• Archives of Plastic Surgery
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• v.35 no.6
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• pp.669-674
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• 2008

Purpose: Although there are many ways to perform midface reconstruction, several difficulties exist for selecting the appropriate method, because of its anatomical and functional complexities, donor site morbidities, and poor aesthetic results. Various flaps based on the angular artery can overcome these limitations of the traditional reconstruction methods. The purpose of this study is to suggest an alternative reconstructive method for the midface using various flaps based on the angular artery. Methods: We investigated the relationship between the angular artery and its surrounding structures through cadaveric studies and then applied the findings clinically. As a result, we were able to perform reconstruction with a retroangular flap for defects of the lower half of the nose and the lower eyelid. In addition, defects of the upper half of the nose and the medial canthal area were reconstructed by using island composite glabellar flap. Results: The angular artery was reliable as a pedicle, whether it was used antegrade or retrograde. All the wounds were successfully closed, with the exception of minor complications such as partial skin necrosis and flap bulkiness. The aesthetic outcomes for the donor and recipient sites were satisfactory. Conclusion: The angular artery has diverse relationships with its surrounding structures according to its course of travel, and if a surgeon has a precise understanding of its anatomical location, we believe that retroangular flap and island composite glabellar flap may improve the treatment of midface defects.

• Journal of Trauma and Injury
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• v.20 no.2
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• pp.101-105
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• 2007

Purpose: This study aimed to find any difference in the clinical or the anatomical findings of vertebral artery dissection (VAD) between the trauma and the non-trauma groups. Methods: We retrospectively reviewed the clinical data and radiologic images of VAD patients. We compared data on symptoms, neurologic deficit, National institutes of health stroke scale (NIHSS) at admission, Rankin score (RS) at admission and discharge, and radiological findings including anatomical features, between the trauma and the non-trauma groups. Results: From January 1997 to May 2006, 42 patients were enrolled and 13 patients (31%) had a history of earlier trauma. Focal neurologic deficit (trauma group 11/13 vs. non-trauma group 11/29), cerebral stroke (10/13 vs. 9/29), and extradural lesions of dissection (6/13 vs. 3/28) were more common in the trauma group than non-trauma group (p=0.007, p=0.017, p=0.018, respectively) and NIHSS at admission and discharge were significantly higher (p=0.012, p=0.001, respectively). Dissecting aneurysms were less frequent in the trauma group (2/13 vs. 19/29, p=0.006). Subarachnoid hemorrhage and unfavorable prognostic value (Rankin score at discharge ${\geq}$ 2) showed no differences between the groups (p=0.540, p=0.267, respectively). Conclusion: In VAD patients after trauma, focal neurologic deficit due to ischemic stroke and a steno-occlusive pattern are more frequent than they are in non-trauma patients. The location of dissection was most frequent at the extradural vertebral artery in the trauma group. NIHSS was higher in the trauma groups but the incidence of an unfavorable prognostic value (RS ${\geq}$ 2) was not significantly different between the groups.

• Journal of the Korean Wood Science and Technology
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• v.29 no.3
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• pp.1-13
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• 2001

Compression, lateral, and opposite woods in the stem and branch of rimu (Dacrydium cupressinum Lamb.), a softwood species indigenous to New Zealand, were described and compared in the anatomical aspects. Qualitatively, growth rings were wide in the compression wood, intermediate in the lateral wood, and narrow in the opposite wood. Tracheid transition from early wood to late wood was very gradual in the compression wood but was more abrupt in both the lateral and opposite woods. When viewed transversely, compression wood tracheids showed a roundish outline except at the growth ring boundary but lateral and opposite wood tracheids were angular to rectangular in outline. Intercellular spaces were occasionally detected in the compression wood except in the late wood at the growth ring boundary but were absent from both the lateral and opposite woods. Slit-like extensions of the bordered pit openings caused by the location of pit apertures within short and narrow helical grooves were observed in the compression wood tracheids but not in the opposite or lateral wood tracheids. In the compression wood tracheids, fine striations in the form of fine checks or grooves were observed on the lumen surfaces and the innermost $S_3$ layer of secondary wall was absent. In the tracheids of lateral and opposite woods, the $S_3$ layer was sometimes absent but occasionally highly developed. Cross-field pits in the compression wood appeared to be piceoid due to slit-like pit apertures but those in the lateral and opposite wood tracheids showed cupressoid to taxodioid. Quantitatively, compression wood tracheids were somewhat shorter than those of opposite or lateral wood in stem but not different from the opposite or lateral wood tracheids in branch. The walls were thicker in the compression wood than in the lateral or opposite wood. Uniseriate rays in the compression wood were fewer than in the lateral or opposite wood.

• Maxillofacial Plastic and Reconstructive Surgery
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• v.21 no.2
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• pp.149-165
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• 1999

The pathomechanism of obstructive sleep apnea(OSA) is not clearly elucidated. The possible mechanisms are pathologic reduction of pharyngeal muscular tonus during sleep, abnormal anatomical stenosis of nasopharyx or a combination of the above two mechanisms. It is very important to find the cause(anatomical location or pathologic dynamic change) of OSA in order to treat it. Cephalometric analysis in patients with obstructive sleep apnea is a good method for evaluating anatomical morphologic change but it cannot give any information about the dynamic changes occurring during sleep. On the contrary, nasopharyngeal endoscopy offer 3 dimensional image and information about the dynamic changes. Accordingly, these two diagnostic tools can be utilize in the diagnosis and treatment planning of OSA Cephalometric analysis of craniofacial skeletal and soft tissue morphology in 53 patients with OSA and 43 controls was performed and cephalometric analysis and nasopharygeal endoscopy were performed in 9 patients with OSA in order to come up with individualized therapy plans. Following results were obtained ; Patients with OSA showed 1. body weight gain 2. clockwise mandibular rotation 3. increased anterior lower facial height 4. inferiorly positioned hyoid bone 5. increased length of soft palate 6. decreased sagittal dimension of nasopharyx 7. increased vertical length of inferior collapsable nasopharyx 8. increased length of tongue Through cephalometric analysis and nasopharygeal endoscopy(mutually cooperative in diagnosis), 9. one can find the possible origin of OSA and make a adequate individualized therapy plan and predict accurate prognosis. Cephalometric analysis and nasopharygeal endoscopy are highly recommended as a diagnostic aid in OSA patients

• Annals of Rehabilitation Medicine
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• v.41 no.6
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• pp.924-934
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• 2017

Objective To investigate the anatomical correlates of the neuropsychological deficits in patients with the cerebellar stroke. Methods We screened patients who were admitted to the National Rehabilitation Center with the cerebellar stroke between October 2012 and November 2016. The patients with the cerebellar stroke who underwent neuropsychological testing for which the Seoul Neuropsychological Screening Battery (SNSB) or the SNSB-II were enrolled. The neuropsychological function capacities were compared in accordance with the stroke type (hemorrhagic vs. ischemic) and the location (right/left anterior, right/left posterior intermediate, right/left posterior lateral lobe, and vermis). Mean z-scores were computed to compare the patient performances with the population averages. Results Twenty-six patients (15 with ischemic stroke and 11 with hemorrhagic stroke) with a mean age of $54.8{\pm}16.6$ years were assessed $8.8{\pm}9.2$ months after the stroke. Differences in the neuropsychological functioning according to the stroke type were not observed. All of the numerical subtests of the stroke patients showed significantly poorer performances compared with the population averages (mean z-score <0), and some of the subtests revealed abnormal performances in attention-, visuospatial function-, memory-, and frontal/executive function-related tasks (mean z-score <-1). The patients with the presence of a lesion in the right posterior intermediate lobe of the cerebellum showed a poorer performance in the subtests evaluating the executive function including the Korean-version Stroop Test (p=0.04), the Digit Symbol Coding Test (p=0.01), and the Korean-version Trail Making Test (p=0.02) compared with the patients without that lesion. Conclusion The present study confirms that the cerebellar stroke affects the neuropsychological functioning which is associated with the anatomical site of stroke.

• Korean Circulation Journal
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• v.48 no.12
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• pp.1081-1096
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• 2018

We reviewed the anatomical characteristics of the conduction system in the ventricles of human and ungulate hearts and then raised some questions to be answered by clinical and anatomical studies in the future. The ventricular conduction system is a 3-dimensional structure as compared to the 2-dimensional character of the atrial conduction system. The proximal part consisting of the atrioventricular node, the bundle of His and fascicles are groups of conducting cells surrounded by fibrous connective tissue so as to insulate from the underlying myocardium. Their location and morphological characters are well established. The bundle of His is a cord like structure but the left and right fascicles are broad at the proximal and branching at the distal part. The more distal part of fascicles and Purkinje system are linear networks of conducting cells at the immediate subendocardium but the intra-mural network is detected at the inner half of the ventricular wall. The papillary muscle also harbors Purkinje system not in the deeper part. It is hard to recognize histologically in human hearts but conducting cells as well as Purkinje cells are easily recognized in ungulate hearts. Further observation on human and ungulate hearts with myocardial infarct, we could find preserved Purkinje system at the subendocardium in contrast to the damaged system at the deeper myocardium. Further studies are necessary on the anatomical characteristics of this peripheral conduction system so as to correlate the clinical data on hearts with ventricular arrhythmias.

• Restorative Dentistry and Endodontics
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• v.47 no.1
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• pp.1.1-1.13
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• 2022

Objectives: This study assessed the shape and anatomical relationship of the mental foramen (MF) to mandibular posterior teeth in an Indian sub-population. Materials and Methods: In total, 475 existing cone-beam computed tomography records exhibiting 950 MFs and including the bilateral presence of mandibular premolars and first molars were assessed. Images were evaluated 3-dimensionally to ascertain the position, shape, and anatomical proximity of MFs to mandibular teeth. The position and shape of MFs were measured and calculated. The Pythagorean theorem was used to calculate the distance between the root apex of the mandibular teeth and the MF. Results: MFs exhibited a predominantly round shape (left: 67% and right: 65%) followed by oval (left: 30% and right: 31%) in both males and females and in different age groups. The root apices of mandibular second premolars (left: 71% and right: 62%) were closest to the MF, followed by distal to the first premolars and mesial to the second premolars. The mean vertical distance between the MF and the nearest tooth apex calculated on sagittal sections was 2.20 mm on the right side and 2.32 mm on the left side; no significant difference was found according to sex or age. The distance between the apices of the teeth and the MF was ≥ 4 mm (left; 4.09 ± 1.27 mm and right; 4.01 ± 1.15 mm). Conclusions: These findings highlight the need for clinicians to be aware of the location of the MF in treatment planning and while performing non-surgical and surgical endodontic procedures.

• The Korean Journal of Pain
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• v.22 no.1
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• pp.47-51
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• 2009

Background: The blind sacroiliac joint (SIJ) block cannot always be performed accurately; it is commonly performed in the office based setting because intraarticular and periarticular injections are effective for SIJ pain. However, knowledge on the surface anatomy of the SIJ is lacking. The purpose of this study was to analyze the surface anatomical location of the posterior-inferior margin of the SIJ. Methods: After informed consent was obtained, fifty patients undergoing SIJ block in the prone position were examined. The oblique angles where the anterior-inferior margin and the posterior-inferior margin of the SIJ overlap on X-ray were evaluated. In addition, the surface anatomical relationships between the posterior-inferior margin of the SIJ on X-ray and the posterior superior iliac spine (PSIS) and sacral hiatus by palpation were assessed. Results: The oblique angle was $5.4{\pm}2.9^{\circ}$. The vertical and transverse distance between the posterior-inferior margin of the SIJ and PSIS were $3.8{\pm}0.8cm$ and $0.9{\pm}0.6cm$, respectively. The vertical and transverse distance between the posterior-inferior margin of the SIJ and the midpoint of the sacral hiatus were $3.4{\pm}0.7cm$ and $3.9{\pm}0.6cm$, respectively. Only the vertical distance between the posterior-inferior margin of the SIJ and PSIS showed significant difference between the male and the female groups (P = 0.0016). Conclusions: The measurements in this study can be used as a reference standards for the blind SIJ block.

• Journal of Korean Neurosurgical Society
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• v.42 no.1
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• pp.35-41
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• 2007

Objective : Determining the location of paraclinoid aneurysms for microsurgery is important for selecting treatment options, especially when deciding on the release of the dural ring in direct clipping. We examined the reliability of using the optic strut as an anatomical landmark for evaluating the location of paraclinoid aneurysms. Methods : Cadaveric dissection was performed to establish the relationship of the optic strut to the dural ring. Results from these anatomic studies were compared with the three-demensional computed tomographic angiographic [3D-CTA] findings of nine patients with ten paraclinoid aneurysms between May 2004 and October 2005. These, 3D-CTA results were then compared with intraoperative findings. Results : The inferior boundary of the optic strut accurately localized the point at the proximal dural ring in cadaveric study. The optic strut and its relationship to the aneurysms was well observed on the multiplanar reformats of 3D-CTA. During microsurgery, nine of ten aneurysms were verified to arise from distal to the upper surface of the optic strut. Two aneurysms that had arisen between the inferior and superior boundary of the optic strut were observed to lie within the carotid cave. One aneurysm which had arisen at the inferior boundary of the optic strut and directed inferiorly was observed to lie within the cavernous sinus just after the release of the proximal ring. Conclusion : The optic strut, as identified with multiplanar reformats of 3D-CTA, provided a reliable anatomic landmark for the proximal rings and an important information about the location of aneurysms around the anterior clinoid process (ACP). Therefore, 3D-CTA and the optic strut could become an invaluable tool and a landmark in the assessment of the location of paraclinoid aneurysms for microsurgery.

• The Korean Journal of Pain
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• v.31 no.4
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• pp.268-276
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• 2018

Background: Although a variety of instruments implement body maps for the precise identification of pain symptoms, no instrument has been validated for use in people with obesity. This study reports the adaptation and validation of body maps for musculoskeletal pain location in people with obesity. Methods: Nine key anatomical regions were highlighted based on the original images of the Nordic Musculoskeletal Questionnaire body maps. Adult silhouettes were generated from photographs of men and women with obesity. The body dimensions were adjusted to take into account the different body fat distribution patterns of people with obesity. The validity of the images was assessed by 12 experts. Subsequently, a data collection stage was performed with 58 patients with severe obesity from both sexes. The reproducibility of the images was tested by comparison with the original images. Results: The results of the validation pilot study indicated that the adapted images facilitated the location of musculoskeletal pain in men and women with obesity. The reproducibility of the original and adapted versions of the body maps indicated good agreement for pain over the last 12 months and 7 days (80% vs. 79.7%). Pain scores in the last 12 months indicated good and high sensitivity and specificity for all body areas (60.9% vs. 89.1%). Considering pain in the last 7 days, high sensitivity and specificity for all areas of the body (85.1% vs. 70.1%). Conclusions: The body maps developed in this study are reliable and valid to identify the location of pain in people with obesity.