• Journal of Korean Neurosurgical Society
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• v.58 no.1
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• pp.36-42
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• 2015

Objective : Complete sellar floor reconstruction is critical to avoid postoperative cerebrospinal fluid (CSF) leakage during transsphenoidal surgery. Recently, the pedicled nasoseptal flap has undergone many modifications and eventually proved to be valuable and efficient. However, using these nasoseptal flaps in all patients who undergo transsphenoidal surgery, including those who had none or only minor CSF leakage, appears to be overly invasive and time-consuming. Methods : Patients undergoing endoscopic endonasal transsphenoidal tumor surgery within a 5 year-period were reviewed. Since 2009, we classified the intraoperative CSF leakage into grades from 0 to 3. Sellar floor reconstruction was tailored to each leak grade. We did not use any tissue grafts such as abdominal fat and did not include any procedures of CSF diversions such as lumbar drainage. Results : Among 200 cases in 188 patients (147 pituitary adenoma and 41 other pathologies), intraoperative CSF leakage was observed in 27.4% of 197 cases : 14.7% Grade 1, 4.6% Grade 2a, 3.0% Grade 2b, and 5.1% Grade 3. Postoperative CSF leakage was observed in none of the cases. Septal bone buttress was used for Grade 1 to 3 leakages instead of any other foreign materials. Pedicled nasoseptal flap was used for Grades 2b and 3 leakages. Unused septal bones and nasoseptal flaps were repositioned. Conclusion : Modified classification of intraoperative CSF leaks and tailored repair technique in a multilayered fashion using an en-bloc harvested septal bone and vascularized nasoseptal flaps is an effective and reliable method for the prevention of postoperative CSF leaks.

• Journal of Korean Neurosurgical Society
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• v.42 no.2
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• pp.89-91
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• 2007

Objective : Cranioplasty is necessary to repair the cranial defect, produced either by decompressive craniectomy or removal of the contaminated depressed skull fracture. Complications are relatively common after cranioplasty, being reported up to 23.6%. We examined the incidence and risk factors of infectious complications after cranioplasty during last 6 year period. Methods : From January 2000 to December 2005, 107 cranioplasties were performed in our institution. The infectious complications occurred in 17 cases that required the removal of the bone flap. We examined the age of the patients, causes of the skull defect, timing of the cranioplasty the size of the defect, and kinds of the cranioplasty material. The size of the skull defect was calculated by a formula, $3.14{\times}long\;axis\;{\times}short$ axis. The cranioplasty material was autogenous bone kept in a freezer in 74 patients, and polymethylmetacrylate in 33 patients. Statistical significance was tested using the chi-square test. Results : The infection occurred in 17 patients in 107 cranioplasties (15.9%). It occurred in 2 of 29 cases of less than $75\;cm^2$ defect (6.9%), and 6 in 54 cases of $75{\sim}125\;cm^2$ defect (11.1%). Also, it occurred in 9 of 24 cases of more than $125\;cm^2$ defect (37.5%). This difference was statistically significant (p <0.01). Conclusion : During the cranioplasty, special attention is required when the skull defect is large since the infection tends to occurr more commonly.

• Journal of Korean Dental Science
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• v.9 no.1
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• pp.35-41
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• 2016

Langerhans cell histiocytosis (LCH) is characterized by proliferation of histiocyte-like cells (Langerhans cell histiocytes) with characteristic Birbeck granules, accompanied by other inflammatory cells. Treatments of LCH include surgery, chemotherapy, and radiotherapy. One of the representative forms of chemotherapy is intralesional injection of steroids. Surgical treatment in the form of simple excision, curettage, or even ostectomy can be performed depending on the extent of involvement. Radiotherapy is suggested in case of local recurrence, or a widespread lesion. This article shows the case of repetitively recurrent LCH of a 56-year-old man who had been through surgical excision and had to have marginal mandibulectomy and radiotherapy when the disease recurred. After the first recurrence occurred, lesions involved the extensive part of the mandible causing pathologic fracture, so partial mandibular bone resection was performed from the right molar area to the left molar area followed by the excision of the surrounding infected soft tissues. The resected mandibular bone was reconstructed with a segment of fibula osteomyocutaneous free flap and overdenture prosthesis supported by osseointegrated implants.

• Journal of Periodontal and Implant Science
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• v.27 no.2
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• pp.347-361
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• 1997

The present study investigates the effects of DFDB graft combined with Calcium sulfate membrane on the periodontal wound healing in dehiscence defects of dogs. Following the initiation of general anesthesia by I.V. administration of 30mg/kg of pentobarbital, first premolar was extracted and full-thickness flap was elevated from the second to the fourth premolar. The portion of premolars coronal to the alveolar crest was removed and mesial and distal roots separated to produce single rooted teeth. Exposed root canals were sealed with Caviton and covered completely with flaps sutured. Following the healing period of 12 weeks, the surgical sites were uncovered and $4{\times}4mm$ dehiscence defects were surgically created. Those defects with DFDB graft combined with Calcium sulfate membrane following root planing, were designated as test sites and those with flap surgery-only were designated as controls. 1. No foreign-body reaction or inflammation were observed in either groups. Calcium sulfate was completely resorbed in the test sites. 2. Significantly greater amounts of new cementum was observed in test sites compared with the controls. Significant amounts of functionally orientated collagens were observed in the test sites. 3. New bone formation was observed in significantly greater amounts in test sites. The results suggest that combined graft of DFDB and calcium sulfate is extremely biocompatible with a potential for new bone and cementum formation, and functional alignment of periodontal ligaments.

• Journal of Periodontal and Implant Science
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• v.27 no.3
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• pp.633-645
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• 1997

The recent trend of research and development on guided tissue regeneration focuses on the biodegradable membranes, which eliminate the need for subsequent surgical removal. They have demonstrated significant and equivalent clinical improvements to the ePTFE membranes. This study evaluate guided tissue regeneration wound healing in surgically induced intrabony periodontal defects following surgical treatment with a synthetic biodegradable membranes, made from a copolymer of glycolide and lactide, in 8 beagle dogs. After full thickeness flap reflection, exposed buccal bone of maxillary and mandibular canine and premolar was removed surgically mesiodistally and occlusoapically at $6mm{\times}6mm$ in size for preparation of periodontal defects. In experimental sites a customized barrier was formed and fitted to cover the defect. Flap was replaced slightly coronal to CEJ and sutured. Plaque control program was initiated and maintained until completion of the study. In 4, 8, 16 and 24 weeks after surgery, the animals were sacrificed and then undecalcified specimens were prepared for histologic evaluation. Histologic examination indicated significant periodontal regeneration characterized by new connective tissue attachment, cementum formation and bone formation. These membranes showed good biocompatibility throughout experiodontal period. The barriers had been completely resorbed with no apparent adverse effect on periodontal wound healing at 24 weeks. These results implicated that present synthetic biodegradable membrane facilitated guided tissue regeneration in periodontal defect.

• Journal of the Korean Association of Oral and Maxillofacial Surgeons
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• v.46 no.6
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• pp.409-416
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• 2020

Objectives: The goal of this retrospective study was to determine the significance and impact of several factors on the alveolar cleft bone grafting procedure. Materials and Methods: The medical records were reviewed. In addition, x-rays were checked. The size of every cleft was measured in this retrospective study. The analyzed factors included sex, age, type of cleft, size of the cleft, and the type of flap used in surgery. The patients were characterized into group A (no complications, Bergland scale 1 or 2), group B (complications or Bergland scale 3), or group C (failure cases). Statistical analysis was performed with a P-value set at 0.05. Results: There were 32 cases in group A, 26 in group B, and 9 in group C. Multinomial logistic regression showed an association between the type of the cleft and the size of the cleft, with the presence of complications, or achieving type 3 on the Bergland scale, with odds ratios of 5.118 and 6.000, respectively. The type of cleft was related to failure with an odds ratio of 4.833. Given a small sample, statistical analysis could not be performed to evaluate the relationship between the size of the cleft and group C. Age, sex, and the type of the flap were not significant factors. Conclusion: The cleft size of more than 10 mm and bilateral clefts were listed regarding their effect on the procedure. Clinicians should not overlook these factors. In addition, patients must be informed of any risks that are present.

• Journal of Periodontal and Implant Science
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• v.27 no.1
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• pp.117-128
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• 1997

Using barrier membrane, guided bone regeneration(GBR) and guided tissue regeneration(GTR) of periodontal tissue are now widely studied and good results were reported. In bone regeneration, not all cases gained good results and in some cases using GTR, bone were less regenerated than that of control. The purpose of this study is to search for the method to improve the success rate of GBR and GTR by examination of the cause of the failure. For these study, rats and beagle dogs were used. In rat study, 5mm diameter round hole was made on parietal bone of the rat and 10mm diameter of bioresorbable membrane was placed on the bone defects and sutured. In 1 ,2, 4 weeks later, the rats were sacrificed and Masson-Trichrome staining was done and inspected under light microscope for guided bone regeneration. In dog study, $3{\times}4mm^2$ Grade III furcation defect was made at the 3rd and 1th premolar on mandible of 6 beagle dogs. The defects were covered by bioresorbable membrane extending 2-3mm from the defect margin. The membrane was sutured and buccal flap was covered the defect perfectly. In 2, 4. 8 weeks later. the animals were sacrificed and undecalcified specimens were made and stained by multiple staining method. In rats. there was much amount of new bone formation at 2 weeks. and in 4 weeks specimen, bony defect was perfectly dosed and plenty amount of new bone marrow was developed. In some cases, there were failures of guided bone regeneration. In beagle dogs, guided tissue regeneration was incomplete when the defect was collapsed by the membrane itself and when the rate of resorption was so rapid than expected. The cause of the failure in GBR and GTR procedure is that 1) the membrane was not tightly seal the bony defects. If the sealing was not perfect, fibrous connective tissue infiltrate into the defect and inhibit the new bone formation and regeneration. 2) the membrane was too tightly attached to the tissue and then there was no space to be regenerated. In conclusion, the requirements of the membrane for periodontal tissue and bone regeneration are the biocompatibility, degree of sealingness, malleability. space making and manipulation. In this animal study. space making for new bone and periodontal ligament, and sealing the space might be the most important point for successful accomplishment of GBR and GTR.

• Journal of Periodontal and Implant Science
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• v.38 no.1
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• pp.75-82
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• 2008

Purpose: The purpose of this study was to evaluate exophytically vertical bone formation in the mandibular premolar area of beagle dogs by the concept of guided bone regeneration with a titanium reinforced e-PTFE membrane combined with human demineralized freeze-dried bone. Materials and Methods: Four one-year old beagle dogs were divided into control and experimental group. All mandibular premolars were extracted and surgical vertical defects of 5 mm in height were created in the extracted sockets. At 8 weeks after the extraction, TR e-PTFE membrane sized with 8 mm in length, 5 mm in width, and 4 mm in height was placed on the decorticated mandible, fixed with metal pins and covered with full-thickness flap and assigned as control group. In experimental group, decorticated mandibule was treated with TR e-PTFE membrane and human demineralized freeze-dried bone. The animals were sacrificed at 16 weeks after the regenerative surgery, and new bone formation was assessed by histomorphometric as well as statistical analysis. Results: Average of new bone formation was 38% in the control group, whereas was 25% in the experimental group (p<0.05). Average of connective tissue formation was 42% in the experimental group, whereas was 30% in the control group (p<0.05). The lamellar bone formation with haversian canals was observed in the both groups. In the experimental group, the particles of human demineralized freeze-dried bone were observed after 16 weeks and complete resorption of graft was not observed. Conclusion: On the basis of these findings, we conclude that titanium reinforced e-PTFE membrane may be used alone for vertical guided bone regeneration, but demineralized freeze-dried bone has no additional effect on vertical guided bone regeneration.

• Journal of Periodontal and Implant Science
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• v.23 no.3
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• pp.577-594
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• 1993

The ultimate goal of periodontal therapy is the regeneration of the periodontium that have been destroyed as a result of periodontal disease. This study were done in order to determine the healing status of periodontium under Polytetrafluoroethylene and millipore fillter combined with fibrin and the effect of the guided tissue regeneration procedures were performed as follows : 1) flap operation using PTFE membrane(control group) 2) flap operation using PTFE membrane which was fixed with fibrin(experimental group 1) 3) flap operation using millipore filter which was fixed with suture(experimental group II) 4) flap operation using millipore filter which was fixed with fibrin(experimental group II) After 1, 2, 4, 8, 12 weeks, dogs were sacrificed by perfusion technique and tissue block was excised including the tooth and prepared for light microscope with H-E & Masson’s trichrome staining. The result were as follows : In control and experimental group, there is no siginificant difference on epithelial cell down growth within 1st week, but more epithelial cell downgrowth in millipore or millipore combined with fibrin group. In this experiment, there were no significant difference in new cementum and alveolar bone formation whether PTFE membrane was fixed with suture or fibrin. In control and each experimental group, bone maturation appeared in 4 weeks, bone width increased bucco-lingually in control and experimental 1 group especially. Both control group and experimental group showed mild mew cementum formation on root surface and irregular arrangement of collagen fiber at 4 weeks, that showed obvious increased cementum formation at 8 weeks, and that was observed the functional arrangement of collagen fiber between new cementum and new alveolar bone at 12 weeks.

• Journal of Periodontal and Implant Science
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• v.32 no.1
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• pp.213-224
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• 2002

The ultimate goal of periodontal disease therapy is to promote the regeneration of lost periodontal tissue, there have been many attempts to develop a method to achieve this goal, but none of them was completely successful. The purpose of this study was to compare the effects of treatment using BBP(R) with control treated by only modified Widman flap. 22 intrabony defects from 12 patients with chronic periodontitis were used for this study, 10 sites of them were treated with BBP(R) as experimental group and 12 site were treated by only modified Widman flap as control group. Clinical parameters including probing depth, gingival recession, bone probing depth and loss of attachment were recorded at 6 months later, and the significance of the changes was statistically analyzed. The results are as follows : 1. Probing depth of control(${\triangle}2.7{\pm}1.3mm$) and experimental group(${\triangle}3.6{\pm}1.8mm$) weres reduced with statistically significance(P<0.05), but this changes were not different between the two experiment, control group with statistically significance. 2. Gingival recession showed statistically significant increase in control group(${\triangle}2.1{\pm}1.2mm$)(P<0.05), but not in experimental group(${\triangle}0.5{\pm}0.7mm$), and this changes were different between the two experiment, control group with statistically significance(P<0.05). 3. Bone probing depth showed statistically significant decrease in experimental group(${\triangle}2.9{\pm}1.0mm$)(P<0.05), but not in control group(${\triangle}1.1{\pm}1.4mm$), and this changes were different between the two experiment, control group with statistically significance(P<0.05). 4. Loss of attachment showed statistically significant decrease in experimental group(${\triangle}3.1{\pm}1.7mm$), but not in control group(${\triangle}0.6{\pm}1.2mm$), and this changes were different between the two experiment, control group with statistically significance(P<0.05) On the basis of these results, treatment using BBP(R) improves the probing depth, bone probing depth and loss of attachment in intrabony defects.