• Archives of Reconstructive Microsurgery
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• 제9권1호
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• pp.6-14
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• 2000

Reconstruction of the composite mandibular defect resulting from ablative resection of tumor involved jaw has been challenging task to the plastic surgeon. A wide variety of different techniques were used with limited success until the advent of microsurgery. The high success rate of microsurgical procedures has allowed for significant improvement in both functional and aesthetic results. A variety of free flap donor sites have been used successfully for mandibular reconstruction. Between April of 1991 and August of 1998, 20 mandibular reconstructions were performed for oncologic defects. 4 patients underwent mandibular reconstruction with pectoralis major flap, 3 patients with free nonvascularized bone graft, 1 patient with metal plate. 12 patients underwent microvascular mandibular reconstruction(8: fibula, 4: ilium). The type of free flap was determined by the requirements of the defect. Satisfactory aesthetic and functional results were achieved in all cases without significant complications. So microvascular mandibular reconstruction should be considered as primary choice in all mandibular defect without hesitation.

• 대한구순구개열학회지
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• 제7권2호
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• pp.77-91
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• 2004

본 연구의 목적은 반안면왜소증 환자의 하악골 신장술시 초기 치아골격 특성들 중에서 치료결과의 차이에 기여하는 인자를 찾는 것이다. 치료전의 치아골격 특성, 골신장술의 효과와 그 유지상태를 관찰하기 위하여 골신장술 직전(T0), 직후(T1), 추적 2년후(T2)에 측모와 정모 두부방사선 계측사진을 촬영하여 전후방, 수직치아, 비대칭 항목들을 계측하였다. T2 시기의 계측 결과에 따라서 환자들을 1군(양호군, 10명)과 2군(불량군, 9명)으로 분류하였다. 두 군에서 각 시기와 T0-T1, T1-T2 동안의 변화량의 차이를 Mann-Whitney U test, Wilcoxon signed independent t-test, rank test, ANOVA test를 사용하여 분석하였다. pruzansky type이 골신 장술의 성공과 실패 여부와 관계가 깊게 나타났다. T0 시기에 2군은 1군에 비하여 하악골이 후방위치되었고, 하악지 고경(ramus height)이 짧았고, 하악각(gonial angle)이 컸으며, 이환측 하악지가 내측경사되었고, 이환측으로의 이부변위(chin point deviation)가 크게 나타났다. 1군에서 골신장술의 주요한 효과는 하악지 고경의 증가, 하악골의 전방위치, 하악각의 증가, articular angle의 감소에 따른 하약골의 반시계방향 회전, 이환측의 하악지 경사의 증가, 교합면경사와 이부변위의 개선으로 나타났다. 그러나 2군에서는 골신장술을 시행했을 때 1군에 비하여 하악골이 시계방향으로 회전되었고 하악지 고경의 증가량이 작게 나타났다. T2 시기에 2군에서는 하악골의 반시계방향 회전이 나타났고, 하악지 성장이 일어나지 않았으나, 1군은 반대의 경향을 보였다. 이러한 인자들이 골신장술 결과의 차이에 기여하는 것으로 생각된다.

• 대한구순구개열학회지
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• 제14권1_2호
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• pp.1-18
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• 2011

Skeletal malocclusion is the result of abnormal dimension and alignment of each skeletal component. Understanding on these mechanisms may help to elucidate the etiology of skeletal malocclusion and to establish population-oriented treatment plans. Attempts to subdivide the Angle's classification have been performed for Class III malocclusion, while few studies have been conducted for Class II malocclusion despite recent growing interests in Class II malocclusion. 200 adults (88 male, 112 female) with skeletal Class II malocclusion were collected and subdivided using cluster analysis, using the measurements representing the dimension and the alignment of each facial skeletal component. The properties of each cluster was grouped within the subjects and a comparison between the subjects and the control group (38 male, 35 female) with normal occlusion was performed. Six clusters were finally recognized in each male and female groups. The clusters in both genders were mainly characterized by the cranial base alignment, dimension of the posterior cranial base, dimension of the mandibular ramus and the degree of mandibular rotation. The results implicate that active treatment of mandible rather than the nasomaxillary complex may be primarily considered for the correction of Korean Class II skeletal pattern.

• Imaging Science in Dentistry
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• 제38권2호
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• pp.81-87
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• 2008

Purpose: To investigate the relationship between 3D bone architectural parameters and direction-related elastic moduli of cancellous bone of mandibular condyle. Materials and Methods: Two micro-pigs (Micro-$pig^R$, PWG Genetics Korea) were used. Each pig was about 12 months old and weighing around 44 kg. 31 cylindrical bone specimen were obtained from cancellous bone of condyles for 3D analysis and measured by micro-computed tomography. Six parameters were trabecular thickness (Tb. Th), bone specific surface (BS/BV), percent bone volume (BV/TV), structure model index (SMI), degree of anisotropy (DA) and 3-dimensional fractal dimension (3DFD). Elastic moduli of three orthogonal directions (superior-inferior (SI), medial-lateral (ML), andterior-posterior (AP) direction) were calculated through finite element analysis. Results: Elastic modulus of superior-inferior direction was higher than those of other directions. Elastic moduli of 3 orthogonal directions showed different correlation with 3D architectural parameters. Elastic moduli of SI and ML directions showed significant strong to moderate correlation with BV/TV, SMI and 3DFD. Conclusion: Elastic modulus of cancellous bone of pig mandibular condyle was highest in the SI direction and it was supposed that the change into plate-like structure of trabeculae was mainly affected by increase of trabeculae of SI and ML directions.

• 대한두개안면성형외과학회지
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• 제15권2호
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• pp.53-58
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• 2014

Background: Maxillomandibular fixation (MMF) is usually used to treat double mandibular fractures. However, advancements in reduction and fixation techniques may allow recovery of the premorbid dental arch and occlusion without the use of MMF. We investigated whether anatomical reduction and microplate fixation without MMF could provide secure immobilization and correct occlusion in double mandibular fractures. Methods: Thirty-four patients with double mandibular fractures were treated with open reduction and internal fixation without MMF. Both fracture sites were surgically treated. For bony fixations, we used microplates with or without wire. After reduction, each fracture site was fixed at two or three points to maintain anatomical alignment of the mandible. Interdental wiring was used to reduce the fracture at the superior border and to enhance stability for 6 weeks. Mouth opening was permitted immediately. Results: No major complications were observed, including infection, plate exposure, non-union, or significant malocclusion. Five patients experienced minor complications, among whom the only one patient experienced a persistant but mild malocclusion with no need for additional management. Conclusion: This study showed that double mandibular fractures correction with two-or three-point fixation without MMF simplified the surgical procedure, increased patient comfort, and reduced complications, due to good stability and excellent adaptation.

• Maxillofacial Plastic and Reconstructive Surgery
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• 제29권5호
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• pp.444-450
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• 2007

In general, labiolingual or buccolingual widths of residual alveolar bone are insufficient in edentulous area, because of alveolar resorption. Horizontal augmentation is bone graft procedure with a view to reinforcing horizontally insufficient bone quantity for installation of implants. The standard method is taking appropriate amount of block bone from intraoral or extraoral autogenous bone, and solid fixation with screws or mini-plate on labial or buccal side of residual alveolar bone. The purpose of this study is to discuss clinical usefulness of horizontal augmentation with autogenous block bone by observation and analysis of course of 41 implants installed to 12 patients by horizontal augmentation in Seoul National University Bundang Hospital from July, 2002 to December, 2005. The mean age of patients is 52.7, from 19 to 70, and the number of men and women is each 2 and 10. Block bone was taken from symphysis, body, ramus of mandible or iliac bone. And 6 types of implants were installed simultaneously or not, the diameters of implants are from 3.3 to 5.5mm, the lengths are from 8 to 15mm. The operator added artificial bone grafting material and optionally covered with membrane. The mean periods of observation after operation and final prosthetics were 28.6 and 17.0 months. As a result, 40 among 41 implants survived, the survival rate was 97.6%. Average 0.9mm crestal resorption was observed at final point of time by periapical view of each patients. Major complication related to the procedure was numbness in 7 patients.

• 한국임상수의학회지
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• 제39권4호
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• pp.156-161
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• 2022

The objective of the present study was to assess the prevalence, occurrence pattern, and clinical outcomes of transfixation pinning and casting (TPC) for fractures in Korean native calves, and to identify the advantages of the procedure. The study investigated 52 cases of bone fractures documented from January 2017 to December 2020. Hindlimb fractures (72%) were the most common in bone fractures (n = 50). The distribution of fractures was highest in the tibia (n = 15), followed by the metatarsal (n = 12), femur (n = 9), radius/ulna (n = 8), metacarpal (n = 3), humerus (n = 3), mandible (n = 1), and caudal vertebrae (n = 1). All cases were diagnosed via radiographic evaluation. Closed fractures (86%) were the most common, followed by open fractures (14%). Surgery was performed on 34 calves using intramedullary pin (IM pin), TPC, cross pin, flexible wire (F-wire), and/or plate fixation. The rest of the calves were treated with external coaptation (n = 12) or were not treated (n = 6). Subsequently, 24 calves with follow-up records were evaluated in the bone fracture cases (n = 50). Bone union was observed in 15 (62%) calves; 3 (12%) calves showed non-union; 4 (16%) calves were dead after surgery; and 2 (8%) calves were euthanized at the owner's request. Among the 24 follow-up surgery cases, the most successful cases were tibia fractures (75%) surgically treated using TPC and/or IM pin. These findings suggest that TPC surgery is effective in the management of fractures in Korean native calves.

• Journal of the Korean Association of Oral and Maxillofacial Surgeons
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• 제42권3호
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• pp.144-150
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• 2016

Objectives: We compared the transbuccal and transoral approaches in the management of mandibular angle fractures. Materials and Methods: Sixty patients with mandibular angle fractures were randomly divided into two equal groups (A, transoral approach; group B, transbuccal approach) who received fracture reduction using a single 2.5 mm 4 holed miniplate with a bar using either of the two approaches. Intraoperatively, the surgical time and the ease of surgical assess for fixation were noted. Patients were followed at 1 week, 3 months, and 6 months postoperatively and evaluated clinically for post-surgical complications like scarring, infection, postoperative occlusal discrepancy, malunion, and non-union. Radiographically, the interpretation of fracture reduction was also performed by studying the fracture gap following reduction using orthopantomogram tracing. The data was tabulated and subjected to statistical analysis. A P -value less than 0.05 was considered significant. Results: No significant difference was seen between the two groups for variables like surgical time and ease of fixation. Radiographic interpretation of fracture reduction revealed statistical significance for group B from points B to D as compared to group A. No cases of malunion/non-union were noted. A single case of hypertrophic scar formation was noted in group B at 6 months postsurgery. Infection was noted in 2 patients in group B compared to 6 patients in group A. There was significantly more occlusal discrepancy in group A compared to group B at 1 week postoperatively, but no long standing discrepancy was noted in either group at the 6 months follow-up. Conclusion: The transbuccal approach was superior to the transoral approach with regard to radiographic reduction of the fracture gap, inconspicuous external scarring, and fewer postoperative complications. We preferred the transbuccal approach due to ease of use, minimal requirement for plate bending, and facilitation of plate placement in the neutral mid-point area of the mandible.

• 대한치과보철학회지
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• 제49권4호
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• pp.324-332
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• 2011

연구 목적: 다양한 물성의 층으로 제작된 마우스가드를 장착하였을 때 치아와 악골에 가해지는 힘의 유한요소 분석을 시행하기 위함이다. 연구 재료 및 방법: 연구대상의 모형을 교합기에 장착한 뒤 Signature Mouthguard System (Dreve dentamid GmbH., Unna, Germany)을 이용하여 맞춤형 구강보호장치를 제작하여 장착한 후 두정부에서 경추까지 1.0 mm로 컴퓨터 단층촬영을 시행하였다. 영상을 Cantibio BIONIX 프로그램을 이용하여 3차원 유한요소 모델을 생성한 뒤 HyperMesh 소프트웨어를 이용하여 데이터 분석을 시행하였다. 마우스가드는 층에 따라 다음과 같이 분류하였다. 1. 연질(Bioplast)(SG) 2. 경질(Duran)(HG) 3. 중질(Drufomat)(MG) 4. 연질+중질(SG + HG) 5. 경질 + 연질(HG + SG) 6. 연질 + 경질 + 연질(SG + HG + SG) 7. 경질 + 연질 + 경질(HG + SG + HG) 하중위치는 하악골의 전방 이부(F1), 하악 좌측 제1대구치 하방의 하악체 중앙(F2), 하악각의 전연(F3) 세점으로 하였고 FH Plane에 45도 방향으로 800N, 0.1초의 힘을 가하였다. 통계방법으로는 반복분산분석과 사후분석(다중비교분석(Multiple comparison test) DUNCAN test)을 이용하였다. SPSS 소프트웨어 (Ver.13, SPSS Inc., Chicago, IL, USA)를 사용하여 분석하였다. 결과: 치아와 상악골에서의 응력분포는 모든 하중위치에 대하여 연질층이 하악 치아에 접촉하는 구강보호장치가 적은 응력값을 나타냈으며, 과두에서의 응력분포는 모든 하중위치에 대하여 경질층이 하악 치아에 접촉하는 구강보호장치가 적은 응력값을 나타내었다. 두 연질층 사이에 경질층이 개재된 세층의 구강보호장치가 하중 시 상대적으로 고르게 응력이 분산되는 것으로 나타났다. 결론: 상하악 치아에는 연질층이 접촉하고 두 연질층 사이에 경질층을 삽입하는 형태의 구강보호장치가 악안면 외상 시 상대적으로 하중을 분산시키는데 가장 우수하다고 생각된다.

• Maxillofacial Plastic and Reconstructive Surgery
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• 제33권3호
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• pp.276-280
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• 2011

BSSRO (bilateral sagittal split ramus osteotomy) is an effective surgical method for maxillofacial deformities. Rigid fixation using a plate and screws can stabilize bony segments and induce early mouth opening. Though this procedure has a low complication rate, normal function and esthetic recovery is achieved through proper and early management of the complications. Complications consisting of temporomandibular disorders, sensory disturbances due to inferior alveolar nerve damage, open bite, malunion or nonunion, and facial nerve palsy occur, but these rarely develop. Facial nerve palsy causes the muscles involved in facial expression to depress, which results in ocular dryness or retinal damage. When facial nerve palsy develops, early management involving steroid medication and physical therapy is effective. In the case of severe damage, surgical intervention should be considered. A 20-year-male patient came to the oral and maxillofacial surgery department for orthognathic surgery. The mandible was set back by BSSRO under general anesthesia. Facial nerve palsy was observed on the left side of the face: steroid and vitamins were administered early and physical therapy was performed daily. These forms of management can aid in function and allow for gradual esthetic recovery. Presumed causes were excessive soft tissue retraction or soft tissue injury by the osteotome at the horizontal osteotomy of the ramus. Careful dissection, retraction and a precise osteotomy are needed for protection of the facial nerve. If nerve damage is observed, early management can help in the recovery of facial nerve function and esthetics.