• Maxillofacial Plastic and Reconstructive Surgery
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• 제13권1호
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• pp.110-116
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• 1991

하악골 골절시 감염으로 인한 합병증에는 비유합, 부정유합, 감염에 의한 골수염, 치아 및 지지골 상실, 국소부위로부터 인접부위로 감염확장 등이 있다. 그 원인으로는 크게 국소요인과 전신요인으로 분류되는데 국소요인으로는 부적절한 고정과 수복, 감염 및 개조된 혈액공급을 들 수 있고 전신 요인으로는 부적절한 고정과 수복, 감염 및 개조된 혈액 공급을 들 수 있는 전신요인으로는 환자의 나이 및 대상장애 질환이나 primary bone disease, 영양결핍을 들 수 있다. 악골골절과 관련된 골수염은 조기에 적절한 고정 및 치료, 항생제 요법, 골절선상의 치아에 대한 치료, 전신적 저항성을 항진 시킴으로서 예방할 수 있다. 본 저자들은 하악골 골절수 이차감염으로 인한 골수염에서 골 이식의 일반적인 원칙인 감염이 없는 부위가 아닌 염증이 존재한 부위에 유리장골 이식술과 고압산소 요법을 병행하여 양호한 결과를 얻었기에 이에 보고하는 바이다.

• Imaging Science in Dentistry
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• 제36권1호
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• pp.49-54
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• 2006

Purpose : To evaluate accuracy and reliability of program to measure facial soft tissue thickness using 3D computed tomographic images by comparing with direct measurement. Materials and Methods : One cadaver was scanned with a Helical CT with 3 mm slice thickness and 3 mm/sec table speed. The acquired data was reconstructed with 1.5 mm reconstruction interval and the images were transferred to a personal computer. The facial soft tissue thickness were measured using a program developed newly in 3D image. For direct measurement, the cadaver was cut with a bone cutter and then a ruler was placed above the cut side. The procedure was followed by taking pictures of the facial soft tissues with a high-resolution digital camera. Then the measurements were done in the photographic images and repeated for ten times. A repeated measure analysis of variance was adopted to compare and analyze the measurements resulting from the two different methods. Comparison according to the areas was analyzed by Mann-Whitney test. Results : There were no statistically significant differences between the direct measurements and those using the 3D images (p>0.05). There were statistical differences in the measurements on 17 points but all the points except 2 points showed a mean difference of 0.5 mm or less. Conclusion : The developed software program to measure the facial soft tissue thickness using 3D images was so accurate that it allows to measure facial soft tissues thickness more easily in forensic science and anthropology.

• Maxillofacial Plastic and Reconstructive Surgery
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• 제33권5호
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• pp.375-384
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• 2011

Purpose: The advent of microsurgical technique and instruments, particularly in the field of perforator flap and supermicrosurgery, which have expanded the scope of microsurgery. However, supermicroanastomosis without any compression, tension, or distortions must be achieved to reach successful outcomes. Small-caliber vessels, such as those with an internal diameter less than 0.2 mm, are susceptible to inadvertent twisting of the anastomosis. In this study, using the superficial inferior epigastric artery (SIEA)-based flap model in Sprague-Dawley (SD) rats, we evaluated the acceptable limits of twisting effects on supermicroanastomotic sites. Methods: A total of 20 supermicroanastomoses were performed using the SIEA-based flap model in 10 male SD rats, 10-weeks-of-age, weighing 300~350 g. Rats were divided into five groups of two with four flaps as follows: 1) sham, 2) control group with end to end SIEA arterial supermicroanastomosis, 3) experimental I (EA1) with $90^{\circ}$ twisting, 4) experimental II (EA2) with $180^{\circ}$ twisting, and 5) experimental III (EA3) with $270^{\circ}$ twisting of the supermicroanastomosis. Each SIEA was anastomosed using six 11-0 $Ethilon^{(R)}$ (Ethicon Inc. Co., NJ, USA) stitches except in the sham group where the SIEA was only clamped with Supermicro vascular $clamps^{(R)}$ (S&T, Neuhausen, Switzerland) for 20 minutes. Results: The anastomosed arterial patency showed no remarkable changes according to doppler waveforms measured with a Smardop 45 Doppler System (Hadeco Inc., Kawasaki, Japan). The pulsatility index (PI) was increased at postoperative day 10 in the EA2 and EA3 groups, and the resistance index (RI) showed no statistically significant difference between preoperative and postoperative values at 10 days. Histologic specimens from the EA3 group showed increased tunica media necrosis, convolution of the internal elastic lamina, densely packed platelets, fibrin, and erythrocytes. Flap viability and anastomosed vessel patency were not significantly affected by the degree of arterial twisting in this study, other than in the EA3 group where minor effects on arterial patency of the microanastomoses were encountered. Conclusion: It appears that minor twisting on small caliber arteries, used in supermicroanastomoses, can be tolerated. However, twisting should be avoided as much as possible, and more than $180^{\circ}$ twisting must be prevented in clinical practice.

• Imaging Science in Dentistry
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• 제32권1호
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• pp.35-39
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• 2002

Purpose: The altered gantry angle during scanning for some multiplanar reconstruction CT program (CT/MPR) may cause distortion of the image. The aim of this study was to ascertain whether there is a image distortion in a reformatted image when the gantry and the object are equally inclined using ToothPix and DentaScan program. Materials and Methods: A resin block model with four cylindrical holes and a human dry mandible were used. Two MPR software packages, ToothPix and DentaScan program, were used for reformatted panoramic images. The block and the gantry were equally inclined at 0°, 15°, and 30°. Results: With ToothPix program, a resin block model with empty holes and a dry mandible showed inclined images in the reformatted panoramic image. Increasing the gantry angle, the depth and inclination of the holes were increased in the reformatted central panoramic images. However, a resin block model with gutta perch a in its holes and a dry mandible with a wire in its mandibular canal didn't show image distortion. With DentaScan program, image distortion was not seen in any situation. Conclusion: ToothPix program may distort the reformatted image when the gantry angle is not at zero degrees. However, with DentaScan program, the patient may be positioned comfortably and the gantry can be adjusted to the patient positioning.

• Journal of International Society for Simulation Surgery
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• 제2권2호
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• pp.87-89
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• 2015

Closed reduction using acrylic splints with circummandibular fixation has been known to be useful techniques in pediatric mandibular fractures. However, this technique has some shortcomings, including needs for impression taking or additional laboratory process, which can increase the exposure time of general anesthesia or make an additional sedation visit. Recently, the advancement of computer-aided maxillofacial surgery offers to clinicians to expansion of its application. This case report represents a technique of computer-assisted virtual reconstruction and computer-aided designed splint fabrication in a 2-year-old boy with mandibular body fracture.

• Journal of the Korean Association of Oral and Maxillofacial Surgeons
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• 제37권2호
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• pp.122-126
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• 2011

Introduction: In the lateral window approach for a maxillary sinus bone graft, there has been considerable controversy regarding the placement of a barrier membrane over the osteotomy site. In particular, when there is no damage to the Schneiderian membrane, clinicians should decide whether to use a barrier membrane or not, considering the benefits and costs. This study presents the clinical cases to demonstrate that only repositioning the detached window can lead to satisfactory bony healing of the grafted material without using a barrier membrane in the lateral approach for a maxillary sinus bone graft. Materials and Methods: Five consecutive patients were treated with the same surgical procedures. After performing the antrostomy on the lateral maxillary wall using a round carbide bur and diamond bur, the bony window was detached by a gentle levering action. After confirming no perforation of the Schneiderian membrane, the grafting procedure was carried out the detached window of the lateral maxillary wall was repositioned over the grafted material without using a barrier membrane. A gross examination was carried out at the postoperative 6 month re-entry, and the the preoperative and postoperative dental computed tomography (CT) at re-entry were compared. Results: All the procedures in the 5 patients went on to uneventful healing with no complications associated with the bone graft. Satisfactory bone regeneration without the interference of fibrous tissue on the gap between the repositioned window and lateral wall of the maxillary sinus was observed in the postoperative 6 month re-entry. The CT findings at re-entry revealed the, reconstruction of the external cortical plate including repositioned bony window. In addition, the loss of the discontinuity of the lateral maxillary wall was confirmed. Conclusion: This preliminary report showed that the detached window, which was just repositioned on the grafted material, could function as a barrier membrane in the lateral approach for a maxillary sinus bone graft. Therefore additional morphometric and histologic studies will be needed.

• Maxillofacial Plastic and Reconstructive Surgery
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• 제29권1호
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• pp.55-62
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• 2007

구순열의 일차 수술 또는 이차 수술 후에 발생하는 상순의 지나친 긴장은 상하순 간의 부조화, 상악열성장, 골격성 III급 부정교합 등 안모추형을 초래한다. 상순의 긴장이 매우 심한 경우에는 하순의 여유 있는 조직을 이용하여 상순을 수정하는 Abbe 피판을 고려할 수 있다. 상순의 긴장이 큐피드궁의 2/3 이상의 조직 손실을 동반할 경우 Abbe 피판의 적응증이 된다. Abbe 피판은 상순과 하순의 반흔, 색상의 부조화, 그리고 상순의 불완전한 운동을 초래하는 단점을 가진다. 그러므로 Abbe 피판은 신중하게 사용되어야 한다. 우리는 편측성 구순열 1예와 양측성 구순열 3예에서 상순의 과도한 긴장과 큐피드궁의 조직 결핍 그리고 비변형이 심한 이차성 구순열비변형을 교정하기 위해 세 가지 형태의 Abbe 피판을 이용한 이차 교정술을 경험하였다. Abbe 피판수술을 시행한 결과 상순의 반흔과 긴장이 해소되고 큐피드궁이 재건되고 비주의 길이가 증가되어 이차 구순열비변형을 교정할 수 있었다. Abbe 피판은 신중을 기해 적용한다면 구순열 수술 후에 발생되는 상순의 수평적 긴장감이나 편평함을 해결하는 데 유용한 술식임을 알 수 있었다.

• Maxillofacial Plastic and Reconstructive Surgery
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• 제28권2호
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• pp.118-126
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• 2006

In oral and maxillofacial surgery, bone graft is very important procedure for functional and esthetic reconstruction. So, many researcher studied about bone graft material like autogenous bone, allograft bone and artificial bone materials. The purpose of this study is to evaluate the quantity of bone generation induced by $Grafton^{(R)}$ graft, human allogenic demineralized bone matrix. Total 24 sites of artificial bony defects prepared using trephin bur(diameter 8 mm) on parietal bone of six adult New Zealand White rabbits. Experimental group had six defect sites which grafted $Grafton^{(R)}$(0.1 cc). Active control group had nine defect sites, into which fresh autogenous bone harvested from own parietal bone was grafted and passive control group had nine defect sites without bone graft. After six weeks postoperatively, the rabbits were sacrificed. The defects and surrounding tissue were harvested and decalcified in 10% EDTA, 10% foamic-acid. Specimens were stained with H&E. New bone area percentage in whole defect area was measured by IMT(VT) image analysis program. Quantity of bone by $Grafton^{(R)}$ graft was smaller than that of autograft and larger than that of empty defects. In histologic view $Grafton^{(R)}$ graft site and autograft site showed similar healing progress but it was observed that newly formed bone in active control group was more mature. In empty defect, quantity and thickness of new bone formation was smaller than in $Grafton^{(R)}$-grafted defect. $Grafton^{(R)}$ is supposed to be a useful bone graft material instead of autogenous bone if proper maintenance for graft material stability and enough healing time were obtained.

• Maxillofacial Plastic and Reconstructive Surgery
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• 제22권1호
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• pp.92-97
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• 2000

하악골에서 low grade 골육종은 매우 드물게 보고되고 있으며 조직검사상 conventional osteosarcoma와는 달리 pleomorphism을 보이지 않기 때문에 양성종양으로 underdiagnosis되기 쉽다. 그러나 정확한 환자의 진단은 적절한 치료와 환자의 예후에 영향을 큰 영향을 미친다. 그러므로 조기에 정확한 진단을 위하여는 의심되는 여러부위에서 조직검사를 시행하고 임상소견과 방사선소견 등을 병리의사와 공유하여야 한다. 이에 저자들은 초기에 진단이 어려웠던 하악골에 발생된 low grade 골육종을 경험하였기에 문헌고찰과 함께 보고하는 바이다.

• 대한구순구개열학회지
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• 제13권1호
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• pp.35-42
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• 2010

한국얼굴기형환자 후원회 의료봉사팀은 2010년 2월 6일에서 12일까지 라오스의 수도인 Vientiane을 방문하여 구순구개열 무료수술을 무사히 마쳤다. 의료봉사팀은 총 11명으로 구성되었다. 구강악안면외과의 6명과 간호사 2명, 학생 3명이었다. 수술은 라오스 비엔찬의 Mahosot 병원에서 수술장 한개에 수술 침대를 두개 놓고, 두팀을 구성하여 수술을 진행하였다. 당시 서울대학교 치과대학 예방치학교실 백대일 교수님께서 안식년을 맞아 라오스에서 라오스인 구강건강에 관한 national survey를 수행하고 계셨는데 수술팀에게 많은 도움을 주셨다. 2월 7일 토요일 예진 때는 한국국제협력단에서 파견한 국제협력의사 박병원 선생님(내과 전문의)께서 통역으로 도와 주셨다. 총 30명의 환자가(남:여=14:16) 수술을 받았으며, 환자들의 평균 나이는 9.7세였다. 수술 종류는 cheiloplasty, palatoplasty, rhinoplasty, scar revision, lip reconstruction로 구분 지을 수 있었으며, 모든 수술은 합병증 없이 마무리되었다. 이번 자선수술을 통해 30명의 환자를 수술하였고, 라오스 의사들에게 구순구개열 진료에 대한 기술을 교육할 수 있었다. 또 라오스 치과대학과 자매결연을 맺는 등 한국-라오스 우호증진에 많은 기여를 한바 이를 보고한다.