• Maxillofacial Plastic and Reconstructive Surgery
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• 제37권
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• pp.25.1-25.9
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• 2015

Background: During the orthognathic surgery, it is important to know the exact anatomical location of the mandibular foramen to achieve successful anesthesia of inferior alveolar nerve and to prevent damage to the nerves and vessels supplying the mandible. Methods: Cone-beam computed tomography (CBCT) was used to determine the location of the mandibular foramen in 100 patients: 30 patients with normal occlusion (13 men, 17 women), 40 patients with skeletal class II malocclusion (15 men, 25 women), 30 patients with skeletal class III malocclusion (17 men, 13 women). Results: The distance from the anterior border of the mandibular ramus to mandibular foramen did not differ significantly among the three groups, but in the group with skeletal class III malocclusion, this distance was an average of $1.43{\pm}1.95mm$ longer in the men than in the women (p < 0.05). In the skeletal class III malocclusion group, the mandibular foramen was higher than in the other two groups and was an average of $1.85{\pm}3.23mm$ higher in the men than in the women for all three groups combined (p < 0.05). The diameter of the ramus did not differ significantly among the three groups but was an average of $1.03{\pm}2.58mm$ wider in the men than in the women for all three groups combined (p < 0.05). In the skeletal class III malocclusion group, the ramus was longer than in the other groups and was an average of $7.9{\pm}3.66mm$ longer in the men than women. Conclusions: The location of the mandibular foramen was higher in the skeletal class III malocclusion group than in the other two groups, possibly because the ramus itself was longer in this group. This information should improve the success rate for inferior alveolar nerve anesthesia and decrease the complications that attend orthognathic surgery.

• Archives of Plastic Surgery
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• 제35권6호
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• pp.663-668
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• 2008

Purpose: Pedicled transverse rectus abdominis myocutaneous(TRAM) flap has been a gold standard for breast reconstruction and one of surgical techniques preferred by many surgeons. The authors examined the course of deep epigastric artery focusing on distance from margins of rectus abdominis to pedicle and location of choke vessels to get minimal muscles during pedicled TRAM flap operation. Methods: Eleven rectus abdominis muscle from nine cadavers were used in this study. Rectus abdominis was separated from the cadavers, deep inferior and superior epigastric artery were isolated and then 8 anatomical landmarks in medial and lateral margins of rectus abdominis were designated. Distance to a pedicle meeting first horizontally was measured and vertical location from umbilicus to choke vessel was determined. In addition, 32 rectus abdominis images of 16 women(average age: 37.2 years old) from 64 channel abdomen dynamic computerized tomography were also examined with the same anatomical landmarks with those of cadavers. Results: Average distance from four landmarks on lateral margin of rectus abdominis to pedicle was 1.9 - 3.4cm and 1.8 - 3.8 cm on medial margin. Choke vessel was located between middle and inferior tendinous intersection in all cases and average distance between two tendinous intersection was 6.7 - 7.0 cm on medial margin and 6.2 cm on lateral margin. Location of inferior tendinous intersection was on umbilicus or superior of it in all cases and its average distance from umbilicus was 1.8 - 5.6 cm on medial margin and 2.7 - 6.2 cm on lateral margin. Conclusion: Distance from medial and lateral margins of rectus abdominis muscle to pedicle was the shortest in inferior tendinous intersection and that was averagely 1.8 cm on medial margin and 1.9 cm in average on lateral margin. All choke vessels were located between middle and inferior tendinous intersection.

• 구강회복응용과학지
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• 제28권1호
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• pp.1-13
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• 2012

짧은 임플란트는 상악동이나 하치조신경 등의 해부학적 구조물이 있거나 심한 치조골 흡수로 인해 제한적인 치조제 높이를 가지는 부위에서 사용되고 있다. 본 연구는 길이 10 mm 이하의 임플란트에서 임플란트의 길이, 직경, 식립 부위, 골이식술 유무, 보철물의 연결고정 유무가 임플란트의 생존율과 변연골 흡수에 미치는 영향을 알아보고자 하였다. 원광대학교 치과병원 임플란트센터에서 길이 10 mm 이하의 임플란트를 식립한 137명의 환자, 227개 임플란트를 대상으로 진료 기록부를 통해 임플란트의 길이, 직경, 식립 위치, 골이식 유무, 보철물의 연결고정 유무를 조사하였다. 변연골 흡수량은 Emago advanced v5.6(Oral diagnostic systems, Amsterdam, The Netherlands) 프로그램을 이용하여 측정하였다. 총 227개의 임플란트 중 8개가 실패하여, 전체 짧은 임플란트의 생존율은 96.5 %로 나타났다. 골이식 부위와 상악에 식립된 경우 더 높은 실패율을 보이는 경향이 있었으며, 임플란트의 길이와 직경은 변연골 흡수량에 영향을 미치지 않았다. 실패 요인을 조사하였을 때, 상악의 불량한 골질과 골이식 유무가 임플란트의 더 높은 실패율에 영향을 미쳤다. 10 mm 이하 임플란트에서 길이, 직경, 식립 부위, 골이식술과 보철물의 연결 고정은 임플란트 생존율과 변연골 흡수량에 영향을 끼치지 않았다.

• 핵의학기술
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• 제14권1호
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• pp.78-82
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• 2010

현재 우리나라 암발생률을 보면 유방암과 갑상샘암이 매년 빠르게 증가하고 있는 추세이다. 따라서 I-131 scan과 전초림프절 검사인 lymphoscintigraphy가 많이 시행되고 있다. 그러나 이러한 검사는 전통적인 핵의학 영상 검사들과 마찬가지로 병리생태를 영상화하는 데에는 탁월하나 해부학적 정보는 많지 않다. 따라서 트랜스미션 스캔을 실시하여 해부학적 위치를 찾는 데 도움을 주는 등 여러 방법을 사용하고 있으나 만족스럽지 못하다. 이에 착안하여 감마실사영상의 fusion으로 좀 더 해부학적 정보가 많은 영상을 구현하고자 한다. 2009년 4월부터 7월까지 본과를 내원하고 SIEMENS사의 Symbia Gamma Camera를 이용하여 lymphoscintigraphy를 시행한 환자와 I-131 추가 검사를 시행한 환자를 대상으로 하였다. 먼저 감마카메라로 촬영한 후 촬영실 천정에 설치한 hyVISION사의 소형카메라(R-2000)로 동일 위치를 촬영하여 감마영상과 소형카메라의 실사영상을 자체개발한 Gamma Ray Tool Fusion 프로그램을 이용하여 fusion하여 일치도를 평가 하였으며, 환자 및 술자의 피폭선량을 평가하였다. 술자와 환자의 피폭선량은 트랜스미션 스캔을 적용하기 위한 플러드 선원의 제작과정과 실제 트랜스미션 스캔이 적용될 때 방사선피폭이 발생되며 술자의 방사선피폭은 평균 14.1743 ${\mu}Sv$이며, 환자의 방사선피폭은 평균 0.9037 ${\mu}Sv$이다. 또한 fusion 영상에서 감마마커와 실사마커가 일치하였고 플러드 선원에 의한 피폭은 없었다. 본원에서 구축한 감마영상과 실사영상의 fusion 프로그램으로 보다 많은 해부학적 정보를 포함하고 있는 영상을 임상의 및 판독의에게 제공할 수 있고, 업무프로세스가 감소되어 편리한 조작이 가능하게 되었다. 또한 플러드 선원에 의한 피폭을 줄일 수 있어서, 다른 핵의학 검사에도 사용이 가능할 것으로 생각되어진다. 하지만 환자의 사생활이 존중되어야 하기 때문에 검사시행 전, 검사진행 과정과 장점 등을 자세하게 설명한 후 환자가 동의할 경우 검사를 실시하여야 할 것이다.

• Korean Journal of Radiology
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• 제22권8호
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• pp.1323-1331
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• 2021

Objective: To identify the association between renal tumor complexity and pathologic renal sinus invasion (RSI) and evaluate the usefulness of computed tomography tumor features for predicting RSI in patients with renal cell carcinoma (RCC). Materials and Methods: This retrospective study included 276 consecutive patients who underwent radical nephrectomy for RCC with a size of ≤ 7 cm between January 2014 and October 2017. Tumor complexity and anatomical renal sinus involvement were evaluated using two standardized scoring systems: the radius (R), exophytic or endophytic (E), nearness to collecting system or sinus (N), anterior or posterior (A), and location relative to polar lines (RENAL) nephrometry and preoperative aspects and dimensions used for anatomical classification (PADUA) system. CT-based tumor features, including shape, enhancement pattern, margin at the interface of the renal sinus (smooth vs. non-smooth), and finger-like projection of the mass, were also assessed by two independent radiologists. Univariable and multivariable logistic regression analyses were performed to identify significant predictors of RSI. The positive predictive value, negative predictive value (NPV), accuracy of anatomical renal sinus involvement, and tumor features were evaluated. Results: Eighty-one of 276 patients (29.3%) demonstrated RSI. Among highly complex tumors (RENAL or PADUA score ≥ 10), the frequencies of RSI were 42.4% (39/92) and 38.0% (71/187) using RENAL and PADUA scores, respectively. Multivariable analysis showed that a non-smooth margin and the presence of a finger-like projection were significant predictors of RSI. Anatomical renal sinus involvement showed high NPVs (91.7% and 95.2%) but low accuracy (40.2% and 43.1%) for RSI, whereas the presence of a non-smooth margin or finger-like projection demonstrated comparably high NPVs (90.0% and 91.3% for both readers) and improved accuracy (67.0% and 73.9%, respectively). Conclusion: A non-smooth margin or the presence of a finger-like projection can be used as a preoperative CT-based tumor feature for predicting RSI in patients with RCC.

• 대한두경부종양학회지
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• 제5권1호
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• pp.5-13
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• 1989

Carotid body paraganglioma is uncommon, with appoximately 900 reports of it in the world literature, and with only 7 documented cases in the Korean literature. The classic carotid body paraganglioma develops in the bifurcation of common carotid artery and involves both the internal and external carotid arteries at it expands. The diagnosis may almost always be established preoperatively by selective angiography which shows a widening of the carotid bifurcation with a well defined vascular mass. Differential consideration of a single, lateral cervical mass in this location include branchial cleft cyst, neurogenic tumor, metastatic thyroid cancer, carotid body aneurysm and salivary gland tumor. Surgical therapy is the preferred method of treatment as these tumors are regarded as radioresistant. Because of their high vascularity and anatomical location, surgical removal of these tumors reguires a considerable degree of caution and a high degree of surgical expertise. With improved diagnostic and surgical technique, the morbidity and mortality has been reduced lately. This report details the management of 3 patients with carotid body paraganglioma who underwent safe resection by subadventitial dissection or using an internal vascular shunt.

• Archives of Reconstructive Microsurgery
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• 제22권2호
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• pp.43-47
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• 2013

Purpose: Un-healing and centrally located defect on back area, it is sometimes a challenge for the reconstructive surgeon. Although skin grafts are considered as the first choice for reconstruction of large skin defect on the back region, it is not always helpful but vascularized flaps provide a superior functional and aesthetic outcome. The present study was designed to investigate the clinical anatomy of the lumbar artery perforator flap to reconstruct back ulcer. Materials and Methods: Clinical anatomy study was undertaken using computed tomographic angiographic analysis. We identified the courses of lumbar arteries and its perforators, measured pedicle length by layers. The location of the perforator vessel was charted against anatomical landmarks. Results: The pedicle lengths of the third and fourth lumbar artery perforator reached a mean of 27.8 mm and 37.1 mm respectively from superficial fascia to deep fascia. The fourth perforator was more laterally located than the third perforator and less than 1 cm above the iliac crest. A case in which the fourth lumbar artery perforator was used as flap pedicle is described. Conclusion: For the reconstruction of central defect on the back area, the lumbar artery perforator flap coverage may be a good alternative option. Computed tomographic angiography can easily identify the course and location of lumbar artery perforators and can be helpful to elevate the flap successfully.

• 지역사회간호학회지
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• 제20권1호
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• pp.105-111
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• 2009

Purpose: The purpose of this study was to identify minimum datasets for ulcer assessment and to map the minimum datasets to paper-based nursing records for pressure ulcer care in homecare setting. Methods: To identify minimum datasets for pressure ulcer assessment, the authors reviewed four guidelines for pressure ulcer care. The content validity of the minimum datasets was assessed by three homecare nurse specialists. To map the minimum datasets to nursing records, the authors examined 107 pressure ulcer events derived from 45 pressure ulcer patients who received home nursing from two hospitals in Gyeonggi Province. Results: The minimum datasets for initial assessment were anatomical location, stage, size, tissue, exudate, condition of periwound skin, undermining, odor, and pain. 'Location' was recorded best, accounting for a complete recording rate of 98.1%. 'Exudate' and 'pain' showed the poorest record, accounting for 2.8% and 0%, respectively. The minimum datasets for progress assessment were wound size, tissue, and exudate, each accounted for 31.8%, 2.8%, and 4.7%, respectively. Conclusion: This study concluded that data on pressure ulcer assessment was not sufficient homecare and it can be improved by adopting minimum datasets as identified in this study.

• 대한골관절종양학회지
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• 제12권2호
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• pp.136-140
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• 2006

골반골은 악성 골종양의 원발 병소 중 예후가 가장 나쁜 위치이다. 그 중에서도 치골결합 주위에서 발생한 악성 골종양은 그 자체가 극히 드물며, 이곳에 발생한 연골육종은 크기가 작은 경우에도 해부학적인 위치 때문에 절제에 어려움이 있다. 저자들은 치골에 생긴 골반강내 연골육종을 양측 치골지의 절골술 후 도달법으로 전 절제가 가능하였으며, 술후 양호한 기능적 결과를 보였기에 보고하는 바이다.

• Archives of Plastic Surgery
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• 제51권2호
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• pp.196-201
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• 2024

Nevus lipomatosus superficialis (NLS) is a hamartoma of adipose tissue, rarely reported in the past 100 years. We treated one case, and we conducted a systematic review of the literature. A 41-year-old man presented with a cutaneous multinodular lesion in the posterior region near the right auricle. The lesion was excised and examined histopathologically. To review the literature, we searched PubMed with the keyword "NLS." The search was limited to articles written in English and whose full text was available. We analyzed the following data: year of report, nation of corresponding author, sex of patient, age at onset, duration of disease, location of lesion, type of lesion, associated symptoms, pathological findings, and treatment. Of 158 relevant articles in PubMed, 112 fulfilled our inclusion criteria; these referred to a total of 149 cases (cases with insufficient clinical information were excluded). In rare cases, the diagnosis of NLS was confirmed when the lesion coexisted with sebaceous trichofolliculoma and Demodex infestation. Clinical awareness for NLS has increased recently. NLS is an indolent and asymptomatic benign neoplasm that may exhibit malignant behavior in terms of huge lesion size and specific anatomical location. Early detection and curative treatment should be promoted.