• Journal of the Korean Association of Oral and Maxillofacial Surgeons
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• 제38권1호
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• pp.55-63
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• 2012

The odontogenic keratocyst (OKC) was originally classified as a developmental cyst, and OKCs were histologically divided into orthokeratotic (O-OKCs) and parakeratotic (P-OKCs) types. Clinical features differ between O-OKCs and P-OKCs with P-OKCs having a tendency to recur after surgical treatment. According to the revised histopathological classification of odontogenic tumors by the World Health Organization (2005), the term keratocystic odontogenic tumor (KCOT) has been adopted to describe P-OKCs. In this retrospective study, we examined 186 KCOTs treated at the Maxillofacial Surgery Department of the Tokyo Medical and Dental University Hospital from 1981 through 2005. The patients ranged in age from 7 to 85 years (mean, 32.7) and consisted of 93 males and 93 females. The most frequently treated areas were the mandibular molar region and ramus. The majority of KCOTs in the maxillary region were treated by enucleation and primary closure. The majority of KCOTs in the mandibular region were enucleated, and the wound was left open. Marginal resection was performed in the 4 patients with large lesions arising in the mandible. In patients who were followed for more than a year, recurrences were observed in 19 of 120 lesions (15.8%). The recurrences were found at the margins of the primary lesion in contact with the roots of the teeth or at the upper margins of the mandibular ramus. Clinicians should consider aggressive treatment for KCOTs because the recurrence rate of P-OKCs is higher than that of other cyst types such as O-OKCs, dentigerous cysts, primordial cysts that were non-keratinized, and slightly keratinized stratified squamous epithelium. Although more aggressive treatment is needed for KCOTs as compared to other cystic lesions, it is difficult to make a precise diagnosis preoperatively on the basis of clinical features and X-ray imaging. Therefore, preoperative biopsy is necessary for selecting the appropriate treatment for patients with cystic lesions.

• Maxillofacial Plastic and Reconstructive Surgery
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• 제15권4호
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• pp.338-345
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• 1993

양성 종양, 악성 종양, 감염, 외상 등에 의한 하악골 결손은 중대한 심미적, 생물학적 결과를 일으킨다. 재건술의 일차적 목적은 완전한 기능 회복이며 이는 이차적으로 심미적 변형의 정상화를 유도한다. 저자들은 1981년에서 1990년까지 서울대학교 치과대학 구강 악안면외과에 내원하여 하악골 재건술을 시행받고 6개월 이상 추적조사가 가능한 61증례의 임상적 자료 및 방사선 검사를 통해 부위별 임상적 성공률을 조사하였다. 본 임상 논문의 목적은 하악골 결손부위와 부위에 따른 유리골 이식의 성공률을 연구하는데 그 의의를 두겠다. 유리골 이식의 임상적 연구를 요약해 보면 유리 자가골 이식의 대부분은 장골이었고 망상피질골이었다. 6개월 이상 추적조사가 가능한 61명의 환자에 있어 전체적 성공률은 80.3% 였다. 강선고정과 구외접근법이 다른 방법보다 그 예후에 있어 훨씬 더 좋은 결과를 나타냈고 다른 부위보다 하악 정중부위가 그 예후에 있어 훨씬 나쁜 결과를 보였다.

• Journal of International Society for Simulation Surgery
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• 제2권2호
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• pp.87-89
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• 2015

Closed reduction using acrylic splints with circummandibular fixation has been known to be useful techniques in pediatric mandibular fractures. However, this technique has some shortcomings, including needs for impression taking or additional laboratory process, which can increase the exposure time of general anesthesia or make an additional sedation visit. Recently, the advancement of computer-aided maxillofacial surgery offers to clinicians to expansion of its application. This case report represents a technique of computer-assisted virtual reconstruction and computer-aided designed splint fabrication in a 2-year-old boy with mandibular body fracture.

• 대한두경부종양학회지
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• 제1권1호
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• pp.35-61
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• 1985

The surgical treatment of advanced carcinomas and some benign tumors having clinically malignant behaviors of the head and neck region often require extensive resection, necessitating large flaps for reconstruction. Since the original upper arm flap was described by Tagliacozzi in 1597, a variety of technique such as random pattern local flap, axial flap, distant flap, scalping flap, myocutaneous flap, free flap etc. have been proposed for reconstruction of head, face and neck defects. Reconstruction of the facial defects usually require the use of distant tissue. Traditionally, nasal reconstruction has been carried out with a variety of forehead flaps. In recent years, there has been more acceptance of immediate repairs following the removal of these tumors. As a result, patients are more willing to undergo these extensive resections to improve their chances of cure, with the reasonable expectation that an immediate reconstruction will provide an adequate cosmetic result. Authors experienced 13 cases of head and neck tumor during last three and half years that required wide excision and immediate reconstruction with various flaps, not with primary closure or simple skin graft. We present our experience with varied flaps for reconstruction after wide resection of head and neck tumors 3 cases of defect of dorsum of nose or medial canthus with island forehead flaps, lower eyelid defect with cheek flap, cheek defect with Limberg flap, orbital floor defect with Temporalis muscle flap, lateral neck defects with Pectoralis major myocutaneous flap or Latissimus dorsi myocutaneous free flap, subtotal nose defect with scalping flap, wide forehead defect with Dorsalis pedis free flap and 3 cases of mandibular defect or mandibular defect combined with lower lip defect were reconstructed with free vascularized iliac bone graft or free vascularized iliac bone graft concomitantly combined with free groin flap pedicled on deep circumflex iliac vessels We obtained satisfactory results coincided wi th goal of treatment of head and neck tumors, MAXIMAL CURE RATE with MINIMAL MORBIDITY, OPTIMAL FUNCTION, and an APPEARANCE as close to normal as possible.

• Maxillofacial Plastic and Reconstructive Surgery
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• 제22권4호
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• pp.449-453
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• 2000

저자등은 하악 복잡골절 정복후 골과 연조직 결손을 보이는 환자에게 internal resorvoir를 이용한 연조직 확장 후 장골 이식으로 골결손 수복을 함으로써 양호한 안모개선을 얻었기에 문헌고찰과 함께 보고하는 바이다.

• Imaging Science in Dentistry
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• 제33권3호
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• pp.187-193
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• 2003

Purpose: To compare the measurements of the mandible and the detectability of the mandibular canal on reformatted images using a newly developed 3-dimensional implant simulation program with traditionally used CT multiplanar reconstruction program and true measurements. Materials and Methods: Ten dry dog mandibles were used in this study. Occlusal templates for CT examination were fabricated and marked with gutta perch a at ten sites. Axial CT scans were taken and reconstructed using DentaScan (D group) and Vimplant program (V group), and each mandible was sectioned at the previously marked sites (R group). Maximum vertical height (H) and maximum width (W) of the mandible, the distances from buccal border of the mandibular canal to the most buccal aspect of the mandible (X), and the distance from the superior border of the mandibular canal to the alveolar crest (Y) were measured, and the mandibular measurements in each group were compared. Detectability of mandibular canal was evaluated using a 3-point scale in both V and D groups by three oral radiologists and compared. Results: H in the V group was slightly greater than that in the D group, and Wand X in the V group was slightly less than those in the D group. H in the V group was less than that in the R group, and Wand X in the V group was larger than those in the R group. The detectability of the mandibular canal did not show statistically significant differences between V and D groups. Conclusion: The results of the experiment show that the newly developed, inexpensive Vimplant/TM/ simulation program can be used as an alternative to the traditionally used, and more expensive CT multiplanar reconstruction program.

• Journal of the Korean Association of Oral and Maxillofacial Surgeons
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• 제47권3호
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• pp.216-223
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• 2021

Preoperative patient analysis for oral cancer involves multiple considerations that are based on multiple factors; these include TNM stages, histopathologic findings, and adjacent anatomical structures. Once the decision is made to excise the lesion, the margin of dissection and its extent should be considered along with the best form of reconstruction and airway management. Treatment methods include surgical resection, radiotherapy, and chemotherapy. Although the combined method of treatment is controversial, surgical resection is considered predominantly, and immediate reconstruction after surgical resection follows. The choice of treatment is dictated by the anticipated functional and esthetic results of treatment and also by the availability of a surgeon with the required expertise. Segmental mandibulectomy with primary reconstruction has been shown to have advantages in both functional and esthetic results. A 52-year-old male patient with basaloid squamous cell carcinoma of the floor of the mouth, and the anterior portion of the mandible was treated with surgical procedures that included segmental mandibulectomy with both supraomohyoid neck dissection (SOHND) at Levels I-III and mandible reconstruction with a left fibula free flap. A 55-year-old male patient with clear cell odontogenic carcinoma of the oral cavity underwent segmental mandibulectomy with both SOHND at Levels I-III and mandible reconstruction with a left fibula free flap. The purpose of this study was to review the anatomic and functional results of patients after immediate reconstruction with a fibula free flap following resection of carcinoma in the anterior portion of the mandible and floor of the mouth.

• Journal of the Korean Association of Oral and Maxillofacial Surgeons
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• 제35권6호
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• pp.474-480
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• 2009

These is a cases of chronic suppurative osteomyelitis occurred in the mandibular body to condyle of 48-year-old male patient. Extensive bone destruction was noted on the right mandibular body, angle, ascending ramus, mandibular notch and condylar region. We made a treatment plan that radicular mandibular resection from body to condyle and mandibular reconstruction with vascularized fibular flap at first time. But, we could observe marked bone regeneration with only mild curettage, local wound care and massive antibiotic therapy. So we preserved the anterior ramus portion of mandible. Defected mandibular condyle was reconstructed with costochondral graft. In this paper we present the case of a patient who has chronic osteomyelitis in mandibular area.

• Maxillofacial Plastic and Reconstructive Surgery
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• 제35권6호
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• pp.437-447
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• 2013

The fibula is one of the most useful sources for harvest of a vascularized bone graft. The fibula is a straight, long, tubed bone, much stronger than any other available bone that can currently be used for a vascularized graft. It has a reliable peroneal vascular pedicle with a large diameter and moderate length. There is a definite nutrient artery that enters the medullary cavity, as well as multiple arcade vessels, which add to the supply of the bone through periosteal circulation. The vascularized fibula graft is used mainly for long segment defects of the long tubed bone of the upper and lower extremities. It can provide a long, straight length up to 25 cm in an adult. The fibula can be easily osteotomized and can be used in reconstruction of the curved mandible. Since the first description as a vascularized free fibula bone graft by Taylor in 1975 and as a mandibular reconstruction by Hidalgo in 1989, the fibula has continued to replace the bone and soft tissue reconstruction options in the field of maxillofacial reconstruction. For the better understanding of a fibular free flap, the constant anatomical findings must be learned and memorized by young doctors during the specialized training course for the Korean National Board of Oral and Maxillofacial Surgery. This article reviews the anatomical basis of a fibular free flap with Korean language.

• Asian Pacific Journal of Cancer Prevention
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• 제13권8호
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• pp.4137-4140
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• 2012

The authors present five cases of combined oral mucosa-mandible defects reconstructed with the vascularized internal oblique-iliac crest myoosseous free flap. This technique has many advantages compared to other conventional methods such as the radial flap, scapula flap, and fibula flap. Vascularized iliac crest flaps provide sufficient high-quality bone suitable for reconstructing segmental madibular defects. Although fibular flaps allow longer donor bone tissue to be harvested, the iliac crest can provide an esthetic shape for mandibular body reconstruction and also provides sufficient bone height for dental implants. Conventional vascularized iliac crest myoosseous flaps have excessive soft tissue bulk for reconstruction of intraoral soft tissue defects. The modification discussed in the present article can reduce soft tissue volume, resulting in better functional reconstruction of the oral mucosa. Another advantage is that complete replacement of the oral mucosa is observed in as early as one month post-operation. The final mucosal texture is much better than that obtained with other skin paddle flaps, which is especially beneficial for the placement of dental implant prostheses. Donor site morbidity looks to be similar to, if not less than that observed for other modalities in terms of function and esthetics. For combined oral mucosa-mandible defects, the vascularized internal oblique-iliac crest myoosseous free flap shows good results with respect to hard and soft tissue reconstruction.