• 대한두개안면성형외과학회지
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• 제10권2호
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• pp.91-96
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• 2009

Purpose: Frontal sinus fractures are relatively less common than other facial bone fractures. They are commonly concomitant with other facial bone fractures. They can cause severe complications but the optimal treatment of frontal sinus fractures remains controversial. Currently, many principles of treatment were introduced variously. The authors present valid and simplified protocols of treatment for frontal sinus fractures based on fracture pattern, nasofrontal duct injury, and complications. Methods: A retrospective chart review was performed on 36 cases of frontal sinus fractures between January, 2004 and January, 2009. The average age of patients was 33.7 years. Fracture patterns were classified by displacement of anterior and posterior wall, comminution, nasofrontal duct injury. These fractures were classified in 4 groups: I. anterior wall linear fractures; II. anterior wall displaced fractures; III. anterior wall displaced and posterior wall linear fractures; IV. anterior wall and posterior wall displaced fractures. Also, assessment of nasofrontal duct injury was conducted with preoperative coronal section computed tomographic scan and intraoperative findings. Patients were treated with various procedures including open reduction and internal fixation, obliteration, galeal frontalis flap and cranialization. Results: 12 patients are group I (33.3 percent), 14 patient were group II (38.8 percent), group III, IV were 5 each (13.9 percent). Frontal sinus fractures were commonly associated with zygomatic fractures (21.8 percent). 9 patients had nasofrontal duct injury. The complication rate was 25 percent (9 patients), including hypoesthesia, slight forehead irregularity, transient cerebrospinal fluid leakage. Conclusion: The critical element of successful frontal sinus fracture repair is precise diagnosis of the fracture pattern and nasofrontal duct injury. The main goal of management is the restoration of the sinus function and aesthetic preservation.

• Maxillofacial Plastic and Reconstructive Surgery
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• 제28권3호
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• pp.247-253
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• 2006

우리는 좌측 전이부 및 하악지 부위에 생긴 $10\times7\times5cm$ 크기의 거대한 종물을 주소로 내원한 67세 남자 환자에서 임상검사, 방사선동위원소 타액선스캔, 전산화단층촬영 및 조직생검 등을 통해 좌측 이하선의 다형성 선종으로 진단하고 변형 Blair 절개법을 통해 안면신경을 보존하면서 이하선 천층엽절제술을 시행하여 기능적 및 심미적으로 만족스러운 결과를 얻었다. 이하선 천층엽절제술과 안면신경의 분리 및 보존을 시행할 경우 단순적출술에 비해 국소 재발율이 낮고 안면신경이 보존되므로 이하선 다형성 선종의 수술법으로 적절함을 알 수 있었다.

• Archives of Plastic Surgery
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• 제37권5호
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• pp.619-625
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• 2010

Purpose: Trapdoor orbital blowout fracture is most common in orbital blowout fracture. Various materials have been used to reconstruct orbital floor blowout fracture. Absorbable alloplastic implants are needed because of disadvantages of nonabsorbable alloplastic materials and donor morbidity of autogenous tissue. The aim of the study is to evaluate usefulness of absorbable mesh plate as a reconstructive material for orbital blowout fractures. Methods: From December 2008 to October 2009, 18 trapdoor orbital floor blowout fracture patients were treated using elevator fixation, depressor fixation, or elevatordepressor fixation techniques with absorbable mesh plates and screw, depending on degree of orbital floor reduction, because absorbable mesh plates are less rigid than titanium plates and other artificial substitutes. Results: Among 18 patients, 5 elevator fixation, 4 depressor fixation, and 9 elevator and depressor fixation technique were performed. In all patients, postoperative computed tomographic (CT) scan showed complete reduction of orbital contents and orbital floor, and no displacement of bony fragment and mesh plate. Mean follow-up was 10 months. There were no significant intraoperative or postoperative complications. Conclusion: Three different techniques depending on the degree of orbital floor reduction are useful for open reduction and internal fixation of trapdoor orbital floor blowout fracture with absorbable mesh plates.

• Journal of Trauma and Injury
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• 제28권3호
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• pp.190-194
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• 2015

Blunt cerebrovascular injury is defined as a vertebral or carotid arterial structural wall injury resulting from nonpenetrating trauma. Complete traumatic internal carotid artery occlusion is very rare condition accounting for 0.08~0.4 0f all trauma patients and believed to be associated with the greatest risk of ischemic stroke reported in 50~90% in a few small series. A 55-year-male was admitted with drowsy mentality and severe headache after a fall down accident. Brain computed tomography showed a subdural hematoma at the both frontal area with a fracture of the occipital skull bone. Two days after admission, he suddenly complained with a right side hemiparesis of motor grade 2. Brain magnetic resonance diffusion demonstrated multiple high flow signal changes from the left frontal and parietal lesion. Computed tomographic angiogram (CTA) revealed absence of the left ICA flow. Trans femoral cerebral angiography (TFCA) showed complete occlusion of the left internal carotid artery (ICA) at ophthalmic segment in the left ICA angiogram and flows on the left whole hemispheric lesions through the anterior communicating artery in the right ICA angiogram. We decided to conduct close observations as a treatment for the patient because of acute subdural hematoma and sufficient contralateral cerebral flow by perfusion SPECT scan. Two weeks after the accident, he was treated with heparin anticoagulation within INR 2~4 ranges. He recovered as the motor grade 4 without another neurologic deficit after 3 months.

• 한국임상수의학회지
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• 제23권3호
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• pp.361-365
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• 2006

A spayed female, 5-year-old, weighing 2.7 kg, domestic short hair cat was referred to Veterinary Medical Teaching Hospital, Seoul National University. The clinical signs of this patient were weight loss, sneezing, respiratory distress, nasal discharge, epistaxis, ocular discharge, left exophthalmos, and left facial edema and deformity. The laboratory tests represented mild leukocytosis. On the skull radiographs, soft tissue density filled nasal cavity with loss of turbinate detail was found. Destructive and lytic changes of the left nasal bone with soft tissue swelling were identified. On the thorax radiographs, there were a tracheobronchial lymph node swelling and a soft tissue round mass in the left caudal lung field. On computed tomographic scan images, asymmetrical destruction of turbinate and nasal septum and increased soft tissue opacity in the nasal cavity were identified. Destruction of the lateral maxillary bone, invasion to the left retrobulbar region, and craniodorsal deviation of the left eye were seen. Also, there was lysis of hard palate and cribriform plate. Invasion to the brain was found. The patient was diagnosed as nasal lymphoma by cytology and histopathology.

• 한국임상수의학회지
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• 제25권3호
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• pp.187-191
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• 2008

A 7-year-old, intact female Yorkshire terrier dog was presented for coughing, anorexia, chest pain and dyspnea. Right lateral thoracic radiograph demonstrated a large mass shape on the heart base with decreased cardiac silhouette and severe right deviation of the trachea with the heart shifted to the left thoracic wall was observed on the ventrodorsal thoracic projection. Echocardiographic examination revealed a large rounded mass compressing left atrium around the heart base without signs of pericardial effusion. On computed tomographic (CT) findings, sagittal CT images depicted the possibility of cranial vena caval invasion and heart base involvement of the mass associated with biatrial compression. Dorsal CT image revealed the right deviation of trachea due to the heart base mass and markedly shrunk lung space was detected on the transverse CT image. Because the dog suddenly had died during the recovery from anesthesia after finishing CT scan, necropsy was performed. On gross findings, a large and lobulated mass was located at the base of the heart. A poorly-demarcated, infiltrative, multilobulated tumor composed of polyhedral cells in solid cellular sheets was confirmed based on histopathologic examination. This dog was diagnosed as a chemodectoma. This case report describes the clinical findings, diagnostic consistency of thoracic radiography, echocardiography and CT, and histopathologic confirmation in a spontaneously occurring chemodectoma with a Yorkshire terrier dog.

• Journal of Chest Surgery
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• 제37권9호
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• pp.800-804
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• 2004

폐기종 및 재발성 기흉의 과거력이 있는 67세 남자가 갑자기 악화된 호흡곤란을 주소로 내원하였다. 흉부 전산화 단층촬영상 우하엽에 새로 발생한 폐기낭으로 인하여 심장이 좌측으로 전위되어 있는 소견을 보였다. 폐기낭 흡인술(변형 Monaldi 술식)로 성공적으로 치료되었으며 수술 후 환자의 증상은 개선되었다. 저자들은 거대 폐기낭으로 인해 심폐기능이 악화된 폐기종 환자에서 변형 Monaldi 술식으로 치료하여 좋은 결과를 치험하였기에 문헌고찰과 함께 보고하는 바이다.

• Journal of Korean Neurosurgical Society
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• 제56권5호
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• pp.410-418
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• 2014

Objective : The epidural fluid collection (EFC) as a complication of cranioplasty is not well-described in the literature. This study aimed to identify the predictive factors for the development of EFC as a complication of cranioplasty, and its outcomes. Methods : From January 2004 to December 2012, 117 cranioplasty were performed in our institution. One-hundred-and-six of these patients were classified as either having EFC, or not having EFC. The two groups were compared to identify risk factors for EFC. Statistical significance was tested using the t-test and chi-square test, and a logistic regression analysis. Results : Of the 117 patients undergoing cranioplasty, 59 (50.4%) suffered complications, and EFC occurred in 48 of the patients (41.0%). In the t-test and chi-test, risk factors for EFC were size of the skull defect (p=0.003) and postoperative air bubbles in the epidural space (p<0.001). In a logistic regression, the only statistically significant factor associated with development of EFC was the presence of postoperative air bubbles. The EFC disappeared or regressed over time in 30 of the 48 patients (62.5%), as shown by follow-up brain computed tomographic scan, but 17 patients (35.4%) required reoperation. Conclusion : EFC after cranioplasty is predicted by postoperative air bubbles in the epidural space. Most EFC can be treated conservatively. However, reoperation is necessary to resolve about a third of the cases. During cranioplasty, special attention is required when the skull defect is large, since EFC is then more likely.

• Journal of Chest Surgery
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• 제39권5호
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• pp.403-406
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• 2006

폐경색은 폐동맥의 폐색으로 인해 발생하며 기관지내 세균오염에 의해 폐감염이 흔하게 속발하며 이는 폐농양, 농흉 그리고 기관지 흉막루 등을 일으켜 결국 패혈증에 이르게 할 수 있다. 이러한 이유로 조기 진단이 중요하며 감염 조절을 위해 폐절제 등을 조기에 고려해야 한다. 67세 남자가 호흡곤란을 주소로 응급실에 내원하였다. 흉부 전산화 단층 촬영에서 좌하엽에 침윤성 병변과 소량의 흉수 그리고 늑막 비후가 관찰되었다. 폐색전은 하엽 폐동맥에서 상엽 폐동맥까지 자라나 있었다. 출혈성 경색이 완연한 좌하엽은 절제되었고 좌주폐동맥을 열어 나머지 폐색전을 제거하였다. 수술 후 15개월간 추적 관찰하고 있으며 폐색전이나 폐경색의 재발은 보이지 않았다.

• Journal of Korean Neurosurgical Society
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• 제43권1호
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• pp.11-15
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• 2008

Objective : Burr hole drainage has been widely used to treat chronic subdural hematoma (CSDH). However, the incidence of recurrent CSDH varies from 3.7 to 30% after surgery. The authors attempted to elucidate the risk factors associated with the recurrence of CSDH in one burr hole drainage technique. Methods : A total of 255 consecutive cases who underwent one burr hole drainage for CSDH were included in this study. Twenty-four patients (9.4%) underwent a repeated operation because of the recurrence of CSDH. We analyzed retrospectively the demographic, clinical and radiologic factors associated with the recurrence of CSDH. Results : In this study, two risk factors were found to be independently associated with the recurrence of CSDH. The incidence of CSDH recurrence in the high- and mixed-density groups was significantly higher than those in the low- and iso-density groups (p<0.001). Bleeding tendency such as in leukemia, liver disease and chronic renal failure was also significantly associated with recurrence of CSDH (p=0.037). Conclusion : These results suggest that high- and mixed- density shown on computed tomographic scan was closely relates with a high incidence of recurrence. Therefore, the operation could be delayed in those cases unless severe symptoms or signs are present. Reoperation using the previous burr hole site is a preferred modality to treat the recurrent CSDH.