• Archives of Plastic Surgery
• /
• 제34권6호
• /
• pp.735-740
• /
• 2007

Purpose: Blowout fracture is an outward fracture of the orbital wall. That usually occurs at inferior or medial wall of the orbit. The main pathophysiology is high intraocular pressure derived from impact of trauma. Among the four orbital wall, the medial wall is thinnest and most vulnerable to trauma. Many kinds of methods were introduced for correction of medial orbital wall fracture. Recently, transnasal endoscopic reconstruction methods were widely used. Endoscopic methods had many advantages. However, we experienced some cases of postoperative maxillary sinusitis. This study was planned to find out the effectiveness of middle meatal antrostomy after endoscopic reconstruction of medial orbital wall fracture. Methods: This study was retrospective analysis of 28 patients who underwent transnasal endoscopic repair of medial orbital wall fracture. The 18 male and 10 female patients were ranged from 17 to 57 years of age(mean, 30.9 years). Among 28 patients, randomly selected 17 patients underwent middle meatal antrostomy as additional procedure by the same surgeon. After at least 12 months of follow-up period, we examined the nasal symptom, endoscopic and CT findings. Results: One patient complained of nasal obstruction in middle meatal antrostomy group and four patients complained nasal symptoms in non middle meatal antrostomy group. On the endoscopic findings, three patients of non middle meatal antrostomy group had continuous nasal discharge. But middle meatal antrostomy group had no abnormal endoscopic findings. The abnormal CT finding(abnormal mucosal hypertrophy) were detected in four patient of non middle meatal antrostomy group. There were no abnormal CT findings in middle meatal antrostomy group. The data were statistically significant at comparative study. Conclusion: Authors think that the middle meatal antrostomy has some advantages as a additional procedure of endoscopic reconstruction of medial orbital wall fracture. Especially, it is good at preventing postoperative maxillary sinusitis. But, more larger group and strict application of disease entity are need for correct evaluation of middle meatal antrostomy effect.

• Maxillofacial Plastic and Reconstructive Surgery
• /
• 제20권2호
• /
• pp.91-96
• /
• 1998

Surgical resection of tumors in the maxillofacial region sometimes results in extended defects of soft and hard tissue that frequently causes aesthetic, functional and especially mental damages. It is essential for patients with such facial defects to reduce the scar and maxillofacial asymmetry. To attain esthetic facial appearance after hemimaxillectomy, we devise a new design, so called 'IOIO Incision' (InfraOrbital-IntraOral incision). The new approach is established on infraorbital region to expose maxillofacial skeleton in aspect of face. And the other incision is designed on intraoral region. The IOIO incision provide excellent aesthetic result after hemimaxillectomy, because of reduced minimal facial scar contraction. Maxillofacial surgeons are used to designing Weber-Fergusson incision in resection of maxillofacial tumors, but disadvantages of the incision were large scar and asymmetry of face. To improve theses problem, we attempted IOIO Incision.. For correct osteotomy of posterolateral wall of maxillary sinus, 1. Fenestra formation on zygomatic body for easily access of reciprocating saw to posterolateral wall of maxillary sinus. 2. To achieve better visual field in posterolateral aspect of maxilla, fat tissue is removed from infratemporal fossa. This new, versatile procedure can be used for benign and malignant lesions of the maxillary area. We introduce cases with review of literatures.

• 대한두경부종양학회지
• /
• 제15권1호
• /
• pp.40-45
• /
• 1999

Objectives: Maxillary cancer is notorious for its poor prognosis because it is usually detected lately and the majority of patients have advanced disease. Especially when the cancer extended to infratemporal fossa or pterygopalatine fossa it is very difficult to remove all the involved structure by conventional maxillectomy. In these cases we have used radical maxillectomy through lateral approach. We tried to figure out the clinical significance of this procedure. Material and Methods: This study retrospectively analyzed 23 patients with squamous cell carcinoma of the maxillary sinus who underwent surgical treatment for cure. Among them 17 patients(group A) were treated with initial surgery and 6 patients(group B) underwent salvage surgery after radiotherpy. Radical maxillectomy was performed in 12 patients and conventional total maxillectomy in 11 patients. Results: In group A, 3 out of 9 total maxillectomy case and none of 8 radical maxillectomy case were recurred. In group B one patient died of postoperative complication and among the other 5 patients only one out of 3 radical maxillectomy was salvaged and 2 total maxillectomy cases were died of intercurrent disease. Conclusion: Wide surgical dissection of pterygopalatine fossa and infratemporal fossa may improve the survival rate in patients with posterior wall invasion of maxillary sinus.

• Journal of Oral Medicine and Pain
• /
• 제41권1호
• /
• pp.30-33
• /
• 2016

Malignant tumors located in the head and neck areas intermittently show symptoms similar to a temporomandibular disorder (TMD). In our case, a patient who first visited us complaining of TMD-like symptoms, such as trismus and temporomandibular joint (TMJ) pain on the left side, was identified as a sufferer of adenoid cystic carcinoma (ACC) that arose from the left maxillary sinus. The patient may have a TMD symptom, but we are skeptical because the patient also complained of a spontaneously developed numbness on the same side of his upper lip. We observed the panoramic radiograph closely and found the blurred maxillary sinus inferior wall. Dental cone-beam computed tomography confirmed the tentative diagnosis of malignancy on the maxillary sinus. After he had been referred to the Department of Otolaryngology, the diagnosis of the ACC was confirmed. Adequate diagnosis is vital for a quick treatment of the malignancy. There are some keys for differential diagnosis of TMD-like symptoms.

• Archives of Plastic Surgery
• /
• 제34권4호
• /
• pp.448-454
• /
• 2007

Purpose: The objective of this study was to evaluate the outcomes of using the free flap in the reconstruction of maxillary defects. Methods: 27 consecutive cases of maxillary reconstruction with free flap were reviewed. All clinical data were analyzed, including ideal selection of flap, time of reconstruction, recurrence of cancer, postoperative complications, flap design, and follow-up results. The main operative functional items, including speech, oral diet, mastication, eye globe position and function, respiration, and aesthetic results were evaluated. Results: Among the 24 patients who underwent maxillary reconstruction with the free flap, 14 patients underwent immediate reconstruction after maxillary cancer ablation, and 10 patients underwent delayed reconstruction. There occurred 1 flap loss. Recurrences of the cancer after the reconstruction happened in 2 cases. Postoperative complications were 3 cases of gravitational ptosis of the flap, 2 cases of the nasal obstruction, and 1 case of fistula formation. Out of 27 free flaps, there were 15 latissimus dorsi myocutaneous flaps, 5 radial forearm, 4 rectus abdominis myocutaneous flaps, 1 scapular flap, 2 fibula osteocutaneous flap, respectively. Flaps were designed such as 1 lobe in 9 cases, 2 lobes in 9 cases, and 3 lobes in 5 cases. Among the 14 patients who had intraoral defect or who had palatal resection surgery, 2 patients complained the inaccuracy of the pronunciation due to the ptosis of the flap. It was corrected by the reconstruction of the maxillary buttress and hung the sling to the upper direction. All of the 14 patients were able to take unrestricted diets. In 6 patients who had reconstruction of inferior orbital wall with rib bone graft, they preserved normal vision. Aesthetically, most of the patients were satisfied with the result. Conclusion: LD free flap is suggested in uni-maxilla defect as the 1st choice, and fibular osteocutaneous flap and calvarial bone graft to cover the larger defect in bi-maxilla defect.

• Journal of the Korean Association of Oral and Maxillofacial Surgeons
• /
• 제39권6호
• /
• pp.274-282
• /
• 2013

Objectives: The posterior maxillary region often provides a limited bone volume for dental implants. Maxillary sinus elevation via inserting a bone graft through a window opened in the lateral sinus wall has become the most common surgical procedure for increasing the alveolar bone height in place of dental implants in the posterior maxillary region. The purpose of this article is to assess the change of bone volume and the clinical effects of dental implant placement in sites with maxillary sinus floor elevation and autogenous bone graft through the lateral window approach. Materials and Methods: In this article, the analysis data were collected from 64 dental implants that were placed in 24 patients with 29 lacks of the bone volume posterior maxillary region from June 2004 to April 2011, at the Department of Oral and Maxillofacial Surgery, Inha University Hospital. Panoramic views were taken before the surgery, after the surgery, 6 months after the surgery, and at the time of the final follow-up. The influence of the factors on the grafted bone material resorption rate was evaluated according to the patient characteristics (age and gender), graft material, implant installation stage, implant size, implant placement region, local infection, surgical complication, and residual alveolar bone height. Results: The bone graft resorption rate of male patients at the final follow-up was significantly higher than the rate of female patients. The single autogenous bone-grafted site was significantly more resorbed than the autogenous bone combined with the Bio-Oss grafted site. The implant installation stage and residual alveolar height showed a significant correlation with the resorption rate of maxillary sinus bone graft material. The success rate and survival rate of the implant were 92.2% and 100%, respectively. Conclusion: Maxillary sinus elevation procedure with autogenous bone graft or autogenous bone in combination with Bio-Oss is a predictable treatment method for implant rehabilitation.

• 대한두개안면성형외과학회지
• /
• 제21권3호
• /
• pp.156-160
• /
• 2020

Background: We have reported orbital wall restoration surgery with primary orbital wall fragment in pure blowout fractures using a combination of transorbital and transnasal approach in pure blow out fractures. However, this method was thought to be difficult to use for complex orbital wall fractures, since the sharp screw tip that fixate the maxillary wall increases the risk of balloon ruptures. In this study, we reviewed 23 cases of complex orbital fractures that underwent orbital wall restoration surgery with primary orbital wall fragment and evaluated the result. Methods: A retrospective review was conducted of 23 patients with complex orbital fracture who underwent orbital restoration surgery with primary orbital wall fragments between 2012 and 2019. The patients underwent orbital wall restoration surgery with primary orbital wall fragment with temporary balloon support. The surgical results were evaluated by the Naugle scale and a comparison of preoperative and postoperative orbital volume ratio. Complex fracture type, type of screw used for fixation and complications such as balloon rupture were also investigated. Results: There were 23 patients with complex orbital fracture that used transnasal balloon technique for restoration. 17 cases had a successful outcome with no complications, three patients had postoperative balloon rupture, two patients had soft-tissue infection, and one patient had balloon malposition. Conclusion: The orbital wall restoration technique with temporary balloon support can produce favorable results when done correctly even in complex orbital wall fracture. Seventeen cases had favorable results, six cases had postoperative complications thus additional procedure seems necessary to complement this method.

• Maxillofacial Plastic and Reconstructive Surgery
• /
• 제35권6호
• /
• pp.427-431
• /
• 2013

Angioedema is defined as self-limited, localized swelling. The swelling is asymmetric, non-pitting, and non-tender. Common locations of swelling include periorbital area, lips, tongue, extremities, and bowel wall. A 54-year-old woman visited our hospital with the clinical complaint of left maxillary swelling. Swelling of the left maxillary area was diffuse and temperature of the involved area was normal. No infectious source was found on panoramic radiography and cone-beam computed tomography. After considering the patient's medical history and assessing clinical examination, we suspected angioedema and administered corticosteroid only. In the oral and maxillofacial area, proper diagnosis and prompt treatment of angioedema is important because angioedema of the tongue or larynx may lead to airway obstruction or a life-threatening condition.

• 치과방사선
• /
• 제19권1호
• /
• pp.163-169
• /
• 1989

The purpose of this study is to investigate on the clinical and radiographic patterns of residual cyst of the jaw for early diagnosis and treatment. The auther studied 87 cases of residual cyst with regard to age, sex distribution, the site of the lesion and several radiographic features. The results were as follows: 1. The average age was found to be 42.6 years, with a range of 15 to 84 years. The incidence was highest in the third and fourth decades(50.6%) and total 87 cases consist of 47 males and 38 females. 2. The common clinical symptoms were pus discharge, swelling, pain and no symptoms was presented in 5 cases(12.5%). 3. Residual cysts were found to be 46.0% maxillary anterior region, 18.4% maxillary molar region, 17.2% mandibular molar region and to be more common in the maxilla(70.1%) than in the mandible(29.9%) 4. Most of residual cysts were unilocular type(86 cases, 98.8%), showing distinct border(62 cases, 71.3%) with smooth margin(78 cases, 89.7%). 5. The adjacent teeth showed root resorption in 13 cases(14.9%), and root divergence in 16 cases(18.4%). 6. The residual cysts extended to the nasal fossa(22 cases, 22.5%), the maxillary sinus(19 cases, 19.4%) and caused the displacement of the mandibular canal wall (11 cases, 11.2%)

• Imaging Science in Dentistry
• /
• 제31권2호
• /
• pp.121-127
• /
• 2001

Inflammatory pseudotumor was originally described in the lung, but recently has been recognized to occur in various sites. A 56-year-old female was referred to our department with a painless swelling of the right midfacial area since 3 months ago. Clinical examination showed non-specific intraoral findings, but asymmetric facial appearance and numbness of the right midfacial area. Plain radiographs and CT images showed aggressive destruction and irregular thickening of the right maxillary sinus wall, increased antral opacification, and destruction of the zygomatic arch. A relatively well-defined soft tissue mass occupied the right maxillary sinus, nasal cavity, zygoma, and infraorbital region. The soft tissue mass showed mild enhancement on CT. Radiographically, this lesion presented a rapidly enlarging mass demonstrating aggressive behavior, mimicking a malignant tumor. Histopathologic examinations showed plasma cells and inflammatory cells in variable fibrotic tissues and demonstrated positive reactivity for vimentin. No malignent changes could be found.