• Journal of Dental Anesthesia and Pain Medicine
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• 제20권5호
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• pp.331-335
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• 2020

Various anesthetic techniques have been utilized for maxillo-mandibular fixation. We report the case of a patient with bilateral condylar and zygomatic arch fractures who had severe pulmonary dysfunction. The patient was administered bilateral image-guided Gasserian ganglion block through the foramen ovale to achieve surgical anesthesia. The technical details, advantages, and disadvantages of this rather unusual technique are discussed. The procedure could be a feasible technique when performed meticulously in cases where other approaches are deemed difficult.

• Journal of Chest Surgery
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• 제54권4호
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• pp.310-313
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• 2021

There are several types of minimally invasive approaches for thymectomy, of which the transpleural approach by video-assisted thoracoscopic surgery is particularly useful. In this approach, thymectomy is performed from either side of the thoracic cage. Thoracic surgeons should be familiar with the principles of the procedure, the anatomy of the region, and surgical strategies for successful thymectomy. The details of transpleural thymectomy are discussed herein.

• Journal of the Korean Association of Oral and Maxillofacial Surgeons
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• 제47권6호
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• pp.476-479
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• 2021

For treatment of mandibular condyle fracture, this article introduces the surgical protocol of intraoral reinsertion after extracorporeal fixation. This efficient, anatomically acceptable, extraoral scar-free, and relatively uncomplicated approach for condylar fracture can be compared with conventional extraoral fixation through various approaches. Clinical step-by-step procedures with a scientific basis were described in this technical strategy note.

• 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.

• Journal of Korean Neurosurgical Society
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• 제29권11호
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• pp.1437-1444
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• 2000

저자들은 10년동안 수술을 시행받았던 212례의 수막종 환자중 뇌기저부에 위치한 61례에 대한 임상 분석을 시행한 결과 다음과 같은 결과를 얻었다. 1) 본 연구기간중 뇌기저부 수막종 환자는 61례로 전체의 29%를 차지하였으며, 평균 추적기간은 약 52개월이었다. 2) 성비는 여성이 남성보다 약 2배 많았으며, 평균연령은 52세였다. 3) 위치별로는 후두개와가 가장 많았으며, 전체적으로는 접형골연부, 천막부 및 소뇌교각부가 대부분을 차지하였다. 4) 호발증상 및 징후로는 두통, 뇌신경마비 및 소뇌징후 순으로 나타났다. 5) 종양제거정도는 심슨등급 I, II로 전적출한 경우가 82%이었으며, 심슨등급 III로 아전적출한 경우가 18%이었다. 6) 병리조직결과는 양성이 85%로 대부분을 차지하였으며, 비정형성과 악성은 각각 10%, 5%를 차지하였다. 7) 술후 보조적 치료는 악성, 부분적출 및 재발한 경우에 사용하였다. 8) 술후 합병증으로는 뇌척수액누출, 뇌신경마비 및 간질 발작 순이었다. 9) 술후 사망한 경우는 수술후 사망한 1례와 종양 재발에 의한 사망 2례이었다. 10) 재발은 약 15%로 심슨등급 III와 악성인 경우에 높았으며, 재발 위치는 천막부, 접형골연 및 소뇌교각부 순이었다. 결론적으로 뇌기저부 수막종의 수술은 종양 주변부의 중요한 구조물이 위치함에 따라 낮은 사망률 및 합병증 발생률을 가지고 수술적 적출이 어렵지만, 술전 방사선학적 소견의 정확한 이해와 적절한 접근법의 선택, 뇌기저부 재건술이 술후 합병증의 감소 및 종양적출을 위해 필수라고 생각한다.

• Journal of Korean Neurosurgical Society
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• 제30권9호
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• pp.1079-1085
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• 2001

Objective : We analysed various surgical approaches and surgical results of 28 middle cranial base tumors for the purpose of selecting optimal surgical approach to the middle cranial base tumor. Methods : In this retrospective review, 28 patients, including 16 meningioma, 6 trigeminal neurinoma, 2 pituitary adenoma, 2 craniopharyngioma, 1 facial neurinoma, and 1 metastatic tumor, underwent surgical treatment using skull base technique. Of theses, 16 tumors were mainly confined to middle cranial fossae, 5 tumors with extension into both anterior and middle fossa, and 7 tumors with extension into both middle and posterior fossa. Tumors that confined to the middle cranial fossa or extended into the anterior cranial fossa were operated with modified pterional, orbitozygomatic or Dolen'c approach, and tumors that extended into the posterior cranial fossa were operated with anterior, posterior or combined transpetrosal approach. Completeness of tumor resection, surgical outcome, postoperative complication, and follow up result were studied. Results : Total tumor removal was achieved in 9 tumors of 10 tumors that did not extended to the cavernous sinus, and was achieved in 7 tumors of 8 tumors that extended to the lateral wall of the cavernous sinus. Of 10 tumors that extended to the venous channel of the cavernous sinus, only 2 were removed totally. Surgical outcome was excellent in 14 patients, good in 10, fair in 2 and poor in 2. There were no death in this series. Dumbell type tumor which extended into both middle and posterior fossae showed tendency of poor prognosis as compared with tumors that confined middle cranial fossa and extended into both anterior and middle cranial fossa. Postoperative dysfunctions were trieminal hypesthesia in 3, oculomotor nerve palsy in 2, abducens nerve palsy in 2, hemiparesis in 2, cerebellar sign in 1, facial palsy in 1 and hearing impairment in 1. Conclusion : Based on our findings and a review of the literature, we conclude that, when selecting the surgical approach to the middle cranial fossa tumors, the most important factors to be considered were exact location of the tumor mass and existence of the cavernous sinus invasion by tumor mass. We recommend modified pterional or orbitozygomatic approach in cases with tumors located anterior and middle cranial base, without cavernous sinus invasion. In cases with tumors invading into cavernous sinus, we recommend Dolen'c or orbitozygomatic approach. And in lateral wall mass and the cavernous sinus, it is preferred to approach the tumor extradurally. For the tumor involing with middle fossa and posterior fossa(dumbell type) a combined petrosal approach is necessary. In cases with cavernous sinus invasion and internal carotid artery encasement, we recommend subtotal resection of the tumor and radiation therapy to prevent permanent postoperative sequele.

• Maxillofacial Plastic and Reconstructive Surgery
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• 제38권
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• pp.36.1-36.6
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• 2016

Background: Fracture of the zygomaticomaxillary complex (ZMC) is one of the most common facial injuries. A previous study has performed 3D analyses of the parallel and rotational displacements that occur in a fractured ZMC. However, few studies have investigated adequate fixation methods according to these displacements. Here, we assessed whether specific approaches and fixation methods for displacement of ZMC fractures produce esthetic results. Methods: Hospital records and pre- and post-surgical computed tomographic scans of patients treated for ZMC fractures at the Department of Oral and Maxillofacial Surgery, College of Dentistry, Wonkwang University, between January 2010 and December 2015, were selected. Data were analyzed according to the direction of displacement and post-reduction prognosis using a 3D software. Results: With ZMC fractures, displacement in the posterior direction occurred most frequently, while displacement in the superior-inferior direction was rare. A reduction using a transconjunctival approach and an intraoral approach was statistically better than that using an intraoral approach, Gillies approach, and lateral canthotomy approach for a posterior displacement (P < 0.05). Conclusions: When posterior displacement of a fractured ZMC occurs, use of an intraoral approach and transconjunctival approach simultaneously is recommended for reducing and fixing the displaced fragment accurately.

• 한국컴퓨터그래픽스학회논문지
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• 제20권1호
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• pp.1-11
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• 2014

뇌성마비에서 나타나는 하지 변형은 정상 보행 및 자세 유지에 어려움을 준다. 이를 교정하기 위해 임상의는 변형 정도를 측정하여 교정 절골술 계획을 수립하고 계획된 정도만큼 절골술을 시행한다. 그러나 절골술 시행 후 원래 계획보다 더 적거나 더 많이 교정되는 상황이나 의도치 않았던 변형이 발견되는 상황이 종종 발생한다. 이러한 문제 상황들이 발생하는 이유는 절골술 계획수립 시, 기존의 방법이 하지골의 정확한 형태학적 정보를 반영하기 어렵고 하지골을 절골하여 회전 시키는 정도에 따라 최종 결과가 어떻게 나오는지 사전에 예측하는 것이 쉽지 않으며 효과적인 교정 결과를 얻을 수 있는 절골술 방법, 회전각도 등 다양한 입력 조건의 최적 조합을 찾기가 어렵기 때문이다. 본 논문은 이를 해결하기 위해 컴퓨터 그래픽스 분야의 정기구학, 역기구학 및 최적화 기법을 하지 교정 절골술에 적용하여 임상의가 최적의 절골술 계획을 수립할 수 있도록 하는 방법을 제안한다. 하지 골의 3차원 메쉬 모델을 입력으로 받아 이를 분석하여 하지 특징점을 추출하고 임상지표를 자동으로 계산하여 변형 정도를 파악하는 방법, 하지 골을 대상으로 하는 5가지 교정 절골술의 시뮬레이션을 통해 그 결과를 사전에 예측할 수 있는 방법 그리고 비선형 최적화 문제로 변환하여 최적 교정 절골술 계획을 자동으로 수립하는 방법을 제안한다. 이를 통해 하지 골 교정 절골술과 관련된 거의 모든 경우의 수를 사전에 확인해 볼 수 있어서 종래의 방법보다 훨씬 쉽고 효율적으로 절골술을 계획하고 실행할 수 있을 것이다.

• Journal of Chest Surgery
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• 제19권2호
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• pp.232-237
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• 1986

The intraventricular conduction disturbances have been documented after correction of ventricular septal defects by any surgical route but debated its etiology. And so the frequency of conduction disturbances following right ventriculotomy, right atriotomy and pulmonary arteriotomy for closure of ventricular septal defects was compared in various conditions. The present series consists of 218 patients with ventricular septal defects. They had the surgical repair at the Seoul National University Hospital from January 1983 to October 1984. Conduction disturbances were studied with conventional 12 leads electrocardiogram. Of the 218 VSD`s 139 patients were repaired via vertical right ventriculotomy, 45 patients via right atriotomy, 34 patients via pulmonary arteriotomy. 1] Of 218 patients the frequency of RBBB was 26.1% and the frequency of RBBB + LAH was 6.0%. 2] There is no statistical difference between right ventriculotomy group [30.2%] and right atriotomy group [24.4%]. But there is significant difference between right ventriculotomy group and pulmonary arteriotomy group [11.8%] [P<0.05]. 3] In respect to anatomical classification by Kirklin`s method, the frequency of RBBB was higher in type II [32.1%] than in type I [14.9%]. [P<0.05] But in each anatomical type, there is no influence of the various surgical approach on the incidence of postoperative RBBB. 4] The frequency of RBBB was 31.8% in patch closure group and 14.3% in direct closure group. [P<0.05] Although the result suggests that there is no significant difference in various surgical approaches on the incidence of postoperative conduction disturbances, it may be reduced by a new-ventricular approach or a limited incision at right ventricular outflow tract in right ventricular approach.

• 대한관절경학회지
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• 제2권1호
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• pp.25-32
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• 1998

The distinction between isolated and combined injuries is crucial both for treatment and prognosis. For most combined injuries, surgical treatment continues to be favored over nonoperative treatment. It is generally agreed that isolatel PCL injuries do well without surgery. There has been an interest by many authors to fix the graft directly to the posterior aspect of the tibia(tibial inlay). With this procedure, tibial graft fixation will be more direct and theoretically reduce the bending effects of the graft with a fixation site far away from the tibial insertion. Modified tibial inlay technique, which is the posterior approach does not require the patient to be in the prone or lateral decubitus position during the operation. Use of a double-bundle reconstructive technique is attractive and has been performed by some surgeons. At this time, this procedure is still being investigated and should not be routinely used in the clinical setting until studies have indicated an advantage over current single-bundle techniques. However theologically, double-bundle reconstructive technique is more useful in severe posterior unstable knee. Recent advances have increased our knowledge of the anatomy and mechanical characteristics of the PCL. Basic science research has further increased our awareness of the interaction of the posterolateral structures with the PCL. To achieve restoration of normal posterior laxity, it is critical to address the posterior as well as the postero-lateral structures. Surgical treatment is often complex and requires a wide range of surgical techniques and skills to treat associated injuries. When the PCL is reconstructed, most surgeons choose to reconstruct the anterolateral component using a graft of sufficient size and strength. The initial postoperative rehabilitation should be addressed cautiously in an effort to avoid excessive forces on delicate repairs and reconstructions in these complex injuries. Further research is necessary to evaluate new surgical approaches such as double-bundle reconstructions and tibial inlay techniques as well as improved techniques for capsular and collateral ligament injuries.