• Maxillofacial Plastic and Reconstructive Surgery
• /
• 제32권5호
• /
• pp.447-453
• /
• 2010

The hemifacial microsomia is characterized by variable underdevelopment of the craniofacial skeleton, external ear, and facial soft tissues. So, patients with hemifacial microsomia have an occlusal plane canting and malocclusion with facial asymmetry. Distraction osteogenesis (DO) with an intraoral or extraoral device is a technique using tension to generate new bone with gradual bone movement and remodeling. DO has especially been used to correct craniofacial deformities such as a hemifacial microsomia, facial asymmetry, and mandible defect that could not adequately be treated by conventional reconstruction with osteotomies. It has a significant advantage to lengthen soft and hard tissue of underdeveloped site without bone graft and a few complication such as nerve injury or muscle contracture. A 13-years old girl visited our clinic for the chief complaint of facial asymmetry. She had a left hypoplastic maxilla and mandible, occlusal plane canting and malocclusion. We diagnosed hemifacial microsomia and lanned DO to lengthen the affected side. Le Fort I osteotomy, left mandibular ramus and symphysis osteotomy were performed. The internal distraction devices fixed with screw on maxillary and mandibular ramus osteotomy sites. External devices were adapted to lower jaw for DO on symphysis osteotomy site and to upper jaw for rapid maxillary expansion (RME). At 7days after surgery, distraction was started at the rate of 1mm per day for 13days, and after 4months consolidation periods, distraction devices were removed. Simultaneous multiple maxillo-mandibular distraction osteogenesis with RME resulted in a satisfactory success in correcting facial asymmetry as well as occlusal plane canting for our hemifacial microsomia.

• 대한치과보철학회지
• /
• 제45권3호
• /
• pp.382-388
• /
• 2007

Statement of problem. The role of calcium sulfate in stimulating the growth of gingival soft tissue has been reported in few studies. Such a unique property of calcium sulfate could serve as a trouble-solving broker in compensating for the lack of soft tissues in various oral surgeries. Purpose. The purpose of this study was to compare the proliferating activities of human gingival fibroblasts seeded on various bone graft barrier materials of calcium sulfate, collagen, and polytetrafluorethylene (PTFE). Material and methods. Two calcium sulfates ($CAPSET^{(R)}$. and $CalForma^{(R)}$, Lifecore Biomedical Inc., St. Paul, Minnesota, USA), a resorbable natural collagen ($Bio-Gide^{(R)}$, Geistlich Pharma Ag., Wolhusen, Switzerland), and a non-resorbable PTFE ($TefGen-FD^{(R)}$, Lifecore Biomedical Inc., St. Paul, Minnesota, USA) served as the human gingival fibroblasts' substrates and comprised the four experimental groups, whereas the untreated floors of culture plastics were used in the control group, in this study. Cells were trypsinized, seeded, and incubated for 48 h. The proliferating activities of fibroblasts were determined by XTT and SRB assay and absorbance (optical density, OD) was measured. One-way ANOVA was used to analyze the differences in the mean OD values between the groups of CAPSET, CalForma, Bio-Gide, TefGen, and the control (p<0.05). Results. From the XTT assay, the mean OD value of the control group, the highest, was significantly greater than that of any of the four experimental groups followed by CalForma, CAPSET, TefGen, and Bio-Gide. Further, the mean OD value of CalForma, was significantly greater compared to that of Bio-Gide. From the SRB assay, Calforma showed the highest mean OD value, which was significantly greater than that of any other groups, followed by the control, CAPSET, Bio-Gide, and TefGen. The mean OD values of both the control and CAPSET were significantly greater compared to that of TefGen (p<0.05). Conclusion. Assessment of the viability and proliferation of cultured fibroblasts seeded and incubated for 48 h on various barrier-material substrates using XTT and SRB assay showed that calcium sulfate $CalForma^{(R)}$ promotes the proliferating activity of human gingival fibroblasts.

• 대한치과보철학회지
• /
• 제54권3호
• /
• pp.298-305
• /
• 2016

상악 전치부는 심미적으로 중요한 역할을 하는 치아이다. 그러므로 발치 후 심미적인 보철 수복을 위하여 경조직 및 연조직의 보존이 중요하다. 상악 전치부 상실을 임플란트를 이용하여 수복하는 경우 몇 가지 난관에 부딪히게 된다. 즉 수복물과 인접치와의 색상 및 형태, 인공치 표면의 조화 및 치은연과의 조화로운 연속성 등이다. 본 증례는 외상으로 인하여 상악 중절치와 측절치의 치관-치근 파절을 주소로 내원하였다. 예후가 불량한 파절 치아를 모두 발치 하였으며 상악 전치부 결손부위에 골이식을 동반한 임플란트를 식립하였다. 보다 나은 심미적 결과를 위하여 캔틸레버 임플란트 보철물을 계획하였고 인공치아 연하의 치조점막을 지속적으로 조정하였고 그것을 정확하게 인기해내는 맞춤형 인상코핑을 이용하여 임플란트 심미 보철 수복을 시행하였다. 최종치료 후 심미적, 기능적으로 만족스러운 결과를 얻었기에 이를 보고하고자 한다.

• Archives of Reconstructive Microsurgery
• /
• 제8권2호
• /
• pp.176-183
• /
• 1999

전북대학교병원 정형외과에서 1993년 12월부터 1998년 9월까지 하지의 만성 골수염 7례에 대하여 유리 근 피판 이식술을 시행하고 최소 1년 2개월부터 최장 5년 3개월까지 추시하여 다음과 같은 임상적 결과를 얻었다. 1. 만성 골수염의 발생 부위는 경골이 4례, 종골 2례 그리고 대퇴골이 1례였다. 2. 만성 골수염의 지속 기간은 평균 31.6년이었다. 3. 전체 7례 중 1례에서 편평 상피암이 발병되었다. 4. 만성 골수염은 4례에서 혈행성 감염으로 초래되었고, 3례는 외상력이 있었는데 2례는 교통사고 그리고 1례는 경미한 외상이었다. 5. 치료는 부골 제거술과 유리 근 이식술을 시행하였던 예가 2례, 부골 제거술없이 유리 근 이식술을 시행한 예가 5례였다. 6. 전체 7례 중 6례에서 유리 근 이식술을 시행하였고 1례에서 유리 근피판 이식술을 시행하였는데 복직 근이 4례였고, 광배 피판, 광배 근피판 그리고 박근이 각각 1례씩이었으며 7례 중 6례(85.7%)에서 생존하였다. 7. 대퇴부에 시행하였던 광배 근피판 1례는 정맥이식술을 통한 단측 문합술을 시행하였으나 술 후 2일째부터 허혈성 변화를 일으켜 실패하였으며, 외상으로 인한 종골 1례에서는 복직근 이식술이 성공하였으나, 술 후 심한 외상성 족관절염으로 인한 극심한 통증으로 슬관절 하부 절단술이 시행되었다.

• Journal of Periodontal and Implant Science
• /
• 제26권4호
• /
• pp.949-965
• /
• 1996

The main goal of periodontal therapy is to restore the lost periodontal tissue and establish the attachment appratus. Current acceptable therapeutic techniques are included : removal of diseased soft tissue, demineralization of exposed root surface, using the barrier membrane for preventing the downgrowth of gingival epithelial cell, insertion of graft materials as a scaffolding action, and biological mediators for promoting the cell activity. The latest concept one among them has been studied which based on the knowledge of cellular biology of destructed tissue. Platelet-derived growth factor(PDGF) is one of the polypeptide growth factor which have been reported as a biological mediator to regulate activities of wound healing progress including cell proliferation, migration, and metabolism. The purposes of this study is to evaluate the influences of the PDGF as biological mediator to periodontal ligament and bone marrow cell. Both right and left maxillary first molar were extracted from rat which had treated with 0.4% ${\beta}-Aminopropionitril$ for 5 days, and feeded until designed date to sacrifice under anesthesisa. Periodontal ligament were removed from the extracted socket of the rat, and cultured with Dulbecco's Modified Essential Medium(DMEM) contained with 10% Fetal Bovine Serum, 100U/ml penicillin, $100{\mu}g/ml$ streptomycin, $0.5{\mu}g/ml$ amphotericin-B. Bone marrow cell were culture from bone marrow suspension with which washed out from femur with same medium. The study was performed to evaluate the effect of PDGF to periodontal ligament and bone cell, cell proliferation rate, total protein synthesis, and alkaline phosphatase activity of rat periodontal ligament(PDL) cell and bone stromal(RBS) cell in vitro. The effects of growth factors on both cells were measured at 3, 5th day after cell culture with (control group) or without growth factors(experimental group). The results were as follows: 1. The tendency of cell proliferation under the influence of PDGF showed more rapid proliferation pattern than control at 3 and 5 days after inoculation. 2. The activity of Alkaline phosphatase revealed 14, 80% increased respectively at 3, 5 days culture than control group. Measurements of ALPase levels indicated that PDL cells had significantly higher activity when compared with that of co-culture groups and GF only(P<0.05). And, ALPase activity in 10 days was higher than that of 7 days(P<0.05). 3. The tendency of formation of the mineralized nodule were observed dose-depend pattern of PDL cells. There was statistically significant difference among group l(PDL 100%), 2(PDL 70%:GF 30%), and 3(PDL 50%:GF 50%)(P<0.01). But, there was no difference among group 3, 4(PDL 30%:GF 70%), and 5(GF 100%). 4. Also, the number of nodule was greater in co-culture of PDL 70% and GF 30% than in culture of PDL 70%(P<0.05). From the above results, it is assumed that the PDGF on PDL cells and RMB cell culture. GF stimulates the cell growth, which is not that of PDL cells but GF. And, the activity of ALPase depends on the ratio of PDL cells, and ALPase may relate to the initial phase of nodule formation. Also, it is thought that the calcified nodule formation principally depends on PDL cells, is inhibited by GF, and affected by cell density. In conclusion, platelet-derived growth factor can promote rapid osteogenesis during early stage of periodontal tissue regeneration.

• Maxillofacial Plastic and Reconstructive Surgery
• /
• 제31권5호
• /
• pp.365-374
• /
• 2009

Purpose : This research evaluates the effect of the use of absorbable membrane barrier with deproteinized bovine bone (Bio-$Oss^{(R)}$, Switzerland) on bone healing in surgically created critical-sized defects in rat calvaria. Materials and Methods : Two standardized transosseous circular calvarial defects (5 mm in diameter) are made in each calvarium of 30 rats. These rats are divided into negative control group(n=15), positive control group(n=15) and two experimental groups(n=15). In the negative control group, defects are only filled with blood clots. In the positive control group, defects are filled with autogenous bone obtained from calvarium; in the experimental group 1, defects are filled with deproteinized bovine bone; and in the experimental group 2, defects are filled with deproteinized bovine bone with absorbable membrane. At the postoperative 1 week, 3 weeks. and 6 weeks, clinical. histologic and histomorphometric evaluations of the defects are performed. Results : 1. The grafted bone without membrane in the calvarial bone defect was scattered but, the grafted bone with membrane was stable. 2. $BioMesh^{(R)}$ membrane was absorbed beginning at 3 weeks, and was absorbed considerably at 6 weeks while maintaining the structural form of the membrane. 3. The use of membrane blocked soft tissue invasion. 4. In histomorphometric analysis. it showed the greatest amount of new bone formation in the positive control group. The amount of new bone formation was greater in the experimental group 2 than experimental group 1. At 6 weeks. the amount of new bone formation was greater in the positive control group than experimental group l(p<0.005). Conclusion : These results suggest that membrane increase the stability of grafted bone and protects from soft tissue invasion, and the use of the membrane may promote new bone formation in deproteinized bovine bone graft area.

• Archives of Plastic Surgery
• /
• 제38권6호
• /
• pp.791-797
• /
• 2011

Purpose: Angiosarcoma is a rare and aggressive malignant soft tissue tumor. Due to a lack of the established optimal treatment modalities, however, an extensive resection followed by an early detection has been reported to be the best treatment of choice. We analyzed the clinical course of six patients, hence attempted to contribute to making a treatment plan for patients with angiosarcoma. Methods: Six patients who have been surgically treated between 2005 and 2010 are included. Through a retrospective analysis of the medical records, we evaluated the pattern of disease detection, a past history, time span between the detection and the primary surgery, surgical treatment modalities, time span between the primary surgery and the recurrence/metastasis, the sites of metastasis and the secondary treatment modalities. Results: The mean age of patients was 70.5 years; all male; and the sites were the scalp. Four patients underwent the reconstruction using a local flap with a skin graft and two patients using a free flap. The mean period elapsed until the primary operation since the identification was 7.3 months and until a recurrence or a metastasis occurred following the primary operation was 12 months. Four patients had pulmonary metastasis. As a secondary therapy, four patients underwent the radiotherapy and one was treated with the chemotherapy. At the present, five patients died and one undergoes a monitoring of the clinical course. Conclusion: It would be mandatory to shorten the length of hospital stay and to return patients to their daily lives as the earliest as possible using relatively simpler surgical methods, thus attempting to give them opportunity to resume their previous normal life.

• Journal of Yeungnam Medical Science
• /
• 제13권1호
• /
• pp.22-31
• /
• 1996

본 교실에서는 1994년 11월부터 1996년 4월까지 수상 후 혹은 일차 교정 후 평균 3.2개월 경과한, 7명의 환자에서 제한된 접근방식으로 2차석 교정술을 시행하여 평균 4.5개월의 추적 조사한 후 만족할 만한 결과를 얻었으며 다음과 같은 결론을 내렸다. 1. 술전에 X-ray 검토, 사고 전의 사진, 충분한 대화 등을 토대로 가능한 정확한 절골선과 변형정도 등의 교정을 위한 계측이 필요하다. 2. 관골의 삼각골절 후 안면변형인 경우는 반드시 광범위 노출법보다는 제한적 방법으로 교정이 가능했다. 3. 절골된 관골은 내측 및 전상방으로 과교정해야 한다. 4. 절골 및 재배치시 저작근을 포함하여 주위 연부조직을 분리시키는 것이 중요하다. 5 안구함몰의 교정을 위해서 안와기저부 및 측부에 자가 골이식이나 고밀도 폴리에틸렌($Medpor^{(R)}$)의 삽입 후 결과의 차이는 발견할 수 없었다.

• Maxillofacial Plastic and Reconstructive Surgery
• /
• 제28권2호
• /
• pp.154-165
• /
• 2006

Objectives : It is difficult to place implants at a severely atrophied edentulous mandible because of vertical and horizontal alveolar defect. The autogenous and allogenic bone graft and guided bone regeneration are useful, but there are some limitations such as the resorption and infection of the grafted bone, and insufficiency of soft tissue. Distraction osteogenesis has recently evolved a challenging technique to overcome major draws of conventional augmentation procedures, we, therefore, report the four applications of implant placement after vertical alveolar distraction osteogenesis. Patients and Methods : Four patients(all female, mean age: $60{\pm}6$ years) with severe alveolar ridge deficiencies at their anterior mandible were treated with vertical alveolar distraction osteogenesis by intraoral device(Track 1.5, 15 mm model, KLS Martin, Tuttlingen, Germany) and placement of implants (Branemark MK III, TiUnite). After the latency periods of 5, 7, 8 days, distraction rhythm and rate were $0.5\;mm{\times}2\;times/day$ in the case of good bone quality, and $0.25\;mm{\times}3\;times/day$ in the case of poor bone quality. After consolidation periods of mean fifteen weeks, five implants for each patients were placed at the interforaminal area. Results : On average, a vertical gain of $11.38{\pm}1.38\;mm$ was obtained by distraction. And all distraction zone showed complete ossification by panoramic radiography. There were no postoperative complications other than numbness of lower lip in one case. Total twenty implants in four patients were placed and their outcomes were satisfactory. Conclusion : It is a useful method to place five implants after vertical distraction osteogenesis of the severely atrophied mandible for the implant-supported fixed prosthesis.

• Journal of Chest Surgery
• /
• 제39권2호
• /
• pp.166-170
• /
• 2006

점액성섬유육종은 성인과 장년의 환자에서 사지의 가장 흔한 연조직 육종의 하나를 나타내고 있다. 하지만 이 종양은 흉벽에서는 희귀하게 발생한다. 58세의 여자환자가 본: 병원 일반외과에서 절제에 이은 수개월 후 재발하여서 우측 아래 흉벽에서 8${\times}$6.5 cm의 거대 종양덩어리를 보였다. 조직은 침윤성 심부에 위치한 피하층 종양이었고 명확한 점액성 변화와 중등도의 세포 충실성을 보이면서 명확한 엽성 성장을 보였다. 종양세포는 다양한 정도의 세포양상과 유사분열을 갖고 있는 방추형세포였고 궁형의 혈관양상을 보였다. 5-100, CD68과 Mac387 그리고 FX IIIa의 면역염색은 음성이었고 Vimentin 염색은 양성을 보였다. 조직양상은 점액성 섬유육종의 증간등급이었다. 광범위절제를 하였고 한달 후 퇴원하였는데 항암제나 방사선치료 없이 결손부위의 피부이식을 준비하고 있다.