• Maxillofacial Plastic and Reconstructive Surgery
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• v.34 no.6
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• pp.398-403
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• 2012

Purpose: Mandible resection and discontinuity defect created lead to aesthetic and functional problems. The iliac crest bone graft exhibits relative ease for bone harvesting, possibility of two team approach, ability to close the wound primarily, large amount of corticocancellous bone and relatively few complications. Whereas the use of free vascularized flaps has donor site morbidity and worse-fitting bone contour, the use of nonvascularized iliac bone graft has advantages in the operation time and patients' recovery time. So, nonvascularized iliac bone graft could be an attractive option. Methods: Twenty-one patients (M:F=1:1.1) underwent iliac crest bone harvesting for reconstruction of mandibular discontinuity defect (mean length : $61.6{\pm}17.8$ mm), from May 2005 to October 2011 at the Department of Oral and Maxillofacial Surgery in Kyungpook National University. The average age was $44.1{\pm}16.4$ years and the mean follow up periods was $28.2{\pm}22.7$ months. Bone resorption rate, according to age, sex, primary lesion, location and distance of defect, type of fixation plate, time of graft and pre-operative radiation therapy, were measured in each patient. Results: The mean bone resorption rate was $16.1{\pm}9.0%$. Bone resorption rate was significantly increased in mandibular defect that is over 6 cm in size (P=0.015, P<0.05) and the cases treated pre-operative radiation therapy (P=0.017, P<0.05). All was successfully fixed and maintained for the long-term follow-up. There were a few donor site complications and almost all patients were shown favorable outcome without severe bone resorption in this study. Conclusion: The nonvascularized iliac bone graft seems to be a reasonably reliable treatment option for reconstruction of mandibular discontinuity defects.

• Archives of Plastic Surgery
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• v.35 no.3
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• pp.273-278
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• 2008

Purpose: The most widely accepted protocol for alveolar cleft reconstruction is to repair it during the mixed dentition stage. There were lower resorption rate (about 88%) at this stage. However we found some cases that need repeated bone grafting. Therefore we sought to analyze the cause of repeated alveolar bone grafting in connection with other factors. Methods: From January 2000 to January 2006, thirty-nine secondary alveolar bone grafts with iliac crest spongiosa were carried out. In 39 patients, 5 patients who had significant bone graft resorption received repeated alveolar bone graft. In all the cases, the causes of repeated bone grafts were dental root exposure(angulation), and the deficiency of the bony support for lateral incisor or canine eruption. In 3 cases, there was deficiency of the alveolar bone at the cleft side. There was the need of repeated bone grafts for orthodontic treatment in 2 cases and for application of dental implants in 1 case. Results: During the follow-up period, the clinical and radiologic examinations showed that repeated alveolar bone grafts were maintained successfully without any complications. The volume of the repeated bone graft was sufficient for orthodontic treatment and implantation. Conclusion: The essential conditions for successful alveolar bone grafting includes the status of cleft sided teeth, further treatment and planed schedule, as well as canine eruption. Alveolar bone grafting has to be performed with difference of each case in mind.

• The Journal of the Korean bone and joint tumor society
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• v.3 no.1
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• pp.32-38
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• 1997

PURPOSE : For the reconstruction of large bone defect after tumor resection, it is possible to reuse the bone involved by tumor with some treatment to it. Several bone-reusing methods have been reported such as autoclaving, low-heat treatment(pasteurization) and intraoperative radiotherapy. We have used extracorporeally radiated autogenous bone graft for reconstruction after tumor resection, and analyzed the periods for junctional union, functional results and complications to know the indications of this method. METHODS : From Dec. 1993 to Sept. 1995, nine patients had taken autogenous bone graft with extracorporeal irradiation. Eight cases were osteosarcoma and 1 giant cell tumor. The graft sites were 5 in femur, 3 proximal tibia and 1 femur and tibia. Stage 3 was 1 case(GCT), Stage IIB 3 and Stage IIIB 5. After wide resection, surrounding soft tissue and intramedullary and extramedullary portion of the tumor were removed. Radiation was done in 5000cGy to the resected bone. Ender nails and bone cement were inserted and filled into the medulla to prevent fracture. RESULTS : Average follow-up period was 12.3(4 to 21) months. Average junctional union period in simple X-ray was 6.5 months in 4 cases. Average functional score following Enneking's criteria was 19(12-27). Complications were as follows ; condylar fractures and femur neck fracture in 4 cases, subluxation of the knee joint 3 and infection 1. Although local recurrence was detected in 1 case, the site of recurrence was not in the radiated bone but surrounding soft tissue. At final follow-up, no recurrence was found in one case(GCT), CDF 2, AWD 2, DOD 3, and died of chemotherapy related sepsis 1. CONCLUSIONS : Extracorporeally radiated bone autograft is considered to be a method for reconstruction of the large bone defect made by tumor resection, especially in the reconstruction around the joint.

• Maxillofacial Plastic and Reconstructive Surgery
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• v.31 no.1
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• pp.46-52
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• 2009

The maxillary posterior edentulous region presents unique and challenging conditions in implant dentistry. The height of the posterior maxilla is reduced greatly as a result of dual resorption from the crest of the ridge and pneumatization of the maxillary sinus after the loss of teeth. Materials previously used for sinus floor grafting include autogenous bone, allogeneic bone, xenogenic bone and alloplastic materials. Autogenous bone is the material of choice, but its use is limited by donor-site morbidity, complications, sparse availability, uncontrolled resorption and marked volume loss. One way to overcome this problem would be to use bone substitutes alone as a osteoconductive scaffold for bone regeneration from the residual bone or in combination with allogeneic bone, which also has osteoinductive properties. The purpose of this article is to describe a double layers technique of demineralized and mineralized bone graft materials instead of autogenous bone in sinus floor augmentation of deficient posterior maxillary alveolar process and to report our experience with this technique. Our results show that maxillary sinus augmentation using mineralized and demineralized bone materials, when installed simultaneously with the implant or not, is good results for bone healing.

• Journal of Korean Foot and Ankle Society
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• v.7 no.1
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• pp.13-20
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• 2003

Purpose: We analysis the outcome and complications of treatment of lesser toe brachymetatarsia. Materials and Methods: We analysed 28 patients 35 cases of lesser toe brachymetatarsia. Mean post operative follow up period was 2 years 8 months. All of the patients were female and mean age at operation was 21 years old. 2 cases of third metatasal bone and 33 cases of fourth metatarsal bone were operated. 8 metatarsal bones were treated using one staged lengthening with tricortical bone graft and 27 metatarsal bones were treated using callotasis with monofixator. Results: The average amount of lengthening was 13.3mm(12mm-15mm) in one staged lengthening, while 14.4mm(4mm-23mm) in callotasis. Average percentile increase was 28.9%(26%-34%) in one staged lengthening and 32%(18%-46%) in callotasis. The average healing index of callotasis was 76 days/cm (41 days/cm-166 days/cm). Satisfied outcomes in 4 cases of 8 cases (50%) after one staged lengthening and 17 cases of 27 cases (63%) after callotasis. 6 complications in 4 cases were occurred after one staged lengthening; insufficient length gain in 3 cases, fracture on the junction of graft bone and metatarsal bone in 1 case, plantar bowing deformity in 1 case and bony fusion of metatarsophalangeal joint in 1 case. 17 complications in 10 patients were occurred after callotasis ; metatarsophalangeal joint stiffness in 8 cases, metatarsophalangeal joint subluxation in 2 cases, overlengthened metatarsal bone in 2 cases, tapering of callus in 1 case, fracture of callus in 1 case, premature consolidation of callus in 1 case, osteomyelitis of metataral head in 1 case and plantar bowing deformity in 1 case. Conclusion: Although one staged lengthening and gradual lengthening using callotasis are effective treatment for lesser toe brachymetatarsia, complications not rarely occured after lengthening. Insufficient lengthening are most common complication after one staged lengthening while metatarsophalangeal joint stiffness lire most common complication after callotasis.

• Maxillofacial Plastic and Reconstructive Surgery
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• v.30 no.3
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• pp.249-257
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• 2008

The authors performed the clinical and radiographic evaluation in the 29 patients with sinus bone graft and $Osstem^{(R)}$ implant placement between Sep 2003 and Jan 2006 and got the following results. 1. Fifteen complications developed in the 13 patients. Intraoperative sinus membrane perforation and postoperative maxillary sinusitis developed frequently. 2. The mean preoperative residual alveolar bone height was 4.5 mm, postoperative height 18.5 mm, height 1 year after operation 16.9 mm. 3. Three primary osseointegration failures(3.7%) developed in 3 patients. 4. The survival rate of prosthodontics was 100% at the final follow up. The mean marginal bone resorption around the implants was 0.69 mm 1 year after prosthodontic loading. Marginal bone resorption more than 1.5 mm developed in nine implants and the success rate was 88%.

• Journal of Trauma and Injury
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• v.25 no.4
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• pp.278-282
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• 2012

An esophageal perforation following anterior cervical fusion is rare. Early development of an esophageal perforation after anterior cervical fusion is usually due to iatrogenic injury from retraction, injury associated with the original traumatic incident, improperly placed instruments or a bone graft. A 31-year-old man had a cervical dislocation and spinal cord injury because of severe cervical trauma after a traffic accident. He was quadriplegic and had no feeling below T4 dermatome. Anterior decompression of the cervical spine and anterior fusion with mesh with autobone were performed. An esophagocutaneous fistula occurred 7 days after anterior cervical surgery. A second anterior surgery was done because of pus drainage. The mesh was changed with an iliac bone graft, and the esophagocutaneous fistula site was primary repaired, but pus continued to drain. Conservative treatment, which consisted of wound drainage and intravenous administration of antibiotics, was tried, but was unsuccessful. After all, we removed the plate and screws, but did not removed the iliac bone graft, We closed the esophageal fistula, and transposed the sternocleidomastoid muscle flap to the interspace between the esophagus and the cervical spine. The wound to the esophagus was well repaired. In conclusion, precautionary measures are needed to avoid the complication, and adequate treatment is necessary to resolve those complications when they occur.

• Journal of the Korean Association of Oral and Maxillofacial Surgeons
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• v.36 no.5
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• pp.353-359
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• 2010

Introduction: This study examined the effect of cyclosporine A (CsA) on the allogenic cranial bone graft in the mice. Materials and Methods: Twenty eight 12-week-old male ICR mice weighing 40 g were used. The experimental group was injected subcutaneously with CsA (10 mg/kg/day) diluted in Caster oil for 7 days prior to the graft until sacrifice. The control group was injected with the same solution without CsA. Two full-thickness bone defects with a diameter of 3 mm were made with a trephine bur in the parietal bone lateral to the sagittal suture. A calvarial defect of a mouse was grafted with allogenic calvarial bone disc from another mouse. The experimental and control groups were injected with CsA and the solution without CsA in the same manner before surgery, respectively. The mice were sacrificed at 1 week, 2 weeks and 4 weeks after the bone graft, respectively. Results: In the experimental group, fibrous connective tissues and small amounts of inflammatory cells were observed. At 2 weeks after the allograft in the experimental group, new bone formation in fibrous collagenous tissue and around the allogenic bone was noted. At 4 weeks after the allograft, new bone formation was active along and at the periphery of the mature allogenic bone. The proliferation of blood vessels increased in bone marrow. In the control group, fibrous tissues and inflammatory cells were observed around the allogenic bone and existing bone at 1 week. At 2 weeks after the allograft, the proliferation of blood vessels accompanied by inflammatory cells were scattered in the fibrous connective tissues. New bone formation around the allogenic and existing bone could be observed. At 4 weeks after the allograft, inflammatory cells were severely infiltrated around the allogenic bone. Osteoclasts were scattered along the allogenic bone and induced bone resorption. Conclusion: These results suggest that the daily administration of CsA (10 mg/kg/day) induces efficient immunosuppression without serious complications, and this protocol might be useful for the experimental model of allogenic bone grafts.

• Journal of Korean Neurosurgical Society
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• v.30 no.2
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• pp.201-206
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• 2001

Objective : The purpose of this study was to assess the complications, duration of admission, cost effectiveness, radiologic stabilization of the anterior cervical bone fusion in the treatment of cervical disc disease with and without plating. Materials and Methods : Fifty-two surgically treated patients for cervical disc disease were reviewed. Group I consisted of consecutive treated patients with iliac auto-bone graft without instrumentation after anterior cervical discectomy. Group II consisted of consecutive treated patients with iliac autologous-bone graft with CASPER cervical plate fixations. Radiologic fusion was decided when loss of end plate boundary between graft bone and vertebral body and immobile, maintenance of the disc space were evident on simple dynamic plain films. The patients were discharged after the stabilization of cervical motion by films was of tained. These groups were analysed multiple variably with Mann-Whitney U-test. Results : Group I consisted of 18 patients, group II consisted of 34 patients. Mean age was $49.0{\pm}8.1years$, mean duration of admission was $17.27{\pm}10.51days$, mean costs for treatment was $1,970,000{\pm}475,000won$. In group I, mean age was 47.7(34-60) years, 16 patients had undergo on one-level operation, 2-patients had undergo on two-level operation, mean duration of admission was $28.7{\pm}10.4days$, mean costs for treatment was $2,194,473{\pm}561,639won$. The periods of stabilization was $6.6{\pm}3.36weeks$ on radiologic study. Mean periods of out patient follow up was 16.8(6-64) weeks after discharge. Mean period of radiologic follow up was 17.3(4-6) weeks after surgical operation. In group II, mean age was 49.7(37-62) years and 18 patients one-level operation, 14- patients had undergo on two-level operation and 2-patients three-level operation. Mean duration of admission was $11.24{\pm}3.29days$, mean costs for treatment was $1,850,823{\pm}389,372won$. The periods of stabilization was $5.88{\pm}7.07weeks$ on radiologic study. Mean period of out patients follow up was 16.7(4-60) weeks after discharge. Mean period of radiologic follow up was 12.4(3-52) weeks after surgical operation. The duration of admission showed statistical significance in Group II but other items showed no significant difference between two groups. Conclusions : The more economic, early life return and effective method of cervical disc disease in our series were evident in patients who had undergone, iliac bone graft and plate fixations after anterior discectomy.

• Journal of the Korean Association of Oral and Maxillofacial Surgeons
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• v.32 no.3
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• pp.226-229
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• 2006

The interforaminal region is usually considered as a safe region in the chin bone graft without important vital anatomical structures to be damaged. But the accurate anatomy of the interforaminal region, with its potential clinical relationships, is controversial. Moreover some complications suggesting damage of incisive terminal branches after chin bone harvesting are reported such as sensory discomfort and pain etc. In order to verify incisive innervation of symphyseal area, we examined the cross-sectional CT scan images taken for preoperative planning of implant placement with chin bone graft and some parameters were measured; (1) visuality rating of incisive canal (2) vertical and horizontal diameter of canal (3) distance from lower border of the incisive canal to the lower border of the mandible (4) shortest distance from anterior border of the incisive canal to the anterior border of the mandible. We report the positive outcome that decrease the complications related with the damages of incisive branch during bone harvesting from the chin.