• Korean Journal of Bronchoesophagology
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• v.4 no.1
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• pp.52-58
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• 1998

BACKGROUND： Aspiration is defined as the laryngeal penetration of secretions below the level of the true vocal cords. Aspiration can result in life-threatening complications, such as bronchospasm, airway obstruction, pneumonia, pulmonary abscess, sepsis, and death. The patient with high vagal palsy had significant aspiration and dysphagia OBJECTIVE： To formulate a step-by-step management paradign for the patients with high vagal palsy MATERIALS AND METHODS : The medical records of 23 patients who were diagnosed as high vagal palsy from September, 1995 to April, 1998 in Seoul National University Hospital were reviewed retrospectively. Eleven patients were managed conservatively and 12 patients were operated to treat chronic aspiration. RESULTS : The main etiologies of high vagal palsy were mass lesions of the skull base such as neurogenic tumor, pseudotumor, meningioma or nasopharyngeal carcinoma. Aspiration and dysphagia improved in 7 out of 11 patients who were managed conservatively after 2.2 months on the average. The patients who were refractory to the conservative management underwent surgery and showed improvement in 10 out of 12 patients. The employed surgical modalities were vocal cord medialization combined with cricopharyngeal myotomy in 7 patients, laryngotracheal separation in 3 patients and arytenoid adduction only in 2 patients. Two patients still had gastrostomy tube due to the persistent symptoms. Two patients had improved after surgery, but died of underlying disease. CONCLUSION : The patients with high vagal palsy are recommended to be managed conservatively for the first 2 months. If aspiration and dysphagia are persisting after conservative management, vocal cord medialization combined with or without cricopharyngeal myotomy should be considered. If failed, laryngotracheal separation or gastrostomy will be the next option based on the control of the oropharyngeal secretion.

• Archives of Craniofacial Surgery
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• v.19 no.4
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• pp.270-274
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• 2018

Background: Nasal bone fractures occur frequently because the nasal bone is located at the forefront of the face. The goal of this study was to examine the cause, change in severity, change in incidence, and demographics of nasal bone fracture according to today's lifestyle. Methods: A total of 2,092 patients diagnosed as having nasal bone fractures at our department between 2002 and 2017 were included in this study. We retrospectively examined patients' medical records to extract information regarding age, sex, cause of injury, combined facial bone fractures, and related injuries such as skull base fracture, spinal cord injury, brain hemorrhage, and other bone fractures. Fracture severity was classified by nasal bone fracture type. Results: No statistically significant difference was found in annual number of patients treated for nasal bone fracture. The proportion of patients who underwent closed reduction was significantly decreased over time for those with nasal bone fractures caused by traffic accidents. However, it was not significantly changed for those with nasal bone fractures due to other causes. The number of patients with combined facial bone fractures increased over time. Incidences of severe nasal bone fracture also increased over time. Conclusion: The study suggested that there is a decrease in the frequency and increase in the severity of nasal bone fracture due to traffic accident. Many protective devices prevent nasal bone fractures caused by a small amount of external force; however, these devices are not effective against higher amounts of external force. This study highlights the importance of preoperative thorough evaluation to manage patients with nasal bone fractures due to traffic accident.

• Journal of Korean Dental Science
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• v.11 no.2
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• pp.86-91
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• 2018

Ameloblastomaa are odontogenic benign tumors with epithelial origin, which are characterized by slow, aggressive, and invasive growth. Most ameloblastomas occur in the mandible, and their prevalence in the maxilla is low. A 27-year-old male visited our clinic with a chief complaint of the left side nasal airway obstruction. Three-dimensional computed tomography showed left maxillary sinus filled with a mass. Except for the perforated maxillary left edentulous area, no invaded or destructed bone was noted. The tumor was excised via Le Fort I osteotomy. The main mass was then sent for biopsy and it revealed acanthomatous ameloblastoma. The lesion in the left maxillary sinus reached the ethmoidal sinus through the nasal cavity but did not invade the orbit and skull base. The tumor was accessed through a Le Fort I downfracture in consideration of the growth pattern and range of invasion. The operation site healed without aesthetic appearances and functional impairments. However, further long-term clinical observation is necessary in the future for the recurrence of ameloblastoma. Conservative surgical treatment could be the first choice considering fast recovery after surgery and the patient's life quality.

• Journal of the Korean Association of Oral and Maxillofacial Surgeons
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• v.45 no.3
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• pp.129-134
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• 2019

Objectives: The objective of this study was to highlight the role of lateral arthroplasty along with interposition of the buccal fat pad (BFP) in the management of Sawhney type III temporomandibular joint (TMJ) ankylosis. Materials and Methods: Ten patients with TMJ ankylosis (7 unilateral and 3 bilateral, total of 13 joints) were treated with lateral arthroplasty and BFP interposition. The bony bridge of the ankylotic mass on the lateral aspect was resected, leaving a distance of 1.5 to 2.0 cm from the base of the skull to the neck of the condyle. The condyle was left intact. Coronoidectomy was performed on the ipsilateral side via the same approach in all cases. The inter-incisal opening was measured at that time, and if it was less than 35 mm, contralateral coronoidectomy was performed by using the intra-oral approach. After satisfactory inter-incisal mouth opening (${\geq}35mm$) was achieved, the TMJ surgical site was revisited, and BFP was retrieved and used to cover the lateral aspect of the medially placed condyle. Results: With lateral arthroplasty, the medially displaced condyle can be left in-situ to maintain the mandibular ramal height and function and to act as a growth center in children. Interposition of the BFP prevents reformation of the lateral bony bridge that was removed. Conclusion: Lateral arthroplasty along with interpositioning of the BFP is a novel technique for managing Sawhney type III ankylosis that achieves management goals while avoiding complex and advanced reconstructive surgical procedures.

• Imaging Science in Dentistry
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• v.49 no.2
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• pp.159-169
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• 2019

Purpose: Cone-beam computed tomography (CBCT) is widely used for 3-dimensional assessments of cranio-maxillo-facial relationships, especially in patients undergoing orthognathic surgery. We have introduced, for reference in CBCT cephalometry, an anatomical mid-sagittal plane (MSP) identified by the nasion, the midpoint between the posterior clinoid processes of the sella turcica, and the basion. The MSP is an updated version of the median plane previously used at our institution for 2D posterior-anterior cephalometry. This study was conducted to test the accuracy of the CBCT measures compared to those obtained using standard posterior-anterior cephalometry. Materials and Methods: Two operators measured the inter-zygomatic distance on 15 CBCT scans using the MSP as a reference plane, and the CBCT measurements were compared with measurements made on patients' posterior-anterior cephalograms. The statistical analysis evaluated the absolute and percentage differences between the 3D and 2D measurements. Results: As demonstrated by the absolute mean difference (roughly 1 mm) and the percentage difference (less than 3%), the MSP showed good accuracy on CBCT compared to the 2D plane, especially for measurements of the left side. However, the CBCT measurements showed a high standard deviation, indicating major variability and low precision. Conclusion: The anatomical MSP can be used as a reliable reference plane for transverse measurements in 3D cephalometry in cases of symmetrical or asymmetrical malocclusion. In patients who suffer from distortions of the skull base, the identification of landmarks might be difficult and the MSP could be unreliable. Becoming familiar with the relevant software could reduce errors and improve reliability.

• Journal of Rhinology
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• v.25 no.2
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• pp.123-129
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• 2018

Background and Objectives: Endoscopic repair of cerebrospinal fluid (CSF) leak can avoid morbidity of open approaches and has shown a favorable success rate. Free mucosal graft is a good method, and multi-layered repair is more favorable. The inferior turbinate has been commonly utilized for the free mucosal graft, but we newly designed it as a bone-periosteal-mucosal composite graft for multilayered reconstruction. Subjects and Method: Four subjects with a skull base defect were treated with this method. The inferior turbinate was partially resected including the conchal bone and was trimmed according to defect size. Both bony parts and periosteum were preserved on the basolateral side of the mucosa as a composite graft. The graft was applied to the defect site using an overlay technique. Results: All cases were successfully repaired without any complications. Three of them had a defect size greater than 10-12 mm, and the graft stably repaired the CSF leakage. Conclusion: Endoscopic repair of CSF leakage using inferior turbinate composite graft is a simple and easy method and would be favorable for defect sizes greater than 10 mm.

• Imaging Science in Dentistry
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• v.50 no.4
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• pp.323-330
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• 2020

Purpose: The mastoid region is ideal for studying sexual dimorphism due to its anatomical position at the base of the skull. This study aimed to determine sex in the Iranian population based on measurements of the mastoid process using different data mining algorithms. Materials and Methods: This retrospective study was conducted on 190 3-dimensional cone-beam computed tomographic (CBCT) images of 105 women and 85 men between the ages of 18 and 70 years. On each CBCT scan, the following 9 landmarks were measured: the distance between the porion and the mastoidale; the mastoid length, height, and width; the distance between the mastoidale and the mastoid incision; the intermastoid distance (IMD); the distance between the lowest point of the mastoid triangle and the most prominent convex surface of the mastoid (MF); the distance between the most prominent convex mastoid point (IMSLD); and the intersecting angle drawn from the most prominent right and left mastoid point (MMCA). Several predictive models were constructed and their accuracy was compared using cross-validation. Results: The results of the t-test revealed a statistically significant difference between the sexes in all variables except MF and MMCA. The random forest model, with an accuracy of 97.0%, had the best performance in predicting sex. The IMSLD and IMD made the largest contributions to predicting sex, while the MMCA variable had the least significant role. Conclusion: These results show the possibility of developing an accurate tool using data mining algorithms for sex determination in the forensic framework.

• Imaging Science in Dentistry
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• v.51 no.2
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• pp.167-174
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• 2021

Purpose: Sex determination can be done by morphological analysis of different parts of the body. The mastoid region, with its anatomical location at the skull base, is ideal for sex identification. Statistical shape analysis provides a simultaneous comparison of geometric information on different shapes in terms of size and shape features. This study aimed to investigate the geometric morphometry of the inter-mastoid triangle as a tool for sex determination in the Iranian population. Materials and Methods: The coordinates of 5 landmarks on the mastoid process on the 80 cone-beam computed tomographic images(from individuals aged 17-70 years, 52.5% female) were registered and digitalized. The Cartesian x-y coordinates were acquired for all landmarks, and the shape information was extracted from the principal component scores of generalized Procrustes fit. The t-test was used to compare centroid size. Cross-validated discriminant analysis was used for sex determination. The significance level for all tests was set at 0.05. Results: There was a significant difference in the mastoid size and shape between males and females(P<0.05). The first 2 components of the Procrustes shape coordinates explained 91.3% of the shape variation between the sexes. The accuracy of the discriminant model for sex determination was 88.8%. Conclusion: The application of morphometric geometric techniques will significantly impact forensic studies by providing a comprehensive analysis of differences in biological forms. The results demonstrated that statistical shape analysis can be used as a powerful tool for sex determination based on a morphometric analysis of the inter-mastoid triangle.

• Sleep Medicine and Psychophysiology
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• v.27 no.2
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• pp.77-81
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• 2020

Obstructive sleep apnea (OSA) is a sleep-related breathing disorder in which narrowing and obstruction of the upper airway lead to frequent arousal and decreased arterial oxygenation during sleep. OSA is more common in children with genetic disorders like achondroplasia compared to children without genetic disorders. Achondroplasia is genetic disorder characterized by hypoplasia of the facial bone and skull base with foramen magnum stenosis, resulting in exceedingly high frequency of OSA. The authors present a case of a patient with achondroplasia diagnosed with severe OSA through polysomnography after adenectomy showed little therapeutic effect and who was treated with continuous positive airway pressure.

• Imaging Science in Dentistry
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• v.51 no.1
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• pp.63-71
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• 2021

Purpose: The aim of this study was to assess the artefacts of 12 fixed orthodontic appliances in magnetic resonance images obtained using 1.5-T and 3-T scanners, and to evaluate different imaging sequences designed to suppress metal artefacts. Materials and Methods: In vitro, study casts of 1 adult with normal occlusion were used. Twelve orthodontic appliances were attached to the study casts and scanned. Turbo spin echo (TSE), TSE with high readout bandwidth, and TSE with view angle tilting and slice encoding for metal artefact correction were used to suppress metal artefacts. Artefacts were measured. In vivo, 6 appliances were scanned: 1) conventional stainless-steel brackets; 2) nickelfree brackets; 3) titanium brackets; 4) a Herbst appliance; 5) a fixed retainer; and 6) a rapid maxillary expander. The maxilla, mandible, nasopharynx, tongue, temporomandibular joints, and cranial base/eye globes were assessed. Scores of 0, 1, 2, and 3 indicated no artefacts and minor, moderate, and major artefacts, respectively. Results: In vitro, titanium brackets and the fixed retainer created minor artefacts. In vivo, titanium brackets caused minor artefacts. Conventional stainless-steel and nickel free brackets, the fixed retainer, and the rapid maxillary expander caused major artefacts in the maxilla and mandible. Conventional stainless-steel and nickel-free brackets caused major artefacts in the eye globe (3-T). TSE with high readout bandwidth reduced image artefacts in both scanners. Conclusion: Titanium brackets, the Herbst appliance, and the fixed retainer caused minor artefacts in images of neurocranial structures(1.5-T and 3-T) when using TSE with high readout bandwidth.