• Clinics in Shoulder and Elbow
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• 제22권1호
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• pp.37-39
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• 2019

Irreducible dislocation of the elbow is an uncommon event. We present the case of a posterolateral elbow dislocation after a fall injury in a 67-year-old woman. A closed reduction performed in the emergency department was unsuccessful since the limited passive range of motion resulted in difficulty to perform longitudinal traction and flexion. Computed tomography images showed that the posterolateral aspect of the capitellum was impacted by the tip of the coronoid process, thus appearing similar to the Hill-Sachs lesion in the humeral head. Subsequent open reduction of the elbow revealed the dislocation to be irreducible since the tip of the coronoid process had wedged into a triangular Hill-Sachs-like lesion in the capitellum. The joint was reduced by providing distal traction on the forearm, and main fragments were disengaged using digital pressure. At the 3-month follow-up, the patient reported no dislocations, and had an acceptable range of motion. Thus, we propose that to avoid iatrogenic injury to the joint or other nearby structures, irreducible dislocations should not be subjected to repeated manipulation.

• Journal of the Korean Association of Oral and Maxillofacial Surgeons
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• 제48권3호
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• pp.133-148
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• 2022

Treatment of mandibular coronoid process hyperplasia (MCPH) has been described and explored in the literature. This systematic review aims to provide a comprehensive overview of the surgical and non-surgical treatment options for MCPH in pediatric and adult populations. Three databases were searched for treatment of MCPH patients (MEDLINE, Embase, and Web of Science). Two reviewers selected case reports and case series based on titles and abstracts. Finally, 55 studies reporting a total of 127 cases were included for qualitative synthesis and data extraction. The mean age at symptom onset was 15.6 years, while the mean age at diagnosis was 23.5 years. Of the included cases, 83.7% were male, and the condition was bilateral in more than 81% of the cases. Coronoidectomy was performed in 82.7% of the included cases, while coronoidotomy was performed in 3.9% of the cases. In 85.0% of the surgically treated cases, the approach was intraoral. The mean maximal intraoperative mouth opening was 38.1 mm compared with 16.5 mm at diagnosis. The mean maximal postoperative mouth opening was 35.3 mm, and the mean follow-up period was 16.3 months. Maximum mouth opening was achieved intraoperatively, and non-surgical treatment after surgery aims to reduce the risk of relapse. Additional research with a higher level of evidence is necessary to confirm these findings.

• Clinics in Shoulder and Elbow
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• 제12권2호
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• pp.159-166
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• 2009

목적: 압박 긴장대 방법을 이용한 작은 구상 돌기 골절의 견고한 고정과 주관절의 조기 운동을 통한 기능의 향상 및 그 결과를 분석하고자 한다. 재료 및 방법: 주관절 내측접근법으로 K-강선과 철선을 이용하여 고정된 8예의 구상돌기 골절을 대상으로 하였다. 분류상 8예 모두 Regan-Morrey type 2였으며 O'Driscoll 분류12)로는 tip형(subtype 2)가 예, anteromedial 형 (subtype 2, 1예 그리고 subtype 3, 2예)3예였다. 동반 손상으로는 측부인대 파열이 6예, 요골두 및 경부골절이 4예였으며 모두 함께 치료하였다. 술 후 5~7일간의 고정 치료 후 경첩 보조기 (hinge brace)을 착용한 상태에서 술후 6주까지 능동적 운동을 허용하였다. 술 후 통증의 여부, 관절 운동 범위, Mayo elbow performance score(MEPS)을 이용한 기능적 평가 방법을 이용하여 치료 결과를 분석하였다. 평균 11 (6~28)개월 추시 하였으며 척골 신경 증상에 대해서도 함께 조사하였다. 결과: 모든 구상돌기 골절은 내고정용 도구의 실패 없이 모두 유합되었다. 평균 2.2 (2~4)개의 K-강선이 사용되었다. 관절운동 범위에 대해 신전은 평균 $3^{\circ}(0^{\circ}\sim25^{\circ})$, 굴곡는 평균 $137^{\circ}(130^{\circ}\sim140^{\circ})$, 회내전은 평균 $69^{\circ}(45^{\circ}\sim90^{\circ})$, 회외전은 $78^{\circ}(45^{\circ}\sim90^{\circ})$이였다. MEPS는 평균 96 (65~100) 이였다. 척골 신경 증상은 terrible triad 1예에서 첫 수술 (index operation)후 요골두를 절제하고 내측 측부 인대의 기능 부전이 있는 1예에서 관찰되었다. 결론: 쉽게 구할 수 있으며 가격이 저렴한 K-강선과 철선을 이용한 압박 긴장대 방법은 충분히 견고하여 조기에 능동적 운동을 허용할 수 있어 주관절의 기능 향상을 가져올 수 있었다. 이 방법은 특히 다발성 소형 구상 돌기 골절의 경우 유용한 하나의 고정 방법으로 생각된다.

• 대한치과교정학회지
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• 제14권1호
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• pp.75-92
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• 1984

This study attempted to analyze the distribution of stress, to examine the bending effect in the mandible according to the pulling directions and determine on which pulling directions are adequate when an orthopedic force was applied to the mandible. An orthopedic force, 500gm, was applied to the gnathion, one point of the chin area, in three directions. The three directions were ; high puli' from gnathion to the center of condyle head, and vertical pull, from gnathion to a parallel line with the posterior border of the ramus, and medium pull, from the gnathion to a parallel line with the lower border of mandible. The distribution of principal stress, bending moment and amount of displacement within the mandible was analyzed by a 3-dimensional finite element method and that of the various portions of mandible were computed and compared according to the pulling directions. The results were as follows : 1. The bending moment of each part of a mandible has been found to be markedly larger in case of vertical pull than in case of either high pull or medium pull. In vertical pull the bending moment turned out to largest at the condyle head and neck portion, the gonial angle portion, the coronoid portion and the ascending ramus portion, respectively, while comparatively large at the cuspid and bicuspid portion and the first molar portion. In case of high pull it was largest at the gonial angle portion and becoming smaller at the coronoid portion, the ascending ramus portion, the condyle head and neck portion, and the cuspid and bicuspid portion, in that order. In case of medium pull, however, the bending moment was largest at the condyle head and neck portion, becoming smaller at the first molar portion, the ascending ramus portion, the coronoid portion, the cuspid and bicuspid portion, and gonial angle portion, in that order. 2. As for the bending effect it was calculated to be mostly oriented downward at the mandibular body and backward at the mandibular ramus in both high pull and vertical pull. In case of medium pull it was oriented upward at the mandibular body and forward at the mandibular ramus. 3. The bending effect also turned out to be mostly oriented outward in case of high pull and medium pull, and inward in vertical pull. 4. At the mandibular body and ramus, the bending effect in the upward-downward direction and that in the forward-backward direction were found to be larger than in the inward-outward direction. 5. If and when we expect any correcting effect on the mandibular protrusion by means of the chin cup appliance, we can say sure as conclusion that high pull and vertical pull are more effective than medium pull.

• 대한소아치과학회지
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• 제36권3호
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• pp.433-439
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• 2009

성장 시기가 다른 쥐의 편측 교근에 보툴리눔 A형 독소를 주사하여 하악골 성장에 미치는 영향을 알아보고자 하였다. 각기 다른 주령의 쥐(N=36, 1군: 4주령, 2군: 5주령, 3군: 6주령)를 대상으로 실험을 시행하였으며 각 군은 다시 대조군, 편측주사군, 양측주사군으로 나누어 하악골의 길이를 계측하고 다음과 같은 결과를 얻었다. 1. 1군에서 편측주사군의 주사측과 양측주사군 모두 하악체 길이, 과두 높이가 대조군 보다 낮은 값을 보였다(p<0.05). 2. 2군에서 편측주사군의 주사측과 양측주사군 모두 하악 전방부 높이와 과두높이에서 대조군 보다 낮은 값을 보였다(p<0.05). 3. 3군에서 편측주사군의 주사측과 양측주사군 모두 하악체 길이와 과두 높이, 과두돌기 높이가 대조군 보다 낮은 값을 보였다(p<0.05). 4. 세 군 모두 편측주사군의 양측 비교시 통계적으로 유의한 차이는 없었으나 주사측은 대조측 보다 낮은 계측값을 보이는 경향이 관찰되었다(p>0.05).

• Journal of the Korean Association of Oral and Maxillofacial Surgeons
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• 제35권4호
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• pp.229-239
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• 2009

The purpose of this study is to evaluate the change in condylar position, width, and angle before and after orthognathic surgery using 3-dimensional computed tomograph. Pre and posterative 3-D CT was taken on 38 patients and through axial, frontal, sagittal measurements and by 3-dimensional reconstruction, the changes in condylar postion, mandibular width and angle were analyzed and others such as the difference in gender, operation and fixation method, setback length and in relation with temporomandibular disorders were done together too. The results were as follows: The inward rotation of condyle in axial condylar angle, the forward movement of right condyle in sagittal anterior-posterior distance, the superior movement of both condyles in sagittal superior-inferior distance, the decrease in gonial angle, the increase in mandibular width, the decrease in distance between the axial coronoid process distance and the increase in the frontal intercondylar distance were statistically significant. There were no statistically significant changes in gender difference, however in the difference in operation method, change in the gonial angle was observed and there was more change in bilateral sagittal split osteotomy group compared to two-jaw surgery group. In the difference in fixation method, the decrease in axial coronoid process distance and the change in sagittal anterior-posterior distance were statistically significant. In the difference in setback, the increase in setback didn't relate directly with the increased change in condyle position. In the relation with temporomandibular disorder, changes in left axial condylar angle and axial coronoid process distance were statistically significant. Changes in condylar position could be observed after the orthognathic surgery but it doesn't seem to have much of a clinical importance. The orthognathic surgery is effective in decreasing the mandibular angle, and it is not related with the temporomandibular disorder.

• Journal of Korean Dental Science
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• 제3권2호
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• pp.50-59
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• 2010

Implant placement is frequently complicated and challenging because of the poor quality and inadequate height of bone. Clinicians should consider various surgical procedures to overcome the problems. We report a case with various surgical procedures used such as inferior alveolar nerve repositioning, sinus bone graft, and autogenous block bone graft using the coronoid process and ramus to overcome severe vertical and horizontal alveolar bone atrophy.

• 구강회복응용과학지
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• 제23권2호
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• pp.171-178
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• 2007

Botulinum toxin type A (BTX-A) has a local effect at the neuromuscular junction by blocking acetylcholine release and thus causing paralysis and atrophy of the affected muscles. In dentistry, Botulinum toxin type A(BTX-A) is used for the treatment of masseteric hypertrophy, temporomandibular disorder, and severe bruxism related neurologic disorder. We hypothesized that the muscle atrophy after BTX-A injection into masseter muscle in growing rats, could affect the jaw growth. The purpose of this study was to determine the effects of the BTX-A injected into the masseter muscle on the jaw growth in rats. Rats were divided into four groups(group 1; control group, group 2; saline injection group, group 3; BTX-A injection group, group 4; baseline control group). Group 4 was sacrificed at the beginning of the experiment to provide baseline values of jaw measurements. The weight, length and width of jaw in those groups were measured every weeks. This study reported that the mandibular body length, condylar length, coronoid process length, anterior region height, coronoid process height and condylar height of the jaw in BTX-A injection group were shorter than those of the control and saline injection groups(P<0.05). In conclusion, BTX-A injected into the masseter muscle may affect the undergrowth of the jaw in rats.

• Archives of Plastic Surgery
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• 제40권4호
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• pp.348-352
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• 2013

Background Temporalis muscle transfer produces prompt surgical results with a one-stage operation in facial palsy patients. The orthodromic method is surgically simple, and the vector of muscle action is similar to the temporalis muscle action direction. This article describes transferring temporalis muscle insertion to reconstruct incomplete facial nerve palsy patients. Methods Between August 2009 and November 2011, 6 unilateral incomplete facial nerve palsy patients underwent surgery for orthodromic temporalis muscle transfer. A preauricular incision was performed to expose the mandibular coronoid process. Using a saw, the coronoid process was transected. Three strips of the fascia lata were anchored to the muscle of the nasolabial fold through subcutaneous tunneling. The tension of the strips was adjusted by observing the shape of the nasolabial fold. When optimal tension was achieved, the temporalis muscle was sutured to the strips. The surgical results were assessed by comparing pre- and postoperative photographs. Three independent observers evaluated the photographs. Results The symmetry of the mouth corner was improved in the resting state, and movement of the oral commissure was enhanced in facial animation after surgery. Conclusions The orthodromic transfer of temporalis muscle technique can produce prompt results by applying the natural temporalis muscle vector. This technique preserves residual facial nerve function in incomplete facial nerve palsy patients and produces satisfying cosmetic outcomes without malar muscle bulging, which often occurs in the turn-over technique.

• 대한치과교정학회지
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• 제41권6호
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• pp.431-439
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• 2011

Objective: To determine whether there is any difference between the cleft and non-cleft sides of the mandible in unilateral cleft lip and palate (UCLP) patients, or the right and left sides in control patients; and to determine if there is any difference between the mandibular asymmetry of UCLP patients and that of control patients. Methods: We examined cone-beam computed tomography (CBCT) scans of 15 patients with UCLP and 15 age- and gender-matched control patients. We evaluated 8 linear, 3 surface, and 3 volumetric measurements and compared the cleft/non-cleft sides of UCLP patients and the right/left sides of controls. Results: There were no statistically significant gender differences in any linear, surface, or volumetric measurement. The single significant side-to-side difference in UCLP patients was a longer coronoid unit on the cleft side than on the non-cleft side ($p$ = 0.046). Body volume was significantly lower in the UCLP group than in the control group ($p$ = 0.008). Conclusions: In general, UCLP patients have symmetrical mandibles, although the coronoid unit length is significantly longer on the cleft side than on the non-cleft side. UCLP patients and controls differed only in body volume.