• Journal of Oral Medicine and Pain
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• v.35 no.2
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• pp.119-122
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• 2010

Carbondioxide($CO_2$) laser is one of the most widely employed lasers in oral soft tissue surgery because of its excellent affinity for water based soft tissues. It has some inherent advantages such as hemostasis, less postoperative swelling, reduction of bacterial population at surgical site, less need for suturing, less scarring, and less postoperative pain compared to conventional surgical therapies including the use of scalpel, diathermy, cryotherapy and electrosurgery. A 30-years-old male was presented with gingival swelling. Clinical examination revealed a well?defined pedunculated fibrotic mass on the buccal gingiva near right maxillary 1st molar. In radiographic examination, no remarkable abnormality was seen. Excisional biopsy was performed with $CO_2$ laser (continuous wave mode, 4.0W). Histological diagnosis was "Irritation fibroma". $CO_2$ laser has advantages those are suitable for surgical treatment of intraoral lesion. If appropriate training and experience are provided, the dentist would be able to manage intraoral lesions more efficiently and successfully with the use of the $CO_2$ laser.

• Journal of the Korea Academia-Industrial cooperation Society
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• v.16 no.10
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• pp.6985-6991
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• 2015

Purpose: Various new techniques in thyroid surgery have been developed to improve visualization and reduce risk of complications. New approaches for robotic endoscopic thyroidectomy help to prevent neck scarring and improve surgical ergonomics. The purpose of this study was to compare the efficacy and adventages of an axillo-breast approach (AB group) and an only-axillary approach (OA group) in robotic endoscopic thyroidectomy. Methods: Between November 2008 and July 2014, axillo-breast approach was performed in 128 patients and only-axillary approach was performed in 128 patients for robotic endoscopic thyroidectomy. We compared tumor characteristics, surgical outcomes, and postoperative complications between the two approaches. The homogeneity between two groups of general characteristics was analyzed by independent t-test, fisher's exact test, Chi-square test. Results: There were no differences in terms of tumor characteristics, extent of thyroidectomy, retrieved nodes, and postoperative complications between the two approaches. The patients in OA group can avoid breast scar. Conclusion: Our techniques of AB and OA approaches for robotic endoscopic thyroidectomy are safe, feasible, and cosmetically excellent procedures. Also the OA approach for robotic endoscopic thyroidectomy is an attractive surgical option for patients with thyroid tumor who want an avoid breast scar.

• Clinical and Experimental Pediatrics
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• v.45 no.12
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• pp.1540-1545
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• 2002

Purpose : Vesicoureteral reflux(VUR) is defined as a retrograde flow of urine from the bladder into the upper urinary tract. It has been shown to predispose patients to hypertension, renal scarring, and end-stage renal failure if not recognized and treated. The observation that VUR occurs in siblings of children with reflux at a significantly higher rate than the general pediatric population has been recognized for many years and VUR was detected in 26% to 51% of siblings of patients with VUR. The purpose of this study is to determine the incidence of VUR in asymptomatic siblings of children with VUR and to see if this form of screening would be practical. Methods : We retrospectively reviewed the records of 28 patients with VUR and their siblings. The total number of asymptomatic siblings investigating VUR were 28 persons. All patients and siblings were evaluated for VUR by a voiding cystourethrography and all patients and siblings with VUR were performed $^{99m}Tc$ 2,3-dimercaptosuccinic acid renal scan. Results : A total of 28 patients(14 boys, 14 girls) with VUR were studied; the mean patient age was 2.7 years(range 1 month to 8.4 years). The total number of asymptomatic siblings investigating VUR were 28 persons(17 boys, 11 girls) and the mean age was 3.3 years(range 2 months to 7.4 years). Renal scar was detected in 20 of 28(71.4%) patients with VUR. VUR was noted in three of 28(10.7%) siblings and renal scar was detected in one of three siblings with VUR. Conclusion : In this study, the predictive value of a positive family history alone in identifying VUR was 10.7%. This incidence suggests more investigation of asymptomatic siblings and continued study of this group of patients at risk is needed for clarifying the family screening of patients with VUR.

• Archives of Plastic Surgery
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• v.33 no.1
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• pp.39-45
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• 2006

This study is to examine the relationship between TGF-b1 expression and CTGF expression, and to evaluate the effect of Sp1 blockade on the expression of TGF-b1, CTGF and extracellular genes, clones of fibroblasts stably transfected with Sp1 decoy ODN. R-Sp1 decoy ODN was highly resistant to degradation by nucleases or serum, compared to the linear or phosphorothioated-Sp1 decoy ODN. Skin wounds were created on the back of 36 anesthetized rats. They were divided into four groups-the rats with normal skin, with wounded skin without decoy, with wounded skin injected with R-Sp1 decoy, and with wounded skin injected with mismatched R-Sp1 decoy, respectively. Skins were collected at 3rd, 5th, 7th, 14th day after wounding. Cellular RNA was extracted by RT-PCR analysis. TGF-${\beta}1$ and CTGF were deeply related with skin fibrosis during scar formation and it appeared that TGF-${\beta}1$ may cause the induction of CTGF expression. R-Sp1 decoy ODN inhibited TGF-${\beta}1$ and CTGF expression both in cultured fibroblasts and in the skin of rats. These results indicate that targeting Sp1 with R-type decoy efficiently blocks extracellular matrix gene expression, and suggest an important new therapeutic approach to control the scarring in normal wound healing and fibrotic disorders.

• Childhood Kidney Diseases
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• v.7 no.1
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• pp.38-43
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• 2003

Purpose : Accurate diagnosis of acute pyelonephritis(APN) using clinical and laboratory parameters is often difficult in children. Clinical and experimental studies have demonstrated that renal scarring can be prevented or diminished by early diagnosis and aggressive treatment of acute pyelonephritis. dimercaptosuccinic acid(DMSA) renal scan has been reported to be useful in children for confirmation of the diagnosis of acute pyelonephritis. An analysis was undertaken to correlate the clinical and laboratory manifestations of APN With the results of the DMSA renal scan in different age groups. Methods : We determined the sensitivity of DMSA renal scan in febrile urinary tract infections(UTI) in two groups according to age : group I in less than 2 years; group II in older than 2 years. During the period March 2001 through September 2002, 67 children presented with febrile UTIs. All patients had DMSA renal scan done in the acute period, 55 had voiding cystourethrography(VCUG) and 66 had renal ultrasonogram(RUS) done. Results : There were no significant difference between the two groups in DMSA renal scan (P>0.05). But, in group I sensitivity of DMSA renal scan was 47%; in group II sensitivity of DMSA renal scan was 70%. The grade of reflux correlated with a positive DMSA renal scan. Vesicoureteral reflux did not correlate with age. RUS did not correlate with a positive DMSA renal scan in any age group. Abnormality of RUS did not correlate with age. Conclusion : At present, we believe that DMSA renal scan is the prevailing method in differention of the APN. In addition, it is not invasive and less costly. Even though there is no statistical difference in the sensitivity of DMSA renal scan between young and older children, we can observe that in the younger group, the sensitivity of DMSA renal scan seemed to be lower(47%).

• Journal of the korean academy of Pediatric Dentistry
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• v.29 no.3
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• pp.450-454
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• 2002

Laceration of soft palate and oropharynx is relatively common in children. Soft palate laceration has been reported patients of all ages, ranging from new born to geriatric patients. However, young children often place objects their mouth, they may fall on the object or receive a direct force on the object which then perforates the soft palate tissue. Most frequently affected site is the left supra-tonsillar area. Lesions are predominately in the soft palate with-out perforation. Linear and superficial wounds are frequent. A typical injury is the flat- U-, or V-shaped with apex directed anteriorly. In those cases without any through-and-through lacerations or any tissue loss, suture is not necessary. Furthermore, suture of the affected site may hinder wound healing. Healing of the wound should be complete by three weeks with minimal scarring. There have been reports of carotid artery injury due to soft palate laceration causing neurologic complications. For such reasons, traumatized child must be in close observation for 2-3days, and if symptoms of complication are noticed consultation with oromaxillofacial surgeons, E.N.T., or neurologist is required. These are two reports of boys 2 and 3 years of age who had soft palate laceration caused by a falling-down-in jury with an object in their mouth. They were treated non-surgically and neurologic evaluation was carried out for 1 week with complete healing.

• Maxillofacial Plastic and Reconstructive Surgery
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• v.30 no.4
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• pp.380-385
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• 2008

Microstomia can be occurred as a result of direct injury to tissues such as chemical, thermal and electrical burns, and animal bites. It also may be secondary to contracture of burned perioral skin, or may result from scarring after reconstructive lip surgery. Narrowing of the oral aperture is not only disfiguring, but also limiting the oral access needed for introduction of food, insertion of dentures, oral hygiene, and dental treatment. Limited mouth opening may also interfere with mastication and speech. Few reports exist regarding correction of microstomia and reconstruction of the corners of the mouth. A 16-year-old girl with a bilateral cleft lip and palate presented with the limited mouth opening (approximately 20 mm), the esthetic problem due to the small lip, and the cleft lip-nasal deformity. The microstomia was corrected by bilateral commissuroplasty using "over and out" buccal mucosa flaps proposed by Converse. The intercommissure distance was increased from the preoperative 40 mm to the postoperative 60 mm. The one-year postoperative intercommissure distance was 54 mm, because the 6 mm relapse was occurred. The bilateral commissuroplasty using "over and out" buccal mucosa flap could increase the width and general size of the oral aperture and improve the lip appearance.

• Journal of Oral Medicine and Pain
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• v.37 no.3
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• pp.147-154
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• 2012

Hematopoietic stem-cell transplantation (HSCT) is a treatment for immune deficiency, autoimmune diseases, and hematopoietic malignancies. The main complication of allogenic HSCT is graft-versus-host disease (GVHD). Oral mucosal biopsy is needed for a definitive diagnosis and treatment planning of GVHD, but this procedure causes bleeding and bacteremia in a poor general condition. We evaluated the efficacy of laser-assisted biopsy as a minimally invasive treatment. Three cases were described in this article. All patients' medical records, clinical photographs, and histopathologic findings were reviewed. All patients felt comfortable and no severe complications occurred. The quality of the obtained biopsy material was adequate for a definitive diagnosis of GVHD. Laser-assisted, minimally invasive biopsy of the oral mucosa does not cause bleeding, and it reduces the chances of infection, bacteremia, and postoperative scarring compared to the usual histopathologic biopsy procedure. It would thus be advantageous to use this procedure to biopsy GVHD patients.

• Archives of Plastic Surgery
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• v.36 no.5
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• pp.583-590
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• 2009

Purpose: In the cases of a vascular compromised condition in an injured lower extremity, soft tissue coverage with free tissue transfer presents a challenging problem to the reconstructive surgeon. For this reason, cross - leg flaps are still used in unusual circumstances. Advances in surgical technique has made the cross - leg free flap possible although it may require long operation time along with significant donor site morbidity. Therefore, a pedicled cross - leg muscle flap may be an alternative treatment modality when local flap or free flap is not possible. Methods: Twelve patients(9 males and 3 females) underwent the operation between October of 2001 and December of 2008. The patients' age ranged from 6 to 82 years. The unusual defects included the regions such as the knee, popliteal fossa, distal third of the tibia, dorsal foot, and the heel. Indications for the cross - leg gastrocnemius flap are inadequate recipient vessels for free flap(in eight cases), extensive soft tissue injuries(in three cases) and free flap failure(in one case). The muscle flap was elevated from contralateral leg and transferred to the soft tissue defect on the lower leg while both legs were immobilized with two connected external fixator systems. Delay procedure was performed 2 weeks postoperatively, and detachment was done after the establishment of the adequate circulation. The average period from the initial flap surgery to detachment was 32 days (3 to 6 weeks). Mean follow - up period was 4 years. Results: Stable coverage was achieved in all twelve patients without any flap complications. Donor site had minimal scarring without any functional and cosmetic problems. No severe complications such as deep vein thrombosis or flap necrosis were noted although mild to moderate contracture of the knee and ankle joint developed due to external fixation requiring 3 to 4 weeks of physical treatment. All patients were able to walk without crutches 3 months postoperatively. Conclusion: Although pedicled cross - leg flaps may not substitute free flap surgery, it may be an alternative method of treatment when free flap is not feasible. Using this modification of the gastrocnemius flap we managed to close successfully soft tissue defects in twelve patients without using free tissue transfers.

• Archives of Plastic Surgery
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• v.45 no.3
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• pp.229-238
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• 2018

Background Nipple-sparing mastectomies (NSMs) are increasingly performed to obtain the best aesthetic and psychological outcomes in breast cancer treatment. However, merely preserving the nipple-areolar complex (NAC) does not guarantee a good outcome. Darkly pigmented NACs and a tendency for poor scarring outcomes are particular challenges when treating Asian patients. Herein, we review the reconstructive outcomes following NSM at Singapore General Hospital. Methods All breasts reconstructed following NSM over an 11-year period from 2005 to 2015 were reviewed. Information was collected from the patients' records on mastectomy indications, operative details, and complications. Patient satisfaction, breast sensation, and aesthetic outcomes were evaluated in 15 patients. Sensation was quantified using the Semmes-Weinstein monofilament test. Results A total of 142 NSMs were performed in 133 patients for breast cancer (n=122, 85.9%) or risk reduction (n=20, 14.1%). Of the procedures, 114 (80.2%) were autologous reconstructions, while 27 (19.0%) were reconstructions with implants. Complications occurred in 28 breasts (19.7%), with the most common complication being NAC necrosis, which occurred in 17 breasts (12.0%). Four breasts (2.8%) had total NAC necrosis. The overall mean patient satisfaction score was 3.0 (good). The sensation scores were significantly diminished in the skin envelope, areola, and nipple of breasts that had undergone NSM compared to non-operated breasts (P<0.05). Half of the subset of 15 patients in whom aesthetic outcomes were evaluated had reduced nipple projection. Conclusions Immediate reconstruction after NSM was performed with a low complication rate in this series, predominantly through autologous reconstruction. Patients should be informed of potential drawbacks, including NAC necrosis, reduced nipple projection, and diminished sensation.