• Anatomy and Cell Biology
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• 제56권3호
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• pp.350-359
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• 2023

The suboccipital triangle (ST) is a clinically relevant landmark in the posterior aspect of the neck and is used to locate and mobilize the horizontal segment of the third part of the vertebral artery before it enters the cranium. Unfortunately, this space is not always a viable option for vertebral artery exposition, and consequently a novel triangle, the inferior suboccipital triangle (IST) has been defined. This alternative triangle will allow surgeons to locate the artery more proximally, where its course is more predictable. The purpose of this study was to better define the anatomy of both triangles by measuring their borders and calculating their areas. Ethical clearance was obtained from the University of Pretoria (reference number: 222/2021) and both triangles were subsequently dissected out on both the left and right sides of 33 formalin-fixed human adult cadavers. The borders of each triangle were measured using a digital calliper and the areas were calculated using Herons Formula. The average area of the ST is 969.82±153.15 mm², while the average area of the IST is 307.48±41.31 mm². No statistically significant differences in the findings were observed between the sides of the body, ancestry, or sex of the cadavers. Measurement and analysis of these triangles provided important anatomical information and speak to their clinical relevance as surgical landmarks with which to locate the vertebral artery. Of particular importance here is the IST, which allows for mobilisation of this artery more proximally, should the ST be occluded.

• Clinics in Shoulder and Elbow
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• 제26권3호
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• pp.302-305
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• 2023

The authors present a case of transient postoperative inferior subluxation of the shoulder after arthroscopic surgical stabilization for recurrent anterior dislocation. The patient was a 61-year-old woman with myasthenia gravis (MG). The first anterior shoulder dislocation occurred because of a fall to the ground. Despite a successful closed reduction, two more dislocations occurred in 3 weeks. Magnetic resonance imaging revealed an anterior labroligamentous periosteal sleeve avulsion (ALPSA) lesion, an engaging Hill-Sachs lesion, and large tears of the supraspinatus and infraspinatus tendons. The patient underwent arthroscopic rotator cuff repair and ALPSA repair with a remplissage procedure. Intraoperatively, no tendency for instability was found; however, a widened glenohumeral joint space and inferior subluxation of the humeral head without functional compromise was observed on the day after surgery and disappeared spontaneously on radiographs 2 weeks later. To the authors' knowledge, this is the first report documenting the occurrence of transient postoperative inferior subluxation of the shoulder in a patient with MG.

• 대한두개안면성형외과학회지
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• 제10권2호
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• pp.86-90
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• 2009

Purpose: Inferior blow-out fracture is the common facial fracture. Unsatisfactory functional and aesthetic outcomes are frequent when it is treated inappropriately. If fractures are extended and reach the posterior end of orbital floor, enophthalmos frequently followed as complication. The purpose of this study was to evaluate reduction technique of extensive inferior blow-out fracture with ballooning of foley catheter through endoscopic transnasal approach and implantation of $Medpor^{(R)}$ through subciliary approach. Methods: A retrospective study was performed on 14 patients with extensive inferior blow-out fracture who underwent ballooning of foley catheter through endoscopic transnasal approach with implantation of $Medpor^{(R)}$ through subciliary approach. Patients were operated from May 2005 to November 2007. Data for 14 patients were acquired from patient's charts. Preoperative and postoperative data for enophthalmos, diplopia, limitation of extraocular motion were reviewed. Preoperative and postoperative CT scan were also checked. The patients were followed up from 4 to 18 months. Results: The enophthalmos was corrected in all patients. Among 7 patients with diplopia preoperatively, diplopia was resolved in three patients postoperatively. The diplopia persisted in four patients and two of them also had limitation of extraocular motion postoperatively. The limitation of extraocular motion occurred in seven patients preoperatively. But five patients recovered after operation immediately. These symptoms were resolved about three months after the operation. Conclusion: The ballooning of foley catheter through endoscopic transnasal approach with implantation of $Medpor^{(R)}$ through subciliary approach can be considered one of the appropriate technique for extensive inferior blowout fracture.

• 대한기계학회논문집B
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• 제36권4호
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• pp.419-424
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• 2012

코의 3 대 생리학적 기능은 공기조화, 불순물과 공해물질의 제거, 그리고 후각 기능이다. 비강 내공기유동장의 특성에 대한 이해는 코 호흡의 생리학적 병리학적 양상을 이해하는 데 있어서 필수적이다. 정상 및 비정상 비강 내 공기유동에 대한 경험을 토대로 3 개의 하비갑개 수술 후 모델을 제작하여 PIV 실험과 수치해석을 통하여 유동을 해석하였다: (1) 하비갑개의 앞 부분만 절제한 I1 모델 (1) 하비갑개의 아래 부분만 절제한 I2 모델 (1) 하비갑개의 거의 전 부분을 절제한 I3 모델. 정밀한 CT 데이터와 이비인후과 전문의와의 긴밀한 협동 연구로 인해 해부학적으로 정확한 물리적 및 수치 모델을 제작할 수 있었으며 수술 방법에 따른 유동장의 차이에 대해 분석하였다.

• Maxillofacial Plastic and Reconstructive Surgery
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• 제16권1호
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• pp.99-103
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• 1994

협골체 골절시 접근방법은 안와하연에 대해 섬모하절개, 하안검절개, 안와하연절개 및 결막절개등이 사용되고 안와측벽, frontozygomatic suture에 대해서는 lateral brow incision, 상안검절개등이 사용되며 관상절개술은 frontozygomatic suture와 협골궁에 접근할 수 있다. 관상절개술을 제외한 접근방법은 한가지 절개술로 단지 한부위의 정복과 고정술이 가능하므로 결국 협골체 골절시 2점이상 고정을 할 경우 2가지 이상의 절개가 필요하게 된다. 이에 저자들은 관상절개술의 적응증이 아닌 협골체 골절에 lateral-canthotomy-conjunctival incision을 사용하여 안와하연 및 측벽의 골절부에 대한 정복술과 고정술을 시행하여 양호한 결과를 관찰하여 이에 보고하는 바이다.

• Clinics in Shoulder and Elbow
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• 제3권2호
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• pp.79-86
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• 2000

Purpose: We analysed the clinical efficacy of inferior capsular shift operation in multidirectional instability of the shoulder joint in terms of functional aspects and patient's satisfaction Materials and Methods: From July, 1998 to March, 2000, we treated 23 cases of multidirectional instability of the shoulder joint with T-shaped inferior capsular shift and/or Bankart repair. All of them have complained of an experience about frank dislocations. Two of them has a voluntary component. We evaluated them according to complication, function, range of motion, stability and patient's satisfaction with an average follow-up of 15 months(the range of 9 to 27 months). Results: Eight cases were atraumatic multidirectional instability and coexisting Bankart lesion were present in 15. There was no redislocation, but one case of symptomatic subluxation, 3 cases of transient nerve palsy and 2 cases of feeling of laxity developed. Limitation of motion after surgery was an average of 3.4° in flexion, and 8.5° in external rotation. With Rowe scoring system, the clinical result was excellent or good in 22 cases and poor in one. According to American shoulder and elbow society, pain score improved to 1.4 from 6.1, and stability score also improved to 1.8 from 9.1. Conclusion: In multidirectional shoulder instability, one should pay attention to finding a coexisting Bankart lesion. In that case, adequate capsular volume reduction by using inferior capsular shift as well as repair of Bankart lesion is needed to get a good surgical outcome.

• Journal of Korean Neurosurgical Society
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• 제45권2호
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• pp.67-73
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• 2009

Objective : Although endoscopic procedures for lumbar disc diseases have improved greatly, the postoperative outcomes for high grade inferior migrated discs are not satisfactory. Because of anatomic limitations, a rigid endoscope cannot reach all lesions effectively. The purpose of this study was to determine the feasibility of endoscopic transforaminal suprapedicular approach to high grade inferior-migrated lumbar disc herniations. Methods : Between May 2006 and March 2008, a suprapedicular approach was performed in 53 patients with high grade inferior-migrated lumbar disc herniations using a rigid endoscope and a semi-rigid flexible curved probe. One-to-four hours after surgery, the presence of remnant discs was checked with MRI. The outcomes were evaluated with the visual analogue scale (VAS) score and the Oswestry Disability Index (ODI) one week after surgery. Results : The L2-3 level was involved in 2 patients and the L3-4 level was involved in 14 patients, while the L4-5 level was involved in 39 patients. There were single piece-type in 34 cases and a multiple piece-type in 19 cases. Satisfactory results were obtained in all cases. The mean preoperative VAS for leg pain was $9.32{\pm}0.43$ points (range, 7-10 points), whereas the mean ODI was $79.82{\pm}4.53$ points (range, 68-92 points). At the last follow-up examination, the mean postoperative VAS for leg pain was $1.78{\pm}0.71$ points and the mean postoperative ODI improved to $15.27{\pm}3.82$ points. Conclusion : A high grade inferior migrated lumbar disc is difficult to remove sufficiently by posterolateral endoscopic lumbar dscectomy using a rigid endoscope. However, a satisfactory result can be obtained by applying a transforaminal suprapedicular approach with a flexible semi-rigid curved probe.

• Tuberculosis and Respiratory Diseases
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• 제65권3호
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• pp.225-229
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• 2008

저자들은 폐색전증과 심부정맥 혈전증을 이전에 진단받았던 말기 전립선암환자에서 외상성 뇌출혈로 인해 항응고제 치료를 시행하지 못하여 하대정맥 필터를 삽입 후 하지 부종, 하지 맥압 소실, 급성 신부전 및 DIC 등으로 사망한 phlegmasia cerulea dolens 1예를 경험하였기에 문헌고찰과 함께 보고하는 바이다.

• Journal of Oral Medicine and Pain
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• 제20권1호
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• pp.195-204
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• 1995

The purpose of this study was to evaluate effect of head posture change on initial occlusal contacts through measuring the distances between initial occlusal contacts and maximum intercuspal position at different head posture. Two special devices were designed and constructed. Mandibular movement replicator was used to assess reliability of the K6 diagnostic system(MKG; Myo-tronic Inc, Seatle, USA) and head posture calibrator was used to maintain the constant head posture during experiment. We measured difference of distance between initial occlusal contact and maximum intercuspal position with MKG in upright, supine, 45 degrees extension, 30 degrees flexion, 30 degrees right and left bending postion of the head. The Frankfurt horizontal plane was used as a reference plane. 21 adults aged from 23 to 25 were selected, who have normal or class I molar relationship, and have no symptoms on TMJ and masticatory muscles, and have restorations less than 3 surfaces on each tooth, and have no other prosthetic restoration. The obtained results were as follows : The mean absolute distances between initial occlusal contact and maximum intercuspal postion were 0.39(0.18mm in the upright position, 0.65(0.37mm in the supine position, 0.59(0.33mm in the 45 degree extension, 0.70(0.53mm in the 30 degrees flexion, 1.12(1.10mm in the 30 degrees right bending and 1.94(0.67mm in the 30 degrees left bending of the head. The positions of the initial occlusal contacts have a tendency to locate anterior, left and inferior to maximal intercuspal position in upright position, posterior and inferior in supine position and 45 degrees extension, anterior and inferior in 30 degrees flexion, right and inferior in 30 degrees right bending, and left and inferior in 30 degrees left bending of the head. There were significant differences among the initial occlusal contacts in each head postures(P<0.0001). Therefore, we need to check initial occlusal contacts in the altered head posture during occlusal analysis and adjustment of occlusal appliance and dental occlusion for diagnosis and treatment of temporomandibular disorder.

• Maxillofacial Plastic and Reconstructive Surgery
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• 제34권1호
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• pp.34-40
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• 2012

Purpose: The study was performed to compare patients with anatomical variations in facial asymmetry with patients in the normal range using cone-beam computed tomography (CBCT) and to take the preoperative condition into consideration in the case of a sagittal split ramus osteotomy (SSRO). Methods: The study was conducted on 46 adult patients composed of 2 subdivided groups, an asymmetry group (n=26) and a symmetry group (n=20). The asymmetry group was divided between patients with hemimandibular hyperplasia (HH, n=8) and hemimandibular elongation (HE, n=18). Using cross-sectional computed tomography images, the thickness of cancelleous bone in the buccal area of the mandible, thickness of buccal cortex in the buccal aspect of the mandible, thickness of cancellous bone in the inferior aspect of the mandible, thickness of buccal cortex in the inferior aspect of the mandible, and cross-sectional surface area of the mandible were measured. Results: In the asymmetry group, the cross-sectional area of the mandible including the inferior alveolar nerve positioned on the affected side was significantly different from the symmetry group. Thickness of cancelleous bone in the buccal aspect of the mandible, thickness of cancelleous bone in the inferior aspect of the mandible, and cross-sectional surface area of the mandible in the affected site of hemimandibular hyperplasia was significantly smaller than in the symmetry group. Conclusion: The inferior alveolar nerve runs lower and in a more buccal direction and shows a smaller cross-sectional surface of the mandible in the hemimandibular hyperplasia patients with asymmetry.