• Maxillofacial Plastic and Reconstructive Surgery
• /
• 제35권2호
• /
• pp.88-93
• /
• 2013

Purpose: Maxillary sinus elevation has been widely used to enable insertion of endosseous implants in severely resorbed maxilla. Maxillary sinusitis after this procedure was considered to be the major drawback, therefore, preoperative evaluation of paranasal sinus is considered to be important. In order to evaluate the condition of the sinus, we used Waters' projection. In this study, asymptomatic patients were evaluated by Waters' view, and compared to timing to assess the sinus cavity. Methods: The retrospective study was based on 14 patients who were performed sinus elevation surgery in Seoul National University Dental Hospital. These patients did not show any signs of maxillary sinusitis. These patients were taken Waters' view at preoperative, postoperative 1 day, 3 months, 6 months. In Waters' view, presence of air fluid level, radiopacity of sinus wall, or radiopacity of entire maxillary sinus were evaluated. The density, and sinus dimension changes were assessed using Adobe Photoshop CS5$^{(R)}$ (Adobe Systems Inc., San Jose, CA, USA). Results: Findings of Waters views in patients with clear maxillary sinus at preoperative time were followed by elevated sinus floor with transplanted bone, mucosal swelling, and air fluid level. At postoperative 3 months, and 6 months, the radiographic findings were similar to preoperative state. By contrast, patients with preoperative mucosal swelling, or haziness in sinus cavity showed radiopacity entire sinus in Waters' view. In cases of the patients who were treated with simultaneous treatment to mucosal swelling, good status of sinus cavity were found. Conclusion: Although Waters' projections provide the limited information, and is less sensitive method compared with computed tomography, it is simple, easy, and economical method to assess of maxillary sinus. We suggest using Waters' view as radiographic routine tool for evaluation of sinus condition, especially in the sinus elevation surgery.

• Archives of Reconstructive Microsurgery
• /
• 제13권1호
• /
• pp.14-23
• /
• 2004

Introduction: The hand and wrist are particularly susceptible to electrical burn. Skin defect with damage or exposure of underlying vital structure requires coverage by skin flap especially in case of the need for late reconstruction. We are reporting 4 cases of electrical burned hand treated by posterior tibial arterial free flap. The commonly used skin flaps such as scapular flap or groin flap are too bulky so that they are not satisfactory in function and cosmetic appearance. So we tried to cover them with a more thin skin flap. Materials and Method: From January 2002 to June 2003, four cases of hand and wrist electrical burn were covered using posterior tibial arterial free flap. All the cases were due to high voltage electrical burn. Age ranged from 31 years to 38 years old and all the cases were male patients. Recipient sites were 2 wrist, one thenar area and one knuckle of 2.3rd MP joint. Additional procedures were flexor tenolysis (simultaneous), FPL tenolysis and digital nerve graft (later) and extensor tendon reconstruction (later). Result: All the flap have survived totally without any complication including circulatory concern about the donar foot. Posterior tibail arterial free flap was so thin that debulking procedure was not required. Conclusion: For skin coverage of the hand & wrist region, posterior tibial arterial free flap have many advantages such as reliable anatomy, easy dissection and easy anastmosis with radial or ulnar artery and possibility of sensory flap. The most helpful advantage for hand coverage is its thinness. So we think this flap is one of the very useful armamentarium for reconstructive hand surgery.

• Maxillofacial Plastic and Reconstructive Surgery
• /
• 제14권3호
• /
• pp.217-227
• /
• 1992

The purpose of this paper is to investigate changes in soft tissue in 22 patients treated by vertical ramus osteotomy and sagittal split ramus osteotomy for the correction of mandibular prognathism. 22 individuals, 12 males and 10 females, were selected from the patients with mandibular prognathism at the Department of Oral and Maxillofacial Surgery, Colledge of Dentistry, Kyung Hee University. Patient were analyzed with cephalogram taken 1 week before and at least 6 weeks after surgery under the same condition. Measurements were made constructed hard tissue and sop tissue points located on each before-and-after film tracing. Comparision were made of these figures to estimate the amount that the soft tissue followed the hard tissue structures in each surgical procedure : ratio of sop and hard tissue changes were formulated. The results were as follows. 1. The horizontal changes of Pogs and Bs as a ratio of the horizontal changes of Pog and B point were 1.02 and 1.16 respectively. 2. One millimeter of posterior changes at Pog resulted in 0.86mm of posterior change at Li and 0.09mm of posterior change at Ls. The greatest amount of sop tissue change occurred at Pogs, with substantially less posterior displacement at Bs, even less at Li and at least at Ls. 3. The ratio of LI to Li was 1:0.81 and the ratio of LI to Ls was not significant.(1 : 0.17) 4. The ULA(Cm-Sn-Ls) and the relative lower lip projection (LLP) was incnease4 but the relative upper lip projection (ULP) was slightly decreased 5. The angular change of the upper lip inclined angle (Ls-Sn/ANS-PNS) and lower lip inclined angle(Li-Pogs/Me-Go) expressed as a ratio of the posterior change of Pog were 0.57 and 0.20 respectively. 6. The ratio of the lower anterior facial height change of the soft tissue(Sn-Mes) to the hard tissue(ANS-Gn) were 0.78 and and the ratio of vertical height changes of the hard tissue and sop tissue to the posterior change of the Pog were 0.18 and 0.19 respectively. 7. The sop tissue angular change of facial convexity(G-Sn-Pogs) expressed as a ratio of the angular change of the hard tissue angle of facial convexity(N-A-Pog) was 1.24.

• Maxillofacial Plastic and Reconstructive Surgery
• /
• 제13권1호
• /
• pp.30-36
• /
• 1991

본 연구는 구강 및 악안면 영역에서의 미세 신경 재건술에 대한 일련의 연구의 하나로서 구강 및 악안면 영역의 신경 결손부를 재건할 경우 가장 많이 이용되는 비복신경에 대한 해부학적 특성을 조사하여 이식 신경 선택시에 도움이 되도록 하고자 본 연구를 시행하였다. 연구 대상은 사체에서 채취한 10편의 비복 신경으로 하였고 각 신경편의 길이 측정후 신경편의 근심부, 중심부, 원심부에 대하여 신경의 평균 총단면적, 신경속의 평균 숫자, 신경속의 평균 총단면적 등을 측정하였고 신경속의 주행 양태 및 신경 주의 외막의 미세혈관 분포를 관찰하였다. 연구결과, 채취 가능한 비복 신경의 길이는 평균 35.5cm 이었고 신경의 평균 총단면적은 근심부, 중심부, 원심부에서 부위별로 각각 $3.83mm^2$, $3.28mm^2$, $4.65mm^2$이고, 신경속의 평균 총단면적은 부위별로 각각 $0.80mm^2$, $0.79mm^2$, $1.23mm^2$이었다. 신경속의 평균 숫자는 부위별로 각각 7.67, 6.17, 3.83개 이었고 주로 복신경속 모양(polyfascicular patten)의 구조를 보이며, 신경속의 주행양태는 불규칙하였고 신경 주위 외막의 미세혈관 분포는 존재하였지만 이약하였다. 신경이식 수술후 바람직한 결과를 얻기 위해서는 신경의 총단면적이 비슷하거나 크며 비슷한 신경속의 숫자를 지니는 유사한 해부학적 구조를 가진 이식신경을 선택하여 최대로 신경속간 접합이 될 수 있도록 해야하는데 비복 신경은 신경속의 해부학적 특성, 크기, 숫자로 보아 하치조신경, 안면신경, 부신경등 악안면부의 신경이식에 널리 쓰일 수 있는 이식 신경으로 사료되며 특히 원심부에서 채취가능한 약 15cm 가량의 비복신경은 하치조 신경의 신경속 구조와 매우 유사하며 하치조신경 결손부의 이식 신경으로 적합한 것으로 사료된다.

• Maxillofacial Plastic and Reconstructive Surgery
• /
• 제13권1호
• /
• pp.44-52
• /
• 1991

하악골의 발육이상과 더불어 상악골의 수평적 및 수직적 발육이상이 동반되어 있는 대부분의 악안면 기형 환자에서 상하악골을 동시에 재위치시키는 "상하악골 동시 이동 수술"은 현재 악교정 수술에서 보편화되어 있는 술식으므로, 이 경우 수술중에 일차로 상악골의 정확한 위치를 얻는 것이 매우 중요하다. Le Fort I 수평골절단술을 이용한 상악골의 재위치시 위치 이동의 정확성을 기하기 위하여 고전적으로 사용되어온 계측방법인 내부계측법(Intrnal measuring technique)은 최근에 이르러 계측상의 삼차원적 오차에 따른 정확도에 많은 의문이 제기되어 왔으며, 따라서 이를 보완하기 위하여 1985년 Johnson 이 처음으로 외부계측법(External measuring technique)을 소개한 이후로, Van Sickels 등의 여러 학자들에 의하여 그 사용의 유용성 및 정확성이 입증되어 왔다. 이에 저자등은 최근 2년간 본 교실에서 경험상 상${\cdot}$하악골동시이동 악교정수술환자중, 외부계측법에만 의존하여 상악골 이동량을 술중 계측했던 17명의 환자에서 수술전 이동계측량과 수술후 이동된 결과를 Lateral cephalometics상에서 전치부와 구치부의 수직 및 수평적 이동 오차 관계로, P-A cephalogram 상에서 수평적 이동 및 상악치열의 중심선 변위에 대한 이동 오차 관계로 분석하여 외부계측법에 의한 수술적 이동의 정확도를 평가하므로써 향후 이 방법의 사용에 대한 신뢰성을 보고자 본 연구를 시행하였다. 연구 결과로써, 상악골의 수직 및 수평적 이동시 외부계측법 만을 이용한 경우, 수술전 이동량에 비해 비교적 신뢰성 있게 상악골을 원하는 위치로 이동시킬 수 있는 것으로 사료되나, 대체적으로 전하방 및 우측으로 위치되기 쉬운 경향을 보여주었으며, 정면상의 수평기울기(transverse plane)에 대한 편차는 수술자에 의해 크게 영향을 받지 않았으나 상악치열의 중심위는 수술자에 의해 영향을 받은것 같다.

• Maxillofacial Plastic and Reconstructive Surgery
• /
• 제22권3호
• /
• pp.274-287
• /
• 2000

The use of dental implants has increased tremendously in recent years and is expected to increase even more in the future. The successful outcome of any implant procedure is surely dependent on interrelationship of the various components of an equation that includes biocompatibility of implant material, macroscopic and microscopic nature of the implant surface, the status of implant bed, surgical technique, undisturbed healing phase and subsequent prosthetic design and long-term loading phase. The purpose of this study was to clarify the effects of adrenalectomy on the osseointegration of pure titanium implants. Seventy rats, 11 weeks of age, were divided into two groups : an adrenalectomized group and a control group. Titanium screw implant(diameter, 2.0mm; length, 3.5mm) was placed into left tibia of 70 rats, 35 in control group and 35 in the experimental group. The rats were sacrificed at different time interval (1, 2, 3, 4, 6, 8, and 12 weeks after implantation) for histopathologic observation, histomorphometric analysis and immunohistochemistry with fibronectin and CD44 antibody. The results obtained from this study were as follows: 1. Histopathogically, findings, newly formed bone was seen at 3 weeks control group and became lamellar bone at 12 weeks. At 6 weeks, lipocytes were observed in bone marrow space. Thickness of regenerated trabecular bone increased till 6 weeks after then, that decreased gradually. 2. By histomorphometric analysis, marrow bone density and contact ratio of marrow bone to implant decreased significantly from 8 to 12 weeks in experimental group compared to control group and also total bone to implant contact ratio decreased significantly from 4 to 12 weeks in experimental group compared to control group. 3. Fibronectin immunoreactivity was very strong at 3 and 4 weeks control group. And after that reduced gradually. But it was continuously strong from 1 to 12 weeks experimental group. 4. CD44 immunoreactivity was very strong in the newly formed osteoblasts at 3 and 4 weeks control group. But it reacted minimally later. However, it reacted continuously strong from 3 to 12 weeks experimental group. From these results, bone to implant contact ratio decreased gradually from 4 weeks in adrenalectomized group compared to control group. CD44 and fibronectin immunoreactivities were strong at all times in adrenalectomized rats. Therefore, it could be stated that immature bone remained continuously for a long time and not readily proceeded into mature status.

• Maxillofacial Plastic and Reconstructive Surgery
• /
• 제42권
• /
• pp.32.1-32.4
• /
• 2020

Background: Le Fort I osteotomy is a highly effective treatment for skeletal jaw deformities and is commonly performed. High Le Fort I osteotomy is a modified surgical procedure performed for improving the depression of the cheeks by setting the osteotomy higher than the conventional Le Fort I osteotomy. Developments in three-dimensional (3D) technology have popularized the use of 3D printers in various institutions, especially in orthognathic surgeries. In this study, we report a safe and inexpensive method of performing a high Le Fort I osteotomy using a novel 3D device and piezosurgery, which prevent tooth root injury without disturbing the operation field for patients with a short midface and long tooth roots. Results: A 17-year-old woman presented with facial asymmetry, mandibular protrusion, a short midface, and long tooth roots. We planned high Le Fort I osteotomy and bilateral sagittal split ramus osteotomy. Prevention of damage to the roots of the teeth and the infraorbital nerve and accurate determination of the posterior osteotomy line were crucial for clinical success. Le Fort I osteotomy using 3D devices has been reported previously but were particularly large in size for this case. Additionally, setting the fixing screw of the device was difficult, because of the risk of damage to the roots of the teeth. Therefore, a different surgical technique, other than the conventional Le Fort I osteotomy and 3D device, was required. The left and right parts of the 3D device were fabricated separately, to prevent any interference in the surgical field. Further, the 3D device was designed to accurately cover the bone surface from the piriform aperture to the infra-zygomatic crest with two fixation points (the anterior nasal spine and the piriform aperture), which ensured stabilization of the 3D device. The device is thin and does not interfere with the surgical field. Safe and accurate surgical performance is possible using this device and piezosurgery. The roots of the teeth and the infraorbital nerve were unharmed during the surgery. Conclusions: This device is considerably smaller than conventional devices and is a simple, low-cost, and efficient method for performing accurate high Le Fort I osteotomy.

• Journal of Chest Surgery
• /
• 제38권12호
• /
• pp.873-877
• /
• 2005

Jeune 증후군은 체염색체 열성으로 유전되는 질환으로 다발성 연골 형성장애에 의한 흉벽, 골반, 사지 등의 골격계 발달 이상을 보이며 신장, 간, 췌장, 망막 등에도 병변을 동반할 수 있는 드문 질환이다. 예후에 가장 중요한 인자는 흉곽 기형의 정도인데 특징적으로 경직된 종 모양의 제한적 흉곽을 보이며, 이로 인해 호흡부전과 폐렴의 증상을 보이게 된다. 어린 나이에 증상이 발현될수록 예후가 좋지 않은 것으로 보고되고 있으며 흉곽 기형을 교정하기 위한 여러 수술 방법들이 소개되어 왔으나 1세 이전에 증상이 발현된 경우에 있어서는 수술 교정을 했다고 하더라도 대부분 사망하는 것으로 보고되고 있다. 생후 11개월 된 남자 환아가 출생 후부터 지속된 호흡부전과 폐렴 증상을 주소로 내원하여, Jeune증후군으로 진단받고 측흉벽 확창술을 우측에 시행하였다. 수술 후 호흡 부전이 해결 되지 않아 첫 수술 3개월째 좌측에 대해서도 같은 시술을 시행하였고, 수술 후 좌측 티타늄 판 골절이 발생하여 티타늄 판 재이식술을 시행하였다. 이후 호흡 양상의 호전과 악화를 반복하다가 첫 수술 6개월째 퇴원하였다. 환자는 퇴원 2개월 후 폐렴의 증상으로 재입원하였으며, 재입원 치료 5개월째에 결국 호흡부전으로 사망하였다. Jeune증후군에 대한 측흉벽 확창술을 시행하였기에 그 결과를 문헌 고찰과 함께 보고하는 바이다.

• Archives of Plastic Surgery
• /
• 제46권6호
• /
• pp.511-517
• /
• 2019

Background Cleft treatment is frequently performed in Indonesia, mostly in charity missions, but without a postoperative protocol it is difficult to establish the risks and complications of cleft treatment. The present study was designed to give an overview of current cleft lip and palate treatment strategies in Indonesia and to assess the complication rates during and after surgery. Methods This prospective study evaluated anesthetic, intraoperative surgical, and short-term postoperative complications in patients undergoing primary, secondary, or corrective surgery for cleft lip and palate deformities. The population consisted of 98 non-syndromic cleft patients. The main anesthetic complication that occurred during general anesthesia was high blood pressure, whereas the main intraoperative surgical complication was excessive bleeding and the main early postoperative complication was extremely poor wound hygiene. Results In this study, there were no cases of perioperative or postoperative mortality. However, in 23 (23.4%) of the 98 operations performed, at least one perioperative complication related to anesthesia occurred. The intraoperative and early postoperative complications following cleft lip and/or palate were assessed. There was a significant difference in the complication rate between procedure types (χ²=0.02; P<0.05). However, no relationship was found between perioperative complications related to anesthesia and the occurrence of postoperative complications (χ²=1.00; P>0.05). Nonetheless, a significant difference was found between procedure types regarding perioperative complications and the occurrence of postoperative complications (χ²=0.031; P<0.05). Conclusions Further evaluation of these outcomes would help direct patient management toward decreasing the complication rate.

• Journal of the Korean Association of Oral and Maxillofacial Surgeons
• /
• 제30권5호
• /
• pp.428-433
• /
• 2004

Sinus floor augmentation has been proven an effective treatment procedure to increase bone volume in the posterior edentulous maxilla. Autogenous bone considered to be the best material for reconstructive bone surgery and has been successfully used as a graft material to augment posterior maxilla. However, the collection of autogenous bone required extra risks for morbidity and complaints. So, various bone graft materials included ${\beta}$-tricalcium phosphate(${\beta}$-TCP) has been introduced for replacing the autogenous bone. The objective of this clinical study was to determine the predictability of endosseous implant placed in a maxillary sinus with ${\beta}$-TCP grafting. We performed sinus elevation with ${\beta}$-TCP to install the implant in the 10 maxillary cases. The prosthetic procedure was performed 6-9 months after. The implant-prosthetics was checked about 1 year. We checked the implant and measured the maximum bite force to evaluate the function of the implant. There was not observed the specific problem and complication in dental implant and maxillary sinus in the grafted materials. The maximum bite force was 558N in case of natural tooth, 365N in implant without grafting, 318N in implant with ${\beta}$-TCP grafting. There was no significant difference between with and without sinus grafting on maximum bite force(p>0.05). As though the long term check-up is needed, the grafting of ${\beta}$-TCP as a osteoconductive materials can expand the volume and induce dense new bone formation in maxillary sinus. So, this short-term results support that ${\beta}$-TCP can be a suitable material for sinus augmentation.