• 한국산학기술학회논문지
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• 제16권10호
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• pp.6985-6991
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• 2015

서론: 통상적인 갑상선 암 수술시 생기는 목의 전면에 있는 흉터를 피하기 위해 여러 다양한 수술 기법들이 고안되고 있다. 저자들이 고안한 로봇 내시경 갑상선 수술법으로 수술을 시행 받은 256예를 대상으로 기구의 변화와 더불어 로봇 내시경적 수술방법(액와 유륜 접근법과 유일-액와 접근법)에 따라 수술 결과를 비교하여 각 수술 방법의 안정성 및 유용성을 확인하고자 하였다. 대상 및 방법: 2008년 11월부터 2014년 7월까지 로봇 내시경 갑상선 수술을 시행 받은 256명의 환자를 대상으로 하였다. 접근방법에 따라 2008년 11월부터 2010년 7월까지 액와-유륜 접근법(Axillo-Breast approach, AB group)이 128례, 2010년 8월부터 2014년 7월까지 유일-액와 접근법(Only-Axillary approach, OA group)이 128예로 구성되었다. 수집된 자료는 SPSS v.12 를 이용하여 실험군과 대조군의 동질성 검정은 independent t-test, fisher's exact test, $x^2$-test로 양측검정을 실시하였다. 결과: 종양의 특성, 수술범위, 채취된 평균 림프절 개수(AB group 5.1개, OA group 6.1개), 수술 후 주요 합병증(AB group 0.8%, OA group 0.8%)은 양 군간에 차이는 없었다. 유일-액와 접근법의 경우 유륜의 흉터를 피할 수 있었다. 결론: 액와-유륜 접근법과 유일-액와 접근을 통한 로봇 내시경적 갑상선 절제술 모두 안전하고 유용한 수술법이다. 로봇 내시경 갑상선 수술에서 유륜의 흉터를 피하고자 하는 경우, 5 mm Maryland dissector 2개를 이용한 유일-액와 접근을 통한 로봇 내시경 갑상선 절제술을 고려해 볼 수 있을 것으로 생각된다.

• Journal of Trauma and Injury
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• 제36권4호
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• pp.362-368
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• 2023

Purpose: Clinical reports on treatment outcomes of sternal fractures are lacking. This study details the clinical features, treatment approaches, and outcomes related to traumatic sternal fractures over a 10-year period at a single institution. Methods: A retrospective cohort study was conducted of patients admitted to a regional trauma center between January 2012 and December 2021. Among 7,918 patients with chest injuries, 266 were diagnosed with traumatic sternal fractures. Patient data were collected, including demographics, injury mechanisms, severity, associated injuries, sternal fracture characteristics, hospital stay duration, mortality, respiratory complications, and surgical details. Surgical indications encompassed emergency cases involving intrathoracic injuries, unstable fractures, severe dislocations, flail chest, malunion, and persistent high-grade pain. Results: Of 266 patients with traumatic sternal fractures, 260 were included; 98 underwent surgical treatment for sternal fractures, while 162 were managed conservatively. Surgical indications ranged from intrathoracic organ or blood vessel injuries necessitating thoracotomy to unstable fractures with severe dislocations. Factors influencing surgical treatment included flail motion and rib fracture. The median length of intensive care unit stay was 5.4 days (interquartile range [IQR], 1.5-18.0 days) for the nonsurgery group and 8.6 days (IQR, 3.3-23.6 days) for the surgery group. The median length of hospital stay was 20.9 days (IQR, 9.3-48.3 days) for the nonsurgery group and 27.5 days (IQR, 17.0 to 58.0 days) for the surgery group. The between-group differences were not statistically significant. Surgical interventions were successful, with stable bone union and minimal complications. Flail motion in the presence of rib fracture was a crucial consideration for surgical intervention. Conclusions: Surgical treatment recommendations for sternal fractures vary based on flail chest presence, displacement degree, and rib fracture. Surgery is recommended for patients with offset-type sternal fractures with rib and segmental sternal fractures. Surgical intervention led to stable bone union and minimal complications.

• Archives of Plastic Surgery
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• 제33권3호
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• pp.388-391
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• 2006

Hemangioma is one of the most common congenital tumors in the region of the face and neck. Although histologically benign, these facial masses are clinically malignant for their deforming and inexorable growth, especially in so-called 'cavernous hemangioma'. Carvenous hemangioma is the most common primary tumor occurring in the adult orbit. This tumor has symptoms that characteristically develop over several years with slowly progressive proptosis, eyeball deviation, hyperopia, diplopia and optic nerve compression. Today, hemangiomas are being treated by various methods; steroids, electrocoagulation, injection of sclerosing agent, cryotherapy, radiation therapy, laser therapy, and surgical treatment, etc. In principle, surgical approaches to the orbit must provide maximum safety and optimal visualization. We have experienced a case of large cavernous hemangioma in the orbit inferolaterally. The surgical treatment of tumor was achieved by the bicoronal approach combined with inferomedial and inferolateral orbitotomy. This surgical approach allows better visualization of the tumor and greater protection of essential anatomic structures. We obtained satisfactory results in terms of aesthetic and functional consideration. We present our case with a brief review of the literature related to orbital cavernous hemangioma.

• 대한두개안면성형외과학회지
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• 제25권3호
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• pp.105-115
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• 2024

The mouth, located in the lower third of the face, is a uniquely visible structure. It serves as a vital organ both aesthetically and functionally, playing a key role in speech, expression, and fundamental oral functions. Consequently, any alterations or defects in its shape, due to various causes, can lead to aesthetic and functional deficiencies. These issues may also result in challenges with social interactions and a decrease in confidence. In cases of microstomia, various surgical approaches are proposed based on the location, extent, shape, and cause of the defect, leading to numerous case reports. Plastic surgeons are proficient in oral reconstruction; however, cases of microstomia are relatively rare, which reduces their familiarity and interest in these cases. Additionally, preferences for oral size and shape vary according to factors such as geographical region and ethnicity, further complicating the functional definition of microstomia. Therefore, both subjective patient and physician judgments play crucial roles in the diagnosis and treatment of microstomia, as these may vary depending on individual and societal aspects. This review aims to classify the various causes and definitions of microstomia, as well as its non-surgical and surgical treatment options, with the goal of the treatment of this condition.

• Clinics in Shoulder and Elbow
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• 제27권2호
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• pp.212-218
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• 2024

Background: Rotator cuff tears commonly cause shoulder pain and functional impairment, prompting surgical intervention such as mini-open and arthroscopic methods, each with distinct benefits. This study aimed to compare the clinical outcomes and complications of these two approaches. Methods: A retrospective analysis was conducted on 165 patients who underwent rotator cuff repair using either arthroscopic-assisted mini-open or full arthroscopic approaches. Patient demographics, tear characteristics, clinical outcomes, and complications were assessed, with statistical analyses conducted to discern differences between the groups. Results: Among the patients, 74 (53.2%) received the mini-open approach, while 65 (46.8%) underwent arthroscopic repair, with a mean follow-up of 19.91 months. The mini-open group exhibited significantly higher postoperative American Shoulder and Elbow Surgeons (ASES) scores compared to the arthroscopic group (P=0.002). Additionally, the mini-open group demonstrated a more significant improvement in ASES scores from preoperative to postoperative assessments (P=0.001). However, the arthroscopic method had a significantly longer operative time (P<0.001). Complications, including anchor placement issues, frozen shoulder, infection, and re-rupture, occurred in 17.3% of patients overall. Re-rupture rates were 13.5% for mini-open and 6.2% for full arthroscopic repair, with no significant difference between the two methods (P=0.317). Conclusions: Both the mini-open and arthroscopic methods yielded favorable clinical outcomes for rotator cuff tear treatment, but the mini-open group exhibited superior results. Surgeons should consider patient characteristics, tear attributes, and surgical expertise when selecting the appropriate technique.

• Maxillofacial Plastic and Reconstructive Surgery
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• 제41권
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• pp.3.1-3.9
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• 2019

Background: The infratemporal fossa (ITF) is an anatomical lateral skull base space composed by the zygoma, temporal, and the greater wing of the sphenoid bone. Due to its difficult approach, surgical intervention at the ITF has remained a heavy burden to surgeons. The aim of this article is to review basic skull base approaches and ITF structures and to avoid severe complications based on the accurate surgical knowledge. Methods: A search of the recent literature using MEDLINE (PubMed), Embase, Cochrane Library, and other online tools was executed using the following keyword combinations: infratemporal fossa, subtemporal fossa, transzygomatic approach, orbitozygomatic approach, transmaxillary approach, facial translocation approach, midface degloving, zygomatico-transmandibular approach, and lateral skull base. Aside from our Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) trial, there have been very few randomized controlled trials. The search data for this review are summarized based on the authors' diverse clinical experiences. Results: We divided our results based on representative skull base approaches and the anatomy of the ITF. Basic approaches to the ITF include endoscopic endonasal, transzygomatic, orbitozygomatic, zygomatico-transmandibular, transmaxillary, facial translocation, and the midfacial degloving approach. The borders and inner structures of the ITF (with basic lateral skull base dissection schemes) are summarized, and the modified zygomatico-transmandibular approach (ZTMA) is described in detail. Conclusions: An anatomical basic knowledge would be required for the appropriate management of the ITF pathology for diverse specialized doctors, including maxillofacial, plastic, and vascular surgeons. The ITF approach, in conjunction with the application of microsurgical techniques and improved perioperative care, has permitted significant advances and successful curative outcomes for patients having malignancy in ITF.

• 대한두개안면성형외과학회지
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• 제16권1호
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• pp.17-23
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• 2015

Background: Treatment of skull base tumors is challenging due to limited access and presence of important neurovascular structures nearby. The success of a complete tumor resection depends on the extent of tumor exposure and secure field of view. While these tumors are often removed by transcranial endoscopic access, transfacial approach is sometimes required depending on the location and size of the tumor. This study describes various transfacial approaches in patients undergoing skull base tumor resection. Methods: From March to November 2013, 15 patients underwent skull base tumor resection via transfacial accesses at a tertiary institution. Data were reviewed for patient demographics, type of access used, completeness of tumor resection, surgical outcome, and postoperative complications. Results: Two clivus tumor patients underwent transmaxillary approach; three tuberculum-sellae and suprasellar-hypothalamus tumor patients underwent transbasal approach; three clinoid and retrobulbar intraconal orbital tumor patients underwent orbitozygomatic approach; and seven petroclival-area, pons, cavernous sinus, and lateral-sphenoid-wing tumor patients underwent zygomatic approach. In all cases, the upper and lower margins of the tumor were visible. Complete tumor removal consisted of 10 cases, and partial tumor removal in 5. There were no immediate major complications observed for the transfacial portion of the operations. The overall cosmetic results were satisfactory. Conclusion: Plastic surgeons can use various transfacial approaches according to the location and size of skull base tumors to secure a sufficient field of view for neurosurgeons.

• 대한소아치과학회지
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• 제27권3호
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• pp.431-437
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• 2000

외상성 함입탈구는 유치열에서는 흔하지만 영구치열에서는 매우 드문 질환으로 그 예후가 좋지 않은 것으로 널리 알려져 있다. 치료법으로는, 치아의 자발적 맹출을 허용하거나, 외과적으로 재위치시킨 후 고정시키는 방법, 외과적인 탈구술 및 교정력을 이용한 재위치술 등이 있었으나, 각각의 단점들이 보고되어 왔다. 한편 치아를 외과적으로 아탈구시킨 후 바로 교정력을 적용시켜, 좋은 성과가 보고된 바 있었는데 완전 함입례에서는 교정용 button 이나 bracket을 bonding하기가 적절치 않다. 본 증례는 비강내로까지의 심한 함입탈구 소견을 보이는 환아의 치료에 관한 것이다. 우선 full mucogingival flap을 행하고, 치주인대의 압박 괴사를 최소화시키기 위해 disimpaction시킬 목적으로 백악-법랑 경계부가 노출되지 않는 범주 내에서 치조와 내로 외과적 재위치 시킨 후 교정적 견인력을 적용시키는 방법을 통해 비교적 양호한 결과를 얻게 되었다.

• 한국정밀공학회지
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• 제24권4호
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• pp.138-146
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• 2007

Some biodegradable polymers and other materials such as hydrogels have shown the promising potential for surgical applications. Post surgical adhesion caused by the natural consequence of surgical wound healing results in repeated surgery and harmful effects. Recently, scientists have developed absorbable anti-adhesion barriers that can protect a tissue from adhesion in case they are in use; however, they are dissolved when no longer needed. Although these approaches have been attempted to fulfill the criteria for adhesion prevention, none can perfectly prevent adhesions in all situations. Overall, we developed a new method to fabricate an anti-adhesion membrane using biodegradable polymer and hydrogel. It employed a highly accurate three-dimensional positioning system with pressure-controlled syringe to deposit biopolymer solution. The pressure-activated microsyringe was equipped with fine-bore nozzles of various inner-diameters. This process allowed that inner and outer shapes could be controlled arbitrarily when it was applied to a surgical region with arbitrary shapes. In order to fulfill the properties of the ideal barriers f3r preventing postoperative adhesion, we adopted the pre-mentioned method combined with surface modification with the hydrogel coating by which anti-adhesion property was improved.

• 대한족부족관절학회지
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• 제26권1호
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• pp.22-29
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• 2022

Purpose: Despite continuous updates of standard treatment guidelines for acute ankle sprain and chronic ankle instability (CAI), in practice preferred treatment protocols vary widely. Based on a Korean Foot and Ankle Society (KFAS) member survey, this study reports current trends in the management of ankle ligament injuries. Materials and Methods: A web-based questionnaire containing 34 questions was sent to all KFAS members in September 2021. Questions mainly addressed clinical experience and preferences for the diagnosis and treatment of ankle ligament injuries. Answers with a prevalence of ≥50% among respondents were considered to reflect tendencies. Results: Eighty-four of the 550 members (15.3%) responded. Answers that showed a tendency were as follows: commonest additional image study (ultrasound), conservative treatment modality (immobilization, oral medication), frequency of surgical treatment (<5 cases per annum), most important factor when deciding on surgical treatment (activity level, e.g., occupation or sport), and commonest surgical procedure (open ligament repair). Answers that showed a tendency for CAI were as follows: most important symptom (repeated sprain, giving way), radiological factors (talar tilt, osteochondral lesion, anterior talar translation), and patient factors (occupation, sports activities, recurrent instability after surgery, etc.). For decision making regarding surgical treatment and method, the most preferred surgical procedure was the modified Broström procedure, and the most common repair technique was suture anchor technique. The following were considered poor prognostic factors; generalized laxity, failed previous surgery, cavovarus, severe mechanical instability, heavy work, obesity, and dissatisfaction after surgery because of residual pain. Conclusion: This study updates information regarding current trends in the management of ankle ligament injuries in Korea, and reveals consensus opinions and variations in approaches to patients with an acute or chronic injury. The divergence of approaches identified indicates the need for further studies to determine standard guidelines and long-term results.