• Journal of Periodontal and Implant Science
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• 제31권2호
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• pp.437-449
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• 2001

The socket preservation procedure was a simple and effective technique, and has better prognosis for implantation. The socket preservation usually used barrier membrane in combination with/without alloplastic bone materials. A recently study had shown that a regenerative therapy to tooth extraction utilizing growth factors made better results. Platelet-rich plasma was clinically easy method that acquired the growth factors, and is known that accelerated new bone formation and mineralization of bone graft materials. The purpose of this study was to evaluate clinical and histopathologic results which occur following socket preservations using platelet-rich plasma and bovine bone powder. Twelve patients who required extraction of one or more teeth for implantation at the department of periodontics in Dankook University Dental Hospital were selected. Extraction sockets were treated by using platelet-rich plasma and bovine bone powder. 3 months later, we observed clinical and histopathological results as follows: 1. Internal vertical measurement was an average of 7.33mm preoperatively and statistically significantly decreased to an average of 1.42mm postoperatively(p<0.05). 2. External vertical measurement was an average of 3.33mm preoperatively and decreased to an average of 2.75mm postoperatively; therefore there was no significant difference. 3. Horizontal measurement was an average of 7.75mm preoperatively and statistically decreased to an average of 6.08mm postoperatively(p<0.05). 4. Osteocyte-like cells and new bone formation connected with bovine bone grafts were observed in histopathologic examination. This study implied that platelet-rich plasma and bovine bone powder grafts were effective treatment for socket preservation and regeneration of severe bony defect made by implantation failure.

• Journal of Korean Neurosurgical Society
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• 제60권1호
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• pp.114-117
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• 2017

A 42-year-old man was admitted to our hospital with complaints of low back pain and intermittent right thigh pain. Twelve weeks before admission, the patient received intradiscal electrothermal therapy (IDET) at a local hospital. The patient still reported low back pain after the procedure that was managed with narcotic analgesics. Follow-up magnetic resonance imaging (MRI) was performed, and his referring physician thought the likely diagnosis was spondylodiscitis at the L4-5 spinal segment with a small epidural abscess. At admission to our department, the patient reported aggravated low back pain. Blood test results, including the erythrocyte sedimentation rate and C-reactive protein levels, were slightly elevated. Biopsy samples of the L4, L5 vertebral bodies and disk were obtained. The material underwent aerobic, anaerobic, fungal, mycobacterial cultures and histologic examination. Results of all cultures were negative. Histologically, necrosis of the bone was evident from the number of empty osteocyte lacunae. In addition, there was no evidence of infection based on biopsy results. No antibiotic treatment was administered on discharge. Repeat computed tomography and MRI performed 12 months after IDET showed a bony defect in the L4 and L5 vertebral bodies, and a decrease in the size of the L4-5 intervertebral disc lesion. We report a case of lumbar vertebral osteonecrosis induced by IDET and discuss etiology and radiologic features.

• Journal of Oral Medicine and Pain
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• 제46권4호
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• pp.161-164
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• 2021

The foramen of Huschke (FH) or foramen tympanicum is a persistent bony defect connecting the external auditory canal (EAC) to the temporomandibular joint (TMJ). It arises from an incomplete ossification of the tympanic part of the temporal bone that persists after the age of 5. If a herniation exists in the TMJ, otological symptoms may occur. An 80-year-old female patient complained of noise in her left TMJ and otorrhea in her left ear. On her cone beam computed tomography images, there were only degenerative joint disease signs on her left mandibular condyle. However, her computed tomography images revealed that the soft tissue of the TMJ herniate into the EAC. Additional examination was planned for the further evaluation. But the patient no longer visited the hospital due to her systemic health status, and symptoms disappeared spontaneously without any treatments. Usually this type of herniation is very rare, but years of mechanical stress from mastication may result in weakening and widening of the foramen with age. Therefore, although FH is usually congenital, sometimes it may be acquired in the elderly. The treatment plan should be determined in consideration of the patient's symptom level and the patient's general health status. If the clinical symptoms are not severe, no treatment is required.

• Archives of Plastic Surgery
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• 제49권2호
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• pp.174-183
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• 2022

Management of traumatic skull base fractures and associated complications pose a unique reconstructive challenge. The goals of skull base reconstruction include structural support for the brain and orbit, separation of the central nervous system from the aerodigestive tract, volume to decrease dead space, and restoration of the three-dimensional appearance of the face and cranium with bone and soft tissues. An open bicoronal approach is the most commonly used technique for craniofacial disassembly of the bifrontal region, with evacuation of intracranial hemorrhage and dural repair performed prior to reconstruction. Depending on the defect size and underlying patient and operative factors, reconstruction may involve bony reconstruction using autografts, allografts, or prosthetics in addition to soft tissue reconstruction using vascularized local or distant tissues. The vast majority of traumatic anterior cranial fossa (ACF) injuries resulting in smaller defects of the cranial base itself can be successfully reconstructed using local pedicled pericranial or galeal flaps. Compared with historical nonvascularized ACF reconstructive options, vascularized reconstruction using pericranial and/or galeal flaps has decreased the rate of cerebrospinal fluid (CSF) leak from 25 to 6.5%. We review the existing literature on this uncommon entity and present our case series of n = 6 patients undergoing traumatic reconstruction of the ACF at an urban Level 1 trauma center from 2016 to 2018. There were no postoperative CSF leaks, mucoceles, episodes of meningitis, or deaths during the study follow-up period. In conclusion, use of pericranial, galeal, and free flaps, as indicated, can provide reliable and durable reconstruction of a wide variety of injuries.

• Archives of Plastic Surgery
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• 제49권6호
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• pp.729-739
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• 2022

Cranioplasties are common procedures in plastic surgery. The use of tissue expansion (TE) in staged cranioplasties is less common. We present two cases of cranioplasties with TE and systematically review literature describing the use of TE in staged cranioplasties and postoperative outcomes. A systematic review was performed by querying multiple databases. Eligible articles include published case series, retrospective reviews, and systematic reviews that described use of TE for staged bony cranioplasty. Data regarding study size, patient demographics, preoperative characteristics, staged procedure characteristics, and postoperative outcomes were collected. Of 755 identified publications, 26 met inclusion criteria. 85 patients underwent a staged cranioplasty with TE. Average defect size was 122 cm², and 30.9% of patients received a previous reconstruction. Average expansion period was 14.2 weeks. The most common soft tissue closures were performed with skin expansion only (75.3%), free/pedicled flap (20.1%), and skin graft (4.7%). The mean postoperative follow-up time was 23.9 months. Overall infection and local complication rates were 3.53 and 9.41%, respectively. The most common complications were cerebrospinal fluid leak (7.1%), hematoma (7.1%), implant exposure (3.5%), and infection (3.5%). Factors associated with higher complication rates include the following: use of alloplastic calvarial implants and defects of congenital etiology (p = 0.023 and 0.035, respectively). This is the first comprehensive review to describe current practices and outcomes in staged cranioplasty with TE. Adequate soft tissue coverage contributes to successful cranioplasties and TE can play a safe and effective role in selected cases.

• Clinics in Shoulder and Elbow
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• 제26권3호
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• pp.287-295
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• 2023

Background: Posterolateral rotatory instability (PLRI) is a common mechanism of recurrent elbow instability. While the essential lesion is a deficiency in the lateral ulnar collateral ligament (LUCL), there are often associated concomitant bony lesions, such as an Osborne-Cotterill lesions (posterior capitellar fractures) and marginal radial head fractures, that compromise stability. Currently, there is no standard treatment for posterior capitellar deficiency associated with recurrent PLRI. Methods: We conducted a retrospective review of five patients with recurrent PLRI of the elbow associated with a posterior capitellar impaction fracture engaging with the radial head during normal range of motion. The patients were treated surgically with LUCL reconstruction or repair and off-label reconstruction of the capitellar joint surface using a small metal prosthesis designed for metatarsal head resurfacing (HemiCAP toe classic). Results: Five patients (three adolescent males, two adult females) were treated between 2007 and 2018. At a median follow-up of 5 years, all patients had complete relief of their symptomatic instability. No patients had pain at rest, but two patients had mild pain (visual analog scale 1-3) during physical activity. Three patients rated their elbow as normal, one as almost normal, and one as greatly improved. On short-term radiographic follow-up there were no signs of implant loosening. None of the patients needed reoperation. Conclusions: Recurrent PLRI of the elbow associated with an engaging posterior capitellar lesion can be treated successfully by LUCL reconstruction and repair and filling of the capitellar defect with a metal prosthesis. This treatment option has excellent clinical results in the short-medium term. Level of evidence: IV.

• Maxillofacial Plastic and Reconstructive Surgery
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• 제28권6호
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• pp.511-519
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• 2006

Autogenous bone grafts have been considered the gold standard for maxillofacial bony defects. However, this procedure could entail a complicated surgical procedure as well as potential donor site morbidity. Possibly the best solution for bone-defect regeneration is a tissue engineering approach, i.e. the use of a combination of a suitable scaffold with osteogenic cells. A major source of osteogenic cells is the bone marrow. Bone marrow-derived mesenchymal stem cells are multipotent and have the ability to differentiate into osteoblastic, chondrocytic, and adipocytic lineage cells. However, the isolation of cells from bone marrow has someproblems when used in clinical setting. Bone marrow aspiration is sometimes potentially more invasive and painful procedure and carries of a risk of morbidity and infection. A minimally invasive, easily accessible alternative would be cells derived from periosteum. The periosteum also contains multipotent cells that have the potential to differentiate into osteoblasts and chondrocytes. In the present study, we evaluated the osteogenic activity and mineralization of cultured human periosteal-derived cells. Periosteal explants were harvested from mandibule during surgical extraction of lower impacted third molar. The periosteal cells were cultured in the osteogenic inductive medium consisting of DMEM supplemented with 10% fetal calf serum, 50g/ml L-ascorbic acid 2-phosphate, 10 nmol dexamethasone and 10 mM -glycerophosphate for 42 days. Periosteal-derived cells showed positive alkaline phosphatase (ALP) staining during 42 days of culture period. The formation of ALP stain showed its maximal manifestation at day 14 of culture period, then decreased in intensity during the culture period. ALP mRNA expression increased up to day 14 with a decrease thereafter. Osteocalcin mRNA expression appeared at day 7 in culture, after that its expression continuously increased in a time-dependent manner up to the entire duration of culture. Von Kossa-positive mineralization nodules were first present at day 14 in culture followed by an increased number of positive nodules during the entire duration of the culture period. In conclusion, our study showed that cultured human periosteal-derived cells differentiated into active osteoblastic cells that were involved in synthesis of bone matrix and the subsequent mineralization of the matrix. As the periosteal-derived cells, easily harvested from intraoral procedure such as surgical extraction of impacted third molar, has the excellent potential of osteogenic capacity, tissue-engineered bone using periosteal-derived cells could be the best choice in reconstruction of maxillofacial bony defects.

• 대한골관절종양학회지
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• 제17권2호
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• pp.73-78
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• 2011

목적: 사지 장골의 거대한 골 낭종이나 소파술 후 남은 골 결손부에 시행한 "내재형 피질 지주골 이식술"의 치료결과를 평가하였다. 대상 및 방법: 사지 장골의 거대한 골 낭종이나 소파술 후 남은 골 결손부에 대하여 내재형 동종 피질 지주골과 동종 망상골 이식술을 시행한 7예를 대상으로 하였다. 6예에서는 추가적인 금속판 내고정술이 시행되었다. 원발병소는 단순 골낭종이 3예, 섬유성 이형성증에서 속발된 동맥류성 골낭종이 2예, 이전에 수술한 골시멘트를 제거한 후 남은 골 결손이 1예, 섬유성 이형성증이 1예였다. 3예에서는 최초 내원시 병적 골절이 동반되어 있었다. 골 융합의 진행, 생역학적 지지기능 및 기능적 결과를 평가하였으며 평균 추시 기간은 25.4개월이었다. 결과: 전예에서 이식된 동종 피질 지주골은 숙주골과 융합되었으며 6예의 골간단부에서는 평균 4.2개월에, 5예의 골간부에서는 평균 5.8개월에 융합되었다. 부가적인 수술 등의 조치없이 7예 중 6예에서 생역학적 지지가 가능하였으며 동종골 이식과 직접 관련된 합병증은 발생하지 않았다. 최종 추시시 기능적 평가상 평균 29.6으로 우수한 결과를 보였다. 결론: 거대한 골 낭종이나 소파술 후 남은 골 결손부에 시행한 내재형 피질 지주골 이식술은 추가적인 생역학적 안정성과 나사못 고정의 골지주판을 제공하여 조기거동과 우수한 기능적 결과를 가능하게 하였다.

• 대한핵의학회지
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• 제30권1호
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• pp.130-138
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• 1996

전기화상후 조직이나 뼈의 상태를 관찰하고 창상변연절제술, 피부판 이식후 경과 관찰 및 절단술여부와 부위를 정하는 데 골스캔이 지표가 되고 골결손이 있는 환자에서 피부판 이식술 시행후 경과가 호전되었는지 여부를 알기 위해 골스캔검사가 유용하다고 알려져 있다. 본 연구에서는 1991년부터 1995년 11월까지 본원에 내원한 전기화상 환자중 골스캔 및 경과관찰이 가능했던 37명을 대상으로 골스캔의 유용성을 조사하였다. 골스캔 시행시기는 대상환자 37명 모두에서 1주일이 내에 골스캔을 시행하였다. 저압전류에 수상한 환자는 8명, 고압전류에 수상한 환자는 29명이었다. 유입부별 분포를 보면 수부가 27례, 두부가 6예, 견관절부위가 2예, 좌흉벽부위가 1예, 수혜부위가 1예로 나타났다. 사출부별 분포는 저압전류 8명에서는 사출부위를 찾을 수 없었고 고압전류 29명중 족부가 22예, 수부가 3예, 견관절부위가 2예, 좌측 흉부가 1예, 둔부부위가 1예 순으로 나타났다. 유입부의 골스캔 소견은 저압전류에 손상받은 환자8명 모두 봉와직염 소견을 보였고 고압전류에 손상받은 환자 29명줌 15명은 골수염, 10명은 봉와직염, 4명은 골결손 소견으로 나타났다. 사출부의 골스캔 소견은 저압전류 손상 8명을 제외한 고압전류 손상 환자29명 모두 봉와직염 소견을 보였다. 피부이식이나 피부판 이식술 시행후 추적관찰이 가능했던 4명의 환자모두 피부이식이나 피부판 이식술 시행후, 골결손 부위가 좋아지는 것을 관찰할 수 있었다. 심근에 섭취가 증가된 경우가 2예, 간에 섭취가 증가된 경우가 1예, 신장에 섭취가 증가된 경우가 6예였는데, 혈청 칼슘농도, 심전도, 심근 효소, 간기능 검사 및 신기능 검사상에서는 이상이 없는 것으로 나타났다. 결론적으로 골스캔은 전기화상후 손상부위를 평가하는데 도움이 되고 봉와직염과 골수염의 감별진단, 피부이식이나 피부판 이식술후 평가에 도움이 된다. 그러나 인체 내부 장기의 손상평가는 앞으로 많은 연구가 필요할 것으로 생각된다.

• Maxillofacial Plastic and Reconstructive Surgery
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• 제30권3호
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• pp.241-248
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• 2008

Tibial bone grafts provide an adequate volume of cancellous bone with cortical bone, high biologic value of bone, minimal gait disturbance and complications, and no special contraindications, and offer a superior clinical results than any other donor sites. Lateral appoach in tibial bone graft was used to gain large bone volume traditionally, but medial approach provides low morbidity associated with the tibial anatomic structure, simple and safety surgical procedure, and better comfortable to patients recently. We have undertaken clinical and retrospective studies on patients in Dept. of Oral and Maxillofacial Surgery, Inha University Hospital from April 2004 to January 2008. 50 patients have maxillofacial bony defect as resection of bening tumor, cyst enucleation, alveolar bone resorption, sinus pneumatization were received the tibial proximal autogenous particulated cancellous bone grafts. They were analyzed sex, age, diagnosis of recipient site, lesion size, dornor site, cortical bone repositioning, complications and we concluded favorable following results. 1. Medial approach for proximal tibia is safer and technically easier than lateral approach, associated with the proximal tibial anatomic structures, and short operative times. 2. Proximal tibia provides an adequate bone volume with predictability for oral and maxillofacial reconstruction. 3. Patients rarely complain of pain, swelling, discomfort and dysfunction such as gait disturbance. In conclusion, medial approach for proximal tibial graft seems to be a valuable tool for oral and maxillofacial reconstruction.