• Journal of Korean Neurosurgical Society
• /
• 제58권1호
• /
• pp.36-42
• /
• 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.

• Maxillofacial Plastic and Reconstructive Surgery
• /
• 제39권
• /
• pp.13.1-13.8
• /
• 2017

Background: Oronasal/antral communication, loss of teeth and/or tooth-supporting bone, and facial contour deformity may occur as a consequence of maxillectomy for cancer. As a result, speaking, chewing, swallowing, and appearance are variably affected. The restoration is focused on rebuilding the oronasal wall, using either flaps (local or free) for primary closure, either prosthetic obturator. Postoperative radiotherapy surely postpones every dental procedure aimed to set fixed devices, often makes it difficult and risky, even unfeasible. Regular prosthesis, tooth-bearing obturator, and endosseous implants (in native and/or transplanted bone) are used in order to complete dental rehabilitation. Zygomatic implantology (ZI) is a valid, usually delayed, multi-staged procedure, either after having primarily closed the oronasal/antral communication or after left it untreated or amended with obturator. The present paper is an early report of a relatively new, one-stage approach for rehabilitation of patients after tumour resection, with palatal repair with loco-regional flaps and zygomatic implant insertion: supposed advantages are concentration of surgical procedures, reduced time of rehabilitation, and lowered patient discomfort. Cases presentation: We report three patients who underwent alveolo-maxillary resection for cancer and had the resulting oroantral communication directly closed with loco-regional flaps. Simultaneous zygomatic implant insertion was added, in view of granting the optimal dental rehabilitation. Conclusions: All surgical procedures were successful in terms of oroantral separation and implant survival. One patient had the fixed dental restoration just after 3 months, and the others had to receive postoperative radiotherapy; thus, rehabilitation timing was longer, as expected. We think this approach could improve the outcome in selected patients.

• 치과방사선
• /
• 제24권2호
• /
• pp.263-274
• /
• 1994

The purpose of this study was to investigate the remodeling process of the streptozotocin-induced diabetic rat's resected condyle. This experiment was performed with male Sprague-Dawly strain rats weighing approximately 250 gm, which were rendered diabetic by an intravenous injection of streptozotocin(70㎎/㎏ body weight). After condylectomy, experimental rats were serially terminated on the 1st week, the 2nd week, the 3rd week, and the 4th week. The following termination, the mandibles were dissected out to make specimens. Each mandibular condyle was radiographed with Hitex HA-80(Hitex Co., Ltd. Japan). In addition to radiographic observation, the mandibular condyles, further decalcified and embedded in paraffin, were sectioned and stained with Hematoxylin and Eosin, Toluidine blue and Masson's trichrome. They were observed with a light microscope and a polarizing microscope. The results were as follows. 1. Soft X-ray radiograms revealed proliferation of bone after 1 week in both groups. Irregularly repaired bones and dense trabeculae were clearly observed in experimental group. 2. The resected condyles were repaired by intramembraneous and endochondral bone formation in both groups. 3. Bone tissue repair was initiated from the adjacent margin of resected bone, and cartilaginous tissues were observed at the top of repaired bone in both groups. 4. The number of osteoblasts of experimental group was small, compared with control group. Each osteoblast was small and flat. The thin trabeculae were irregularly formed. 5. Collagens of bone were gradually matured in both groups, but the degree of maturation was lower in experimental group. 6. Fibrous tissues covered the upper parts of repaired bone were densely arranged in the both groups. Conclusively, atrophied osteoblasts, immature collagen of bone, and thin and irregular trabeculae which were characterized in the diabetes experimental group showed diabetes disturbed osteoblastic function and caused disturbance of remodeling process of bone.

• Journal of the Korean Association of Oral and Maxillofacial Surgeons
• /
• 제36권1호
• /
• pp.7-15
• /
• 2010

Complex human tissues harbor stem cells and precursor cells, which are responsible for tissue development or repair. Recently, dental tissues such as dental pulp, periodontal ligament (PDL), dental follicle have been identified as easily accessible sources of undifferentiated cells. These tissues contain mesenchymal stem cells that can be differentiate into bone, cartilage, fat or muscle by exposing them to specific growth conditions. In this study, the authors procured the stem cell from pulp, PDL, and dental follicle and differentiate them into osteoblast and examine the bone induction capacity. Dental pulp stem cell (DPSC), periodontal ligament stem cell (PDLSC), and dental follicle precursor cell (DFPC) were obtained from human 3rd molar and cultured. Each cell was analyzed for presence of stem cell by fluorescence activated cell sorter (FACs) against CD44, CD105 and CD34, CD45. Each stem cell was cultured, expanded and grown in an osteogenic culture medium to allow formation of a layer of extracellular bone matrix. Osteogenic pathway was checked by alizarin red staining, alkaline phosphatase (ALP) activity test and RT-PCR for ALP and osteocalcin (OCN) gene expression. According to results from FACs, mesenchymal stem cell existed in pulp, PDL, and dental follicle. As culturing with bone differentiation medium, stem cells were differentiated to osteoblast like cell. Compare with stem cell from pulp, PDL and dental follicle-originated stem cell has more osteogenic effect and it was assumed that the character of donor cell was able to affect on differential potency of stem cell. From this article, we are able to verify the pulp, PDL, and dental follicle from extracted tooth, and these can be a source of osteoblast and stem cell for tissue engineering.

• 대한구순구개열학회지
• /
• 제8권1호
• /
• pp.31-37
• /
• 2005

In alveolar deformity of cleft patient, the flap design is very important to make the functional and esthetic outcome. Especially in bilateral cleft alveolus with wide defect, deficiency of covering tissue is a greatest problem. Wound dehiscence may develop oronasal fistula of palatal and labial region and loss of the bone graft. We report 2 cases with bilateral cleft alveolus. In both case, bilateral buccal mucosal flap was used for closure of bilateral cleft alveolus with wide defect. The one was operated with iliac bone graft according to secondary grafting method, the other was closed without bone grafting. The patient was 3 years old. So, secondary alveolar bone graft will be required some years later for the establishment of bony continuity and esthetic advantage. In both cases, we found the entire soft tissue closure without the lack of covering flap. In these case, the closure of alveolus defect was accomplished successfully by the use of bilateral buccal mucosal flap. There was no complication, secondary fistula. The most important thing is the tension-free closure of the bilateral buccal mucosal flap. So, we report these cases with literatures.

• Journal of Periodontal and Implant Science
• /
• 제24권1호
• /
• pp.120-130
• /
• 1994

The purpose of the present investigation was to compare the effectiveness of porous hydroxyapatite (PHA) and coralline based porous calcium carbonate(PCC) as implant materials in human periodontal osseous defects. 10 adult patients having periodontitis and 2 similar angular osseous defects ${\ge}$5mm as verified by radiographic analysis and clinical probing depth ${\ge}$4mm were selected. The measurements were recorded just before surgery and after 6 month. Clinical parameters used in this study included gingival recession, pocket depth, probing attachment level, Sulcus Bleeding Index, Plaque Index, tooth mobility and bone defect depth measurements. After initial therapy, patients were treated with mucoperiosteal flap surgery. The contralateral bony defects in each patient randomly assigned to either bone graft material, one with PHA(Interpore 200) and the other with coralline based calcium carbonate(Biocoral). After 6 month both groups showed statistically significant reduction of pocket depth, Sulcus Bleeding Index, Plaque Index and significant improvement in probing attachment level. No statistically significant differences were found between the groups. There were 3.0mm or 68% of bone repair with PHA and 3.1mm, 61% with PCC. These values were likewise not significantly different. The data and clinical impression strongly suggest that both PHA and PCC are alloplastic implants with clinically apparent acceptance by the soft and hard tissue and that they can be used as bone graft materials successfully.

• 구강회복응용과학지
• /
• 제29권2호
• /
• pp.153-162
• /
• 2013

이번 연구는 2개의 임플란트 식립 후 로케이터를 이용한 하악 임플란트 유지 피개의치를 한 20명의 환자를 대상으로 임플란트 생존율, 변연골 흡수량, 보철적 합병증을 알아보았다. 진료 기록부를 조사하고 방사선 사진을 계측하여 후향적 임상연구를 하였으며, 임플란트는 95%의 누적 생존율을 보였고, 평균 94주 후 방사선 사진에서 임플란트는 평균 1.21 mm($SD{\pm}0.20mm$)의 골소실을 보였다. 보철적 합병증으로는 피개의치 파절, 의치상 이장 또는 개상, 메일의 탈락 또는 유지력 감소로 인한 메일 교체 등이 있었다. 그러나 의치상 이장 및 개상, 메일 인써트의 간단한 교체로 인해 장기적으로 임플란트 및 임플란트 유지 피개의치가 환자에게 유지되고 있었다. Locator를 이용한 하악 임플란트 유지 피개의치는 최소침습적인 수술, 간단한 보철 과정 및 수리 과정의 장점으로 인해 장기적으로 안정적인 치료법으로 사료된다.

• 대한족부족관절학회지
• /
• 제23권3호
• /
• pp.100-104
• /
• 2019

Purpose: This study examined the clinical outcomes and assessed the average time to return to play following a peroneal tendon repair in Korean athletes. Materials and Methods: Between March 2004 and February 2017, a total of 30 athletes underwent peroneal tendon repair for a peroneal tendon tear. The indications of surgical treatment were chronic pain or intractable symptoms after a previous ankle sprain affecting sports activity refractory to conservative treatment for at least six months. The patient underwent tubulization for a longitudinal tendon rupture. Peroneus longus to peroneus brevis tenodesis was performed when tendon repair was impossible due to total rupture or multiple longitudinal rupture. Results: Twenty patients not included in this study were as follows: insufficient follow-up, previous surgery, and additional bone surgery. All 10 patients had a previous ankle sprain history, tenderness and swelling on the retromalleolar area. In the 10 patient population, there were five peroneus brevis tendon tears, three peroneus longus tendon tears, one peroneus longus and brevis tendon tear, and one peroneus brevis and superior peroneal retinaculum tear. In the 10 patients, six cases of peroneal brevis tendon repair and four cases of peroneal longus to brevis tenodesis were performed. The preoperative American Orthopaedic Foot and Ankle Society score was improved from a mean of 60.6 (standard deviation [SD], 8.64) to a mean of 90.2, postoperatively (SD, 4.4; p<0.012). The preoperative visual analogue scale was improved from a mean of 5.43 (SD, 1.2) to 0.5 (SD, 0.16), postoperatively (p<0.023). The mean length of time to return to play was 12.2 weeks (range, 8~16 weeks). Conclusion: Peroneal tendon tear can occur due to sports injuries. If there is tenderness at the retromalleolar area, the surgeon should consider a peroneal tendon lesion. Surgical repair of the peroneal tendon can be an effective treatment to help athletes to return to play.

• Journal of Periodontal and Implant Science
• /
• 제23권2호
• /
• pp.261-281
• /
• 1993

The author transplanted periodontally-diseased teeth which had been treated with citric acid into a clinically healthy extraction sockets and periodontally-affected extraction sockets, and compared with the healing processes within these tissues. Recipient sites were prepared by surgically removing a part of alveolar bone of premolars of adults dogs, placing elastic orthodontic ligatures for 8weeks, thereby inducing periodontal disease. The diseased roots were extracted and transplanted into healthy extraction sockets, and these were designated as control group 1. Diseased roots transplanted into diseased sockets were designated as control group 2. Diseased roots which had been root planed, treated with citric acid and transplanted into healthy sockets were designated as experimental group 1, while identically treated roots which had been transplanted into diseased sockets were designated as experimental group 2. Observations were made at weeks 2, 8 and 12, with following results. 1. At week 2, experimental group 2 showed some inflammatory cell infiltration in the connective tissue above the extraction sockets, while control groups showed less inflammatory or foreign body reactions throughout the experiment. 2. In both control groups, root surface resorption was observed throughout the experiment, while experimental groups showed a little resorption. 3. Control group 1 & 2 showed ankylosis by newly-formed bone ground the resorbed root surfaces, while experimental group 1 & 2 displayed collagen fibers which are not functionally-arranged, with random, loose arrangement or parallel orientation to root surfaces, and newly-formed bone outside of them. 4. In both control groups & experimental groups which had been transplanted into a clinically healthy extraction sockets & periodontally affected extraction sockets groups, histological differences were not significant. 5. Root resorption or ankylosis in control group 1 & 2 had increased quantitatively as experiment progressed. 6. New bone formation developed from the base and lateral wall of extraction sockets. In both control groups & experimental groups, root surfaces lying next to the upper portion of extraction sockets showed little alveolar bone formation and surrounded by connective tissue fiber at weeks 2 & 8, while at weeks 12, they did show alveolar bone formation. 7. At week 12, experimental group 2 showed numerous cells which appeared to be periodontal ligament cells, with functionally arranged connective tissue fibers between the roots and alveolar bone.

• Journal of the Korean Association of Oral and Maxillofacial Surgeons
• /
• 제33권5호
• /
• pp.405-418
• /
• 2007

Mesenchymal stem cells(MSCs) have been though to be multipotent cells that can replicate that have the potential to differentiate into lineages of mesenchymal tissue including the bone, cartilage, fat, tendon, muscle, and marrow stroma. Especially, scaffolds to support cell-based tissue engineering are critical determinants of clinical efforts to regenerate and repair the body. Selection of a matrix carrier imvolves consideration of the matrix's role as a scaffold for physical support and host tissue integration as well as its ability to support of synergize the osteoinductive program of the implanted mesenchymal stem cell. The aim of this study is to evaluate the effect of autobone and Bio-$Oss^{(R)}$ to adherent mesenchymal stem cells as scaffolds on sinus augmentation with fibrin glue mixture in a rabbit model. 16 New Zealand White rabbits were divided randomly into 4 groups based on their time of sacrifice(1, 2, 4 and 8 weeks). First, mesenchymal stem cells were isolated from iliac crest marrow of rabbits and expanded in vitro. Cell culture was performed in accordance with the technique described by Tsutsumi et al. In the present study, the animals were sacrificed at 1, 2, 4 and 8 weeks after transplantation, and the bone formation ability of each sides was evaluated clinically, radiologically, histologically and histomorphologically. According to the histological observations, autobone scaffolds group showed integrated graft bone with host bone from sinus wall. At 2 and 4 weeks, it showed active newly formed bone and neovascularization. At 8 weeks, lamellae bone was observed in sinus graft material area. Radiologically, autobone with stem cell showed more radiopaque than Bio-$Oss^{(R)}$ scaffolds group. there were significant differences in bone volume between 4 and 8 weeks(p<0.05).