• 대한치과마취과학회지
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• 제13권4호
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• pp.189-193
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• 2013

We experienced dfficult airway management in a patient who had Ludwig angina with morbid obesity, dfficulty with mouth opening and neck extension. We planned to perform awake-nasotracheal intubation with fiberoptic bronchoscopy but the patient's condition was not suitable to do this procedure. Thus, we tried fiberoptic nasotracheal intubation under general anesthesia but we experienced difficult airway management due to epistaxis. We tried to use video laryngoscope instead of fiberpotic bronchoscopy but also failed to guide the tube into trachea due to limited mouth opening. We used video laryngoscope to make a view of vocal cord and used fiberoptic bronchoscope as an intubation guide of endotrachedal tube and successfully intubated the patient.

• 대한두개안면성형외과학회지
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• 제20권4호
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• pp.265-269
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• 2019

Congenital hypoplasia of the depressor anguli oris muscle is a rare cause of asymmetrical crying facies in newborns. The clinical manifestations range from mild to severe asymmetry and may persist up to adulthood. In the current case, the patient did not exhibit other congenital anomalies or paralysis of other branches of the facial nerve. This adult patient presented with severe asymmetrical lower lip deformity during full mouth opening since birth. A chromosomal study for the detection of 22q gene deletion yielded negative results. The electromyography findings of the lower lip were insignificant. Depressor labii inferioris muscle resection was not effective, but bidirectional (horizontal and vertical) fascia lata grafting improved the aesthetic appearance of the asymmetrical lower lip. The patient showed improved lower lip symmetry during full mouth opening at 1 year after the surgery. Therefore, the details of this rare case are reported herein.

• 수산해양기술연구
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• 제24권1호
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• pp.17-21
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• 1988

인망그물의 어획효율을 향상시키기 위한 기초연구로써 철골 재료를 사용하지 않고 Fig.1과 같은 규격의 부드러운 나일론 천으로 단엽.복엽의 모형 전개깃판을 제작하여 유향과 이루는 영각별 유수저항과 양력을 측정 조사하였고, 이 전개깃판을 그물에 부착하였을 때의 어구의 동적 특성을 모형으로 시험하였다. 또 복엽 전개깃판에 의한 어구의 자동전개조 건에 관해서도 아울러 조사하였다. 이상의 실험결과를 요약하면 다음과 같다. 1. 단엽전개깃판이 유향과 이루는 각도가 $30^{\circ}일$ 때 최소의 유수저항으로 최대의 양력을 얻을 수 있었다. 2. 안쪽 전개깃판은 $30^{\circ},$ 바깥쪽 전개깃판은 $40^{\circ}의$ 영각이 되도록 복엽 전개깃판을 구성하였을 때 수중 동태가 가장 안정되었고 Fig.1의 (a)와 (c)를 내외 전개깃판으로 하였을 때 최소의 유수저항으로 최대의 양력을 얻을 수 있었다. 3. 유속이 0.4m/sec 일 때 단엽 전개깃판과 복엽 전개깃판의 유수저항은 각각 모형 어구 전체저항의 27% 및 38%를 차지하였다. 4. 모형어구의 자동전개는 두깃판의 전연쪽은 6cm, 후연쪽은 3cm의 간격을 갖고 바깥쪽 전개깃판으 후연을 안쪽 전개깃판의 2/3되는 곳에 고정하고, 바깥쪽 전개깃판의 고삐줄은 전연쪽 간격의 3배 이상으로 길게 하였을 때 가장 효과적이었다.

• 대한두개안면성형외과학회지
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• 제21권3호
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• pp.161-165
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• 2020

Background: Microstomia is defined as a condition with a small sized-mouth that results in functional impairment such as difficulty with food intake, pronunciation, and poor oral hygiene and cosmetic problems. Several treatment methods for microstomia have been proposed. None of them are universally applicable. This study aims at analyzing the cases treated at our institution critically reviewing the pertinent literature. Methods: The medical records of all microstomia patients treated in our hospital from November 2015 to April 2018 were reviewed retrospectively. Of these, all patients who received surgical treatment for microstomia were included in the study and analyzed for etiology, chief complaint, surgical method, and outcomes. The functional outcomes of mouth opening and intercommissure distance before and after the surgery were evaluated. The cosmetic results were assessed according to the patients' satisfaction. Results: Five patients with microstomia were corrected. Two cases were due to scar contracture after chemical burn, two cases derived from repeated excision of skin cancer, and one patient suffered sequela of Stevens-Johnson syndrome. The following surgical methods were applied: one full-thickness skin graft on the buccal mucosa, three buccal mucosal advancement flaps after triangular excision of the mouth corner, and one local buccal mucosal flap. Mouth opening was increased by 6.0 mm, and the intercommissure distance improved by 7.2 mm on average. Follow-up was 9.6 months (range, 5-14 months). Cosmetic assessment was as follows: two patients found the results excellent, three judged it as good. Conclusion: Microstomia has several causes. In order to achieve optimal functional recovery and aesthetic improvement it is important to precisely evaluate the etiologic factors and the severity of the impairment and to carefully choose the appropriate surgical method.

• Journal of Oral Medicine and Pain
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• 제37권4호
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• pp.205-211
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• 2012

35세 여자환자가 갑작스런 개구장애와 함께 발생한 급성 교합변화를 주소로 내원하였다. 환자는 이전 수년 동안의 관절잡음의 병력을 가지고 있었으며 관절잡음의 소실과 동시에 개구제한이 발생하였음을 보고하였다. 환자는 개구제한과 함께 개구시 우측 악관절의 통증을 호소하였으며 구강내 교합 검사 시 전치부의 개교합과 함께 하악이 우측으로 전위된 양상이 관찰되었다. 또한 좌측으로의 측방운동량 또한 감소된 것으로 관찰되었다. 자기공명영상에서 우측 악관절에서 비정복성 관절 원판 전방 변위가 관찰되었으며 후방 관절강의 협착이 관찰되었다. 이 환자는 우측 악관절의 비정복성 관절원판 전방변위로 진단되었으며, 급성 교합변화는 변위된 관절원판에 의해 야기된 과두위치의 변화로 초래된 것으로 추정하였다. 처음 3개월간의 물리치료와 약물치료와 병행된 안정교합장치요법에서는 만족할 만한 치료결과를 얻지 못하였으나, 그 다음 약 8개월간 사용된 악간견인장치 치료를 통해서 통증 및 교합변화가 해소되었으며 정상적인 개구량으로 회복되었다. 술후 촬영된 자기공명영상에서 우측 과두가 재형성된 양상을 관찰할 수 있었다.

• Journal of Oral Medicine and Pain
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• 제24권1호
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• pp.37-47
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• 1999

This study was performed to investigate the factors related to vibration of temporomandibular joint during mandibular opening movement. For this study, 144 patients with temporomandibular disorders were randomly selected. Angle's classification, lateral guidance pattern, range of maximal mouth opening, preferred chewing side, and affected side were investigated clinically. Mandibular torque rotational movement during opening was recorded with $BioEGN^{(R)}$ and vibration of temporomandibular joint during opening was recorded with $Sonopak^{(R)}$. After clinical diagnosis was made, visual analogue scale(VAS) was used for evaluation of clinical progress of the subject's chief complaints. The author calculated VAS treatment index(VAS Ti) from the record of VAS. The more VAS Ti was, the less remission of subjective symptom was, The data were analyzed with SAS/Stat program and the results of this study were as follows: 1. There were no significant difference in all the variables of joint vibration by age and sex. 2. Integral and peak amplitude in patients of Angle's class I were higher than those of class II or III patients. Integral in patients of group function was higher than that in patients of canine guidance or other types of lateral excursion. 3. As to Angle's classification or lateral guidance type, there were almost not significant difference between subgroup of same class or type and subgroup of different class or type on both sides. And there were also almost not difference between one side and the other side related to preferred chewing side or affected side. 4. Patients with disk displacement with reduction showed higher value of integral and peak amplitude than any other patients. 5. Joint vibration variables significantly correlated with VAS Ti of pain. with clinical range of mouth opening, and with ingredients of mandibular torque rotational movement.

• Maxillofacial Plastic and Reconstructive Surgery
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• 제38권
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• pp.12.1-12.6
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• 2016

Background: Temporomandibular joint (TMJ) ankylosis can be accompanied by various degrees of functional and esthetic problems. Adequate mouth opening, occlusal stability, and harmonious facial form are the main goals of treatment for ankylosis. Distraction osteogenesis has proven to be an excellent treatment for lengthening the ramus-condyle unit. However, various timings for distraction have been suggested, and there is no consensus on selection criteria for performing the procedure in stages or simultaneously with other treatments. Case presentation: In this case report, concomitant intraoral distraction and gap arthroplasty was planned to treat TMJ ankylosis and associated facial asymmetry. After gap arthroplasty and 23 mm of distraction, the ramus-condyle segment was successfully lengthened and mouth opening range was significantly increased. The resultant interocclusal space was stably maintained with an occlusal splint for 4 months after distraction. Finally, good occlusion was achieved after prosthetic treatment. The remaining mandibular asymmetry was corrected with osseous contouring and augmentation surgery. The mouth-opening range was maintained at 35 mm 24 months after treatment. Conclusion: Gap arthroplasty with intraoral distraction as a one-stage treatment and subsequent contouring surgery can be applied to correct ankylosis with moderate malocclusion and facial asymmetry.

• Journal of Oral Medicine and Pain
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• 제42권2호
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• pp.35-43
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• 2017

Purpose: This study aims to evaluate the correlation between joint sounds and radiographic bone change patterns along with clinical symptoms of temporomandibular joint osteoarthritis (TMJ OA) patients. Methods: The patients for this study were over 19 years of age, diagnosed tentatively with TMJ OA. The patients were examined with temporomandibular disorders analysis test and all three radiographs, including panoramic radiography, transcranial radiography, and cone beam computed tomography (CBCT). Information of the patients' age, pain status, joint sound and mouth opening range were collected. And bone change pattern was examined by reviewing panoramic radiography, transcranial radiography and CBCT images. Results: The patients with crepitus had a higher average active mouth opening (AMO) range than patients without crepitus, and the group with bilateral crepitus had a higher average AMO range than the group with unilateral crepitus (p<0.001). And the patient with pain during mastication was increased in the group with clicking than the group without clicking, and the group with bilateral clicking showed a statistically significant increase in the patient with pain during mastication than the group with unilateral clicking (p<0.05). The analytical results of the relevance of crepitus showed a high correlation with bone change observed from each of the three radiographs. And the agreement in bone change findings from 3 groups of paired radiographs showed high agreement (p<0.001). Meanwhile, 77.2% of CBCT findings showed bone change of condyle without crepitus (p<0.001). Conclusions: This study presented significant results in the evaluation of the correlation with crepitus and bone change of TMJ OA patients from panoramic radiography or transcranial projection. However, the accurate assessment is required through CBCT for the patient with complains of persistent pain, limitation of mouth opening, and occlusal change even if the crepitus does not exist.

• 한국산학기술학회논문지
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• 제6권6호
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• pp.542-546
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• 2005

연성 크랙의 발생 평가를 위한 J-적분이 충격 하중을 받는 탄소성 3점 굽힘 시험편들에 대하여 연구한다. J-적분을 측정하고 평가하는 실험적인 방법이 연구되었으며 이 결과가 유한 요소법을 이용한 탄소성 이론 해석을 한 값들과 비교하여 거의 일치함을 보였다. 이론적인 수치 해석으로서도 본 연구의 유한 요소 모델로서 J-적분값을 계산할 수 있으며 삼점 굽힘 시험편의 동적 비선형 파괴 실험에 있어서 크랙 입구 개구 변위 (CMOD)에 의하여 J-적분값의 단순 계산이 가능함을 입증하였다. 탄소성 재료의 특성이 여러 가지의 충격 속도들에서 고려된다. J-적분은 충격 실험 동안 얻어진 사진들로부터 직접적으로 측정된 크랙 입구 개구 변위로부터 예측될 수 있다.

• Maxillofacial Plastic and Reconstructive Surgery
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• 제33권1호
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• pp.49-54
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• 2011

A case of Behcet's syndrome found in a 22 years old male was is reported along with the histological and immunohistochemical studiesfindings. He The patient had had received prolonged medical therapy of anti-inflammatory agents for the conjunctival ulcer, genital ulcer, oral ulcer, and intestinal ulcers since the first onset of the Behcet's syndrome about approximately 7 years agoearlier. Recently, he felt the athickening of both corners of his lip causing that caused mouth opening difficultydifficulties. A plastic rReconstructive surgery was performed to enlarge the size of the oral orifice by multiple Z-plasty incisions, and finallywhich resulted in proper enlargement of the circumferential length of the lip. During the operation, a scar-like thick fibrous tissue was obtained and examined pathologically. In theThe microscopic observation the revealed the submucosal lesion was to be diffusely fibrosed with the a distribution of sclerotic collagen bundles. Particularly, sSeveral foci of collagen degeneration were found observed in the deep connective tissue, and the degenerating collagen bundles were gradually lost their fibrillar appearance. In the immunohistochemical observations, the foci of collagen degeneration was were strongly positive for IgK, but almost negative for TNF${\alpha}$ lysozyme, and MMP-3. Taken together, it was presumed that tThe submucosal fibrosis was presumed to have firstly presented in this study was probablybeeninduced by the prolonged anti-inflammatory therapy, which may inhibit the removal of sclerosed collagen bundles by the cell-mediated immunity and proteolytic digestion of macrophages, and that it was secondarily aggravated by the deposition of immunoglobulins derived from an autoimmune origin. Therefore, even after the successful plastic surgery of the lip to ameliorate the mouth opening difficulty, the recurrent submucosal fibrosis of lip should be carefully managed in the follow-up treatment.