• Maxillofacial Plastic and Reconstructive Surgery
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• 제21권1호
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• pp.54-59
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• 1999

1992년 1월 1일부터 1996년 12월 31일까지 본과에 입원하여 치료받은 환자중 추적이 가능한 관골 골절 환자 164명을 대상으로 후향적, 임상통계학적으로 비교 분석하여 다음과 같은 결과를 얻었다. 관골 골절 환자의 연령 분포의 범위는 8세부터 78세까지로 평균연령은 35.6세였고, 성별 분포는 7:1로 남성에서 호발하였다. 월별로는 10월(14.0%)과 8월(11.6%)에 많았고 계절별로는 가을(31.1%), 여름(25.6%), 겨울(23.2%), 봄(20.1%)의 순이었다. 발생시각별 분포는 21~24시 (34.2%)와 1~4시 (21.3%)에 많았고, 원인별로는 교통사고(53.7%)가 가장 많은 분포를 보였다. 관골 골절의 분류에 따른 분포는 class IV(33.5%)와 class III(25.6%)가 많았고, 동반된 안면부 골절은 164명중 114명(69.5%)에서 147례가 발생하였으며, 그중 상악골 골절이 52.4%로 가장 많았다. 내원 방법은 응급실을 통해 내원한 경우가 72.3%, 외래를 통해 내원한 경우가 26.8%였으며, 타과와의 연관 손상이 있는 경우는 37.2%였다. 수상후 수술을 받을때까지 경과된 시간은 5 일 이내가 36.6%로 가장 많았으며, 접근방법으로는 구내절개법(57.1%)과 눈썹절개법(38.4%)이 많이 사용되었다. 술후 합병증으로는 안구 함몰증(7.3%), 안모 비대칭 (6.7%), 감각저하(6.1%), 복시 (2.4%) 등이 발생하였다. 이상의 결과에서 관골 골절시에는 골절의 정도와 동반 골절 및 연관 손상에 대한 정확한 진단과 치료가 필요하고 타과와의 유기적인 협조하에 적절한 처치를 해줌으로써 술후 합병증을 줄일 수 있으리라 사료된다.

• Maxillofacial Plastic and Reconstructive Surgery
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• 제16권3호
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• pp.281-289
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• 1994

This is a clinical study on 235 inpatients who sustained a total of 350 mandibular fractures and who were treated in our department during the period of Oug., 1989 through Dec., 1993. The results obtained are as follows : 1. The mumber of patients has not been increased year after year. In respect of incidence, there were the highest frequency as 67 patients(28.5%) in 1991 and the least frequency as 16 patients(6.8%) in 1989 and the highest frequency as 28 patients(11.9%) in October and the least frequncy as 12 patients(5.2%) in February. 2. The age frequency was the highest in the second decade(30.6%). The youngest patient was 8 months and the eldest patient was 80 years and mean age was 27.8 years. The ratio of men to Wemen was 4 : 1. 3. The most frequent cause was fall down as 86 patients(36.6%) and the next was fist blow 4 as 75 patients(31.9%), traffic accident as 56 patients(23.9%) in order. 4. The most common location was symphysis as 141 numbers(40.3%) and the next was condyle as 96 numbers(27.4%), angle as 94 numbers(26.8%), body as 14 numbers(4.0%) in order. The sum of fracture sites were 350 and there were 1.49 fracture sites per one patient and multiple fractures occured in 100 patients(40.5%) of the 235 patients. The ratio of Left to Right except for symphysis was 1.71 : 1. 5. Among the 333 associated injuries, facial laceration was 136(57.9%) and tooth injury was 58(24.7%) and extremity was 31(13.2%). 6. Among the 350 mandibular fractures, complications after treatment occured in 51(14.6%) and infection as 20(5.7%) was the most frequent complication. 7. In respect of treatment of mandibular fracture, close reduction was 64 patients(27.2%) and open reduction was 164 patients(69.8%) and other were 7 patients(3.0%) of all and so open reduction was the most common in type of treatment.

• Archives of Plastic Surgery
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• 제35권5호
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• pp.589-596
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• 2008

Purpose: The nasal bone fracture is most common fracture in facial bone injuries. Regardless of the severity or type of fracture, closed reduction has traditionally been the common method of treatment. However, through detailed pre-operative evaluation, we found out that many patients consider rhinoplasty prior to trauma due to aesthetic desire or nasal deformity with or without septal deviation. In treatment of nasal bone fracture, we focused not only on the fracture management but also on the patients' desire prior to trauma, and we made additional operation according to patients' desire with fracture reduction and gained rewarding outcomes. Methods: From March 2005 to June 2007, total 263 patients were treated for nasal bone fracture. Among these patients, 57 patients (21%) had the additional operation with nasal fracture reduction. The additional operations were categorized in three types: augmentation rhinoplasty with tip plasty (40%), septoplasty only (16%), corrective rhinoplasty (44%). The mean follow-up period was 5.6 months and results were evaluated by scoring. Results: Forty four of 57 patients (77%) were highly satisfied regardless of any additional operation kinds. The complications were one septal perforation, two displacement of implant and four remnant nasal deformities. For the septal perforation, no further management was performed because we lost the contact with the patient. Then 4 of the other complicated patients were revised. Conclusion: In general, many physicians tend to consider nasal fracture as a simple trauma. However through the strict history taking, physical examination and professional counseling, we could catch the patient's cosmetic desire and get the eyes on new concept: the nasal fracture is not only a trauma but a cosmetic and functional field. In the treatment of nasal bone fracture, if additional rhinoplasty is performed, patients will be more satisfied and we also can expect higher profits.

• Maxillofacial Plastic and Reconstructive Surgery
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• 제19권4호
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• pp.367-376
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• 1997

저자등은 1992년 1월 1일부터 1996년 12월 31일까지 최근 5년간 전남대학교병원 구강악안면외과에 입원하여 치료받은 환자중 추적이 가능한 중안면골 골절 환자 234례에 대해 임상통계학적 비교 분석하여 다음과 같은 결과를 얻었다. 남녀비는 5.3 : 1로 남자에서 호발하였고, 연령별로는 20대, 30대, 10대순으로, 월별로는 8월, 5월, 9월과 10월 순으로 발생하였다. 발생원인은 자동차사고, 추락사고, 오토바이 사고의 순이었고, 골절부위로는 관골-상악골 복합골절이 86례로 가장 많았다. 연관 손상으로는 안면열상이 가장 많았으며 신경외과적 손상, 하악골 골절순이었다. 수상후 수술시 까지 경과시간은 1주일이내가 55%였다. 사용된 금속판수는 관골 또는 상악골 단독골절시에는 2개, 관골-상악골 복합 골절시에는 3개, Le Fort I, Le Fort I, II ; II, III ; I, III ; Le Fort I,II,III 골절시에는 각각 4개, 5.5개, 7개였다. 술후 합병증으로는 감염 7례, 안면비대칭 6례, 안구함몰증 5례, 부정교합 2례로 모두 20례(8%)가 발생하였다. 이상의 결과는 중안면골 골절시에 골절 부위와 환자의 전신상태 및 연관 손상에 대한 신속한 진단과 치료가 필요하고 타과와의 협동 치료가 이루어져야 함을 시사하였다.

• 대한두개안면성형외과학회지
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• 제17권3호
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• pp.128-134
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• 2016

Background: Blowout fracture is one of the most common facial fractures, and patients usually present with accompanying ocular complications. Many studies have looked into the frequency of persistent ocular symptoms, but there is no study on assault patients and related ocular symptoms. We evaluated the incidence of residual ocular symptoms in blowout fractures between assaulted and non-assaulted patients, and sought to identify any connection among the degree of enophthalmos, defect size, and assault-related injury. Methods: A retrospective review was performed for any patient who sustained a unilateral blowout fracture between January 2010 to December 2014. The collected data included information such as age, gender, etiology, and clinical ocular symptoms as examined by an ophthalmologist. This data was analyzed between patients who were injured through physical altercation and patients who were injured through other means. Results: The review identified a total of 182 patients. Out of these, 74 patients (40.7%) have been struck by a fist, whereas 108 patients (59.3%) have sustained non-assault related injuries. The average age was 36.1 years, and there was a male predominance in both groups (70 patients [94.6%] in the assaulted group and 87 patients [80.6%] in the non-assault group). Diplopia and enophthalmos were more frequent in patients with assault history than in non-assaulted patients (p<0.05). Preoperatively, 25 patients (33.8%) with assault history showed diplopia, whereas 20 patients (18.5%) showed diplopia in the non-assaulted group (p<0.05). Preoperative enophthalmos was present in 34 patients (45.9%) with assault history, whereas 31 patients (28.7%) showed enophthalmos in the non-assaulted group (p<0.05). Conclusion: Patients with an assault history due to a fist blow experienced preoperative symptoms more frequently than did patients with non-assault-related trauma history. Preoperative diplopia and enophthalmos occurred at a higher rate for patients who were assaulted. Surgeons should take into account such characteristics in the management of assaulted patients.

• 대한치과보철학회지
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• 제35권2호
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• pp.330-343
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• 1997

Extraoral maxillofacial prostheses are essential for restoring facial structures that are lost as a result of congenital missing, injuries from accidents, surgical treatments of head and neck cancer. Recently, silicone is the most useful material for this purpose and is more advantageous than other maxillofacial prosthetic materials. However, there are some problems for long-term usage of silicone prostheses due to tear and color change. These are major contributing environmental factors to those problems that are such as ultraviolet light, cleansing agents, changes in humidity and successive adhesion and removal. The aim of this study is to evaluate the physical properties and color changes of maxillofacial prosthetic silicone material by those environmental factors using A-2186 silicone material (Factor II, USA) and two pigments, cadmium yellow medium and cosmetic red. Aluminium molds were fabricated according to the ASTM No. D412 & D624 specifications and resulted specimens from molds were fabicated and treated as follows. Control group and experimental I group were fabricated with 0.1% wt. pigment mixing in silicone elastomer and II-1 group, II-2 group of experimental II group were fabricated with 0.2%, 0.3% wt. pigment mixing in silicone elastomer, respectively. Control group was kept in darkroom at room temperature, I-1 group was kept under natural sunlight during 1week, I-2 group was soaked in 20% soap water during 1wk. I-3 group was successively adhered and removed 200 times on inner region of arm using Daro adhesive-33. Experimental II groups were kept in darkroom at room temperature. Instron universal testing machine was used to measure the % elongation, tensile strength, tear strength of control, experimental I, II groups and reflectance spectrophotometer(COLOR EYE-3000, Macbeth, USA) was used to measure the color differences between control group and experimental I group. The results were as follows : 1. When compared with control group, natural weathering group and 20% soap-water soaking group had no significant differences in % elongation(p>0.05). 2. 200 times successive adhesion and removal group, 0.2% wt. pigment group and 0.3% wt. pigment group had significant decreases in % elongation(p<0.05). 3. Natural weathering group, 20% soap-water soaking group and 200 times successive adhesion and removal group had no significant differences in tensile strength (p>0.05). 4. 0.2%, 0.3% wt. pigment groups had significant decreases in tensile strength(p<0.05). 5. Values of all experimental groups were decreased in tear strength. and 200 times successive adhesion and removal group had significant decrease in tear strength(p<0.05). 6. Natural weathering group and 20% soap-water soaking group had significant color differences(${\Delta}E$) and it could be detectable to naked eye(p<0.05). 7. Color differences between control group and 200 times adhesion and removal group were not detectable to the naked eye (${\Delta}E<1.0$).

• Journal of Oral Medicine and Pain
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• 제34권3호
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• pp.333-340
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• 2009

골수염은 골수의 염증을 의미하며 임상적으로는 골을 구성하고 있는 조직등의 염증을 포함한다. 일반적으로 골수에서 시작되어 수질내로 확장되며 피질골, 골막등에 이환되어 골 전반에 걸친 골괴사를 야기시킨다. 원인은 일반적으로 세균에 의한 감염으로 여겨지며 항생제의 발달로 그 유병율이 감소하였으나 여전히 외상, 매독, 만성 신질환, 알코올 중독, 영양결핍, 방사선 조사나 화학적 항암요법은 골의 감염을 위험하는 인자로 알려져 있다. 골수염의 치료는 비교적 까다로우며 난치성으로 진행될 가능성이 있다. 특히 소아에서는 하악구조가 성숙이 덜되어 있어 염증이 쉽고 빠르게 퍼진다. 따라서 소아에서는 골수염을 조기에 발견하고 치료하는 것이 중요하다. 또한 소아는 성장중이므로 악골의 성장 또한 고려해야 하므로 조기발견이 더욱 중요하다고 볼 수 있다. 특히 하악골중에서 하악과두는 하악골 성장의 중요한 곳으로 하악과두의 질환발생시 하악성장율감소, 안면비대칭과 같은 큰 문제를 야기할 수 있어 주의가 요구된다. 하악과두의 골수염은 대부분 치성감염이나 하악골절후의 감염으로 발생한다. 단, 소아의 경우에는 특별한 감염원인 없이 하악의 골수염이 발생했다는 보고도 있다. 이에 저자는 9세의 소아에서 뚜렷한 원인을 찾기 어려운 하악과두의 골수염을 경험하였기에 증례보고와 함께 문헌고찰을 하고자 한다.

• Maxillofacial Plastic and Reconstructive Surgery
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• 제13권1호
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• pp.117-127
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• 1991

현대 사회에서 외상의 특성은 다발성 손상이 빈발하는 것이며 상악골절시 생명을 위협하는 다발성 전신손상이 동반되면 수술이 지연되어 골절부의 지연된 부정유합을 보일 수 있다. 또한 골절된 양상에 따라서는 관혈적 정복술의 적용여부가 고려되는데 특히 골절편의 분쇄가 심하면 수술시 골절부위의 이개 후 정상위치로의 이동이 어렵고 설사 골절편의 이동이 이루어졌다고 하여도 정상위치로의 고정이 용이하지 않을 뿐만 아니라 분쇄골절편의 상실량이 많아지면 골이식까지 시행해야 하는 등 외과적이술식의 적용에 많은 난관이 예상된다. 따라서 상악골절 후 통상 6주일 간의 시간경과가 없다면 오히려 상악골절편의 이동방향을 예측하여, 전방견인용 headgear 또는 headcap 을 사용한 교정적인 치료를 시도함이 바람직할 수도 있다. 더우기 reverse headgear를 이용한 치료법은 골절된 경우가 아니더라도 상악골의 전방이동에 유용함이 실험적으로나 임상적으로 입증된 만큼 이를 상악골절후 후퇴된 상악골의 전방견인에 적용할 경우 교정치료의 최대장애인 cortical bone의 연속성이 골절로 인해 끊어지고 섬유성 유착상태로 남게되어 교정력의 효과가 치아이동 뿐만 아니라 골편의 이동에 매우 유익하리라 사료된다. 이에 저자는 상악골적이 분쇄양상인 한 환자에서 headgear와 headcap을 이용한 교정치료법을 5개월간 적용해 양호한 결과를 얻었고, 골절양상이 분쇄형이 아닌 증례에서는 외상후 5주간 경과 되었지만 관혈적 정복술을 시행하여 정상교합을 회복했으며, 심한 두부 손상으로 6개월만에 의식 회복을 한 LeFort I, II, III, 환자에서는 두부방사선 계측학적 분석, 교합기 상에서의 모형분석, 전산화 단층촬영 검사 등을 시행한 후 새로운 골면에다 LeFort I -osteotomy with iliac bone graft를 시행해 정상교합 및 안모추형을 개선시켰기에 이를 보고한다.