• The korean journal of orthodontics
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• v.40 no.3
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• pp.145-155
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• 2010

Objective: Lateral cephalometric radiographs have been the main form of resource for assessing two dimensional anteroposterior airway changes. The purpose of this study was to evaluate the three dimensional volumetric change in the upper airway space in Class III malocclusion patients who underwent mandibular setback surgery. Methods: Three dimensional cone-beam computed tomographs (CBCT) and their three dimensional reconstruction images were analyzed. The samples consisted of 20 adult patients (12 males and 8 females) who were diagnosed as skeletal Class III and underwent mandibular setback surgery. CBCTs were taken at 3 stages - Baseline (1.8 weeks before surgery), T1 (2.3 months after surgery), and T2 (1 year after surgery). Pharyngeal airway was separated according to the reference planes and reconstructed into the nasopharynx, the oropharynx and the hypopharynx. Measurements at Baseline, T1, and T2 were compared between groups. Results: The result showed the volume of the pharyngeal airway decreased significantly 2.3 months after surgery (p < 0.001) and the diminished airway did not recover after 1 year post-surgery. The oropharynx was the most decreased area. Conclusions: These findings suggest that mandibular setback surgery causes both short-term and long-term decrease in the upper airway space.

• Korean Journal of Bronchoesophagology
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• v.6 no.1
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• pp.29-37
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• 2000

Background and Objectives : The concentration of sulfur dioxide($SO_2$) gas in the ambient air appears increasing in the industry and urban area day by day. It was known that $SO_2$ is noxious gas. $SO_2$ can be irritating to the eyes, nose, throat, upper respiratory tract and skin. It produces sulfurous acid on contact with water and is extremely irritating to the nasopharynx and respiratory tract. Laminin is a family of extracellular matrix glycoproteins localized in the basement membrane that separates epithelial cells from the underlying stroma. The biological activities of laminin are to promote cell migration, wound healing, growth and differentiation. Meterials and Methods : The histologic changes and the expression of laminin in tracheal mucosa sacrificed at every weeks (to 7 weeks) after continued $SO_2$ exposure of 250ppm for 30 minutes a day were studied in rats. Results : Pathologic tissue was formed at the tracheal mucosa and the underlying tissue by the infiltration of monocytes and epithelium was transformed to the single cell layered epithelium above 5 weeks after exposure. At the 6 weeks after exposure, epithelial cells were partially lost and epithelial cell layer was transformed to be leaf-shaped. Submucosal tissue was transformed to be lymphatic tissue. An intense positive staining for laminin was found in apical cytoplasm and lateral surface of the normal epithelial cells and basement membrane but at the 5 and 6 weeks after exposure, laminin activity was decreased to the moderate activity. At the 7 weeks after exposure, laminin activity was decreased to the weak activity. Conclusion : Our finding suggests that $SO_2$ makes histologic damage on the tracheal mucosa and decreases immunoreactivity for laminin. Longer duration of the exposure of $SO_2$ makes more histologic damage on the tracheal mucosa and decreases immunoreactivity for laminin.

• Journal of radiological science and technology
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• v.43 no.4
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• pp.265-272
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• 2020

The purpose of this study was to investigate the dose-volume indices and radiobiological indices according to the change in dose calculation grid size during the planning of nasopharyngeal cancer VMAT treatment. After performing the VMAT treatment plan using the 3.0 mm dose calculation grid size, dose calculation from 1.0 mm to 5.0 mm was performed repeatedly to obtain a dose volume histogram. The dose volume index and radiobiological index were evaluated using the obtained dose volume histogram. The smaller the dose calculation grid size, the smaller the mean dose for CTV and the larger the mean dose for PTV. For OAR of spinal cord, brain stem, lens and parotid gland, the mean dose did not show a significant difference according to the change in dose calculation grid size. The smaller the grid size, the higher the conformity of the dose distribution as the CI of the PTV increases. The CI and HI showed the best results at 3.0 mm. The smaller the dose calculation grid size, the higher the TCP of the PTV. The smaller the dose calculation grid size, the lower the NTCP of lens and parotid. As a result, when performing the nasopharynx cancer VMAT plan, it was found that the dose calculation grid size should be determined in consideration of dose volume index, radiobiological index, and dose calculation time. According to the results of various experiments, it was determined that it is desirable to apply a grid size of 2.0 - 3.0 mm.

• Journal of Chest Surgery
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• v.34 no.6
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• pp.465-471
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• 2001

Background: Hypothermia protects the brain by suppressing the cerebral metabolism and it is performed well enough before the total circulatory arrest(TCA) in the operation of aortic disease. Generally, TCA has been performed depending on the rectal or nasopharyngeal temperatures; however, there is no definite range of optimal temperature for TCA or an objective indicator determining the temperature for safe TCA. In this study, we tried to determine the optimal range of temperature for safe hypothermic circulatory arrest by using the intraoperative electroencephalogram(EEG), and studied the role of EEG as an indicator of optimal hypothermia. Material and Method: Between March, 1999 and August 31, 2000, 27 patients underwent graft replacement of the part of thoracic aorta using hypothermia and TCA with intraoperative EEG. The rectal and nasopharyngeal temperatures were monitored continuously from the time of anesthetic induction and the EEG was recorded with a ten-channel portable electroencephalography from the time of anesthetic induction to electrocerebral silence(ECS). Result: On ECS, the rectal and nasopharyngeal temperatures were not consistent but variable(rectal 11$^{\circ}C$ -$25^{\circ}C$, nasopharynx 7.7$^{\circ}C$ -23$^{\circ}C$). The correlation between two temperatures was not significant(p=0.171). The cooling time from the start of cardiopulmonary bypass to ECS was also variable(25-127min), but correlated with the body surface area(p=0.027). Conclusion: We have found that ECS appeared at various body temperatures, and thus, the use of rectal or nasopharyngeal temperature were not useful in identifying ECS. Conclusively, we can not fully assure cerebral protection during hypothermic circulatory arrest in regards to the body temperatures, and therefore, the intraoperative EEG is one of the necessary methods for determining the range of optimal hypothermia for safe circulatory arrest. :

• The Journal of Korean Academy of Prosthodontics
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• v.57 no.4
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• pp.356-363
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• 2019

A patient who went through maxillectomy can have soft palate defects including oronasal fistulas and suffer from dysphagia and dysarthria due to velopharyngeal insufficiency. This defect causes the food to enter nasal cavity and creates hypernasal sound which debilitates a quality of life. An obturator can rehabilitate the substantial oral tissue defects. The maxillary obturator separates the nasopharynx from the oropharynx during speech and deglutition by closing of the defect. For edentulous obturator patient, it is difficult to obtain proper retention due to reduced peripheral sealing. Therefore, the contours of the defects must be used to maximize the retention, stability, and support. Hollow type obturator can improve physiologic function by reducing weight than the traditional obturator. This case report describes a patient with hemi-maxillectomy who recovers mastication, speech, deglutition, and appearance with a maxillary obturator using physiological border molding of the velopharyngeal area and double-processing method.

• Tuberculosis and Respiratory Diseases
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• v.58 no.3
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• pp.295-298
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• 2005

We report a case of a 48-year-old man with a paradoxic upper airway obstruction and central sleep apnea that developed after an anterior cervical spinal fusion. Nine months before being admitted to this hospital, he was diagnosed with a herniated intervertebral disc between the 5th and 6th cervical spine, and the first operation was carried out. Two months later, a pseudoarthrosis has developed and a second operation, an anterior interbody fusion of the C5 and C6 using autogenous strut bone graft, was performed. After the second operation, he began to complain of snoring, excessive daytime sleepiness, insomnia, and a bizarre sound heard near the upper airway during breathing. Nasopharyngoscope and magnetic resonance imaging disclosed a paradoxical narrowing of the nasopharynx during expiration. On the overnight polysomnography, the apnea index was 8.7/h (central apnea, 7.0/h; obstructive apnea, 1.7/h). Nasal continuous positive airway pressure was applied, but he complained of pressure-intolerance, and laser-assisted uvulopalatoplasty was then performed. Two months after surgery, clinical symptoms as well as the apneas had improved markedly. We suggest that this paradoxic upper airway obstruction might be associated with the anterior cervical spinal surgery even though the mechanism is unclear. This case also emphasizes that an upper airway obstruction can contribute to the development of central sleep apnea.

• Neonatal Medicine
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• v.18 no.2
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• pp.240-247
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• 2011

Purpose: The rationale for skin surface cultures is that bacterial colonization precedes infection and, as a result, that identification of a potential pathogen is predictive of later systemic infection in preterm infants. We aimed to analyze results of surveillance surface cultures in extremely low birth weight (ELBW) infants and seek for effective ways of performing surveillance surface cultures. Methods: We analyzed the surveillance surface cultures of 113 ELBW infants over a 4-year period. Surveillance cultures were obtained routinely from five sites: axilla, external ear canal, nasopharynx, throat (or tracheal aspirate if intubated) and anus. Each surface culture obtained during the 13 days, prior to the date of the blood culture, was compared with the blood culture obtained when sepsis was suspected. The sensitivity, specificity and positive predictive value (PPV) of the surveillance cultures were calculated among 1894 blood-surface culture pairs by surface sites, recovered organisms and interval between surveillance samples and blood cultures. Results: The overall sensitivity, specificity and PPV of surface cultures were 45.9, 22.4 and 6.8%, respectively. The PPV was highest for the throat/tracheal cultures (11.0%) and lowest for the anal cultures (2.3%). As the time of culturing progressed toward the day of blood culturing, the sensitivity and specificity of the surface cultures significantly increased. Only axillary and throat/tracheal cultures were useful in predicting the microorganisms causing sepsis. Conclusion: Surface cultures could help to predict sepsis pathogens and infection surveillance in preterm infants could be continued with a reduced number of cultured sites focusing on the axilla and throat/trachea.

• Radiation Oncology Journal
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• v.17 no.1
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• pp.1-8
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• 1999

Purpose : Experimental studies have implicated the wild type p53 In cellular response to radiation. Whether altered p53 function can lead to changes in clinical radiocurability remains an area of ongoing study. This study was performed to investigate whether any correlation between change of p53 and outcome of curative radiation therapy in patients with head and neck cancels. Methods : Immunohistochemical analysis with a mouse monoclonal antibody (DO-7) specific for human p53 was used to detect to overexpression of protein in formalin fixed, paraffin-embedded tumor sample from 55 head and neck cancer patients treated with curative radiation therapy (median dose of 7020 cGy) from February 1988 to March 1996 at 51. Mary's Hospital. Overexpression of p53 was correlated with locoregional control and survival using Kaplan-Meier method. A Cox regression multi-variate analysis was peformed that included all clinical variables and status of p53 expression. Results : Thirty-seven (67.2$\%$) patients showed overexpression of p53 by immunohistochemical staining in their tumor. One hundred percent of oral cavity, 70$\%$ of laryngeal, 66.7$\%$ of oropharyngeal, 66.7$\%$ of hypopharyngeal cancer showed p53 overexpression (P=0.05). The status of p53 had significant relationship with stage of disease (P=0.03) and history of smoking (P=0.001). The overexpression of p53 was not predictive of response rate to radiation therapy. The locoregional control was not significantly affected by p53 status. Overexpression of p53 didn't have any prognostic implication for disease free survival and overall survival. Primary site and stage of disease were significant prognostic factors for survival. Conclusions : The p53 overexpression as detected by immunohistochemical staining had significant correlation with stage, primary site of disease and smoking habit of patients. The p53 overexpression didn't have any predictive value for outcome of curative radiation therapy in a group of head and neck cancers.

• Journal of Korean Academy of Oral and Maxillofacial Radiology
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• v.20 no.2
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• pp.253-264
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• 1990

The purpose of this study was to estimate the distribution of absorbed doses of each important organs of head and neck region in panoramic radiography. Radiation dosimetry at internal anatomic sites and skin surfaces of phantom (RT-210 Humanoid Head & Neck Section/sup R/) was performed with lithium fluoride (TLD-100/sup R/) thermoluminescent dosimeters according to change of kilovoltage (65kVp, 75kVp and 85kVp) with 4 miliamperage and 20 second exposure time. The results obtained were as follows; Radiation absorbed doses of internal anatomic sites were presented the highest doses of 1.04 mGy, 1.065 mGy and 2.09 mGy in nasopharynx, relatively high doses of 0.525 mGy, 0.59 mGy and 1.108 mGy in deep lobe of parotid gland, 0.481 mGy, 0.68 mGy and 1.191 mGy in submandibular gland. But there were comparatively low doses of 0.172 mGy and 0.128 mGy in eyes and thyroid gland that absorbed dose was estimated at 85kVp. Radiation absorbed doses of skin surfaces were presented the highest doses of 1. 263 mGy, 1.538 mGy and 2.952 mGy in back side of first cervical vertebra and relatively high doses of 0.267 mGy, 0.401 mGy and 0.481 mGy in parotid gland. But there were comparatively low doses of 0.057 mGy, 0.068 mGy and 0.081 mGy in philtrum and 0.059 mGy in middle portion of chin that absorbed dose was estimated at 85kVp. According to increase of kilovoltage, the radiation absorbed doses were increased 1.1 times when kilovolt age changes from 65kVp to 75kVp and 1.9 times when kilovolt age changes from 75kVp to 85kVp at internal anatomic sites. According to increase of kilovoltage, the radiation absorbed doses were increased 1.3 times when kilovolt age changes from 65kVp to 75kVp and 1.6 times when kilovoltage changes from 75kVp to 85kVp at skin surfaces.

• Sleep Medicine and Psychophysiology
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• v.7 no.1
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• pp.18-26
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• 2000

Objectives: To investigate the airway narrowing patterns by multi-level airway pressure(MAP) monitoring during sleep and to evaluate the value of CT scan taken during waking and sleep apneic periods to identify the level of airway narrowing(LAN) in patients with obstructive sleep apnea syndrome(OSAS). Methods: Eleven patients with OSAS underwent a night polysomnography with continuous MAP monitoring by 4-sensor(placed at nasopharynx, caudal-uvula, hypopharynx, esophagus) or 2-sensor(placed at caudal-uvula and esophagus) catheter. All patients had cine CT at five levels of high retro and alatal, low retropalatal, retroglossal, epiglottis and hypopharynx during awake and sleep periods. In each patient, LAN determined by CT scan($LAN_{CT}$) during sleep apnea was compared with LAN by MAP monitoring($LAN_{MAP}$). Results: MAP monitoring showed that four patients(36%) had a single pattern of LAN while the other seven patients(64%) showed two or more different LANs in different apneic episodes. Velopharynx was the most common level of frequently observed airway narrowing during sleep apnea(63.6%). However, a single pattern of airway narrowing was more frequent(72.7%) in airway CT during sleep apnea. Velopharynx was the most common narrowest level also in apneic CT(66%). In comparing $LAN_{CT}$ with $LAN_{MAP}$, the $LAN_{CT}$ of five patients(45.5%) were high-concordant, those of another five(45.5%) low-concordant, and that of one(9%) discordant with $LAN_{MAP}$. Conclusions: Cine CT scan during the awake state or sleep apnea may not reflect the LAN correctly in OSAS because most patients showed two or more different airway narrowing patterns during different episodes of sleep apnea in each patient.