• Maxillofacial Plastic and Reconstructive Surgery
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• v.34 no.3
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• pp.186-199
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• 2012

Purpose: Single implants, of which screw loosening has been observed frequently, presents problems such as fixtures fractures, marginal bone loss, and inflammation of the soft tissue around the implant. However, the single implant is more conservative, cost effective, and predictable compared to the 3 unit bridge with respect to the long-term outcome. This study evaluated the survival rate as well as future methods aimed at increasing the survival rate in single implants in posterior teeth. Methods: Among the implants placed in the Dankook University Dental Hospital department of Oral & Maxillofacial surgery from January 2001 to June 2008, 599 implants placed in the maxillar and mandibular posterior were evaluated retrospectively. Survival rates were investigated according to implant location, cause of tooth loss, gender, age, general disease, fixture diameter and length, surface texture, implant type and shape, presence of bone graft, surgery stage, surgeons, bone quality and opposite teeth. Results: Out of 599 single implants in posterior teeth, 580 implants survived and the survival rate was 96.8%. The difference in survival rate was statistically significant according to the implant location. The survival rate was low (84.2%) in implants exhibiting a wide diameter (${\geq}5.1mm$) and the surface treated by the acid etching group demonstrated a significantly lower survival rate (91.1%). One stage surgical procedure, which implemented a relatively better bone quality survival rate (100%), was higher than the two stage surgical procedure (96.1%). The survival rate of type IV bone quality (75%) was significantly lower than the other bone quality. Conclusion: Single posterior teeth implant treatments should use an improved surface finishing fixture as well as careful and safe procedures when performing implant surgery in the maxilla premolar and molar regions since bone quality is poor.

• Maxillofacial Plastic and Reconstructive Surgery
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• v.32 no.1
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• pp.37-42
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• 2010

Purpose: The mental foramen (MF) is an important anatomical structure during local anesthesia and surgical procedures in terms of achieving effective mental nerve blocks and avoiding injuries to the neurovascular bundles. Thus, understanding the anatomic features of the mandibular canal and accessory mental foramen in Korean could contribute to the surgical anatomic assessment. This study was to elucidate frequency, position and course of AMF (accessory mental foramen) in Korean using 3D cone beam computed tomography. Materials and Methods: The CBCT (Conbeam computed tomography) DICOM data (Alphard, Asahi, Japan) from 540 patients in korean were analyzed. We investigated images of 3D CBCT using Ondemand (CyberMed, Korea) software program on the incidence and anatomical characteristics of accessory foramen. Results: The accessory mental foramina were found in 17 patients. Accessory mental foramina exist predominantly in the apical area of the second premolar and posteroinferior area of the mental foramen. The accessory branches of the mandibular canal showed common characteristics in the course of gently sloping posterosuperior direction in the buccal surface area. The size of most AMF was obviously smaller than that of MF. Conclusion: We could identify frequency, position and course of AMF (accessory mental foramen) by the anatomical study of the accessory mental foramen using 3D cone beam CT in Korean.

• Journal of the Korean Academy of Esthetic Dentistry
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• v.10 no.1
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• pp.30-45
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• 2001

In recent years, clinicians' and dentists' esthetic demands in dentistry have increased rapidly. The ultimate goal in modern restorative dentistry is to achieve "white" and "pink" esthetics in the esthetically important zones. Therefore, modern esthetic dentistry involves not only the restoration of lost teeth and their associated hard tissues, but increasingly the management and reconstruction of the encasing gingiva with adequate surgical techniques. Interdental space are filled by interdental papilla in the healthy gingiva, preventing plaque deposition and protecting periodontal tissue from infection. This also inhibits impaction of food remnants and whistling through the teeth during speech. These functional aspects are obviously important, but esthetic aspects are important as well. Complete and predictable restoration of lost interdental papillae remains one of the biggest challenges in periodontal reconstructive surgery. One of the most challenging and least predictable problems is the reconstruction of the lost interdental papilla. The interdental papilla, as a structure with minor blood supply, was left more or less untouched by clinicians. Most of the reconstructive techniques to rebuild lost interdental papillae focus on the maxillary anterior region, where esthetic defects appear interproximally as "black triangle". Causes for interdental tissue loss are, for example, commom periodontal diseases, tooth extraction, excessive surgical periodontal treatment, and localized progressive gingiva and periodontal diseases. If an interdental papilla is absent because of a diastema, orthodontic closure is the treatment of choice. "Creeping" papilla formation has been described by closing the interdental space and creating a contact area. In certain cases this formation can also be achieved with appropriate restorative techniques and alteration of the mesial contours of the adjacent teeth. The presence of an interdental papilla depends on the distance between the crest of bone and the interproximal contact point, allowing it to fill interdental spaces with soft tissue by altering the mesial contours of the adjacent teeth and positioning the contact point more apically. The interdental tissue can also be conditioned with the use of provisional crowns prior to the definitive restoration. If all other procedures are contraindicated or fail, prosthetic solutions have to be considered as the last possibility to rebuild lost interdental papillae. Interdental spaces can be filled using pink-colored resin or porcelain, and the use of a removable gingival mask might be the last opportunity to hide severe tissue defects.

• Archives of Plastic Surgery
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• v.40 no.2
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• pp.104-108
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• 2013

Background Microsurgical techniques are considered standard procedures in reconstructive surgery. Although microsurgery by itself is defined as surgery aided by optical magnification, there are no guidelines for determining in which clinical situations a microscope or loupe should be used. Therefore, we conducted standardized experiments to objectively assess the impact of optical magnification in microsurgery. Methods Sixteen participants of microsurgical training courses had to complete 2 sets of experiments. Each set had to be performed with an unaided eye, surgical loupes, and a regular operating microscope. The first set of experiments included coaptation of a chicken femoral nerve, and the second set consisted of anastomosing porcine coronary arteries. Evaluation of the sutured nerves and vessels were performed by 2 experienced microsurgeons using an operating microscope. Results The 16 participants of the study completed all of the experiments. The nerve coaptation and vascular anastomoses exercises showed a direct relationship of error frequency and lower optical magnification, meaning that the highest number of microsurgical errors occurred with the unaided eye. For nerve coaptation, there was a strong relationship (P<0.05) between the number of mistakes and magnification, and this relationship was very strong (P<0.01) for vascular anastomoses. Conclusions We were able to prove that microsurgical success is directly related to optical magnification. The human eye's ability to discriminate potentially important anatomical structures is limited, which might be detrimental for clinical results. Although not legally mandatory, surgeries such as reparative surgery after hand trauma should be conducted with magnifying devices for achieving optimal patient outcomes.

• Archives of Craniofacial Surgery
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• v.18 no.4
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• pp.243-248
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• 2017

Background: To evaluate the versatility and reach of modified nasolabial flap used in reconstruction of defects created in and around the oral cavity. Methods: A total number of 20 cases were selected. Out of which 13 were males and 7 females. The age of these patients ranged from 24-63 years. 29 modified nasolabial flaps were raised in twenty patients. Based on clinical and histopathological examination, out of 20 patients, 14 patients were diagnosed with oral submucous fibrosis, 3 with verrucous carcinoma, 1 with squamous papilloma, 1 with oro-antral fistula and 1 with traumatic loss of lower lip. Results: Minimum preoperative interincisal distance (IID) was 0 mm and maximum was 15 mm with mean of $6.00{\pm}4.76mm$ in patients with oral submucous fibrosis and 12 months postoperatively minimum IID was 16 mm and maximum was 41 mm with mean of $28.00{\pm}8.96mm$. In one case, dehiscence (3.4%) was noted on the anterior tip for which tip revision was done. Bulky appearance of the flap intraorally was observed in 2 cases (6.9%). Five (17.2%) among the 29 flaps had visible scar at the donor site postoperatively up to 3 months. Conclusion: Numerous reconstructive techniques have been employed in the reconstruction of small to intermediate sized defects of oral cavity. Modified nasolabial flap is a versatile flap which has robust vascularity and can be successfully used with minimal complications. It can be rotated intraorally to extend from the soft palate to the lip. Thus, it can be used efficiently to treat the small defects of the oral cavity as well as recreating lost lip structure.

• Archives of Plastic Surgery
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• v.48 no.1
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• pp.15-25
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• 2021

Thoracodorsal artery (TDA) flaps, ranging from the vascular-pedicled thoracodorsal artery perforator (TDAP) flap, the propeller TDAP flap, and the muscle-sparing latissimus dorsi (MSLD) flap to the conventional latissimus dorsi (LD) flap and the extended LD flap, can all be used for breast reconstruction. The aim of this paper and review is to share our experiences and recommendations for procedure selection when applying TDA-based flaps for breast reconstruction. We describe the different surgical techniques and our thoughts and experience regarding indications and selection between these procedures for individual patients who opt for breast reconstruction. We have performed 574 TDA flaps in 491 patients: 60 extended LD flaps, 122 conventional LD flaps, two MSLD flaps, 233 propeller TDAP flaps, 122 TDAP flaps, and 35 free contralateral TDAP flaps for stacked TDAP breast reconstruction. All the TDA flaps are important flaps for reconstruction of the breast. The LD flap is still an option, although we prefer flaps without muscle when possible. The vascular-pedicled TDAP flap is an option for experienced surgeons, and the propeller TDAP flap can be used in most reconstructive cases of the breast, although a secondary procedure is often necessary for correction of the pedicle bulk. The extended LD flap is an option for women with a substantial body mass index, although it is associated with the highest morbidity of all the TDA flaps. The MSLD flap can be used if the perforators are small or if dissection of the perforators is assessed to be hazardous.

• Maxillofacial Plastic and Reconstructive Surgery
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• v.29 no.4
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• pp.340-352
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• 2007

In this systematic review on bone reduction procedures for the correction of the prominent mandibular angle, we collected and sorted the methods. The strength and weakness, indication, complication, and final esthetic result of each method were evaluated. After searching and filtering the literatures on the base of inclusion criteria, 9 eligible case series studies were included in this study. There were 3 types of curved ostectomies and 4 types of lateral cortical ostectomies. Surgical procedures for curved ostectomies were divided into 2 types. One was single curved ostectomy and the other was multistaged curved ostectomy. Lateral cortical ostectomies reported were all similar to sagittal split ramus osteotomy. The complications reported in the included studies were scarce, but curved ostectomies may be able to induce many complications. The prominent mandibular angle must be analyzed in the lateral dimension and frontal dimension, and curved ostectomy can reduce the mandibular angle laterally while lateral cortical ostectomy can reduce the bigonial distance frontally. Because curved ostectomies can induce complications and unnaturally large mandibular angle while can not reduce bigonial distance efficiently, the current trend for the angle reduction procedure is lateral cortical ostectomies.

• Maxillofacial Plastic and Reconstructive Surgery
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• v.13 no.2
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• pp.153-159
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• 1991

The use of the autogenous free fat is a well-known procedure to fill in superficial depressions resulting from the traumatic or congenital defects. The major donor site for this procedure was the abdominal subcutaneous fat or buttocks. In 1977, Egyedi was the first to report the use of the buccal fat pad as a pedicled graft. The buccal fat pad is a structure usually considered to be a nuisance when encountered in intraoral procedures such as facial bone osteotomies, elevation of buccal falp, or procedures on Stensen's duct. In these operations, appearance of the buccal fat pad complicates surgical exposure. The buccal fat pad is a lobulated convex mass of fatty tissue covered by a very delicate membrane, and is described as having a body from which four processes extend. These projection serve as a filling material between the various muscular structures in the area. Recently malar depression was augmented with the pedicled buccal fat pad in 3 cases, and it was used for the reconstruction of the nasolabial fold in one case.

• Archives of Plastic Surgery
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• v.39 no.4
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• pp.384-389
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• 2012

Background Numerous procedures are available for nipple reconstruction without a single gold standard. This study presents a method for reducing donor-site morbidity in nipple reconstruction using a composite nipple graft after transverse rectus abdominis musculocutaneous flap breast reconstruction. Methods Thirty-five patients who underwent nipple reconstruction using a composite nipple graft technique between July of 2001 and December of 2009 were enrolled in this study. To reduce the donor site morbidity, the superior or superior-medial half dome harvesting technique was applied preserving the lateral cutaneous branch of the fourth intercostal nerves. The patients were asked to complete a previously validated survey to rate the color and projection of both nipples, along with the sensation and contractility of the donor nipple; and whether, in retrospect, they would undergo the procedure again. To compare projection, we performed a retrospective chart review of all the identifiable patients who underwent nipple reconstruction using the modified top hat flap technique by the same surgeon and during the same period. Results Thirty-five patients were identified who underwent nipple reconstruction using a composite nipple graft. Of those, 29 patients (82.9%) responded to the survey. Overall, we received favorable responses to the donor site morbidity. Projection at postoperative 6 months and 1 year was compared with the immediate postoperative results, as well as with the results of nipples reconstructed using the modified top hat flap. Conclusions The technique used to harvest donor tissue is important. Preserving innervation of the nipple while harvesting can reduce donor site morbidity.

• Archives of Plastic Surgery
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• v.45 no.4
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• pp.363-366
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• 2018

Background Camptodactyly refers to permanent flexion contracture at the proximal interphalangeal joint. Most cases are limited to fifth-finger involvement. Although common, the treatment of camptodactyly is controversial. Many published studies have emphasized conservative treatment, while others have described surgical procedures. The problem with this deformity is that it presents in several forms, which means that there is no single model for effective treatment. The aim of this paper is to present the difficulties encountered with this condition and the management thereof on an individual basis. Methods This is a case series of 14 patients (nine males, five females) who underwent surgical treatment. The results were classified using the method from Mayo Clinic as excellent, good, fair, and poor. Results Fourteen patients with 15 fingers underwent surgery, and the results achieved were as follows: excellent, 0; good, 1; fair, 6; poor, 8. The treatment of camptodactyly still remains controversial, and hence proper planning individualized to each patient is needed to achieve the maximal improvement with realistic goals. Conclusions Although we performed individualised surgery, our careful follow-up was not able to identify any method as superior over another with respect to gain in extension and loss of flexion. We therefore propose that the extensor mechanism should not be disturbed during surgery to treat camptodactyly cases.