• 대한두개안면성형외과학회지
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• 제15권2호
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• pp.70-74
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• 2014

Background: Many options are available to cover a palatal defect, including local or free flaps. The objective of this study was to evaluate the usefulness of palatal mucoperiosteal island flap in covering a palatal defect after tumor excision. Methods: Between October 2006 and July 2013, we identified 19 patients who underwent palatal reconstruction using a palatal mucoperiosteal island flap after tumor excision. All cases were retrospectively analyzed by defect location, size, tumor pathology, type of reconstruction, and functional outcomes. Speech and swallowing functions were evaluated using a 7-point visual analog scale (VAS) score. Results: Among the 19 patients, there were 7 men and 12 women with an age range of 25 to 74 years (mean, $52.5{\pm}14.3$ years). The size of flaps was $2-16cm^2$ (mean, $9.4{\pm}4.2cm^2$). Either unilateral or bilateral palatal island flaps were used depending on the size of defect. During the follow-up period (mean, $32.7{\pm}21.4$ months), four patients developed a temporary oronasal fistula, which healed without subsequent operative. The donor sites were well re-epithelized. Speech and swallowing function scores were $6.63{\pm}0.5$ and $6.58{\pm}0.69$ on the 7-point VAS, indicating the ability to eat solid foods and communicate verbally without significant disability. Conclusion: The palatal mucoperiosteal island flap is a good reconstruction modality for palatal defects if used under appropriate indications. The complication rates and donor site morbidity are low, with good functional outcomes.

• Nutrition Research and Practice
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• 제17권5호
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• pp.934-944
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• 2023

BACKGROUND/OBJECTIVES: Maintaining total muscle mass in the older adults with swallowing difficulty (dysphagia) is important for preserving swallowing function. Increasing protein intake can help sustain lean body mass in the older adults. The aim of this study was to evaluate the effect of various high-protein texture-modified foods (HPTMFs) on muscle mass and perform dietary assessment in ≥ 65-yrs-old patients with dysphagia. SUBJECTS/METHODS: Participants (n = 10) received the newly developed HPTMFs (average 595.23 ± 66.75 kcal/day of energy, 54.22 ± 6.32 g/day of protein) for 10 days. Relative handgrip strength (RHS), mid-upper arm circumference (MUAC), body composition, mini nutritional assessment (MNA), mini dietary assessment (MDA), and Euro Quality-of-Life questionnaire 5-dimensional classification (EQ-5D) were assessed. RESULTS: After 10 days, an increase in MUAC (26.36 ± 2.35 cm to 28.50 ± 3.17 cm, P = 0.013) and RHS (0.38 ± 0.24 kg/kg body weight to 0.42 ± 0.22 kg/kg body weight, P = 0.046) was observed. Although MNA, MDA, EQ-5D, subjective health status, muscle mass, and calf circumference showed a tendency to increase after intervention, no significant differences were found. CONCLUSIONS: These results suggest that the HPTMFs can be used for improving the nutritional and health status in patients with dysphagia.

• Journal of Chest Surgery
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• 제30권1호
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• pp.48-54
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• 1997

본 인제대학교 의과대학 흉부외과학교실 서울백병 원에서는 1986년 10월부터 1995년 12월까지 부식제 의 음용으로 하인두와 식도 입구부터 심한 협착이 발생한 1 1례의 환자에서 하인두의 양배꼴동에 대용식 도를 문합하는 식도재건술을 시행하였다. 환자는 남자 7례, 여자 4례로 모두가 성인으로 연령은 21세 에서 47세까지로 평균 34세였다. 식도협착의 원인이 된 부식제는 산성이 6례: 알칼리성이 5례였다. 이들의 부식제 음용 동기는 자살 목적이 9례였 고, 사고로 인한 경우가 2례였다. 부식제의 음용후 최종적으로 식도재건술까지의 기간은 4개월에서 부 터 21년까지 였다. 식도재 건술시 이용한 대용식도는 9례에서는 우측 결장을 사용하였고, 2례는 이 전에 우측 결장을 이용한 식도재건술이 실패한 상태여서 좌측 결장을 사용하였다. 모든 환자에서 식도 절제술은 하지 않았고 결장은 흉골하로 거상하였다. 경부 문합은 환자의 머리를 똑바로 놓은 상태에서 경부에 J형태로 피부를 절개하고 흉골설골, 갑상설 골근을 절단하고 갑상연골의 연골막을 박리하여 감상연골을 역삼각형모양으로 부분절제하고 양배꼴동을 열고 결장과 단단문합하였다. 수술 직후 類觀隙\ulcorner환자는 음식물을 삼킬 때 연하곤란과 기도내로 음식물이 넘어가 고형 음식물로 삼키는 훈련이 필요하였다. 수술 후 발생한 합병증은 대용식도의 괴사가 3례가 발생하여 유리공장을 이식하였다. 3례에서는 경부 문합부위에 협착이 있어 2례에서 상부문합부위를 확장하였고 1례에서는 유착띠제거술을 시행하였으며 모두 협착이 해소되었다. 수술 후 외래 추적관찰에서 10례에서는 정상적으 로 음식물을 삼킬 수 있었고 유리공장을 사용하여 2차수술을 시행한 1례는 유리공장의 괴사로 3차수술 을 기다리고 있다.

• Journal of International Society for Simulation Surgery
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• 제1권1호
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• pp.32-36
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• 2014

Reconstruction of the maxilla is quite a difficult challenge for reconstructive surgeons. The maxilla is the most important part of the midface, which contributes to facial esthetics, mastication, swallowing, speech, supporting orbital contents and sinus function. Free fibular flap is most versatile to reconstruct jaw bone because of its adequate length, containing both soft and bony tissues and acceptance of dental implants. In this case report, a reconstruction of the maxilla using free fibular flap and dental implants is described in which rapid prototype was used before surgery to simulate the final prosthetic results.

• 대한후두음성언어의학회지
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• 제21권1호
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• pp.22-26
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• 2010

Neuromuscular Disorders Affecting the Larynx are steadily important topics at laryngology. Physiology of larynx is controlled by the frame structure and neuromuscular dynamics to acting on the specialized soft tissue, Therefore, for a proper understanding of the larynx, it is needed the voice and swallowing, a series of prayers on the regulation of neurologic function and the correlation between systemic neuromuscular disease and laryngeal symptoms and clinical knowledge, We described that clinical findings and treatments of the 3 neurological diseases causing dysphonia well (Parkinson's disease, laryngeal tremor, spasmodic dysphonia) and vocal impairments for stoke patients.

• 대한기관식도과학회지
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• 제17권1호
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• pp.29-34
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• 2011

Traditionally, the main strategy of treatment of the head and neck cancer was en bloc resection including adjacent normal tissues through wide incision. However, the procedures may leave severe functional deficit such as swallowing difficulty, aspiration, and wide neck scar. Therefore, many attempts have been made up to minimize these morbidities. Of them, the minimal invasive approach such as transoral laser microsurgery (TLM) and transoral robot surgery (TORS) have been spolighted as a sensible strategy for organ preservation of the head and neck cancer patients. Results of TLM are equivalent to those obtained by conventional surgery, with considerably less morbidity, less hospital time and better postoperative function. Oncologic results of TLM are equivalent to conventional surgery. TORS are safe, feasible, and promising but oncologic safety is not yet verified. This article covers to current application of TLM and TORS, their advantages and limitations, and future direction.

• 대한치과의사협회지
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• 제56권6호
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• pp.333-338
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• 2018

The mouth guard is a device with elasticity to be installed in the oral cavity. It has a function to reduce the trauma in the oral cavity and to protect the teeth and surrounding tissues from trauma. The purpose of mouth guard is to prevent trauma and concussion. It is mandatory to wear a mouthguard in sports where there is a lot of contact and the possibility of trauma or concussion in the mouth area is high. The mouse guard is divided into a stock type, a mouth formed type, and a custom made type according to the manufacturing method. The custom made type is made on the individual dentition model and has excellent retention because of its excellent fit. Also, the effect of trauma prevention is excellent. It is possible to design and adjust by the dentist and reduce the complaint the athlete has about the mouthguard. In this article, the process of making a dentist-customized mouthguard was described.

• 대한구순구개열학회지
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• 제13권2호
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• pp.43-52
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• 2010

Intraoral prosthesis (Palatal Augmentation Prosthesis, PAP) may be used to augment swallowing function in patients with dysphagia. PAP can be used to recontour the dimensions of hard palate to fit the tongue following removal of oral cancer. Use of PAP can significantly improve the patient's ability to use the tongue to propel the bolus through the pharynx. The aim of this study is to show the effects of PAP through videofluoroscope in patients with dysphagia. The results were as follows: 1. A decrease in pharyngeal transit time was detected wearing with PAP. 2. Pharyngeal cross area was decreased wearing with PAP. 3. The results indicated PAP may effectively help lingual movement in patients with dysphagia.

• 구강회복응용과학지
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• 제18권3호
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• pp.185-195
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• 2002

Purpose This article describes the historic and clinical aspects of the determination of the vertical dimension of occlusion and the synoptic procedure of the determination of the vertical dimension of occlusion in complete denture. The determining procedure of the susceptible vertical dimension of occlusion is one of the most important steps in construction of complete denture and prosthodontic treatment. It is considered essential for the improvement and the recovery of facial esthetics and stomatognathic functions. Results Several methods have been suggested for measurement of the vertical dimension of occlusion in the construction of complete denture and the prosthodontic rehabilitation. These range from pre-extraction records to the use of physiologic rest position, swallowing, phonetics, esthetics and facial proportion, etc. But, there is no universally accepted or completely accurate method. There seems to be no significant advantages of one technique other than those of cost, time and equipment requirements, and seems to be in controversial in determining the vertical dimension. Conclusion The vertical dimension of occlusion should be determined and reinspected carefully by dentist for a successful prosthesis with several methods. The more investigations are necessary for more objective and scientific techniques in determining the vertical dimension of occlusion.

• 재활간호학회지
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• 제5권1호
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• pp.38-48
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• 2002

The purpose of this study is to identify the effects of a nursing intervention using sensory stimulation in dysphagic patients. Quasi-experimental with a nonequivalent control group pretest-posttest design was used. 15 patients of each group were assigned for this study, who were hospitalized in the oriental medicine hospital of K. University. Specific stimulation plans were devised based on a dysfunctional area of the subjects. For each modality, subjects were systematically stimulated for 30 minutes, in the experimental group prior to each meal and 3 times per day for a week. The data were analyzed by SPSS PC program using $X^2$-test, Wilcoxon Signed Rank test and Mann-Whitney U test. The results of this study are as follows : 1. The tongue control score of the experimental group is greater than that of the control group(u=52.0, p=.007). 2. The score of chewing ability, lip control, swallowing ability of the experimental group is greater than that of the control group. But no difference is statistically seen between the experimental group and control group. Therefore, this study shows that sensory stimulation using icing, quick stretch, etc., was effective in improving or oropharyngeal function in patients with dysphagia.