• 대한구순구개열학회지
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• 제7권1호
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• pp.17-24
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• 2004

Cleft lip and palate are most common congenital defomity to affect the orofacial region. Cleft lip and palate are caused by abnormal development of primary and secondary palate. Its causative mechanism is not completely understood, but genetic and environmental factors play important roles. Lots of epidemiologic surveys have been done extensively about incidence, racial influence, sex ratio, parent age, associated syndrome and genetic factors. These researches are useful to dissolve many problems in prevention and treatment of cleft lip and palate. We performed epidemiologic survey of cleft lip and palate who visited the department of Oral and Maxillofacial Surgery, Guro hospital of Korea University from 1995 to 2004.

• Journal of the Korean Association of Oral and Maxillofacial Surgeons
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• 제44권4호
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• pp.159-166
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• 2018

Objectives: The aim of the study was to compare wound healing complications following the use of either absorbable or non-absorbable sutures for skin closure in cleft lip repair. Materials and Methods: This was a randomized controlled trial conducted at the Department of Oral and Maxillofacial Surgery, Lagos University Teaching Hospital, Idi Araba, Lagos State, Nigeria. Sixty subjects who required either primary or secondary cleft lip repair and satisfied all the inclusion criteria were recruited and randomized into two groups (Vicryl group or Nylon group). The surgical wounds in all subjects were examined on 3rd, 7th, and 14th postoperative days (POD) for presence or absence of tissue reactivity, wound dehiscence, and local wound infection. Results: Hemorrhage, tissue reactivity, wound dehiscence, and local wound infection were identified as wound healing complications following cleft lip repair. The incidence of postoperative wound healing complications on POD3 was 33.3%. Tissue reactivity was more common throughout the evaluation period with the use of an absorbable (Vicryl) suture compared to a non-absorbable (Nylon) suture, although the difference was statistically significant only on POD7 (P=0.002). There were no significant differences in the incidences of wound dehiscence and infection between the two groups throughout the observation period. Conclusion: There were no statistically significant differences in the incidences of wound dehiscence and surgical site wound infection following the use of either Vicryl or Nylon for skin closure during cleft lip repair. However, more cases of tissue reactivity were recorded in the Vicryl group than in the Nylon group on POD7. Particular attention must be paid to detect the occurrence of wound healing complications, most especially tissue reactivity, whenever a Vicryl suture is used for skin closure in cleft lip repair.

• 대한구순구개열학회지
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• 제4권2호
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• pp.9-18
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• 2001

구순구개열은 악안면 영역의 선천기형 중 발생빈도가 가장 높으며 출생시부터 성장완료 시기까지 일관된 치료계획에 의한 종합적 진료체계가 필수적이다. 구순구개열의 개선을 위한 구개부 및 입숭? 조기 봉합 후의 반흔조직의 형성은 치열궁 협착 뿐 아니라 상악골 열성장에 의한 중안모의 함몰을 야기하며 이러한 상악골의 열성장 경향은 연령이 증가할수록 점진적으로 증가하는 성향을 보인다. 따라서, 성장잠재력을 이용한 조기의 악정형치료는 구순구개열 환자에서 반드시 필요하며, 적절한 치료 결과를 얻어내기 위하여 환자의 전후방 골격 형태 뿐 아니라, 성장 방향에 대한 고려가 필요하다. 그러나 혼합치열기의 악정형치료는 좋은 결과를 얻었다 하더라도 높은 재발 성향 및 잔여성장에 의한 악골관계의 변화가 예상되므로 장기간의 보정이 필수적이며 성장에 대한 지속적 평가가 이루어져야 할 것이다.

• Archives of Plastic Surgery
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• 제46권1호
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• pp.16-22
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• 2019

Background Various surgical techniques have been used to correct Tessier number 7 craniofacial cleft, which involves macrostomia, ear deformity, and hemifacial microsomia. To achieve symmetrical and satisfactory results in patients with macrostomia, the authors performed a 1-mm medial overcorrection on the cleft side and evaluated the results of this procedure. Methods A retrospective medical record review of patients diagnosed with Tessier number 7 craniofacial cleft from March 1999 to February 2017 was performed. Using clinical photographs, outpatient clinic records, and operative records, information was recorded regarding concurrent congenital anomalies, postoperative complications, and follow-up. Using Photoshop CS2, the length of both sides of the lip was compared. The ratio of these lengths was calculated to evaluate lip symmetry. Results Of the patients treated at the Department of Plastic and Reconstructive Surgery at Kyungpook National University Chilgok Hospital, 11 (male-to-female sex ratio, 7:4) were diagnosed with Tessier number 7 craniofacial cleft. Concurrent congenital anomalies included skin tag, hemifacial microsomia, and cleft palate. The mean duration of follow-up was $78.273{\pm}72.219$ months and the mean ratio of the lengths of both sides of the lip was $1.048{\pm}0.071$. Scar widening occurred as a postoperative complication in some patients. No cases of wound infection, bleeding, or wound dehiscence occurred. Conclusions For the successful correction of macrostomia, plastic surgeons should consider both functional and aesthetic problems of the lip. Adequate repair of the orbicularis oris muscle, skin closure with Z-plasty, and medial overcorrection of the neo-oral commissure led to good results in our patients.

• 대한구순구개열학회지
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• 제4권1호
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• pp.13-26
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• 2001

Cleft lip and/or palate is the congenital orofacial malformation most commonly occurred in humans, The disease is multifactorial and is probably caused by genetic and/or environmental factors, So, there are many problems in research concerning etiology and in treatment of the disease, Even the most practiced and sophisticated methods of surgical repair are necessarily followed by scar contraction and fibrosis, which result in skeletal defects, dental abnormalities, cosmetic disfigurement, and speech impairment, As a result, Fetal surgery can be considered but practiced rarely when the deformity is not fatal to life, And treatment of cleft palate is performed in the form of medicine projection into uterus in animal experiments, Many studies show that growth factor and its receptor emerge from the developing palate; and the epidermal growth factor receptors have a important role in craniofacial development and in palatal fusion, The palatal morphogenesis of the avine is different from the mammal's; it takes the form of physiologic cleft palate, Recently, cleft palate fusion experiment was performed when the avine were in the period of palate formation through the exogenous TGF-β3 addition, and it showed that the exogenous TGF-β3 makes fusion of divided palate through certain process when cleft palate is occurred in palatal formation, In this study, I had the conformation of the fusion of cleft palate through the addition of TGF-β in case of chicken embryo, and observed the effect of TGF-β in EGF receptor distribution, And the following is the results of this study, 1. In case of the TGF-βl and β3 addition group, there was the decrease of EGFR(Epidermal Growth Factor Receptor) immunoreactivity in mesenchymal cells beneath the medial edge epithelium and also in epithelial mesenchymal interface which is between medial edge epithelium and nasal septum in 72 hours, 2, The immunoreactivity of the control group resembles that of normal chicken embryo palate in development, 3. In the view through fluorescence confocal microscopy, there was confluence in TGF-β3 addition group, This shows that the confluence induced by exogenous TGF-β3 is related to EGFR expression in palate of chicken embryo, which is a physiologic cleft palate model.

• Archives of Plastic Surgery
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• 제44권3호
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• pp.202-209
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• 2017

Background No consensus exists on the optimal treatment protocol for orofacial clefts or the optimal timing of cleft palate closure. This study investigated factors influencing speech outcomes after two-stage palate repair in adults with a non-syndromal complete unilateral cleft lip and palate (UCLP). Methods This was a retrospective analysis of adult patients with a UCLP who underwent two-stage palate closure and were treated at our tertiary cleft centre. Patients ${\geq}17$ years of age were invited for a final speech assessment. Their medical history was obtained from their medical files, and speech outcomes were assessed by a speech pathologist during the follow-up consultation. Results Forty-eight patients were included in the analysis, with a mean age of 21 years (standard deviation, 3.4 years). Their mean age at the time of hard and soft palate closure was 3 years and 8.0 months, respectively. In 40% of the patients, a pharyngoplasty was performed. On a 5-point intelligibility scale, 84.4% received a score of 1 or 2; meaning that their speech was intelligible. We observed a significant correlation between intelligibility scores and the incidence of articulation errors (P<0.001). In total, 36% showed mild to moderate hypernasality during the speech assessment, and 11%-17% of the patients exhibited increased nasalance scores, assessed through nasometry. Conclusions The present study describes long-term speech outcomes after two-stage palatoplasty with hard palate closure at a mean age of 3 years old. We observed moderate long-term intelligibility scores, a relatively high incidence of persistent hypernasality, and a high pharyngoplasty incidence.

• 대한구순구개열학회지
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• 제2권1_2호
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• pp.29-41
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• 1999

구순구개열은 악안면의 선천기형중 발생빈도가 가장 높은 것으로 알려져 있으며,출생시부터 성장이 완료되는 시기까지 일관된 치료계획에 의한 종합적인 진료체계가 필수적이다. 구순구개열이 존재할 경우 구개부의 조기 봉합후의 반흔조직 형성으로 인한 치열궁의 협착 또는 중안모의 함몰 경향과 함께 상악 측절치의 선천적 결손 또는 기형치, 전치의 회전과 경사 등이 수반되므로 교정치료에 의한 기능적, 심미적인 치열의 회복이 필요하게 된다. 구순구개열 환자의 교정치료에 있어서 상악치열의 정상적인 배열과 구치부 반대교합의 치료를 위해 상악골 확대가 종종 필요하며, 이를 위하여 Hyrax appliance, Quad-helix 및 Fan-type expansion screw, Jointed fan type expander 등 다양한 장치가 활용될 수 있다. 심하지 않은 구순구개열 환자의 교정치료에서 상악골 확대를 위한 장치의 선택은 환자의 치열궁 형태, 연령, 구치부와 전치부의 치열궁 폭경 등 다양한 요인이 고려되어야 하며, 치료 후 악궁형태의 보정에 특별한 주의를 기울여야 할 것이다.

• Journal of the Korean Association of Oral and Maxillofacial Surgeons
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• 제32권1호
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• pp.19-26
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• 2006

Objective: In order to elucidate the retrogressive degeneration of orofacial cleft, the fissured tissues of prenatal and postnatal cleft lip and palate were examined by histological and immunohistochemical methods. Design: Totally 42 cases of prenatal (n=17) and postnatal (n=25) cleft lip and/or palate were examined in comparison with 10 cases of normal lip and oral mucosa using immunohistochemical stainings of MMP-3, MMP-9, MMP-10, cathepsin G, PCNA, E-cadherin, TGase 2, HSP-70, vWF, and VEGF. Main Outcome Measures: In the fissured tissue the sebaceous glands were strongly positive for PCNA and grew into the underlying fibromuscular tissue (24/42). Some hyperplastic sebaceous glands of prenatal cleft lip produced infundibular follicular cyst (9/17). The skin and mucosal epithelia from the postnatal cleft lip and palate (10/25) showed severe basal hyperplasia (11/25) and melanocyte infiltration (7/25). Results: The immunostaining of MMP-3 and HSP-70 were strongly positive in the hyperplastic sebaceous glands and nearby atrophying muscle bundles of the fissured tissue, while MMP-9, MMP-10, and cathepsin G were almost negative. The immunoreactions of the other antibodies used in this study were similar between in the fissured tissues and in the normal controls. Conclusions: These data suggest that the over-expression of MMP-3 is closely related to the sebaceous gland hyperplasia, epithelial dysplasia, and the muscle degeneration, and that the over-expression of MMP-3 in the fissured tissue may continuously aggravate the cleft condition in the later life.

• 대한소아치과학회지
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• 제24권2호
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• pp.352-360
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• 1997

구순 구개열 신생아는 출생시부터 수유의 어려움을 비롯하여 중이염, 언어장애, 부정교합, 부적절한 악안면 성장과 이로 인한 정신적 손상등에 직면하게 된다. 이런 복합적인 문제를 갖고 있는 신생아의 전반적인 치료를 위해서는 여러 관련분야 전문가들의 포괄적인 관리가 필요하다. 특히 수유의 어려움은 유아의 영양 상태를 좌우할 수 있는 중요한 문제이므로 가장 먼저 관리하여야 할 부분이다. Obturator의 사용은 수유보조의 역할 뿐만 아니라 구강과 비강을 구분하여 중이염의 발생빈도를 감소시키고, 구개판의 성장을 촉진시키며, 정상적인 구강 안면조직의 발달을 유도할 수 있다. 소아치과의사는 구순 구개열 신생아의 정상적인 성장, 발육을 위해 출생 직후 부모에게 적절한 수유방법의 조언과 함께 obturator 를 장착해 주고, 다른 team과 긴밀한 협진을 통해 유치열기, 혼합치열기까지 지속적으로 치과적 관리를 제공하여야 한다.

• 대한두개안면성형외과학회지
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• 제24권4호
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• pp.185-188
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• 2023

Rhabdomyosarcoma is the most common soft tissue sarcoma in children, accounting for 4.5% of all cases of cancer in childhood. Although the head and neck are the most common sites of rhabdomyosarcoma, oral lesions are relatively rare and account for only 10% to 12% of head and neck rhabdomyosarcoma cases. This is a case report of a girl aged 2 years and 1 month who initially presented with an upper lip mass that invaded the oral mucosa, oral skin, and nostril skin, causing narrowing of the airway. Through our case, we show that rapidly growing small round cell malignancies, especially rhabdomyosarcoma, can be effectively diagnosed and treated at the same time using primary resection with intraoperative frozen section biopsy and that the time spent waiting for the results of preoperative biopsy can be saved in this way, particularly when the patient's symptoms are intensifying rapidly and require immediate operation.