• 대한치과의사협회지
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• 제50권2호
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• pp.58-63
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• 2012

The fundamental principles and the role of surgeons and orthodontists to produce successful results in orthodontic treatment combined with orthognathic surgery is not different from those of conventional procedures and FOS: surgery-first-orthodontic-treatment-later approach. The communication and cooperation between surgeon and orthodontist is of crucial importance. In FOS, the pre-surgical orthodontic preparation is not carried out in the patient's mouth, but in the mounted stone model and in addition to the simulation of tooth movement, to get a precise surgical occlusion, the entire steps of treatment should be simulated on the articulator as well. Right after the surgery, due to the instability of the occlusion, appropriate post operational care should be given according to the surgical technique applied to the mandible by use of final surgical wafer about 8 weeks.

• Journal of International Society for Simulation Surgery
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• 제1권1호
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• pp.23-26
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• 2014

The aim of this report is to evaluate accuracy using3D surgical simulationand digitally printedwafer in orthognathic surgery. 22-year-old female was diagnosed with mandibular prognathism and apertognathia based on 3D diagnosis using CT. Digital dentition images were taken by laser scanning from dental cast, and each STL images were integrated into one virtual skull using simulation software. Digitalized intermediate wafer was manufactured using CAD/CAM software and 3D printer, and used to move maxillary segment in real patient. Constructed virtual skull from 1 month postoperative CT scan was superimposedinto simulated virtual model to reveal accuracy. Almost maxillo-mandibular landmarks were placed in simulated position within 1 mm differences except right coronoid process. Thus 3D diagnosis, surgical simulation, and digitalized wafer could be useful method to orthognathic surgery in terms of accuracy.

• Journal of Mechanical Science and Technology
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• 제20권1호
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• pp.19-28
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• 2006

This paper describes rapid prototyping (RP) and reverse engineering (RE) application for orthopedic surgery planning to improve the efficiency and accuracy of the orthopedic surgery. Using the symmetrical characteristics of the human body, CAD data of undamaged bone of the injured area are generated from a mirror transformation of undamaged bone data for the uninjured area. The physical model before the injury is manufactured from Poly jet RP process. The surgical plan, including the selection of the proper implant, pre-forming of the implant and decision of fixation positions, etc., is determined by a physical simulation using the physical model. In order to examine the applicability and efficiency of the surgical planning technology, two case studies, such as a distal tibia comminuted fracture and an iliac wing fracture of pelvis, are carried out. From the results of the examination, it has been shown that the RP and RE can be applied to orthopedic surgical planning and can be an efficient surgical tool.

• Journal of International Society for Simulation Surgery
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• 제3권1호
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• pp.22-27
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• 2016

Background Craniosynostosis management using distraction osteogensis represent a challenge for surgeons due to the great variability of the skull deformity even within the same etiology. The ability to apply the simulation surgery for improving the preoperative planning for distraction osteogensis could improve the results.Planning and Simulation 14 patients presented with craniosynostosis had been subjected to simulation surgery prior to real surgery. 3D CT scans was obtained upon patient admission. Adjustment of all skull position to Frankfort horizontal plane was done. 3 different distraction osteogensis plans were done for each patient according to the skull morphology. For each plane, movement for each bone segment was done according to the pre-planned distraction vectors. Also the distances of distractions were pre-determined according to the cephalic index as well as brain volume. Intraoperatively, we choose the most appropriate plan for the patient by the surgeon. At the end of distraction, 3D CT scan was obtained, and was compared to the simulation plan. Also the distance and the direction of distraction was compared to that of the plan. Accordingly, the distance was almost matching that of the simulation surgery, however the vector of distraction was not matched.Conclusion Preoperative stimulation planning for craniosynostosis patient is very valuable tool in the surgical management of craniosynostosis patients.

• Maxillofacial Plastic and Reconstructive Surgery
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• 제37권
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• pp.21.1-21.8
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• 2015

Computer Assisted Simulation Surgery (CASS) is a reliable method that permits oral and maxillofacial surgeons to visualize the position of the maxilla and the mandible as observed in the patient. The purpose of this report was to introduce a newly developed strategy for proximal segment management according to Balanced Orthognathic Surgery (BOS) protocol which is a type of CASS, and to establish the clinical feasibility of the BOS protocol in the treatment of complex maxillo-facial deformities. The BOS protocol consists of the following 4 phases: 1) Planning and simulation phase, 2) Modeling phase, 3) Surgical phase, and 4) Evaluation phase. The surgical interventions in 80 consecutive patients were planned and executed by the BOS protocol. The BOS protocol ensures accuracy during surgery, thereby facilitating the completion of procedures without any complications. The BOS protocol may be a complete solution that enables an orthognatic surgeon to perform accurate surgery based on a surgical plan, making real outcomes as close to pre-planned outcomes as possible.

• Journal of Trauma and Injury
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• 제32권1호
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• pp.8-16
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• 2019

Purpose: The Essential Surgical Procedures in Trauma (ESPIT) course was developed as a model to teach necessary surgical procedures to trauma physicians. Its goals are to improve knowledge, self-confidence, and technical competence. Methods: The ESPIT course consisted of five lectures and a porcine lab operative experience. The ESPIT course has been run seven times between February 2014 and April 2016. ESPIT participants completed a questionnaire to assess self-efficacy regarding essential surgical procedures in trauma before and immediately after taking the ESPIT course. Sixty-three participants who completed both pre- and post-course questionnaires on self-efficacy were enrolled in this study. Results: The overall post-ESPIT mean self-efficacy score was higher than the pre-ESPIT mean self-efficacy score ($8.3{\pm}1.30$ and $4.5{\pm}2.13$, respectively) (p<0.001). Self-efficacy was significantly improved after the ESPIT course in general surgeons (p<0.001), thoracic and cardiovascular surgeons (p<0.001), emergency medicine doctors, and others (neurosurgeons, orthopedic surgeons) (p<0.001). The differences in self-efficacy score according to career stage (<1 year, 1-3 years, 3-5 years, and >5 years) were also statistically significant (p<0.001). Conclusions: The data of the ESPIT participants indicated that they felt that the ESPIT course improved their self-efficacy with regard to essential surgical procedures in trauma. The ESPIT course may be an effective strategy for teaching surgical procedures, thus promoting better management of traumatic injuries.

• 한국가시화정보학회지
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• 제18권3호
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• pp.96-102
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• 2020

Oral cancer surgery changes the morphologic characteristics of the human upper airway. These changes can affect the flow patterns. In this study, computational fluid dynamics (CFD) simulations with transient solver were performed to numerically investigate the air flows in the human upper airways depending oral cancer surgery. 3D reconstructed models were obtained from 2D CT images of one patient. For the boundary condition, the realistic breathing cycle of human was applied. The hydraulic diameters of cross-sections for post-surgical model are changed greatly along streamwise direction, so these variations can cause higher wall shear stress and flow disturbance compared to pre-surgical model. The recirculation flows observed in the protruding region result in the relatively large pressure drop. These results can be helpful to understand the flow variations after resection surgery of oral cancer.

• Journal of International Society for Simulation Surgery
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• 제1권1호
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• pp.16-18
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• 2014

The orbit has a very special anatomical structure. The complex anatomical structure should be restored when we encounter the patient with orbital wall fracture. Unless these specific anatomy were reconstructed well, the patient should suffer from various complications such enophthalmos, diplopia or orbital deformity. In addition, because the patient has a his own specific orbital shape, individualized approach will be necessary. The aim of this trial is to try to restore the original orbit anatomy as possible based on the mirrored three dimensional CT images based on the computer simulation. Preoperative computed tomography (CT) data were processed for the patient and a rapid prototyping (RP) model was produced. At the same time, the uninjured side was mirrored and superimposed onto the traumatized side, to create a mirror-image of the RP model. In order to restore the missing skipped images between the cuts of CT data because of the thinness of the orbital walls, we manipulated the DICOM data for imaging the original orbital contour using the preoperatively manufactured mirror-image of the RP model. And we fabricated Titanium-Medpor to reconstruct three-dimensional orbital structure intraoperatively. This prefabricated Titanium-Medpor was then inserted onto the defected orbital wall and fixed. Three dimensional approach based on the computer simulation turned out to be very successful in this patient. Individualized approach for each patient could be an ideal way to manage the traumatic patients in near future.

• Journal of International Society for Simulation Surgery
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• 제2권2호
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• pp.80-82
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• 2015

The mandibuloplasty for the facial aesthetic reason has been the one of the most popular procedures in aesthetic facial bone surgery in East Asia. Most East Asian women prefer smaller-looking and smooth-shaped facial contour. Prominent mandible angle which are common in Asia would be the main problem for smooth facial contour. In addition, recently, the mandibular body and broad chin shape also are known to be remodeled in order to get the ideal smooth facial shape. However, mandibuloplasty is not that easy to cut because many patients has inward mandibular angle and the visual field in operation is limited. The aim of this trial is to try to provide the prefabricated cutting guide for the symmetric and appropriate mandibuloplasty with the surgeons. Preoperative computed tomography(CT) data were processed for the patient and computer simulation model was produced. Then, mandibuloplasty was done on the computer simulation screen. Based on this data, customized cutting guide was made. This prefabricated cutting guide was used in real mandibuloplasty bilaterally. Premade cutting guide for the mandibuloplasty based on the computer simulation turned out to be very successful in this patient. Individualized approach for each patient could be an ideal way to manage the patients in near future.

• Archives of Plastic Surgery
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• 제44권4호
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• pp.293-300
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• 2017

Background Simulation training is becoming an increasingly important component of skills acquisition in surgical specialties, including Plastic Surgery. Non-living simulation models have an established place in Plastic Surgical microsurgery training, and support the principles of replacement, reduction and refinement of animal use. A more sophisticated version of the basic chicken thigh microsurgery model has been developed to include dissection of a type 1-muscle flap and is described and validated here. Methods A step-by-step dissection guide on how to perform the chicken thigh adductor profundus free muscle flap is demonstrated. Forty trainees performed the novel simulation muscle flap on the last day of a 5-day microsurgery course. Pre- and post-course microvascular anastomosis assessment, along with micro dissection and end product (anastomosis lapse index) assessment, demonstrated skills acquisition. Results The average time to dissect the flap by novice trainees was $82{\pm}24$ minutes, by core trainees $90{\pm}24$ minutes, and by higher trainees $64{\pm}21$ minutes (P=0.013). There was a statistically significant difference in the time to complete the anastomosis between the three levels of training (P=0.001) and there was a significant decrease in the time taken to perform the anastomosis following course completion (P<0.001). Anastomosis lapse index scores improved for all cohorts with post-test average anastomosis lapse index score of $3{\pm}1.4$ (P<0.001). Conclusions The novel chicken thigh adductor profundus free muscle flap model demonstrates face and construct validity for the introduction of the principles of free tissue transfer. The low cost, constant, and reproducible anatomy makes this simulation model a recommended addition to any microsurgical training curriculum.