both maxillary first molars and between right and left mandibular first molars were suitable midlines. In the other portions, the perpendicular bisecting line between right and left landmarks crossing the lesser wing of the sphenoid bone and orbit, the perpendicular bisecting line between right and left mental foramens, and the connecting line between crista galli and prosthion were suitable midlines for evaluating the asymmetry of dental portion. 5. In the lower facial portion, the perpendicular bisecting lines between right and left condylions and between right and left gonions were suitable midlines. In the other portions, the line between the crista galli and anterior nasal spine, the perpendicular bisecting line between right and left foramen rotundums, and the perpendicular bisecting lines between right and left buccal cusps of both mandibular first molars and between right and left maxillary first molars were suitable midlines for evaluating the asymmetry of the lower facial portion.

• 대한소아치과학회지
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• 제27권2호
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• pp.318-332
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• 2000

탈회냉동건조골과 교원질을 치수치료제로서 이용할 수 있는지의 여부를 규명하기 위하여, 성견의 치아를 대상으로 치수절단술을 시행하여 치수조직의 염증반응, 재생성 상아질의 형성 등 치수조직반응을 평가하기 위하여 시행되었다. 체중 10kg 내외의 4마리의 성견 치아에 소독된 round bur을 이용하여 5급 와동을 형성한 후 치수절단술을 시행하였다. 대조군으로는 수산화칼슘으로 치수 복조을 시행하고 IRM으로 밀봉하였으며, 실험군으로는 교원질과 탈회냉동건조골을 이용하여 복조한 후 대조군에서와 같은 방법으로 밀봉하였다. 실험동물은 3일, 1주일, 2주일, 4주일 경과 후 관류 고정으로 희생되었으며, 조직표본을 제작한 후 광학현미경과 투과전자현미경으로 치수 조직 반응을 관찰 평가한 결과 다음과 같은 결론을 얻었다. 1. 모든 군에서 치수괴사 소견은 보이지 않았으며, 대조군과 실험 2군에서는 1주일 후부터 염증이 소실되었으나, 실험 1군에서는 2주까지 염증소견을 보이며 절단된 치수 측벽의 조상아세포들도 배열이 불규칙하였다. 2. 대조군에서는 2주부터 불완전한 상아질교가, 4주 경과 후에는 골양상아질과 완전한 상아질교가 관찰되었으며, 1군에서는 섬유성피막은 형성되었으나 조상아세포와 상아질교의 형성소견은 관찰되지 않았다. 2군의 경우 2주 경과 후 탈회냉동건조골 주위에 분화된 조상아세포들에 의해 형성된 상아전질과 재생성 상아질이 관찰되었으나 상아질교의 형성소견은 관찰되지 않았다. 3. 대조군과 2주군에서 1주일 경과 후에 크고 호염기성 핵을 갖는 세포들이 치수절단부 하방과 탈회냉동건조골 주위에 모여드는 양상을 보였는데, 이와 같은 현상은 대조군에 비해 2군에서 더욱 현저하였으며 시간이 경과될수록 규칙적으로 배열한 조상아세포와 재생성 상아질을 관찰할 수 있었다. 4. 대조군과 2군에서 조상아세포는 극성을 띤 핵, 조면내형질세망, 골지체, 분비과립 등을 포함하는 세포질과 유기기질을 분비하는 소견 등, 석회화가 이루어지는 초미세구조를 보였다. 이상의 결과를 종합하면 탈회냉동건조골은 치수의 미분화 간엽세포로부터 조상아세포의 분화를 유도하여 치수절단부위에 재생 상아질을 형성할 수 있는 것으로 사료된다.