• The korean journal of orthodontics
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• v.49 no.4
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• pp.265-276
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• 2019

Patients with obstructive sleep apnea (OSA) whose phenotype belongs to a craniofacial vulnerability are referred from sleep doctors to orthodontists. In adults, for osseo-pharyngeal reconstruction (OPR) treatment, permanent maxillomandibular advancement (MMA) surgery and use of a temporary mandibular advancement device (MAD) are applied. This case report demonstrates successful treatment of OSA through application of phased MAD and MMA in a 16-year-old male with craniofacial deformity and residual growth potential. This patient showed skeletal and dentoalveolar changes after 7-year MAD use throughout post-adolescence, which affected the design and timing of subsequent MMA surgery, as well as post-surgical orthodontic strategy. This case report suggests that OPR treatment can be useful for treatment of OSA in post-adolescent patients, from an orthodontic point of view, in close collaboration with sleep doctors for interdisciplinary diagnosis and treatment.

• Imaging Science in Dentistry
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• v.42 no.1
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• pp.35-39
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• 2012

A 9-year-old girl visited our hospital, complaining of a rapid-growing and rigid swelling on the left posterior mandibular area. Panoramic radiograph showed a moderately defined multilocular honeycomb appearance involving the left mandibular body. CT scan revealed an expansile, multilocular osteolytic lesion and multiple fluid levels within cystic spaces. Bone scan demonstrated increased radiotracer uptake and angiography showed a highly vascularized lesion. The lesion was suspected as aneurysmal bone cyst (ABC) and preoperative embolization was performed, which minimize the extent of operation and the surgical complication. The lesion was treated by surgical curettage and lateral decortication with repositioning. No additional treatment such as a surgical reconstruction or bone graft was needed. Early diagnosis of ABC is very important and appropriate treatment should be performed considering several factors such as age, surgical complication, and possibility of recurrence.

• Maxillofacial Plastic and Reconstructive Surgery
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• v.42
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• pp.21.1-21.6
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• 2020

Background: Fibula free flap mandible reconstruction is the standard procedure after wide resection of the mandible. Establishment and maintenance of normal occlusion are important in mandible reconstruction both intraoperatively and after surgery. However, scar formation on the surgical site can cause severe fibrosis and atrophy of soft tissue in the head and neck region. Case presentation: Here, we report a case of severe soft tissue atrophy that appeared along with scar formation after mandibular reconstruction through the fibular free flap procedure. This led to normal occlusion collapse after it was established, and the midline of the mandible became severely deviated to the affected side that was replaced with the fibula free flap, leading to facial asymmetry. We corrected the malocclusion with a secondary operation: a sagittal split ramus osteotomy on the unaffected side and a sliding osteotomy on the previous fibula graft. After a healing time of 3 months, implants were placed on the fibula graft for additional occlusal stability. Conclusion: We report satisfactory results from the correction of malocclusion after fibula reconstruction using sliding fibula osteotomy and sagittal split ramus osteotomy. The midline of the mandible returned to its original position and the degree of facial asymmetry was reduced. The implants reduced difficulties that the patient experienced with masticatory function.

• Maxillofacial Plastic and Reconstructive Surgery
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• v.12 no.3
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• pp.87-91
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• 1990

This is to report a case of secondary reconstruction after partial mandibulectomy by using of marrow-cancellous bone and cortical bone harvested from the iliac crest in the case of an ameloblastoma on the mandible. According to the past experimental studies, the marrow and cancellous bone have the marked osteogenic potential of hematopoietic. And the cortical bone has the highest activity of bone induction, which is mediated through the action of bone morphogenic protein(BMP). This grafting technique, the combination of PMCB and cortical bone, has advantage in restoring lange defect of the mandible.

• The Korean Journal of Pain
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• v.8 no.1
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• pp.86-92
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• 1995

Temporomandibular disorders typically present findings of limited or asymmetric patterns of jaw opening and joint sounds usually described as clicking, popping, grating, or crepitus. Recently, patients with temporomandibular disorders have received an increasingly aggressive treatment with a greater emphasis on surgical and dental reconstruction. Scientific studies have not clearly identified the specific causes of the temporomandibular disorders and therefore some of the treatments are empiric, without a firm scientific foundation. We carried out a study on the patients of pain clinic OPD and concluded that the causes of the temporomandibular joint(TMJ) pain are the prolonged contraction of the muscles of mastication, especially the masseter muscle. Therefore, the spasmolytic treatment of masseter muscle would be a better treatment for TMJ syndrome rather than the surgical and dental reconstruction.

• Korean Journal of Head & Neck Oncology
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• v.28 no.1
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• pp.50-53
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• 2012

Advanced cancer of the oral cavity has been treated with wide excision in conjunction with mandibulectomy and neck dissection. This has resulted in significant mandibulofacial defects with functional and cosmetic significance. Therefore, proper mandibular reconstruction is very important for physiologic and esthetic restoration. The risk factors of free flap reconstruction have been reported including obesity, age, smoking, previous irradiation, and systemic vascular disease. We recently experienced a case of donor site necrosis after fibular osteocutaneous free flap in oral cavity cancer.

• Korean Journal of Computational Design and Engineering
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• v.21 no.3
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• pp.234-241
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• 2016

Conventional bent plate used in mandibular reconstruction surgery needs safety verification since its mechanical properties are changed due to the plastic deformation during the bending process. In this study we investigate stability of the plastically deformed plate and the plate with the same shape without plastic deformation through the finite element analysis(FEA). First we simulate the process of plate bending to fit the defect in patient. Then, the other plate is modelled to represent a customized plate with the same shape of the plastically deformed one, but without any residual stresses from plastic deformation. After binding these plates to the mandible, we conduct the masticatory simulation. Finally, we compare the resulting Von Mises stress of the customized plate and of the bent plate. The bent plate shows much higher stress than the customized one due to the residual stresses form the bending process. The study shows that plastic deformation in the plate may decrease the safety of the reconstruction surgery.

• Journal of The Korean Dental Society of Anesthesiology
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• v.13 no.3
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• pp.127-131
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• 2013

We experienced failed airway management in a patient who had partial mandibulectomy and reconstruction with free-flap. 40 year-old man (height: 164 cm, body weight: 59 kg) with malignant melanoma on #38 tooth area of mandibular body was scheduled for partial mandibulectomy and reconstruction with free flap. Approximately fifteen-hours after surgery, the patient was extubated without complication. Seven hours after extubation, we experienced respiratory failure andfailed airway managementdue to airway edema and neck. We failed orotracheal intubation with direct laryngoscopy andlaryngeal mask airway, thus we tried tracheostomy but the patient was hypoxic state for more than 30 minutes. The patient had got hypoxic brain damage in whole cerebral cortex and basal ganglia. We should have the policy of airway management of the patients who have massive oro-maxillo-facial surgery and all medical personnel who treat these patients should be educated the policy and airway management methods.

• Maxillofacial Plastic and Reconstructive Surgery
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• v.40
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• pp.25.1-25.4
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• 2018

Background: Some of head and neck cancer patients are in compromised general condition after ablation surgery and chemoradiation therapy, which makes secondary free tissue transfer quite challenging. Elderly cancer patients also have some risk for microvascular surgery with lengthened general anesthesia. In those cases, the pedicled flap vascularized by supraclavicular artery could be considered as an alternative to free flap. Despite several authors have demonstrated the clinical reliability of supraclavicular artery island flap (SCAIF), to date, SCAIF has not been widely used among reconstructive surgeon. In this article, we clarified vascular flow pattern and introduce simple surgical technique of SCAIF with a literature review. Case presentation: Three patients who had underwent previous neck surgery and adjuvant therapy received maxillofacial reconstruction using SCAIF. It required only a few landmarks, flap harvesting was carried out, and the elapsed time gradually decreased to 15 min with experiences. There were no remarkable morbidities in both donor and recipient sites. Conclusion: SCAIF exhibited minimal anatomic variations and short learning curve of surgical techniques, which might be valuable reconstruction modality for beginning surgeon. And it can be beneficial option for the patients with vessel-depleted neck, medically compromised status for lengthened general anesthesia and failed free tissue transfer.

• Journal of Dental Anesthesia and Pain Medicine
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• v.17 no.4
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• pp.313-316
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• 2017

Mask ventilation, the first step in airway management, is a rescue technique when endotracheal intubation fails. Therefore, ordinary airway management for the induction of general anesthesia cannot be conducted in the situation of difficult mask ventilation (DMV). Here, we report a case of awake intubation in a patient with a huge orocutaneous fistula. A 58-year-old woman was scheduled to undergo a wide excision, reconstruction with a reconstruction plate, and supraomohyoid neck dissection on the left side and an anterolateral thigh flap due to a huge orocutaneous fistula that occurred after a previous mandibulectomy and flap surgery. During induction, DMV was predicted, and we planned an awake intubation. The patient was sedated with dexmedetomidine and remifentanil. She was intubated with a nasotracheal tube using a video laryngoscope, and spontaneous ventilation was maintained. This case demonstrates that awake intubation using a video laryngoscope can be as good as a fiberoptic scope.