• Title/Summary/Keyword: 수술 전 계획

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A study on long-term soft tissue changes after superior repositioning of the maxilla (상악골의 수술적 상방이동에 대한 연조직의 장기적 변화에 관한 연구)

  • Lee, Dong-Yul
    • The korean journal of orthodontics
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    • v.29 no.5 s.76
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    • pp.627-635
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    • 1999
  • Soft tissue changes that occurred between presurgery to 5-years post-surgery in 49 orthognathic surgery patients whose maxillae were moved upward by Le Fort I osteotomy were examined by lateral cephalometric film. The objective of this paper was to document soft tissue changes at long-term follow-up after superior repositioning of the maxilla and to relate soft tissue and hard tissue changes in this group. The results were as follows. 1. On average, soft tissue landmarks in the nose and the upper lip were not changed statistically significantly except superior movement of superior labial sulcus and forward movement of pronasale between presurgery and 5 years postsurgery. 2. Upward and forward movement of the lower lip were found at 5 years postsurgery in comparison with presurgery and genioplasty added this effects. 3. Upper lip length and vertical dimension of upper vermilion didn't show any significant changes, but increase of lower lip length and decrease of vertical dimension of lower vermilion were statistically significant between presurgery and 5 years post-surgery. 4. The decrease of upper incisor exposure and interlabial distance from presurgery to 1 year were continued from 1 year to 5 years and the amount of the decrease was more than that of vertical movement of the maxilla by surgery. 5. Long term changes in soft tissue landmarks from 1 to 5 years postsurgery exceeded hard tissue changes, meaning soft tissue moved down more than skeletal changes.

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Implant Supported Fixed Restoration for Maxillary Edentulism using CAD/CAM Guided Implant Surgery (NobelGuide$^{TM}$) and Immediate Loading (상악 완전 무치악 환자의 CAD/CAM 을 이용한 임플란트 식립(NobelGuide$^{TM}$) 및 즉시하중 후 고정성 보철수복 증례)

  • Huh, Yoon-Hyuk;Yi, Yang-Jin;Kim, Dae-Gon;Cho, Lee-Ra;Park, Chan-Jin
    • Journal of Dental Rehabilitation and Applied Science
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    • v.28 no.4
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    • pp.423-439
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    • 2012
  • This case report described a technique utilizing a computer-aided design (CAD)/computer-aided machining (CAM) - guided surgical implant placement and prefabricated temporary fixed prosthesis for an immediately loaded restoration. The advantages of CAD/CAM guided implant procedures are flapless, minimally invasive surgery and shorter surgery time. With this technique, less postoperative morbidity and delivery of prosthesis for immediate function would be possible. A patient with an edentulous maxilla received 8 implants in maxilla using CAD/CAM surgical templates. Prefabricated provisional maxillary implant supported fixed prosthesis were connected immediately after implant installation. Provisional prosthesis was evaluated for aesthetics, function during 6 months. Definitive implant supported fixed porcelain fused metal bridges were fabricated.

Radiotherapy of Squamous Cell Carcinoma of Maxillary Antrum (원발성 상악동 편평상피암의 방사선치료)

  • Yun, Hyong-Geun;Park, Charn-Il;Kim, Kwang-Hyun
    • Radiation Oncology Journal
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    • v.8 no.1
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    • pp.45-50
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    • 1990
  • One hundred-ten patients with squamous cell carcinoma of the maxillary antrum treated at the Department of Therapeutic Radiology, Seoul National Unviersity Hospital between February 1979 and September 1986 were retrospectively analyzed. Of these, only 73 patients were eligible for analysis. Forty-one patients were treated with combination of surgery and radiation therapy and 32 patients were treated with radiation therapy alone. The majority of patients had advanced stage (including $47\%\;T_4$ tumor). Overall 5 year survival rate was $40.0\%$. In the radiotherapy alone group,5 year survival rate was $22.1\%$, and in the combined surgery and radiotherapy group,5 year survival rate was $65.3\%$. Of 31 patients who had failures,22 patients ($71.0\%$) had local failures, 6 patients ($19.3\%$) had regional failures and 3 patients ($9.7\%$) had distant metastasis. Planned combined treatment with surgery followed by radiation therapy is an effective modality for carcinoma of the maxillary antrum.

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The Evaluation of Non-Coplanar Volumetric Modulated Arc Therapy for Brain stereotactic radiosurgery (뇌 정위적 방사선수술 시 Non-Coplanar Volumetric Modulated Arc Therapy의 유용성 평가)

  • Lee, Doo Sang;Kang, Hyo Seok;Choi, Byoung Joon;Park, Sang Jun;Jung, Da Ee;Lee, Geon Ho;Ahn, Min Woo;Jeon, Myeong Soo
    • The Journal of Korean Society for Radiation Therapy
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    • v.30 no.1_2
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    • pp.9-16
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    • 2018
  • Purpose : Brain Stereotactic Radiosurgery can treat non-invasive diseases with high rates of complications due to surgical operations. However, brain stereotactic radiosurgery may be accompanied by radiation induced side effects such as fractionation radiation therapy because it uses radiation. The effects of Coplanar Volumetric Modulated Arc Therapy(C-VMAT) and Non-Coplanar Volumetric Modulated Arc Therapy(NC-VMAT) on surrounding normal tissues were analyzed in order to reduce the side effects caused fractionation radiation therapy such as head and neck. But, brain stereotactic radiosurgery these contents were not analyzed. In this study, we evaluated the usefulness of NC-VMAT by comparing and analyzing C-VMAT and NC-VMAT in patients who underwent brain stereotactic radiosurgery. Methods and materials : With C-VMAT and NC-VMAT, 13 treatment plans for brain stereotactic radiosurgery were established. The Planning Target Volume ranged from a minimum of 0.78 cc to a maximum of 12.26 cc, Prescription doses were prescribed between 15 and 24 Gy. Treatment machine was TrueBeam STx (Varian Medical Systems, USA). The energy used in the treatment plan was 6 MV Flattening Filter Free (6FFF) X-ray. The C-VMAT treatment plan used a half 2 arc or full 2 arc treatment plan, and the NC-VMAT treatment plan used 3 to 7 Arc 40 to 190 degrees. The angle of the couch was planned to be 3-7 angles. Results : The mean value of the maximum dose was $105.1{\pm}1.37%$ in C-VMAT and $105.8{\pm}1.71%$ in NC-VMAT. Conformity index of C-VMAT was $1.08{\pm}0.08$ and homogeneity index was $1.03{\pm}0.01$. Conformity index of NC-VMAT was $1.17{\pm}0.1$ and homogeneity index was $1.04{\pm}0.01$. $V_2$, $V_8$, $V_{12}$, $V_{18}$, $V_{24}$ of the brain were $176{\pm}149.36cc$, $31.50{\pm}25.03cc$, $16.53{\pm}12.63cc$, $8.60{\pm}6.87cc$ and $4.03{\pm}3.43cc$ in the C-VMAT and $135.55{\pm}115.93cc$, $24.34{\pm}17.68cc$, $14.74{\pm}10.97cc$, $8.55{\pm}6.79cc$, $4.23{\pm}3.48cc$. Conclusions : The maximum dose, conformity index, and homogeneity index showed no significant difference between C-VMAT and NC-VMAT. $V_2$ to $V_{18}$ of the brain showed a difference of at least 0.5 % to 48 %. $V_{19}$ to $V_{24}$ of the brain showed a difference of at least 0.4 % to 4.8 %. When we compare the mean value of $V_{12}$ that Radione-crosis begins to generate, NC-VMAT has about 12.2 % less amount than C-VMAT. These results suggest that if NC-VMAT is used, the volume of $V_2$ to $V_{18}$ can be reduced, which can reduce Radionecrosis.

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The differences of STO between before and after presurgical orthodontics in skeletal Class III malocclusions (골격성 III급 부정교합자에서 술 전 교정치료 전과 후의 수술계획의 차이)

  • Lee, Eun-Ju;Son, Woo-Sung;Park, Soo-Byung;Kim, Seong-Sik
    • The korean journal of orthodontics
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    • v.38 no.3
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    • pp.175-186
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    • 2008
  • Objective: To evaluate the discrepancies between initial STO and final STO in Class III malocclusions and to find which factors are related to the discrepancies. Methods: Twenty patients were selected for the extraction group and 20 patients for the non-extraction group. They were diagnosed as skeletal Class III and received presurgical orthodontic treatment and mandibular set-back surgery at Pusan National University Hospital. The lateral cephalograms were analyzed for initial STO (T1s) at pretreatment and final STO (T2s) after presurgical orthodontic treatment, and specified the landmarks 3s coordinates of the X and V axes. Results: Differences in hard tissue points (T1s-T2s) in the X coordinates of upper central incisor edge, upper first molar mesial end surface, lower central incisor apex, lower first molar mesial end surface and mesio-buccal cusp and Y coordinates of upper central incisor edge, upper central incisor apex, upper first molar mesio-buccal cusp were statistically significant in the extraction group. Differences in hard tissue points (T1s-T2s) in the X coordinates of upper central incisor edge, lower central incisor apex, lower first molar mesial end surface and Y coordinates of lower central incisor apex were statistically significant in the non-extraction group. In the extraction group, the upper arch length discrepancy (UALD) had a statistically significant effect on maxillary incisor and first molar estimation. Lower arch length discrepancy and IMPA had statistically significant effects on mandibular incisor estimation in both groups. Conclusions: Discrepancies between initial STO and final STO and factors contributing to the accuracy of initial STO must be considered in treatment planning of Class III surgical patients to increase the accuracy of prediction.

Reconstruction of a Large Cricotracheal Defect Using a Sternocleidomastoid Myoperiosteal Flap : A Case of Locally Aggressive Papillary Thyroid Carcinoma with Tracheal Invasion (갑상선 수술 후 흉쇄유돌근 근골막피판을 이용한 큰 기도 결손부 재건 1예)

  • Kim, Sang Min;Kim, Mi Ra;Kim, Yong-Wan;Baek, Moo Jin;Park, Jun-Ook
    • Korean Journal of Head & Neck Oncology
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    • v.31 no.1
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    • pp.18-21
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    • 2015
  • 기관을 침범한 갑상선 악성종양을 제거한 후에 성문하부에 비교적 큰 기관 결손이 발생할 수 있다. 단단문합술은 넓은 부위의 결손부를 재건하는 방법으로 널리 받아들여지고 있지만, 문합부 파열, 반회후두신경마비, 재협착 등의 합병증이 발생할 수 있다. 본 증례는 기도를 침범한 갑상선 유두암종을 제거한 후 윤상연골과 기관연골의 비교적 큰 결손부를 흉쇄유돌근 근골막피판을 사용하여 안전하게 재건한 사례이다. 55세 남자 환자가 기도를 침범한 갑상선 유두상암으로 내원하였으며 기도침범은 윤상연골(둘레의 약 30%)과 4개의 기관연골(둘레의 약 50%)을 해당하는 넓은 부위였다. 수술 전 기관절개술을 시행하여 주위 기관연골의 상태가 좋지 않아 단단문합술 시행 후 문합부 파열 가능성이 있다고 판단하여 흉쇄유돌근 근골막피판을 이용하여 재건하기로 계획하였다. 갑상선 절제술, 경부림프절 절제술, 흉쇄유돌근 근골막피판을 이용한 재건술을 시행하였으며 수술 후 12일째 별다른 문제없이 퇴원하였다. 환자는 수술 후 현재 22개월 간 기도 협착 등의 별다른 합병증 없이 지내고 있다. 흉쇄유돌근 근골막피판은 성문하부나 기관지 전외측벽의 비교적 큰 결손부를 재건하는 데 유용하게 사용될 수 있다.

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Suspected Intimal Sarcoma in the Abdominal Aorta -A case report- (복부 대동맥에 발생한 혈관 내막 육종 의증 - 1예 보고 -)

  • Choi, Eun-Seok;Kim, Kyung-Hwan;Choi, Jin-Ho;Lee, Jae-Hang;Hwang, Ho-Young;Kim, Ki-Bong
    • Journal of Chest Surgery
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    • v.43 no.2
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    • pp.204-207
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    • 2010
  • A 68 year-old man visited our institution due to chest pain. Coronary angiography revealed triple vessel disease. A computed tomographic angiogram performed as a routine preoperative examination demonstrated an intraluminal spider-web-like mass from the infrarenal abdominal aorta to both common iliac arteries. The infrarenal aorta and both common iliac arteries were excised and replaced with concomitant off-pump coronary artery bypass grafts. Histologic examination of the aorta suggested an intimal sarcoma. A postoperative computed tomographic angiogram performed 3 months postoperatively showed no evidence of a residual or a recurred lesion.

Full mouth rehabilitation of a patient with severe periodontitis using immediate loading after computer aided flapless implant surgery (심한 치주질환을 가진 환자에서 computer aided flapless surgery와 즉시 부하를 통한 전악 구강 회복 증례)

  • Kang, Seong hun;Choi, Yeon jo;Ryu, Jae jun
    • Journal of Dental Rehabilitation and Applied Science
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    • v.34 no.1
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    • pp.46-55
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    • 2018
  • Oral rehabilitation of a patient having severe periodontitis with alveolar bone resorption and periodontal inflammation presents a challenge to clinicians. However, if appropriate implant placement according to the bone shape is selected, unnecessary bone grafting or soft tissue surgery can be minimized. In recent years, using cone beam CT and software, it has become possible to operate the planned position with the surgical guide made with 3D printing technology. This case was a 70 years old female patient who required total extraction of teeth due to severe periodontitis and performed a full-mouth rehabilitation with an implant - supported fixed prosthesis. During the surgery, the implant was placed in a flapless manner through a surgical guide. Immediate loading of the temporary prosthesis made by CAD/CAM method before surgery was done. Since then, we have produced customized abutments and zirconia prostheses, and have reported satisfactory aesthetic and functional recovery.

Outcome of Gamma Knife Radiosurgery for Trigeminal Neuralgia (삼차신경통에 대한 감마나이프방사선 수술)

  • Jeon, Sang Ryong;Lee, Dong Joon;Kim, Jeong Hoon;Kim, Chang Jin;Kwon, Yang;Lee, Jung Kyo;Kwun, Byung Duk
    • Journal of Korean Neurosurgical Society
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    • v.29 no.9
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    • pp.1228-1232
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    • 2000
  • Objective : This study was undertaken to analysis gamma knife radiosurgery(GKR) effect for trigeminal neuralgia after long term follow-up. Methods : There were 11 trigeminal neuralgia patients. The authors irradiated 67-85 Gy maximally to the nerve root entry zone(NREZ) using single 4mm collimator, just 1-6mm lateral side from the junction of the trigeminal nerve and pons. For the first 3 cases, we targeted the junction between the nerve and the pons. In theses cases, the pons was irradiated 56 or 60 gray in the surface. In the later 8 cases, the isocenter is positioned more distal side so that the brain stem surface would receive less than the 20% isodose. Results : The average follow-up duration was 25 months(13-50 months). Pain relief was noticed within a week to 5 months. In 3 patients, pain was relieved completely and in other 3 patients, mark improvement was achieved(80-90%). Remaining 4 patients showed significant improvement(30-50%). There was recurrence in only one case and she complained with similar intensity of pain at the last follow-up. There was no significant complication related to GKR. Conclusion : GKR is considered effective for trigeminal neuralgia based on the long term follow-up evaluation, but more clinical experience is needed to evaluate the efficacy of GKR for trigeminal neuralgia as a primary treatment modality.

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Pulmonary Aspergilloma Treated by one Stage Cavernostomy and Myoplasty (공동절개술과 근육충진술을 이용한 폐국균증의 수술)

  • 안현성;김응중;신윤철;지현근;최광민
    • Journal of Chest Surgery
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    • v.34 no.9
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    • pp.729-732
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    • 2001
  • A 49-year-old male patient was admitted with chief complaint of hemoptysis. Preoperative chest PA and CT scan revealed air-filled large cavitary lesion at the right upper lobe with typical meniscus sign. Serum anti-fungus antibody for Aspergillus was positive and he was diagnosed as aspergilloma. We planned RULobectomy but it was impossible due to severe pleural adhesion in apex and mediastinal pleura. Therefore, we performed a cavernostomy and serratus anterior muscle flap transposition in one stage. The patient recovered without complication and was followed up for 8 months without recurrence of hemoptysis.

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