• Maxillofacial Plastic and Reconstructive Surgery
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• 제35권4호
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• pp.248-255
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• 2013

Reconstruction techniques of orofacial defects caused by wide excision of the intraoral malignant lesions are various. Although radial forearm free flap is a common donor site on reconstruction of soft tissue defect, anterolateral thigh (ALT) free flap also has an established site in orofacial soft tissue reconstruction as the favored donor flap with recent progress of the microsurgical technique. A 59-year-old female complained of hyperplastic mass on the right retromolar and buccal cheek, which was diagnosed as a squamous cell carcinoma (SCC) by an incisional biopsy. Before the operation, we planned a wide excision of the SCC lesion, supraomohyoid neck dissection, reconstruction with radial forearm free flap (RFFF), and split thickness skin graft. We accidentally found an arterial variation of the forearm area during elevation of RFFF, and changed the plan of reconstruction operation to reconstruction with ALT free flap. Operative sites was healed well during the post-operative period, and we referred to the department of radiation oncology for post-operative radiotherapy.

• 대한치과보철학회지
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• 제37권5호
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• pp.567-580
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• 1999

Accurate reproduction of intraoral tissue is essential in the fabrication of fixed prosthesis. This selection of impression material and method is very important. In this study, vinyl polysiloxane type impression material $Panasil^{(R)}$ was used. Three impression methods ; one-step technique, individual tray technique, and individual tooth tray technique using the vinyl polysiloxane type bite registration material $Futar^{(R)}$ Occlusion, were used to take horizontal and vertical impression. Improved stone models were fabricated. The amount of occlusal surface discrepaneies, interabutment distance discrepancies, amount of marginal defect were evaluated with the $X-PLAN360d^{(R)}$ and photoscanning. The results were as follows. 1. There was no significant difference in occlusal surface according to the directions and techniques of impression taking. 2. There was no significant difference in interabutment distance discrepancies according to the directions and techniques of impression taking 3. There was no significant difference in marginal discrepancies according to the direction of impression taking but there was significant difference between one-step technique and individual tray technique, individual tooth tray technique (P<0.05). Taken together, these results suggest that individual tray technique and individual tooth tray technique are more accurate for impression taking than one-step technique.

• Archives of Plastic Surgery
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• 제38권3호
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• pp.251-256
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• 2011

Purpose: A nasolabial cyst is a rare non-odontogenic, soft-tissue, developmental cyst arising anywhere on the face inferior to the nasoalar region. It is thought to arise from either epithelial remnants trapped along the lines of fusion during the development of face or the remnants of the developing nasolacrimal duct. This study examines various features of nasolabial cysts with bony involvement to provide a basis for correct diagnosis and treatment. Methods: Eight cases of nasolabial cyst treated in Soonchunhyang Hospital between March 2002 and July 2010 were examined in terms of their clinical features and radiological and histological findings. Seven patients underwent surgical excision of the cyst via an intraoral, sublabial approach. One underwent incision and drainage. Results: Our eight patients were seven women and one man. The most frequent symptoms and signs were facial deformity and swelling of the nasolabial fold. Computed tomography (CT) showed a well-circumscribed cystic mass lateral to the pyriform aperture. Seven cases had erosive lesions on CT, and the intraoperative findings were consistent with a nasolabial cyst with a bony defect. Typical histopathological findings showed that these cysts were most frequently lined with respiratory epithelium with ciliated columnar cells and cuboid cells. No patient developed complications or recurrences. Conclusion: A nasolabial cyst is often unrecognized or confused with other intranasal masses, including fissural and odontogenic cysts, midface infections, or swelling in the nasolabial area. Therefore, a careful clinical and radiological evaluation should be preformed when considering the differential diagnosis. We present eight patients with nasolabial cysts treated via a gingivobuccal approach with excellent functional and cosmetic results.

• Maxillofacial Plastic and Reconstructive Surgery
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• 제16권2호
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• pp.113-121
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• 1994

Large oral defects following tumor resection pose formidable challenge for the reconstructive surgeon. Ideally, wound closure should utilize like tissue in providing expedient, single-stage closure, returning maximum function while minimizing deformity. Recent methods have reported and utilize variable mucocutaneous flaps. However, the ideal reconstruction has yet to defined. The small bowel serves as a readily available donor site for satisfying reconstructive needs in oropharyngeoesophageal defects. Segments of jejunum may be opened along the antimesenteric border and transferred to oral defect as free tissue transfers. Some of the benefits of this technique have included a one-stage procedure, abundant donor tissue with characteristics similar to oral mucosa, near normal facial appearance, preservation of maximum tongue function and relief of annoying xerostomia by jejunal mucous secretion. Three cases re presented in which two cases show successful use of this flap. The other one patient developed total necrosis of this flap. We report cases of reconstruction using free jejunal flap transfer in oral reconstruction.

• 대한장애인치과학회지
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• 제14권2호
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• pp.97-101
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• 2018

저자는 입술 및 혀에 대해 자해증상을 보이는 2명의 Lesch-Nyhan 증후군 환아에서 구강조직에 대한 자해행동을 예방하기 위해 soft mouth guard를 이용한 보존적 치료법과 전악발거의 침습적 방법을 이용하여 치료한 증례를 보고하는 바이다. Lesch-Nyhan 증후군 환자의 자해행동을 예방하기 위한 치료법은 아직 정립된 기준이 존재하지 않아 각 환자의 자해양상 및 정도에 따라 치료방법은 달라질 수 있다. 가능하다면 치아를 보존할 수 있는 장치 또는 BTX-A 제재 등을 이용한 보존적 방법을 먼저 시도해 보는 것이 좋다. 이 때 치료의 성공률을 높이기 위해서는 치과적 접근 이외에도 소아정신과와의 협진을 통한 정신심리학적 접근, 필요시 약물치료를 고려하는 것 등 여러 방향으로 접근하는 것이 더욱 바람직한 결과를 가져올 것으로 사료된다. 보존적 접근이 실패할 경우 더 이상의 조직상실과 전신적 감염 예방을 위해 극단적 방법이지만 전악발거를 고려해야 할 것이다.

• 치과방사선
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• 제29권2호
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• pp.423-433
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• 1999

Purpose : To assess the methods for the clinical evaluation of the longitudinal bone changes after implantation of tooth ash-plaster mixture into the defect area of human jaws. Materials and methods : Tooth ash-plaster mixtures were implanted into the defects of 8 human jaws. 48 intraoral radiograms taken with copper step wedge as reference at soon, 1st, 2nd, 4th, and 6th week after implantation of mixture were used. X-ray taking was standardized by using Rinn XCP device customized directly to the individual dentition with resin bite block. The images inputted by Quick scanner were digitized and analyzed by NIH image program. Cu­equivalent values were measured at the implanted sites from the periodic digital images. Analysis was performed by the bidirectional subtraction with color enhancement and the surface plot of resliced contiguous image. The obtained results by the two methods were compared with Cu­equivalent value changes. Results : The average determination coefficient of Cu-equivalent equations was 0.9988 and the coefficient of variation of measured Cu values ranged from 0.08~0.10. The coefficient of variation of Cu-equivalent values measured at the areas of the mixture and the bone by the conversion equation ranged from 0.06 ~0.09. The analyzed results by the bidirectional subtraction with color enhancement were coincident with the changes of Cu-equivalent values. The surface plot of the resliced contiguous image showed the three dimensional view of the longitudinal bone changes on one image and also coincident with Cu-equivalent value changes after implantation. Conclusion : The bidirectional subtraction with color enhancement and the surface plot of the resliced contiguous image was very effective and reasonable to analyze clinically and qualitatively the longitudinal bone change. These methods are expected to be applicable to the non-destructive test in other fields.

• Maxillofacial Plastic and Reconstructive Surgery
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• 제32권5호
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• pp.447-453
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• 2010

The hemifacial microsomia is characterized by variable underdevelopment of the craniofacial skeleton, external ear, and facial soft tissues. So, patients with hemifacial microsomia have an occlusal plane canting and malocclusion with facial asymmetry. Distraction osteogenesis (DO) with an intraoral or extraoral device is a technique using tension to generate new bone with gradual bone movement and remodeling. DO has especially been used to correct craniofacial deformities such as a hemifacial microsomia, facial asymmetry, and mandible defect that could not adequately be treated by conventional reconstruction with osteotomies. It has a significant advantage to lengthen soft and hard tissue of underdeveloped site without bone graft and a few complication such as nerve injury or muscle contracture. A 13-years old girl visited our clinic for the chief complaint of facial asymmetry. She had a left hypoplastic maxilla and mandible, occlusal plane canting and malocclusion. We diagnosed hemifacial microsomia and lanned DO to lengthen the affected side. Le Fort I osteotomy, left mandibular ramus and symphysis osteotomy were performed. The internal distraction devices fixed with screw on maxillary and mandibular ramus osteotomy sites. External devices were adapted to lower jaw for DO on symphysis osteotomy site and to upper jaw for rapid maxillary expansion (RME). At 7days after surgery, distraction was started at the rate of 1mm per day for 13days, and after 4months consolidation periods, distraction devices were removed. Simultaneous multiple maxillo-mandibular distraction osteogenesis with RME resulted in a satisfactory success in correcting facial asymmetry as well as occlusal plane canting for our hemifacial microsomia.

• Maxillofacial Plastic and Reconstructive Surgery
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• 제28권2호
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• pp.154-165
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• 2006

Objectives : It is difficult to place implants at a severely atrophied edentulous mandible because of vertical and horizontal alveolar defect. The autogenous and allogenic bone graft and guided bone regeneration are useful, but there are some limitations such as the resorption and infection of the grafted bone, and insufficiency of soft tissue. Distraction osteogenesis has recently evolved a challenging technique to overcome major draws of conventional augmentation procedures, we, therefore, report the four applications of implant placement after vertical alveolar distraction osteogenesis. Patients and Methods : Four patients(all female, mean age: $60{\pm}6$ years) with severe alveolar ridge deficiencies at their anterior mandible were treated with vertical alveolar distraction osteogenesis by intraoral device(Track 1.5, 15 mm model, KLS Martin, Tuttlingen, Germany) and placement of implants (Branemark MK III, TiUnite). After the latency periods of 5, 7, 8 days, distraction rhythm and rate were $0.5\;mm{\times}2\;times/day$ in the case of good bone quality, and $0.25\;mm{\times}3\;times/day$ in the case of poor bone quality. After consolidation periods of mean fifteen weeks, five implants for each patients were placed at the interforaminal area. Results : On average, a vertical gain of $11.38{\pm}1.38\;mm$ was obtained by distraction. And all distraction zone showed complete ossification by panoramic radiography. There were no postoperative complications other than numbness of lower lip in one case. Total twenty implants in four patients were placed and their outcomes were satisfactory. Conclusion : It is a useful method to place five implants after vertical distraction osteogenesis of the severely atrophied mandible for the implant-supported fixed prosthesis.

• Maxillofacial Plastic and Reconstructive Surgery
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• 제41권
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• pp.43.1-43.5
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• 2019

Background: Reconstructive surgery is often required for tumors of the oral and maxillofacial region, irrespective of whether they are benign or malignant, the area involved, and the tumor size. Recently, three-dimensional (3D) models are increasingly used in reconstructive surgery. However, these models have rarely been adapted for the fabrication of custom-made reconstruction materials. In this report, we present a case of maxillary reconstruction using a laboratory-engineered, custom-made mesh plate from a 3D model. Case presentation: The patient was a 56-year-old female, who had undergone maxillary resection in 2011 for intraoral squamous cell carcinoma that presented as a swelling of the anterior maxillary gingiva. Five years later, there was no recurrence of the malignant tumor and a maxillary reconstruction was planned. Computed tomography (CT) revealed a large bony defect in the dental-alveolar area of the anterior maxilla. Using the CT data, a 3D model of the maxilla was prepared, and the site of reconstruction determined. A custom-made mesh plate was fabricated using the 3D model (Okada Medical Supply, Tokyo, Japan). We performed the reconstruction using the custom-made titanium mesh plate and the particulate cancellous bone and marrow graft from her iliac bone. We employed the tunneling flap technique without alveolar crest incision, to prevent surgical wound dehiscence, mesh exposure, and alveolar bone loss. Ten months later, three dental implants were inserted in the graft. Before the final crown setting, we performed a gingivoplasty with palate mucosal graft. The patient has expressed total satisfaction with both the functional and esthetic outcomes of the procedure. Conclusion: We have successfully performed a maxillary and dental reconstruction using a custom-made, pre-bent titanium mesh plate.

• Journal of the Korean Association of Oral and Maxillofacial Surgeons
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• 제29권2호
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• pp.102-107
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• 2003

At orthodontic treatment, we have made every effort to get rigid anchorage which is not stirred when teeth move. As a result, the miniscrew that is rigid anchorage was invented recently, and now it is used widely. Concerning the advantage of miniscrew, it is reduced dependence of extraoral anchorage and it shortens treatment time for rapid tooth movement. In contrast, the defect of miniscrew is falling off it resulted from increasing of the mobility. So the purpose of this research is to be of help to prognose clinical use of miniscrew, which is inserted for intraoral anchorage, by investigating and comparing the failure rate of miniscrew for loading time. This study researches the failure rate of miniscrew for teeth movement at the orthodontic treatment. The failure rate of miniscrew in mid course, after inserting 147 miniscrews in 51 patients, is 13%(20/147). It showed no statistically significant differences as compared man with woman, maxilla with mandible, double-head with uni-head miniscrew, and drilling and non-drilling before inserting the miniscrew. In comparison below twenties with over twenties and the times that we give load to miniscrew, it produced that the failure rate of miniscrew is 9.7% higher in the case of below the twenties than over the twenties. Also, the failure rate of loading immediately is 10.8% higher than loading after 7 days. According to using driver for the insertion of miniscrew, the failure rate of miniscrew is higher in the case of using machined driver than in the case of using hand driver when the level of significance is 95%. According to the research, we can suppose that the failure rate has no concern with using miniscrew on man or woman, maxilla or mandible, the shape of head, and drilling or non-drilling before insertion of miniscrew. Therefore, we can choose eclectic miniscrew as demands. In addition, we must notify the patient, below twenties, to be possibility of high failure rate. And It is strongly recommended to give load after $1{\sim}2$ weeks for healing of the insertion area.