• Radiation Oncology Journal
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• 제10권2호
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• pp.267-275
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• 1992

원격조정 고선량 근접치료는 새로운 각광받는 테크놀로지이다. 이에, 저자들은 3년간의 서울중앙병원의 590횟수, 116 환자를 대상으로 고선량 근접치료의 그 시술과 임상적 결과를 평가해 보고자 한다 자궁경부암 58 환자와 비인두강암 26 환자의 관내 방사선치료 471 횟수, 식도암 12 환자, 내 기관지암 11 환자, 클라스킨 종양 1 환자의 관내 방사선치료 79 횟수와 유방암 4 환자, 육종 1 환자, 요도암 1 환자의 조직내 방사선치료 40 횟수가 1989년 9월에서 1992년 8월 사이에 시행되어졌다. 추적 관찰 기간은 1 개월에서 35개월이었고, 그 중간 기간은 7개월이었다. 조직내 방사선치료를 제외한 모든 시술은 국소 마취로 시행하였고, 모든 환자에서 급성 합병증은 생기지 않았다. 또한, 6 환자를 제외하고는 모두 계획 선량대로 치료를 마칠 수가 있었다. 자궁경부암 58 환자에서, 비인두강암 26 환자 중 20 환자에서 완전 관해가 일어났으며, 증상 완화 목적으로 치료한 15 환자에서 $80{\%}$의 환자에서 소기의 목적을 이룰 수 있었다. 이 논문에서 원격조정 고선량 근접치료의 자세한 시술과 그에 따른 결과를 설명할 것이다. 이 치료의 생물학적인 효과와 적당한 선량/선량 횟수/분할치료를 평가하기 위해, 우리는 더욱 긴 추적 관찰을 시행하여야 하며, 이 새로운 근접치료 시술이 저선량 근접치로 시술보다 효과적이고 외래 환자로 통근 치료가 가능하며, 안전한 치료 방법이라고 생각하고 있다.

• 대한소아치과학회지
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• 제26권3호
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• pp.499-506
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• 1999

악골에서 비교적 흔한 빈도로 발생하는 치아종은 치배조직의 과성장으로 인하여 발생한다. 세계보건기구에서는 치아종을 복잡 치아종과 복합 치아종으로 구분하고 있다. 치아종은 악골내 모든 부위에서 발생할 수 있지만 치아와 유사한 복합 치아종은 비교적 상악 전치부에 호발하고, 불규칙한 형태를 나타내는 복잡 치아종은 하악 구치부에 호발한다. 치아종의 원인은 정확히 알려져 있지 않으며 치배에 대한 국소적인 외상이나 감염이 주된 요인으로 추측되고 있고, 최근에는 유전적인 원인에 대해서도 연구되고 있으나 아직 확실히 입증되지는 않고 있다. 일반적인 증상이 없기 때문에 일상적인 방사선 검사에서 주로 발견되고 영구치의 맹출지연이나 유치의 만기잔존 등의 증상이 있을 수 있다. 치아종은 구강내의 어떤 부위에서도 발생이 가능하고 드물기는 하지만 상악동, 하악의 하연, 하악지 및 하악과두 하방에서 발견되기도 하며, 이공 부위에서 발생되는 경우도 있다. 치아종은 발육중인 치열과 악궁에 미치는 영향을 최소화하기 위하여 발견되는 즉시 낭포 및 주위 연조직을 함께 외과적으로 제거하는 것이 바람직하다. 환자의 연령과 치과치료에 대한 협조도, 영구치열의 발육상태, 치아종의 악골내 위치 및 동시적인 치과치료가 요구되는 가를 고려하여 외래 진료실에서 하는 경우도 있고 전신마취를 통하여 하는 경우도 있다. 본 증례는 치아종의 악골내 위치가 깊지 않고 치과치료에 대한 협조도가 양호하다고 판단되는 환아에서는 외래 진료실에서 국소마취하에 수술하여 치료하였고, 연령이 어리고 치아종의 악골내 위치가 깊어 장시간의 시술 시간이 요구되고 동시에 보존적인 치과치료가 필요한 환아에서는 전신마취하에 치료한 것을 보고한 것이다. 두 증례에서 수술 4개월 후 외과적 결손 부위에 골이 형성되었고, 매복된 영구치의 맹출이 정상적으로 이루어진 것으로 나타났다.

• Maxillofacial Plastic and Reconstructive Surgery
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• 제30권6호
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• pp.567-571
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• 2008

Purpose: The purpose was to assess the usefulness of midazolam in patients undergoing minor oral surgery under conscious sedation. Materials and methods: Bispectral index was examined in 20 patients receiving oral minor surgery with conscious sedation supplemented with local anesthesia. All patients included were ASA I and had no contraindications to the study medications. The patients were escorted to the day surgery operation room where, before the commencement of the sedation and surgical procedures, routine monitoring was applied, including the noninvasive monitoring of arterial blood pressure, arterial oxygen saturation, and 3-lead electrocardiogram (Electrocardiogram). Bispectral index electrodes were applied on the frontotemporal region after cleansing the skin with alcohol. Bispectral index was calculated with the Electrocardiogram monitor (A-2000; Aspect Co.). Midazolam was then titrated (initially 3mg wait 2min and 2mg). Vital sign and Bispectral index checked every 5 minute until the end of the procedure. The results were then compared. Results: The Bispectral index index values throughout the sedation study period alter many level. The index was dropped at 5 minutes after administration, but raised at injection and odontomy procedure. During the operation, mean Bispectral index index was higher than conscious sedation index range($60{\sim}80$). The amnesic effect was shown 17 cases out of 20 cases(85%). Conclusion: Conscious sedation technique using midazolma is a safe and effective method of controlling behavior in oral and maxillofacial surgery.

• Archives of Plastic Surgery
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• 제38권4호
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• pp.477-484
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• 2011

Purpose: Retro-orbicularis oculi fat (ROOF) and preseptal fat pad (PSF) are deep fat structures of frontal and supraorbital area, that encounter galeal fat pad (GFP). If galeal wall is weakened by aging process, GFP loses its anchoring structure, moved downward pushing ROOF and PSF. This especially occur in lateral brow area. As a result of drooping, eyebrow affects the eyelid covering PSF as a sac descended to a lateral hooding and ptotic eyelid simultaneously. Consequently, in the case of lateral hooding and brow ptosis, besides the skin, deep fat structures (ROOF and PSF) should be corrected as well. Methods: ROOF-PSF repositioning technique in subbrow resection were performed. 21 cases of patients from April, 2007 to January, 2008. Before surgery, all patients were examined carefully to evaluate the degrees of dermatochalasia, drooping of the eyebrow, marginal reflex distance 1 (MRD1), eyelid crease height. Surgery was performed under local anesthesia, then excised the drooped eyelid skin by lateral subbrow resection, removed proper amount of ROOF, repositioned ROOF-PSF at the supraorbital rim, and fix it on periosteum. During follow up periods, the patients were surveyed of the satisfaction of surgery, and postoperative MRD1 was evaluated. Results: One patient had a hematoma on left eyebrow, and another one patient had a numbness on left forehead for two months. Except for these two patients, all patients had good results without any significant complications. The mean follow up period was about 5 months, and the position of lateral eyebrow maintained above the supraorbital rim in all cases. Postoperatively, MRD1 increased by 0.8 mm in 5-months mean follow up period. Conclusion: In patient with lateral brow ptosis and lateral hooding, the ROOF-PSF repositioning technique in sub-brow resection could be a good operative option.

• Maxillofacial Plastic and Reconstructive Surgery
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• 제23권4호
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• pp.338-347
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• 2001

Purpose: This is to review the cases of posterior maxillary segmental osteotomies to regain the interarch spaces for dental implants in the posterior mandible. Materials & Methods: Seven patients who presented with alveolar extrusion of upper posterior molars underwent segmental osteotomies by single-stage Kufner's buccal approach under the intravenous sedation and local anesthesia. The posterior maxillary cento-alveolar segments were repositioned upward using pre-fabricated palato-occlusal resin splints and immobilized with osteosynthesis microplates and screws. Dental implants were installated simultaneously. The regained spaces, tooth vitality, periodontal healing, relapse, tenderness on function, and complications including maxillary sinus involvements were evaluated periodically for over one year after the surgeries. Results: The single-tage procedures were completed within 80 minutes without any surgical complications. The posterior maxillary segments were repositioned upward to regain the interarch spaces ranging from 2.5 to 5.5mm. All teeth involved in the procedures keep their vitalities. The repositioned segments were maintained showing neither evidence of periodontal break-down nor tenderness to function. One patient whose segments had not been immobilized by osteosynthesis plate resulted in 2mm down-ward relapse in post-operative 8 months. A case of postoperative nasal bleeding from the posterior-lateral wall resulted in oroantral fistula and chronic maxillary sinusitis later. Conclusion: The extruded dento-alveolar segments of the posterior maxilla were repositioned properly by Kufner's one-stage segmental osteotomies. One microplate can be of help to keep the position until the osseous healing enough to support the masticatory force.

• Journal of Korean Neurosurgical Society
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• 제29권5호
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• pp.659-663
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• 2000

The motality rate of acute subdural hematoma(ASDH) associated with closed head injury is high in spite of recent advances in neurosurgery. Many variables in regard to outcome of ASDH have been assessed. But among them, intracranial pressure(ICP) control and the time interval between injury and operative evacuation are the only things that can be affected by doctor. We introduced a simple method to the management of ASDH for reducing the time interval between injury and operation. When the immediate decompressive operation of ASDH was impossible by any causes, we made a burr hole at the center of hematoma, usually on 2-3cm above temporal squama and 1-2cm behind coronal suture under local anesthesia before main operation. Partial hematoma evacuation was achieved through the burr hole and it was effective in preventing further worsening of patients neurological status before main operation. Prompt hematoma evacuation through the burr hole seemed to be effective in delaying secondary ischemic brain damage and made easy to closing the dura opening and replacement of the bone flap at the end of main decompressive operation. This easy method may reduce the time interval between injury and operation. We represent surgical technique with two cases of ASDH managed with this simple method.

• Maxillofacial Plastic and Reconstructive Surgery
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• 제29권3호
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• pp.255-261
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• 2007

Preface: Dental implant is important method that may solve the mastication, occlusion, esthetic, temporomandibular joint, and psychologic problem in oral and maxillofacial surgery. It is ideal that all of the implant are well positioned by adequate technique. By the way it‘s not always possible because of some anatomic, physiologic factor. In this case, If the implant can be moved to adequate position, it may be possible more esthetically and implanted patients more satisfied, but the majority of Implantists and orthodontists have thought that it is not possible. However, Implant, in fact, can be moved. and thus we can overcome the limit of implantation more. The aim of the present study was to evaluate the possibility of implant movement after corticotomy. Case report: Patient missed the upper right first molar. and implantation was done after completion of socket healing. We wait six months for osseointegration. Then, corticotomy was done under local anesthesia and close coil was used for orthodontic force. After traction during 3 weeks, we find the change of implant position at horizontal plane. we can not see the degenerative change on adjacent structure and tracted implant. there is a clinical mobility on upper right second premolar that used for anchorage but it subside spontaneously at the timing of prosthetic restoration without additional treatment. Discussion: As we could have some knowledge with this experiment, we report the case of implant movement after corticotomy and suggest a method about more esthetic implant treatment with a review of literature.

• Archives of Plastic Surgery
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• 제39권6호
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• pp.637-642
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• 2012

Background Fingertip injuries involving subtotal or total loss of the digital pulp are common types of hand injuries and require reconstruction that is able to provide stable padding and sensory recovery. There are various techniques used for reconstruction of fingertip injuries, but the most effective method is functionally and aesthetically controversial. Despite some disadvantages, cross-finger pulp flap is a relatively simple procedure without significant complications or requiring special techniques. Methods This study included 90 patients with fingertip defects who underwent cross-finger pulp flap between September 1998 and March 2010. In 69 cases, neurorrhaphy was performed between the pulp branch from the proper digital nerve and the recipient's sensory nerve for good sensibility of the injured fingertip. In order to evaluate the outcome of our surgical method, we observed two-point discrimination in the early (3 months) and late (12 to 40 months) postoperative periods. Results Most of the cases had cosmetically and functionally acceptable outcomes. The average defect size was $1.7{\times}1.5$ cm. Sensory return began 3 months after flap application. The two-point discrimination was measured at 4.6 mm (range, 3 to 6 mm) in our method and 7.2 mm (range, 4 to 9 mm) in non-innervated cross-finger pulp flaps. Conclusions The innervated cross-finger pulp flap is a safe and reliable procedure for lateral oblique, volar oblique, and transverse fingertip amputations. Our procedure is simple to perform under local anesthesia, and is able to provide both mechanical stability and sensory recovery. We recommend this method for reconstruction of fingertip injuries.

• Journal of the Korean Association of Oral and Maxillofacial Surgeons
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• 제35권3호
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• pp.158-163
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• 2009

Objective : Recently, we are interested in bisphosphonate related osteonecrosis of the jaw (BRONJ). Most of patients with osteonecrosis have taken medicine bisphosphonate for a long time. But the mechanism of osteonecrosis in BRONJ was not clarified yet. The aim of this study is to evaluate the difference of bone healing effect after bone graft from ilium to maxillary sinus in rabbits between zoledronate-treated and zoledronate-not treated groups. Method : The subjects was divided into two groups. The experimental group was 9 rabbits, treated with intraperitoneal administration of zoledronate(0.06mg/kg) once per week for 3 weeks. In control group, same procedure was applied but administerd saline instead of zoledronate. After 4 weeks, surgical operation under local anesthesia (ketamine 3.0cc, xylazine 1.0cc) was done. At postoperative 1, 2, 4, 8 weeks later, each rabbits were sacrificed and removed the bone grafted area. Gross, radiologic and histopathologic exminations of bone grafted area were performed. Result : There were no conspicuous differences of radiological findings between experimental and control groups in any experimental weeks. In experimental group, new bone formation appeared earlier than control group at 1 week after operation, and maturation of bony tissue were more conspicuous at 2 and 4 weeks after operation, compared with control group. In 8 weeks after operation, similar microscopic findings were noted in both groups. Conclusion : In the bisphosphonate-treated rabbits, new bone formation in the bone grafted area appeared earlier and bony maturation was more concpicuous, even though there were no significant differences of gross and radiological findings. These findings suggest that bisphosphonate might be promotive effect in the healing process in early stage after administration.

• Archives of Plastic Surgery
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• 제35권3호
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• pp.321-324
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• 2008

Purpose: Lymphoma originated from mucosa associated lymphoid tissue(MALT) is most common in gastrointestinal system, and rarely found in salivary gland, thyroid, bronchus or orbit. We experienced a case of MALT lymphoma which was originated from conjunctiva and involving lower eyelid without metastasis. Methods: A 40-year-old man suffered palpable mass on right lower eyelid without pain. Orbital computed tomographic and ultrasonographic findings showed a conical mass($1.9{\times}1.2{\times}0.9cm$ size) inside lower eyelid. The mass was completely excised under local anesthesia and histopathological examination was followed. Results: Microscopic finding showed a multiple follicular colonization. In the follicle, small lymphocytes and plasma cells differentiated to centrocyte-like cell, monocyte B cell, plasma cell were diffusely infiltrated. Immunophenotyping was preformed on fixed section. The majority of the small cells were immunoreactive for the B cell marker CD20. Based on the typical histological findings supported by immunostaining, the mass was defined as MALT lymphoma. After excision, SPECT, abdominal CT was carried out and there were no evidence of extraorbital disease. Conclusion: Biopsy and pathological examination should be performed in patients who complain palpable mass on lower eyelid because of possibility of MALT lymphoma. Although MALT lymphoma is rarely metastasized, it is necessary to evaluate the extraorbital involvement using SPECT or other radiologic exams. For detecting extraorbital involvement, periodic follow-up examination is need.