• Archives of Plastic Surgery
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• 제36권1호
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• pp.66-74
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• 2009

Purpose: The importance of the deformities in alar - columellar complex has been underestimated in Asian ethnic groups for the last decades. Fortunately, with increasing familiarity of the open rhinoplasty techniques, the anatomic details of the nasal tip have been pointed up. Definitely, having an interest and demand for improving the sub - normal relationship between the alar rim and columella are indebted for such growing of knowledge about nasal tip anatomy. However, it is true that any single procedure is not settled as versatile and fully confident modality to correct the retracted notching of the alar rim. With this article, I should like to propose another useful option for treating retracted ala. Methods: The author has tried to correct alar rim retraction by means of: (1) Triangular onlay septal cartilage graft on the lower lateral cartilage with the medial end fixed to the anterior surface of the lateral crus(Alar extension graft), (2) Inserting lateral end of the alar extension graft to the vestibular skin pocket in the form of a finger - in - groove, (3) using the vestibular skin in the form of an advancement flap, and (4) using the soft shield graft to prevent possible visible step - off of the alar margin. Results: The author applied an alar extension graft to 16 patients in order to correct a retracted ala for the last 27 months (August, 2003 - October, 2005). The distances from alar rim to long axis of nostril were improved to be within 2 mm in all of the cases, and also the shape of the alar rim changed to a round form. Nostril asymmetry (6%) in one case, temporary palpable step - off (18%) in three cases, temporary visible step - off (6%) in one case, and temporary paresthesia of the tip (25%) in four cases were observed. Conclusion: The alar extension graft is simple and efficacious. It does not need donor sites other than the operative field, and its results are predictable. In particular, since it may give structural intensity to a weak lower lateral cartilage, it may be preferentially used for the correction of a retracted ala that arises from hypoplastic lower lateral cartilage. Moreover intensified lower lateral cartilage also improves the esthetic shape of lobule.

• Journal of Korean Neurosurgical Society
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• 제59권1호
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• pp.52-57
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• 2016

Objective : Many surgeons advocate for watertight dural reconstruction after posterior fossa surgery given the significant risk of cerebrospinal fluid (CSF) leak. Little evidence exists for posterior fossa dural reconstruction utilizing monolayer collagen matrix onlay graft in a non-watertight fashion. Our objective was to report the results of using collagen matrix in a non-watertight fashion for posterior fossa dural reconstruction. Methods : We conducted a retrospective review of operations performed by the senior author from 2004-2011 identified collagen matrix (DuraGen) use in 84 posterior fossa operations. Wound complications such as CSF leak, infection, pseudomeningocele, and aseptic meningitis were noted. Fisher's exact test was performed to assess risk factor association with specific complications. Results : Incisional CSF leak rate was 8.3% and non-incisional CSF leak rate was 3.6%. Incidence of aseptic meningitis was 7.1% and all cases resolved with steroids alone. Incidence of palpable and symptomatic pseudomeningocele in follow-up was 10.7% and 3.6% respectively. Postoperative infection rate was 4.8%. Previous surgery was associated with pseudomeningocele development (p<0.05). Conclusion : When primary dural closure after posterior fossa surgery is undesirable or not feasible, non-watertight dural reconstruction with collagen matrix resulted in incisional CSF leak in 8.3%. Incidence of pseudomeningocele, aseptic meningitis, and wound infection were within acceptable range. Data from this study may be used to compare alternative methods of dural reconstruction in posterior fossa surgery.

• Maxillofacial Plastic and Reconstructive Surgery
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• 제31권6호
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• pp.469-477
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• 2009

육안적 검사결과 실험군과 대조군 모두에서 특별한 염증 소견이나 창상 이개 없이 반원 모양의 골형성이 관찰되었다. 조직학적으로 3주째에 대조군, 실험 1군, 실험2군, 실험 3군 모두 이식골 주위 및 티타늄 반구 내면을 따라 신생 골형성이 관찰되었다. 조직학적으로 6주째에 모든 군에서 3주째에 비하여 신생골 면적의 증가 및 성숙 소견이 관찰되었고, 실험2군에서는 부분적으로 이식골이 흡수되면서 신생골이 형성되는 것이 관찰된 반면, 실험 3군에서는 이식골의 흡수 소견이 관찰되지 않았다. 조직형태계측학적으로 3주, 6주 모두 자가골에서 가장 많은 신생골 형성이 나타났고, 신생골 면적 비교시 자가골, 이종골, 합성골 순으로 크게 나타났고, 각 군간의 통계학적으로 유의한 차이는 없었다(p>0.05). 본 연구결과 골유도 재생술시 골형성 능력은 자가골이 가장 좋지만, 자가골 채취가 불가능할 경우, 적절한 차폐막을 사용한 합성골과 이종골 복합 이식방식도 좋은 대체제가 될 것으로 생각된다.

• Maxillofacial Plastic and Reconstructive Surgery
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• 제28권6호
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• pp.570-578
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• 2006

A severely atrophic maxilla may disturb the proper implant placement. The various bone graft techniques are required for simultaneous or delayed implantation in the cases of atrophic alveolar ridges. We present 11 consecutive patients treated with simultaneous implantation using the autogenous inlay and/or onlay bone grafts from iliac crest to the floor of the maxillary sinus and the alveolar crest. In the cases of atrophic maxilla, a total 69 implants were simultaneously placed with autogenous iliac bone graft. 40 fixtures were inserted in the sinus floor simultaneously with subantral block bone graft, the other 29 fixtures were placed in the anterior or premolar areas with block or particulate bone graft. The vertical alveolar bone height was measured with Dental CT at the preoperation and 6 months postoperation. Moreover, the implant stability quotients (ISQ) were measured by $Osstell^{TM}$ during second implant surgery at 6 months later of first implantation. All implants were obtained successful osseointegration with the grafted bone. The mean vertical increases were 3.9mm in the anterior ridges and 12.8mm in the posterior ridges. During the second implant surgery, mean ISQ were 62.95 in the anterior ridge and 61.32 in the posterior ridge. We concluded that the simultaneous implantation with autogenous iliac bone graft were stable and available methods for severely atrophic maxilla.

• Journal of Periodontal and Implant Science
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• 제43권2호
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• pp.64-71
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• 2013

Purpose: The objective of this study was to elucidate the role of collagen membranes (CMs) when used in conjunction with bovine hydroxyapatite particles incorporated with collagen matrix (BHC) for lateral onlay grafts in dogs. Methods: The first, second, and third premolars in the right maxilla of mongrel dogs (n=5) were extracted. After 2 months of healing, two BHC blocks ($4mm{\times}4mm{\times}5mm$) were placed on the buccal ridge, one with and one without the coverage by a CM. The animals were sacrificed after 8 weeks for histometric analysis. Results: The collagen network of the membranes remained and served as a barrier. The quantity and quality of bone regeneration were all significantly greater in the membrane group than in the no-membrane group (P<0.05). Conclusions: The use of barrier membranes in lateral onlay grafts leads to superior new bone formation and bone quality compared with bone graft alone.

• Maxillofacial Plastic and Reconstructive Surgery
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• 제38권
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• pp.40.1-40.4
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• 2016

Background: This report describes the authors' experience of "melting" septal cartilage after placement of a septal extension graft in a nasopharyngeal cancer patient that had been previously undergone radiation therapy, and provides a review of the literature. Methods: Electronic medical records were used to obtain details of the patient's clinical history. Results: A 32-year-old woman, who had previously undergone radiotherapy for nasopharyngeal cancer, visited our department to for rhinoplasty. Rhinoplasty was performed using a septal extension graft to raise the nasal tip (first operation). Five days after surgery, it was found that the septal extension graft was melting without any signs of infection, that is, the graft had softened, lost elasticity, thinned, and partially disappeared without any sign of infection at 5 days, and thus, the nasal tip was reconstructed with conchal cartilage (second operation). Five months after surgery, it was found that almost all septal cartilage had disappeared without any sign of infection, and thus, the entire nasal septum was reconstructed using 2-mm costal cartilage and an onlay graft was used for tip augmentation (third operation). Conclusions: After cartilage has been exposed to radiotherapy, its patency should be viewed with suspicion. Further studies are needed for determine the mechanism responsible for cartilage damage after radiotherapy.

• Archives of Plastic Surgery
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• 제37권3호
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• pp.259-264
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• 2010

Purpose: Most surgeons have used autogenous cartilage for columella strut graft. But the supply of autogenous cartilage is often limited. So, this study is to investigate the usefulness of biodegradable plate as columella strut material. Methods: We studied 19 patients who have secondary cleft nasal deformity. Patients were divided into two groups. Group A patients who were not closed their growth plate underwent columella strut graft only with biodegradable plate through endonasal approach. The biodegradable plate was inserted between nasal tip and anterior nasal spine. Group B patients were closed their growth plate. They had an operation for columella strut graft with biodegradable plate fixed with autogenous conchal cartilage. If nasal tip projection was insufficient, we performed additionally onlay graft on nasal tip with autogenous soft tissue or remnant cartilage. Results: As a result of mean 14 months follow-up, we achieved a good nasal tip projection, narrowing of interalar distance and symmetrical nostril shape. No specific complications were reported except 2 cases, which were the extrusion of biodegradable plate into the nasal cavity and Staphylococcus aureus infection. Conclusion: The columella strut graft using biodegradable plate is simple and effective method. Biodegradable plate can be a good substitute for columella strut in patients who can not use autogenous cartilages.

• Journal of Periodontal and Implant Science
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• 제44권2호
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• pp.94-99
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• 2014

Purpose: Various surgical techniques target achieving adequate keratinized tissue around dental implants; however, these techniques are usually performed before implant placement or upon the exposure of submerged implants. The aim of this case report is to describe a simultaneous placement of an interpositional free gingival graft (iFGG) with that of nonsubmerged implants in a patient lacking keratinized tissue and to assess the longterm outcome of this grafted gingiva. Methods: A wedge-shaped free gingnival graft (FGG), including an epithelium-connective tissue (E-C) portion and a connective-tissue-only (CT) portion, was harvested from the palate. The CT portion was inserted under the buccal flap, and the E-C portion was secured tightly around the implants and to the lingual flap. Results: At the 8-year follow-up, the gingival graft remained firmly attached and was well maintained, with no conspicuous shrinkage or reported discomfort during oral hygiene procedures. The use of an iFGG at a nonsubmerged implant placement minimizes the required number of surgical steps and patient discomfort while providing adequate buccal keratinized tissue. Conclusions: Therefore, the technique could be considered an alternative method in increasing the keratinized tissue for cases that have a minimal amount of keratinized tissue.

• Journal of the Korean Association of Oral and Maxillofacial Surgeons
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• 제41권5호
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• pp.232-239
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• 2015

Objectives: The purpose of this study was to estimate the volumetric change of augmented autobone harvested from mandibular body cortical bone, using cone-beam computed tomography (CBCT) and three-dimensional reconstruction. In addition, the clinical success of dental implants placed 4 to 6 months after bone grafting was also evaluated. Materials and Methods: Ninety-five patients (48 men and 47 women) aged 19 to 72 years were included in this study. A total of 128 graft sites were evaluated. The graft sites were divided into three parts: anterior and both posterior regions of one jaw. All patients included in the study were scheduled for an onlay graft and implantation using a two-stage procedure. The dental implants were inserted 4 to 6 months after the bone graft. Volumetric stability was evaluated by serial CBCT images. Results: No major complications were observed for the donor sites. A total of 128 block bones were used to augment severely resorbed alveolar bone. Only 1 of the 128 bone grafts was resorbed by more than half, and that was due to infection. In total, the average amount of residual grafted bone after resorption at the recipient sites was $74.6%{\pm}8.4%$. Conclusion: Volumetric stability of mandibular body autogenous block grafts is predictable. The procedure is satisfactory for patients who want dental implants regardless of atrophic alveolar bone.

• Maxillofacial Plastic and Reconstructive Surgery
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• 제31권4호
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• pp.330-333
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• 2009

저자들은 본 증례의 경우 치근이 흡수된 전치와 매복 견치의 발치 후 심한 치조골의 흡수와 연조직의 변화가 예상되는 것을 고려하여 발치 후 즉시 임플란트 수술을 결정하였다. 초기 안정성을 확보하기 위해 가능한 적은 골삭제, 보다 큰 직경과 치근형태의 임플란트를 선택하여 발치 후 즉시 임플란트를 식립하였고, 장골에서 채취한 망상골로 골결손부를 채우고 부가적으로 상순 지지를 위해 흡수성 차폐막과 순측 골면에 onlay형태의 골이식술을 시행하여 자연스럽고 심미적인 결과를 얻을 수 있었다.