• 대한치과교정학회지
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• 제46권6호
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• pp.395-408
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• 2016

We report a case involving a young female patient with severe mandibular retrognathism accompanied by mandibular condylar deformity that was effectively treated with Le Fort I osteotomy and two genioplasty procedures. At 9 years and 9 months of age, she was diagnosed with Angle Class III malocclusion, a skeletal Class II jaw relationship, an anterior crossbite, congenital absence of some teeth, and a left-sided cleft lip and palate. Although the anterior crossbite and narrow maxillary arch were corrected by interceptive orthodontic treatment, severe mandibular hypogrowth resulted in unexpectedly severe mandibular retrognathism after growth completion. Moreover, bilateral condylar deformities were observed, and we suspected progressive condylar resorption (PCR). There was a high risk of further condylar resorption with mandibular advancement surgery; therefore, Le Fort I osteotomy with two genioplasty procedures was performed to achieve counterclockwise rotation of the mandible and avoid ingravescence of the condylar deformities. The total duration of active treatment was 42 months. The maxilla was impacted by 7.0 mm and 5.0 mm in the incisor and molar regions, respectively, while the pogonion was advanced by 18.0 mm. This significantly resolved both skeletal disharmony and malocclusion. Furthermore, the hyoid bone was advanced, the pharyngeal airway space was increased, and the morphology of the mandibular condyle was maintained. At the 30-month follow-up examination, the patient exhibited a satisfactory facial profile. The findings from our case suggest that severe mandibular retrognathism with condylar deformities can be effectively treated without surgical mandibular advancement, thus decreasing the risk of PCR.

• 대한구순구개열학회지
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• 제12권1호
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• pp.21-32
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• 2009

Generally, an adult cleft lip or/and palate patient shows some amount of maxillary deficiency due to limitation of bony growth caused by heavy scars resulted from previous operations such as a cheiloplasty and/or a palatoplasty at an early child age. To solve the problem, advancement of the maxilla is usually required during orthognathic surgery. However, severe tensional force resulted from heavy scars on the palate and/or the lip, as well as the bony defect at the cleft area limited sufficient advancement of the maxillary segment and finally caused relapse of the reposed maxilla. Therefore, distraction osteogenesis of the maxilla was introduced for the successful maxillary advancement inthose kinds of patients. As both hard and soft tissues can be simultaneously and gradually extended with this technique, tensional force caused by heavy scars opposed to forward movement of the maxilla can be reduced to an extent not to develop severe relapse of the advanced maxilla. Since distraction osteogenesis of the maxilla was applied as one of standard protocols for the treatment of the patients with severe maxillary hypoplasia dueto cleft lip and/or palate, the devices for the distraction was improved to control the vectors of distraction with better and more stable. We have treated a 23-year-old male cleft patient with a severe maxillary hypoplasia using a newly developed a maxillary distraction device and a RP model for a pre-operative simulation surgery. As a result, we could successfully move the maxilla as we designed pre-operatively and also reduce much of operation time. Therefore, we report of the case to share our experience with colleagues.

• 대한치과교정학회지
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• 제49권6호
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• pp.413-426
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• 2019

This study was performed to describe the longitudinal management of recurrent temporomandibular joint (TMJ) ankylosis from infancy to adulthood in perspective of surgical and orthodontic treatment. A 2-year-old girl was referred with chief complaints of restricted mouth opening and micrognathia due to bilateral TMJ ankylosis. For stage I treatment during early childhood (6 years old), high condylectomy and interpositional arthroplasty were performed. However, TMJ ankylosis recurred and symptoms of obstructive sleep apnea (OSA) developed. For stage II treatment during early adolescence (12 years old), gap arthroplasty, coronoidectomy, bilateral mandibular distraction osteogenesis, and orthodontic treatment with extraction of the four first premolars were performed. However, TMJ ankylosis recurred. Because the OSA symptoms reappeared, she began to use a continuous positive airway pressure device. For stage III treatment after completion of growth (20 years old), low condylectomy, coronoidectomy, reconstruction of the bilateral TMJs with artificial prostheses along with counterclockwise rotational advancement of the mandible, genioglossus advancement, and orthodontic treatment were performed. After stage III treatment, the amount of mouth opening exhibited a significant increase. Mandibular advancement and ramus lengthening resulted in significant improvement in the facial profile, Class I relationships, and normal overbite/overjet. The OSA symptoms were also relieved. These outcomes were stable at the one-year follow-up visit. Since the treatment modalities for TMJ ankylosis differ according to the duration of ankylosis, patient age, and degree of deformity, the treatment flowchart suggested in this report could be used as an effective guideline for determining the appropriate timing and methods for the treatment of TMJ ankylosis.

• 대한치과의사협회지
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• 제53권1호
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• pp.47-56
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• 2015

Obstructive sleep apnea (OSA), most common respiratory disorder of sleep, is characterized by intermittent partial or complete occlusions of the upper airway due to loss of upper airway dilating muscle activity during sleep superimposed on a narrow upper airway. Termination of these events usually requires arousal from sleep and results in sleep fragmentation and hypoxemia, which leads to poor quality of sleep, excessive daytime sleepiness, reduced quality of life and numerous other serious health consequences Untreated OSAS can cause various problems such as hypertension, diabetes, stroke, cardiac disease, daytime sleepiness. Various treatments are available, including non-surgical treatment such as medication or modification of life style, surgical treatment, continuous positive airway pressure (CPAP) and oral appliance (OA). Oral appliance is known to be effective in mild to moderate OSA, also genioglossus muscle advancement (GA) or maxillomandibluar advancement (MMA) is a good option for OSA patients with muscular or skeletal problems. Although the prevalence of OSA is increasing, the proportion of the patient treated by dentist is still very law. Dentists need to understand the mechanism of OSA and develop abilities to treat OSA patients with dental problems. The purpose of this paper is to give a brief overview about OSA and the dentist's role in OSA patients.

• Journal of Korean Dental Science
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• 제13권1호
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• pp.11-20
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• 2020

Purpose: This study sought to identify differences in hard and soft tissue chin profile changes in skeletal Class III patients after bimaxillary surgery, with or without advancement genioplasty. Materials and Methods: The retrospective study was conducted based on cephalometric analysis of skeletal and soft tissue variables. Lateral cephalograms taken at 3 different time points were utilized: pre-operation (T0), immediately post-operation (T1), and at least 6 months (11.0±2.6 months) post-operation (T2). The 2 groups were matched for sample size (n=20 each). Data were analyzed using independent t-tests with Bonferroni correction. Result: Group N (bimaxillary surgery alone) and Group G (bimaxillary surgery with an advancement genioplasty by horizontal sliding osteotomy) did not differ significantly in terms of demographic characteristics. The soft tissue chin thickness of Group G increased more after surgery, followed by a greater decrease during the postoperative period, and was eventually not significantly different from Group N at T2. On the other hand, the mentolabial sulcus depth of Group G (5.5±1.3 mm) was significantly greater than that of Group N (4.4±0.9 mm) (P=0.006) at T2. Conclusion: Although Group G showed a statistically significantly greater decrease in soft tissue chin thickness during the postoperative period, there were no significant intergroup differences in the chin profile for at least 6 months after the surgery, except for the mentolabial sulcus depth, which was greater in Group G than in Group N.

• 한국체육학회지인문사회과학편
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• 제54권1호
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• pp.47-55
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• 2015

이 연구는 한국 스포츠문화의 현재성을 살펴보고, 지향점과 선진화 대안을 모색하는데 목적이 있다. 첫째, 학교체육의 현재성은 가장 중요한 스포츠문화의 토대임에도 모순으로 가득 차 변화의 속도가 더디고, 엘리트스포츠는 학교체육이 정상적으로 운영되어 연계될 때 안정된 영역으로써 존재의 가치를 지닐 것이며, 대중스포츠는 그동안 국가의 체육정책이 엘리트스포츠에 집중된 관계로 자생력이 부족하다고 진단하였다. 둘째, 스포츠문화의 지향점은 아직도 승리제일주의에 매몰되어 있음을 강조하였고, 스포츠문화의 새로운 지향점으로 스포츠컬처리즘이 스포츠의 선진화 의식임을 강조하였다. 따라서 스포츠문화의 지향점은 승리제일주의에서 휴머니즘에 기반을 둔 스포츠컬처리즘으로의 변화 가능성이 확장될 것으로 기대하였다. 셋째, 스포츠문화의 대안 찾기는 우선 학교체육진흥법 제정이 중요한 의미를 지니며 학교체육 정상화를 위한 개정의 필요성도 요구된다. 다음으로 엘리트스포츠의 주요문제로써 체육단체의 비윤리성, 승부조작, 심판오심 등을 설정하였고, 각 영역의 대안도 설정하였다. 마지막으로 대중스포츠는 시대적 중요성을 담아내기 위한 생활체육법이 제정되어야함을 역설하였다.

• 대한영양사협회학술지
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• 제16권3호
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• pp.195-207
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• 2010

This study aimed to examine factors and the correlations of burnout and job satisfaction in hospital dietitians. Burnout was classified into three sub-concepts: emotional exhaustion, depersonalization, and reduced personal accomplishment. Job satisfaction was also classified into three sub-concepts, including relationships, self-realization, and advancement opportunities. A survey was conducted with dietitians working in general hospitals of over 400 beds, in the Seoul metropolitan area. The factors that significantly influenced emotional exhaustion were health, work hours, number of intern dietitians, self-esteem, level of responsibility, while the factors that influenced depersonalization were relationships with coworkers, and role ambiguity. Personal accomplishment was influenced by age, the number of staff dietitians, the general number of managed workers, and self-esteem. In terms of job satisfaction, relationship was affected by age and relationships with supervisors, while self-realization was influenced by work hours, health, the number of patient meals, and role ambiguity. Age, job regularity, business management, role ambiguity, and relationships with supervisors also affected advancement opportunities. Emotional exhaustion, depersonalization, and reduced personal accomplishments, which represented burnout, had negative relationships with satisfaction with relationships, self-realization and advancement opportunities. Dietitians with low job satisfaction were likely to experience burnout. These results suggest that burnout and job satisfaction are influenced by internal and external factors that are individual or organizational problems encountered by hospital dietitians. Therefore, managers as well as dietitians need to understand these factors and overcome them through communication and mutual support.

• 대한임상검사과학회지
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• 제43권2호
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• pp.82-88
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• 2011

Mandibular advancement devices (MAD) are therapeutic options for obstructive sleep apnea (OSA). The aim of study was to investigate treatment outcomes of before and after insertion of MAD in OSA patients. We retrospectively selected a total of 13 patients who were diagnosed with OSA syndrome. All sleep-related parameters including apnea-hypopnea index (AHI), oxygen desaturation index (ODI), wake after sleep onset (WASO), total arousal were measured by before and after MAD. The use of MAD proves to be efficient in reducing snoring, apnea-hypopne index ($17.2{\pm}14.6$ vs $20.9{\pm}14.6$), WASO ($27.4{\pm}28.8$ vs $47.9{\pm}43.6$), oxygen desaturation index ($9.0{\pm}11.6$ vs $16.4{\pm}11.7$), stage N3 ($54.8{\pm}45.2$ vs $36.6{\pm}22.0$), REM sleep times ($73.3{\pm}19.4$ vs $66.0{\pm}31.0$) and increases sleep efficiency ($92.6{\pm}6.6$ vs $87.2{\pm}11.2$). The decreases in apnea index based on a reduction in the overall and supine AHI values after MAD therapy were significantly greater for the positional OSA than nonpositional OSA patients. The use of MAD proves to be efficient in snoring, WASO, sleep efficiency, reduced AHI and associated with good compliance of patients.

• 영재교육연구
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• 제21권2호
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• pp.357-372
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• 2011

본 연구는 개인의 역량 강화와 국가 경쟁력 제고에 이바지하는 창의인재육성 실현이라는 비전을 추진하기 위해, 한국적 토양과 문화를 고려한 창의인재육성의 방향성을 정립하기 위한 기초연구의 일환으로 진행하였다. 이를 위해 인문사회, 예술, 과학 영역 및 산학연 전문가 6인을 대상으로 3차에 걸친 질적 연구를 진행하였다. 그 결과 한국적 창의인재에 대한 정의와 그 요소, 이를 육성하기 위한 교육적 전략을 '융합'과 '통합'의 키워드에서 찾을 수 있었고, 세부적으로는 평생교육측면에서 창의인재육성을 어떻게 해야 할 것인가에 대해서도 연구할 수 있었다.

• 한국지반공학회논문집
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• 제32권12호
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• pp.5-13
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• 2016

본 연구에서는 대변형 해석기법 중 하나인 Coupled Eulerian-Lagrangian 해석기법을 적용하여 TBM 굴진으로 발생하는 굴착손상영역을 분석하였다. 실제 TBM 굴진과정을 모사하기 위해 quasi-static 조건을 고려하여 동적해석을 수행하였으며, 해석시간의 효율성과 정확도를 만족시키는 최적의 조건을 찾기 위해 mesh 및 TBM 굴진속도를 변수로 하여 case study를 수행하였다. 또한 암반 종류 및 터널 직경이 굴착손상영역에 미치는 영향을 확인하기 위해서 매개변수연구를 수행하였다. 수치해석 결과, TBM 굴착으로 인한 굴착손상영역은 대부분의 경우 0.4D 이내로 나타났으며, 터널직경이 커짐에 따라 굴착손상영역도 증가하는 것으로 나타났다.