• 수면정신생리
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• 제12권2호
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• pp.105-110
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• 2005

The pathogenesis and mechanism of obstructive sleep apnea (OSA) has been under investigation for over 25 years, but its etiology and mechanism remains elusive. Skeletal (maxillary and/or mandibular hypoplasia or retrodisplacement, inferior displacement of hyoid) and soft tissue (increased volume of soft tissue, adenotonsillar hypertrophy, macroglossia, thickened lateral pharyngeal walls) factors, pharyngeal compliance (increased), pharyngeal muscle factors (impaired strength and endurance of pharyngeal dilators and fixators), sensory factors (impaired mechanoreceptor sensitivity, impaired pharyngeal dilator reflexes), respiratory control system factors (unstable respiratory control) and so on facilitate collapse upper airway. Therefore, OSA may be a heterogeneous disorder, rather than a single disease entity and various pathogenic factors contribute to the OSA varies person to person. As a result, patients may respond to different therapeutic approaches based on the predominant abnormality leading to the sleep-disordered breathing.

• 대한두경부종양학회지
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• 제26권2호
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• pp.221-224
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• 2010

Papillary thyroid carcinoma frequently invades the lymph node, trachea, esophagus and perithyroid tissue. However, direct extension to posterior pharyngeal area is known to be rare. A 64-year-old male was referred to our clinic presenting as posterior pharyngeal mass during gastrofiberscopy. The neck CT scan showed soft tissue mass in retropharynx and lymph node in right level III with calcifications. We performed the total thyroidectomy with selective(level II, III, IV) and anterior compartment neck dissection. In operative findings, the right thyroid mass were connected to the retropharynx through the posterior portion of inferior constrictor muscle. Histopathologic findings revealed the papillary thyroid carcinoma extended to retropharynx. We report a unique case with a literature review.

• Archives of Plastic Surgery
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• 제33권4호
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• pp.407-412
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• 2006

Purpose: Various attempts of reconstruction for pharyngoesophageal defects after ablative surgery have been made to restore the function of the pharyngoesophagus. A fabricated tubed radial forearm free flap or free jejunal free flap was used when the width of remnant pharyngeal wall was less than 50% of the normal width. However there are many disadvantages such as stricture, saliva leakage and fistula formation on tubed radial forearm free flap. The jejunal free flap has the problem such as short pedicle, poor tolerance of ischemic time, wet voice and delayed transit of swallowed food due to the uncoordinated contraction. The authors studied the utility of patch-type radial forearm free flap using the remnant posterior pharyngeal wall of the hypopharynx. Methods: Retrospective reviews in Severance Hospital were made on 25 patients who underwent reconstruction surgery with patched radial forearm free flap because of the hypopharyngeal cancer between 1996 and 2005. The patients of Group I had the narrow posterior pharyngeal wall and its width was less than 3centimeters after the tumor was resected. Those of Group II had the partial pharyngectomy and the width of the remnant pharynx was larger than 3 centimeters. Results: Seven patients belonged to the group I and the flap of this group had 100% survival rate. One case of fistula and no swallowing discomfort due to stricture was reported. The Group II including 18 patients also had the 100% flap survival rate. Neither fistula nor stricture was seen but the lower diet grade was checked. Conclusion: The patch type radial forearm free flap using the remnant pharyngeal wall have the advantage of the radial forearm free flap, and furthermore this flap is the safe reconstructive method even if the width of the remnant pharyngeal wall is less than 30% of that of normal pharynx.

• 대한의용생체공학회:의공학회지
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• 제24권6호
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• pp.515-522
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• 2003

인두는 구강과 식도, 비강과 폐의 중간에서 능동적으로 구강을 통해 섭취되는 음식물과 비강을 통해 흡입되는 공기의 통로역할을 하는 주요한 기관이다. 본 연구는 유한요소기법을 이용한 인두의 3차원 구조의 재구성 과정을 거쳐 인두의 생체역학모델을 구현하였으며, 연하곤란환자의 인두근육의 주요부분에 대한 구조적 변형특성을 3가지로 분류하여 유한요소기법을 이용하여 인두내의 압력에 대한 형상의 변형을 관찰 후 최적화 과정을 거쳐 각 부분에서의 추정 압력 구배를 측정하여 연하과정에서 내부에 생성되는 압력의 연속적인 압력분포를 추정하였다. CT에 의한 인두의 변형 형상을 추정하여 임의 압력에 의한 인두구조의 변형 형상을 유한요소 해석에 의해 계산한 후 비교하여 실제 인두강 내에 형성되는 압력을 추정하였다. 재료적 특성은 인두의 기능이상 시 근조직경화가 발생, 즉 stiffness 가 증가하는 것으로 가정하여 응력-변형률 관계에 있어서 각각 $25\%,\;50\%,\;75\%$씩 증가시켜 분석하였다. 이러한 인두의 생체역학모델은 인두기능장애를 가진 환자의 치료 계획 수립에 도움이 되는 유용한 자료를 제공 할 것으로 생각된다.

• 대한의용생체공학회:의공학회지
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• 제19권5호
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• pp.495-502
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• 1998

Y.C. Fung[1]에 의한 연조직의 점탄성에 관한 수학적 모델이론 (Fung's Quasi-linear vlscoelastic theory)을 이용하여 인간의 인두조직의 점탄성(vlscoelatlcity)특성을 측정하기 위하여 반복성하중(cyclic load) ,응력완화 (tensile stress relaxation), incremental load, 그리고 일축성인장 (uniaxial tensile) 시험 등을 실시하였다. 실험적으로 측정한 인두조직의 점탄성특성이 이미 조사된 다른 조직의 점탄성특성과 정량적으로 비교되었다. 인두조직의 점탄성특성의 정량화를 위하여 Y.C.Fung의 수학적 모델이 적용되었는데 응력완화(tensile stress relaxation) 시험 측정결과로부터 도출된 표준화된 응력완화(reduced stress relaxation)함수 G(t)와 일축성인장(uniaxial tensile)시험에서 도출된 탄성반응(elastic response)함수 5(t)를 이용하여 시간에 따른 응력의 궤적을 산출하여 이를 반복성 하중(cyclic load)실험에서 측정된 결과와 비교, 분석하였다. 이러한 인두조직의 점탄성특성에 관한 연구결과는 향후 유한요소를 이용한 인두의 생체역학적 모델의 기본 데이터로 이용될 수 있다.

• 한국동물학회지
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• 제28권4호
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• pp.211-226
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• 1985

실험에 사용한 플라나리아는 Dugesia japonia Ichikawa et Kawakatsu로서 核型分析에 의하여 種을 확인하였다. 이 種의 咽頭 및 腸을 구성하는 세포들의 세포화학적 및 미세구조적 특징을 밝히고자 본 실험을 行하였다. 세포화학적 방법으로는 hematoxylin-eosin, periodic acid-Schiff(PAS) 反應, alcian blue(pH 2.5), PAS-alcian blue 反應 그리고 methylene blue-basic fuchsin등으로 염색을 시행하고, 光學顯微鏡으로 관찰하였으며 또한 各部位의 微細構造를 透査電子顯微鏡으로 관찰하여 다음과 같은 결과를 얻었다. 1. 咽頭(pharynx) 內腔上皮는 遊離面에 미세융모를 가지고 있었다. 세포질에는 PAS반응에 양성을 나타내는 약 0.4$\\times$0.6 $\\mum$의 과립들이 있고, 小胞 및 液胞가 분화되어 있었다. 핵은 基底部 쪽으로 치우쳐져 있고 基底膜은 관찰되지 않았다. 咽頭外腔의 咽頭 측상피에서는 섬모와 미세융모가 발달되어 있었고 上皮內側에는 근육층이 발달되어 있었다. 咽頭外腔을 둘러싸는 壁側上皮細胞에서는 미세융모가 관찰되었고 세포질에는 전자밀도가 높은 과립들이 포함되어 있었다. 2. 腸(caeca) 腸上皮細胞는 食細胞와 顆粒性棍棒體細胞 그리고 이 세포들을 둘러싸고 있는 貯藏細胞와 幼若貯藏細胞로 구성되어 있었다. 1) 食細胞(phagocytic cell) 세포질에는 비교적 많은 lysosome을 포함하고 있었으며 無顆粒性小胞體와 mitochondria등의 細胞小器官도 잘 발달되어 있었다. 특히 無顆粒性小胞體의 cisternae는 대부분 팽윤되어 있었고 polyribosome도 풍부하게 관찰되었다. 2) 顆粒性棍棒體細胞(granular club cell) 세포질에는 PAS 반응에 강한 양성을 보이고 또 약한 eosinophilia도 나타내는 약 5 $\\mum$의 球形의 과립들을 포함하고 있었다. 특히 顆粒性小胞體가 잘 발달되어 있어TEk. 3) 貯藏細胞(storage cell) 세포질내에는 glycogen 과립들과 PAS에 각기 다른 정도의 양성반응을 보이는 다수의 中性多糖性 과립과 脂肪顆粒들이 포함되어 있었다. 4) 幼若貯藏細胞(immature storage cell) 세포질에는 PAS반응에 양성을 보이는 소수의 작은과립과 脂肪顆粒이 내포되어 있으며 세포질에 비하여 핵은 매우컸다. 핵막 주위의 세포질에서는 chromatoid body들이 관찰되었다.

• Archives of Plastic Surgery
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• 제38권4호
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• pp.438-444
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• 2011

Purpose: Adipose-derived stromal cells (ASCs) are readily harvested from lipoaspirated tissue or subcutaneous adipose tissue fragments. The stromal vascular fraction (SVF) is a heterogeneous set of cell populations that surround and support adipose tissue, which includes the stromal cells, ASCs, that have the ability to differentiate into cells of several lineages and contains cells from the microvasculature. The mechanisms that drive the ASCs into the osteoblast lineage are still not clear, but the process has been more extensively studied in bone marrow stromal cells. The purpose of this study was to investigate the osteogenic capacity of adipose derived SVF cells and evaluate bone formation following implantation of SVF cells into the bone defect of human phalanx. Methods: Case 1 a 43-year-old male was wounded while using a press machine. After first operation, segmental bone defects of the left 3rd and 4th middle phalanx occurred. At first we injected the SVF cells combined with demineralized bone matrix (DBM) to defected 4th middle phalangeal bone lesion. We used P (L/DL)LA [Poly (70L-lactide-co-30DL-lactide) Co Polymer P (L/DL)LA] as a scaffold. Next, we implanted the SVF cells combined with DBM to repair left 3rd middle phalangeal bone defect in sequence. Case 2 was a 25-year-old man with crushing hand injury. Three months after the previous surgery, we implanted the SVF cells combined with DBM to restore right 3rd middle phalangeal bone defect by syringe injection. Radiographic images were taken at follow-up hospital visits and evaluated radiographically by means of computerized analysis of digital images. Results: The phalangeal bone defect was treated with autologous SVF cells isolated and applied in a single operative procedure in combination with DBM. The SVF cells were supported in place with mechanical fixation with a resorbable macroporous sheets acting as a soft tissue barrier. The radiographic appearance of the defect revealed a restoration to average bone density and stable position of pharyngeal bone. Densitometric evaluations for digital X-ray revealed improved bone densities in two cases with pharyngeal bone defects, that is, 65.2% for 4th finger of the case 1, 60.5% for 3rd finger of the case 1 and 60.1% for the case 2. Conclusion: This study demonstrated that adipose derived stromal vascular fraction cells have osteogenic potential in two clinical case studies. Thus, these reports show that cells from the SVF cells have potential in many areas of clinical cell therapy and regenerative medicine, albeit a lot of work is yet to be done.

• Maxillofacial Plastic and Reconstructive Surgery
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• 제39권
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• pp.22.1-22.9
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• 2017

Background: Two-jaw surgery including mandibular and maxillary backward movement procedures are commonly performed to correct class III malocclusion. Bimaxillary surgery can reposition the maxillofacial bone together with soft tissue, such as the soft palate and the tongue base. We analyzed changes of pharyngeal airway narrowing to ascertain clinical correlations with the prevalence of snoring after two-jaw surgery. Methods: A prospective clinical study was designed including a survey on snoring and three-dimensional (3D) computed tomography (CT) in class III malocclusion subjects before and after bimaxillary surgery. We conducted an analysis on changes of the posterior pharyngeal space find out clinical correlations with the prevalence of snoring. Results: Among 67 subjects, 12 subjects complained about snoring 5 weeks after the surgical correction, and examining the 12 subjects after 6 months, 6 patients complained about the snoring. The current findings demonstrated the attenuation of the largest transverse width (LTW), anteroposterior length (APL), and cross-sectional area (CSA) following bimaxillary surgery given to class III malocclusion patients, particularly at the retropalatal level. The average distance of maxillary posterior movements were measured to be relatively higher (horizontal distance 3.9 mm, vertical distance 2.6 mm) in case of new snorers. Conclusions: This study found that bimaxillary surgery could lead to the narrowing of upper airway at the retropalatal or retroglossal level as well as triggering snoring in subjects with class III malocclusion. Based on the current clinical findings, we also found that upper airway narrowing at retropalatal level may contribute to increasing the probability of snoring and that polysonography may need to be performed before orthognathic surgery in subjects with class III malocclusion.

• 대한치과교정학회지
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• 제18권2호
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• pp.343-366
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• 1988

Craniofacial complex is influenced by numerical skeletal elements. Though the analysis of growth change has been done by various analytical methods, it was dependent on any method of registration and superimposition, based on reference plane and reference point. However, the craniofacial growth is composed of a number of local growth elements. Therefore, it will be necessary to use a clinically useful method for estimating craniofacial skeletal growth independently. The author analysed longitudinal cephalometric roentgenogram of 15 Korean males and 15 Korean females aged from 6 to 12 years by the finite element method and results were as follows : 1. The finite element method for craniofacial skeletal complex and soft tissue made it possible to analyze the independent local growth. 2. Regression equations from the value of each strain will make it possible to predict the craniofacial growth. 3. The growth of anterior cranial base was different from that of other facial bone. 4. The growth of posterior cranial base influenced the growth of upper pharyngeal region, midfacial region, maxilla and posterior region of mandible. 5. The growth of maxillary complex was vertical rather than horizontal. 6. The growth direction of ramus, mandibular body, alveolar bone was various. 7. The relation between hard tissue and soft tissue by finite element method was variant.

• The Journal of Advanced Prosthodontics
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• 제4권4호
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• pp.243-247
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• 2012

The velopharynx is a tridimensional muscular valve located between the oral and nasal cavities, consisting of the lateral and posterior pharyngeal walls and the soft palate, and controls the passage of air. Velopharyngeal insufficiency may take place when the velopharyngeal valve is unable to perform its own closing, due to a lack of tissue or lack of proper movement. Treatment options include surgical correction, prosthetic rehabilitation, and speech therapy; though optimal results often require a multidisciplinary approach for the restoration of both anatomical and physiological defect. We report a case of 56 year old male patient presenting with hypernasal speech pattern and velopharyngeal insufficiency secondary to cleft palate which had been surgically corrected 18 years ago. The patient was treated with a combination of speech therapy and palatal lift prosthesis employing interim prostheses in various phases before the insertion of definitive appliance. This phase-wise treatment plan helped to improve patient's compliance and final outcome.