• Archives of Plastic Surgery
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• 제37권4호
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• pp.477-480
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• 2010

Purpose: Ganglioneuromas are well-differentiated tumors derived from neuroectodermal neural crest cells. Although these tumors can occur anywhere along the sympathetic chain from the base of the skull to the pelvic cavity, they usually develop in the posterior mediastinum and retroperitoneum these tumors are rarely found in the cervical region. Method: We report the case of a 16-year-old male patient with neurofibromatosis type 1 who was admitted because of a palpable mass centrally located on the left side of the neck. A preoperative contrast-enhanced neck computed tomography image showed a low-density homogeneous mass on the parapharyngeal space along with marked displacement of the trachea and carotid vessels. Round and soft masses were also detected on both axillae. Results: The patient subsequently underwent complete excision of the neck mass via the transcervical approach. The mass was smooth and well encapsulated between the sternocleidomastoid muscle and the trachea. Further, the mass appeared to arise from the cervical sympathetic chain, which was preserved during surgery. Both the axillary masses were also excised. The histopathological findings were ganglioneuroma for the neck mass and neurofibroma for both the axillary masses. Conclusion: Cervical ganglioneuromas are rare tumors that present as enlarging parapharyngeal cervical masses in the oropharynx or neck. To our knowledge, a case of cervical ganglioneuroma associated with neurofibromatosis type 1 has never been reported. In patients with neurofibromatosis, multiple tumors may develop, and therefore periodic clinical and radiological follow-up is recommended. Further, repeated imaging analysis should be performed if the presence of another tumor is suspected.

• Archives of Plastic Surgery
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• 제46권5호
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• pp.414-420
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• 2019

Background Congenital muscular torticollis (CMT) is characterized by persistent head tilt toward the affected side. No consensus exists regarding the cause of this disorder. In this study, we analyzed various clinical factors in patients with CMT who were treated with surgical release. This analysis enabled us to identify potential causative factors of CMT and to establish a basis for surgical interventions. Methods In total, 584 patients who underwent surgical intervention for CMT from October 2007 to December 2016 were included in this study. Their demographic characteristics, birthrelated factors, and clinical features were analyzed. Results Data from 525 patients were analyzed in this study after exclusion of those with insufficient information. Before birth, 31 patients (5.9%) were diagnosed with oligohydramnios, and 87 (16.6%) had a breech presentation. Seven (1.3%) cases of clavicle fracture and two (0.4%) cases of cephalohematoma were noted at birth. Before surgery, 397 patients (75.6%) underwent physiotherapy and 128 patients (24.4%) did not. The duration of physiotherapy ranged from 1 to 50 months (average, 6 months). Conclusions Our study shows that 16.6% of the CMT patients presented in the breech position, which is a much higher rate than that observed in the general population (3%-4%). We hypothesize that being in the breech position as a fetus appears to exert a significant influence on shortening and fibrosis of the sternocleidomastoid muscle.

• 대한물리의학회지
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• 제14권2호
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• pp.53-61
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• 2019

PURPOSE: Forward head posture (FHP) is a head-on-trunk malalignment that results in musculoskeletal dysfunction and neck pain. To improve forward head posture, both the craniocervical flexion exercise (CCFE) and the visual guide (VG) technique have been used. This study compared the immediate effects of CCFE and VG combined with CCFE on craniovertebral angle (CVA), as well as on the activity of the sternocleidomastoid (SCM) and anterior scalene (AS) muscles during CCFE in subjects with FHP. METHODS: In total, 16 subjects (nine males, seven females) with FHP were recruited using the G-power software. Each subject conducted CCFE and CCFE combined with VG in random order. The CVA was recorded using a digital camera and the ImageJ image analysis software. The EMG data of SCM and AS were measured by surface electromyography. A paired T-test was used to assess differences between the effects of the CCFE and VG combined with CCFE interventions in the same group. RESULTS: The CVA was significantly greater for CCFE combined with the VG than for CCFE alone (p<.05). The activity of the SCM and AS muscles was also significantly greater when the VG was combined with CCFE than during CCFE alone across all craniocervical flexion exercise phases (p<.05). CONCLUSION: Use of the VG technique combined with CCFE improved FHP in subjects with FHP compared to CCFE alone.

• 대한정형도수물리치료학회지
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• 제29권2호
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• pp.77-91
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• 2023

Background: Congenital muscular torticollis results in reduced head mobility, such as cervical rotation, due to the abnormal size and contraction of the sternocleidomastoid muscle. Korea Pediatric integrative manual therapy and stretching are recommended to improve head rotation upper cervical spine mobility. Therefore, in this study, the effect of the new PIMT was investigated. Methods: The patient is a 3.5 month-old diagnosed with congenital muscular torticollis (CMT). Due to the limitation of head rotation and cervical spine rotation and flexion mobility, the child visited a rehabilitation center and after diagnosis, Pediatric integrative manual therapy (PIMT) treatment was performed five times a week for a total of 15 weeks. The child's head rotation and flexion limitation and plagiocephaly were evaluated. Results: In conclusion, this study shows that compared to other treatments, PIMT approach is a more effective treatment for improving head rotation and cervical limitation for range of motion in CMT infants. Conclusion: PIMT approach was effective in improving cervical rotation and Head lateral flexion mobility and plagiocephaly in CMT patients.

• 대한통합의학회지
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• 제11권4호
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• pp.147-155
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• 2023

Purpose: Headache is a very common disease experienced at least once in daily life, and tension-type headaches have a high and increasing prevalence. Chronic headaches can cause functional damage and huge socioeconomic impacts. This study aimed to compare the effects of myofascial release technique with manual therapy and self-myofascial release technique using a foam roller on the pain threshold and body schema in patients with chronic tension-type headaches. Methods: The study was conducted on 20 patients living in Busan with chronic tension headaches. Myofascial release technique with manual therapy was performed on the suboccipital, sternocleidomastoid, scalene, and upper trapezius muscles. The self -myofascial release technique using a foam roller was applied to the cervical and thoracic muscles. A laterality test was performed using a recognized neck application developed to evaluate body schema ability. A pressure-pain threshold test was performed using an electronic pressure algometer to compare the results before and after the myofascial release technique. Results: After applying myofascial release with manual therapy and a foam roller, the pressure-pain threshold values showed significant changes in both groups (p<.05). As a result of the laterality test, myofascial release with manual therapy and a foam roller were applied to the painful area. The values showed significant changes in both groups (p<.05), but only the group using the foam roller showed a significant difference (p<.05) in painless areas. Conclusion: The myofascial release technique with manual therapy can be the primary treatment technique for pain control in painful areas. The self-muscle release technique using a foam roller can be an effective method when there is no pain or when maintenance is needed after pain control.

• 한방안이비인후피부과학회지
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• 제23권1호
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• pp.224-252
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• 2010

Objective : The purpose of this study is to investigate tinnitus of Plain Questions $\ll$素問$\gg$ and Miraculous Pivot $\ll$靈樞$\gg$. Methods : We conducted a study on the original text paragraphs of Internal Classic $\ll$內經$\gg$ containing the tinnitus and analysis of Yang, Ma, Zhang, Wang etc. We drew a parallel between tinnitus from Internal Classic $\ll$內經$\gg$ and matching diagnoses from western medicine. Results : The results were as follows. 1. Tinnitus in Plain Questions $\ll$素問$\gg$Tong Pyeong Heo Sil Ron <通評虛實論> was similar to the symptoms of diabetes mellitus complication and schizophreniform disorder in western medicine. 2. Liver fire tinnitus in Plain Questions $\ll$素問$\gg$ Yuk Won Jeong Gi Dae Ron <六元正紀大論> was similar to the symptoms of psychological distress in western medicine. 3. Phlegm fire tinnitus in Plain Questions $\ll$素問$\gg$ Ji Jin Yo Dae Ron <至眞要大論> was similar to the symptoms of meniere's disease and malfunction of autonomic nervous system in western medicine. 4. Blood deficiency tinnitus in Miraculous Pivot $\ll$靈樞$\gg$ Sa Gi Jang Bu Byeong Hyeong <邪氣藏府病形> was similar to the symptoms of anemia in western medicine. 5. Tinnitus in Miraculous Pivot $\ll$靈樞$\gg$ Gyeong Geun <經筋> was similar to the myofacial pain syndrome of the sternocleidomastoid muscle and the masseter muscle in western medicine. 6. Gallbladder deficiency tinnitus in Miraculous Pivot $\ll$靈樞$\gg$ Gwol Hyeong <厥病> was similar to the symptoms of otitis media and labyrinthitis in western medicine. 7. Kidney deficiency tinnitus in Miraculous Pivot $\ll$靈樞$\gg$ Gyeol Gi <決氣> and Hai Ron <海論> was similar to the symptoms of degenerative auditory organ in western medicine. 8. Tinnitus in Internal Classic $\ll$內經$\gg$ showed close relations with the symptoms of the wind character. Conclusion : We analyzed the original text paragraphs of Internal Classic $\ll$內經$\gg$ and explanations about tinnitus. Further studies are needed to compare oriental medicine and western medicine diagnoses to develop better treatments for tinnitus.

• Clinical and Experimental Pediatrics
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• 제52권11호
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• pp.1273-1278
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• 2009

목 적:선천성 근육성 사경은 흉쇄유돌근의 단축으로 경부가 기울어지고 이로 인해 안면의 비대칭적인 발달을 야기하며 목에 종괴가 만져지는 경우가 흔하다. 대부분 생후 수개월 이내에 소실되나 수술이 필요할 수도 있어 빠르고 정확한 진단이 요구된다. 선천성 근육성 사경 발생에 관여하는 산과적 위험요인을 살펴보고 임상 양상 및 치료 경과를 살펴보고자 하였다. 방 법:2007년 2월부터 2008년 8월까지 관동대학교 소아청소년과 외래에 사경으로 내원한 6개월 이하 영아들 중 본원에서 출생한 98명을 대상으로 병력청취, 이학적 검사, 신경학적 검사와 경추 방사선 및 초음파 검사를 시행하였다. 종괴군과 자세군으로 분류하고 산전 병력과 출생력, 산과적 위험요인을 조사하였으며, 재활의학과와 협진을 통해 가정 및 외래에서 물리치료를 받았고, 보호자와 전화 통화 및 외래 면담을 실시하였다. 결 과:진찰 소견 상 36명(36.7%)은 흉쇄유돌근의 종괴나 긴장이 촉진되었으며, 62명(63.3%)은 종괴 없이 목이 한쪽으로 기울었다. 81명의 환아에서 경부 초음파를 시행하였고, 종괴군은 모두 초음파에서 근육성 사경을 확인하였고, 자세군 62명 중 48명이 초음파를 시행하여 1명에서 근육성 사경이 확인되었다. 종괴군의 사경 발견시기는 평균 1.4개월, 자세군은 2.7개월로, 종괴군이 자세군에 비해 어린 나이에 발견되었다(P<0.001). 종괴군은 두혈종과 산류가 자세군보다 흔했고, 자세군은 사두증이 종괴군보다 흔하게 관찰되었다. 안과 검진이나 경추 방사선 검사는 모두 정상이었다. 재활의학과에서 물리치료를 시행한 43명 중 평균 재활 치료 기간은 종괴군 4.6개월, 자세군 2.6개월로, 자세군이 종괴군보다 유의하게 치료 기간이 짧았다(P=0.005). 총 88명의 환아 중 87명이 완전히 회복하였고, 불완전 회복을 보인 1명은 외래 추적관찰 중이다. 결 론:선천성 근육성 사경은 대부분 예후가 좋으나 수술을 요할 수도 있기 때문에 조기에 정확한 진단 및 치료를 요한다. 6개월 이하의 선천성 근성 사경 환아를 대상으로 산과적 위험 요인을 살펴봄으로써 출생 손상 및 복잡 분만과의 관련성을 확인하였고 조기 진단 및 치료를 통해 대부분 호전되는 것을 확인할 수 있었다.

• Clinical and Experimental Pediatrics
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• 제50권3호
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• pp.241-247
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• 2007

목 적 : 선천성 근성 사경은 목빗근의 섬유화 변화로 인해 머리가 병변쪽으로 기울고 턱이 반대쪽으로 돌아가는 변형을 말하는 것으로 대개 생후 4주내에 발견되고 생후 수개월내에 소실되는 예후가 좋은 질환이다. 이와 관련된 국내 보고가 부족하나 비교적 흔한 근골격계 기형이기에 저자들은 연구를 시행하였다. 방 법 : 2003년 3월부터 2006년 5월까지 본원 소아과와 재활의학과에 사경을 주소로 내원한 환아 중 안과적 검사, 신경학적 진찰 및 정형외과적 진찰 소견에서 이상이 없는 선천성 근성 사경 환아 47명을 대상으로 하였다(남자 31명, 여자 16명). 임상적 특성으로 발견 당시의 연령, 진찰 소견, 초음파 검사, 치료 방법, 치료 기간, 치료 결과 등을 조사하였다. 결 과 : 진단 당시의 연령은 최소 18일에서 최고 9세 7개월로, 이들 연령의 중앙값은 90일이었고, 좌우측 발생 빈도는 우측이 26명, 좌측이 21명이었다. 진찰 소견상 경부 종괴가 만져지는 군은 24명으로 이 중 21명에서 초음파가 시행되었고 19명에서 초음파상 목빗근의 종괴가 관찰되었다. 진찰 소견상 정상적이었던 환아는 22명으로 이 중 11명에서 초음파가 시행되었으며, 3명에서 초음파상 목빗근의 종괴가 관찰되었다. 진단 당시 가장 나이가 많았던 환아는 수술로서 회복되었고, 그 외의 환아들은 모두 집이나 병원에서 수동적인 신연 운동을 받았다. 총 47명의 환아 중 7명이 추적관찰에서 누락되었고, 추적 관찰된 40명 중 36명은 완전한 회복을 보였다. 환아들의 진단 당시 연령과 회복 기간은 음의 상관관계를 가졌고, 초음파 소견에 따라 분류하였을 때 자세군에서는 85.7%, 종괴군에서는 90.0%, 근성군에서는 66.6 %의 완전한 회복을 보였다. 회복 기간은 자세군은 1개월, 종괴군은 2.4개월, 근성군은 7.5개월로 자세군에서 회복 기간이 가장 짧았다(P=0.0011). 결 론 : 초음파에서 목빗근의 이상 소견을 보였던 환아에서 더 느리게 호전되는 양상을 보이고 초음파 소견에 따라 서로 다른 치료 효과를 보였기에, 치료 효과와 기간을 예측하는데 초음파 소견이 도움이 될 것으로 생각된다.

• Maxillofacial Plastic and Reconstructive Surgery
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• 제22권4호
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• pp.442-448
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• 2000

저자들은 2례의 제2새열낭종을 경험하였다. 증례 1은 26세의 여자에서 3년 전부터 서서히 크기가 증가하다가 1년 전 임신과 함께 현저히 크기가 증가한 병력이 있으며, 낭종은 우측 악하부와 흉쇄유돌근 전내측에 위치한 무통성의 파동을 보이는 $7.5{\times}5{\times}4cm$ 크기의 연성 종물로서 내외측으로 누공 형성은 없었다. 증례 2는 56세 남자에서 2년전 악하간극 농양으로 진단하고 절개 및 배농을 시행한 병력이 있으며, 낭종은 좌측 악하부와 흉쇄유돌근 전내측에 위치한 무통성의 파동을 보이는 $5.5{\times}4{\times}3cm$ 크기의 연성 종물로서 역시 내외측으로 누공 형성은 보이지 않았다. 조직학적으로 중층편평상피로 이장되어 있었고 상피 하방에서는 림프양 조직이 관찰되었으며, 완전절제술을 시행한 다음 술후 $3{\sim}4$년이 경과된 현재까지 재발이나 다른 합병증 없이 양호한 경과를 보이고 있다.

• Archives of Plastic Surgery
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• 제36권3호
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• pp.351-355
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• 2009

Purpose: Cervical necrotizing fasciitis tends to involve the deep soft tissues and spread caudally to the anterior chest and mediastinum, often resulting in major complications and death. It may rapidly spread into the thorax along fascial planes, and the associated diagnostic delay results in this descending necrotizing mediastinitis. So, aggressive multidisciplinary therapy with surgical drainage is mandatory. We present a very rare case of descending necrotizing mediastinitis with literature review. Methods: A 53 years old male visited our department 7 days after trauma in neck. His premorbid conditions and risk factors of necrotizing fasciitis were concealed hepatoma, trauma history, chronic liver disease, and nutrition deficit. Computed tomographic scans of the head and neck region were performed in this patient : signs of necrotizing fasciitis, were seen in the platysma, sternocleidomastoid, trapezius muscle and strap muscles of the neck. Fluid accumulations involved multiple neck spaces and mediastinum. At the time, he diagnosed as necrotizing fasciitis on his neck and anterior chest. Necrotic wound was excised serially and we treated this with the Vacuum - assisted closure(VAC, Kinetics Concepts International, San Antonio, Texas) system device. After appropriately shaping the sponge and achieving additional 3 pieces drainage tubes in the pockets, continuous negative pressure of 125 mmHg was applied. The VAC therapy was utilized for a period of 12 days. Results: We obtained satisfactory results from wide excision, abscess drainage with the VAC system, and then split thickness skin graft. The postoperative course was uneventful. Conclusion: The refined technique using the VAC system can provide a means of simple and effective management for the descending necrotizing mediastinitis, with better cosmetic and functional results. Finally, the VAC system has been adopted as the standard treatment for deep cervical and mediastinal wound infections as a result of the excellent clinical outcome.