• Archives of Craniofacial Surgery
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• v.16 no.2
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• pp.49-52
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• 2015

The alveolar cleft has not received as much attention as labial or palatal clefts, and the management of this cleft remains controversial. The management of alveolar cleft is varied, according to the timing of operation, surgical approach, and the choice of graft material. Gingivoperiosteoplasty does not yet have a clear concensus among surgeons. Primary bone graft is associated with maxillary retrusion, and because of this, secondary bone graft is the most widely adopted. However, a number of surgeons employ presurgical palatal appliance prior to primary alveolar bone graft and have found ways to minimize flap dissection, which is reported to decrease the rate of facial growth attenuation and crossbite. In this article, the authors wish to review the literature regarding various advantages and disadvantages of these approaches.

• Archives of Craniofacial Surgery
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• v.21 no.1
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• pp.22-26
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• 2020

Background: This study investigated the outcomes of pharyngeal flap surgery in Asian patients with velopharyngeal dysfunction (VPD), with a focus on postoperative improvements in speech articulation and complications. Additionally, this study explored whether the cause of VPD and the timing of surgery affected outcomes in terms of speech improvement. Methods: A retrospective review was conducted of the medical records of 72 Asian VPD patients who underwent pharyngeal flap surgery performed by a single surgeon from 1996 to 2014. Operative complications were analyzed for all 72 patients, and preoperative and postoperative speech articulation tests were compared for the subset of 43 patients in whom such testing was possible. The relationships of age at surgery and the cause of VPD with the extent of improvement in speech articulation were also investigated. Results: Nine of the 72 patients (13%) experienced wound-related complications. Furthermore, 34 patients (47%) reported persistent snoring lasting for over 3 months, and 16 (22%) reported snoring for over 1 year. Three patients (4%) underwent reoperation. Speech articulation scores significantly improved postoperatively across all groups. Younger age at surgery was associated with greater improvements in speech outcomes, but no significant relationship was found between the cause of VPD and the extent of the postoperative improvement in speech outcomes. Conclusion: Speech outcomes improved after pharyngeal surgery in Asian patients with VPD. Early surgery was associated with favorable speech outcomes, but no association was found between the cause of VPD and postoperative speech outcomes.

• Journal of Korean Neurosurgical Society
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• v.46 no.1
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• pp.31-37
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• 2009

Objective : This study was performed to elucidate the technical and patient-specific risk factors for postoperative ischemia in patients undergoing temporary arterial occlusion (TAO) during the surgical repair of their aneurysms. Methods : Eighty-nine consecutive patients in whom TAO was performed during surgical repair of an aneurysm were retrospectively analyzed. The demographics of the patients were analyzed with respect to age. Hunt and Hess grade on admission, Fisher grade of hemorrhage, aneurysm characteristics, timing of surgery, duration of temporary occlusion, and number of temporary occlusive episodes. Outcome was analyzed at the 3-month follow-up, along with the occurrence of symptomatic and radiological stroke. Results : In overall, twenty-seven patients (29.3%) had radiologic ischemia attributable to TAO and fifteen patients (16.3%) had symptomatic ischemia attributable to TAO. Older age and poor clinical grade were associated with poor clinical outcome. There was a significantly higher rate of symptomatic ischemia in patients who underwent early surgery (p=0.007). The incidence of ischemia was significantly higher in patients with TAO longer than 10 minutes (p=0.01). In addition, patients who underwent repeated TAO, which allowed reperfusion, had a lower incidence of ischemia than those who underwent single TAO lasting for more than 10 minutes (p=0.011). Conclusion : Duration of occlusion is the only variable that needs to be considered when assessing the risk of postoperative ischemic complication in patients who undergo temporary vascular occlusion. Attention must be paid to the patient's age, grade of hemorrhage, and the timing of surgery. In addition, patients undergoing dissection when brief periods of temporary occlusion are performed may benefit more from intermittent reperfusion than continuous clip application. With careful planning, the use of TAO is a safe technique when used for periods of less than 10 minutes.

• Health Policy and Management
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• v.3 no.1
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• pp.1-24
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• 1993

This study is designed to find clues to make a plan for efficient hospital bed utilization. Author has tried to estimate the level of appropriateness and to find out factors affecting intra-hospital variation of inappropriate bed utilization using modified Appropriateness Evaluation Protocol of which criteria are based on service intensity and patients' conditions. Systematic random sampling was done from the population of inpatients during one month in on university hospital. Data were collected by concurrent and retrospective medical record review and analysed by multiple logistic regression. In medical services, 83.5% of admission reveals appropriate and the level of inappropriate admission shows significant differences by patients' residence, type of department admitted to, admission 개\ulcorner, and length of stay. In surgical services, 97.3% and 34.7% are appropriate in location and timing of surgery respectively. Inappropriate timing of surgery differs significantly depending on patients' age, type of department admitted to, admission route, and length of stay. Sixty two percent of hospital days shows appropriate and the level of inappropriateness show marked differences by patients'age, type of services, admission routes, part of the month, part of the stay, and length of stay. Inappropriate hospital days are due to inappropriate level of care, premature admission, improper scheduling of diagnostic or therapeutic procedures, and problems in scheduling surgery in sequence. In conclusion, substantially high proportion of inappropriate hospital bed utilization was confirmed. To reduce it, it is necessary to develop alternative services with which can replace inpatient services, and to introduce utilization management system which may include internal peer review.

• Radiation Oncology Journal
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• v.31 no.2
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• pp.72-80
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• 2013

Purpose: We designed this study to identify and suggest the reasonable timing of adjuvant radiotherapy in the treatment of uterine carcinosarcoma according to the surgical intent and patterns of progression. Materials and Methods: We retrospectively analyzed a total of 50 carcinosarcoma patients diagnosed between 1995 and 2010. Among these 50 patients, 32 underwent curative surgery and 13 underwent maximal tumor debulking surgery. The remaining five patients underwent biopsy only. Twenty-six patients received chemotherapy, and 15 patients received adjuvant radiotherapy. Results: The median follow-up period was 17.3 months. Curative resection (p < 0.001) and stage (p < 0.001) were statistically significant factors affecting survival. During follow-up, 30 patients showed progression. Among these, eight patients (16.0%) had loco-regional progression only. The patients who had received adjuvant radiotherapy did not show loco-regional progression, and radiotherapy was a significant negative risk factor for loco-regional progression (p = 0.01). The time to loco-regional progression was much earlier for non-curative than curative resection (range, 0.7 to 7.6 months vs. 7.5 to 39.0 months). Conclusion: Adjuvant radiotherapy in the treatment of carcinosarcoma might be related to a low loco-regional progression rate. Radiotherapy should be considered in non-curatively resected patients as soon as possible.

• Maxillofacial Plastic and Reconstructive Surgery
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• v.16 no.4
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• pp.477-497
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• 1994

The purpose of this study was to investigate the effect of timing of implant insertion on osseointegration after tooth extraction. Fifteen mongrel dogs, weighing 15kg or more, were used. The lower right 1st, 2nd, 3rd, 4th premolars and 1st molar were extracted under general anesthesia. Implants were inserted at 2, 4, and 8 weeks after extraction of the teeth, being designated as 2-, 4-, and 8-week groups, respectively. Results obtained were as follows. 1. Macroscopically there was neither an infection at the implant site nor an exposure of the implant. 2. Histologically the surrounding bone of the implant was less mature in the 2-week group than in the 4- and 8-week groups. 3. The implant-bone contact ranged from 75 to 82%, with no significant differences among the groups. No increase in the implant-bone contact was found with increasing healing periods from 4 to 12 weeks after implant insertions. 4. The average depth (0.64mm) of the fibrous connective tissue ingrowth in the 2-week group was slightly deeper than those in the 4- (0.51mm) and 8-week (0.53mm) groups at 12 weeks after implant insertion. 5. the implant-bone interfacial bond strengths were 73.05 kgf in the 2-week group, 69.71 kgf in the 4-week group and 73.76 kgf in the 8-week group. No significant difference was noted in pullout force among the groups. The degree of confidence of interfacial bone strength was highest in the 8-week group, followed by the 4- and 2-week groups. These results indicate that at least 4 weeks of healing period will be required before implant is to be inserted following tooth extraction.

• Maxillofacial Plastic and Reconstructive Surgery
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• v.16 no.4
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• pp.359-370
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• 1994

The reconstruction of major head and neck defects must be an integral part of the overall cancer treatment plan. The priorities of surgical treatment of head and neck tumor are 1) local tumor control, 2) relief of pain, 3) avoidance of difficult dressing, 4) provision of oral continence, and 5) ability to swallow and manage saliva. The recent advances in reconstructive surgery including the development of musculocutaneous flaps and microvascular free tissue transfer have allowed the surgical restoration of head and neck tumor defects that previously were not possible. These techniques have provided the opportunity to undertake larger, more aggressive resection while at the same time permitting functional rehabilitation. The timing of reconstruction demands on the nature of the resection, the ability of the ablative and reconstructive teams to coordinate efforts, the overall health of the patients, the patient's needs and wishes. So, we report to emphasize current methods for restoring major head and neck tumor defects after tumor ablation, reviewing for the reconstructive operations, postoperative complications, and postoperative sequelae etc, of patients from Jan, 1990 to Dec, 1993.

• Maxillofacial Plastic and Reconstructive Surgery
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• v.41
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• pp.2.1-2.6
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• 2019

Objectives: This study was aimed to analyze the reducing pattern of decompression on mandibular odontogenic keratocyst and to determine the proper time for secondary enucleation. Materials and methods: Seventeen patients with OKC of the mandible were treated by decompression. Forty-five series of CT data were taken during decompression and measured by using InVivo software (Anatomage, San Jose, Calif) and were analyzed. Results: The expected relative volume during decompression is calculated using the following formula: V(t) = V_initial × exp.(at + 1/2bt²) (t = duration after decompression (day)). There was no significant directional indicator in the rate of reduction between buccolingual and mesiodistal widths. Conclusion: The volume reduction rate gradually decreased, and 270 days were required for 50% volume reduction following decompression of OKC. The surgeon should be aware of this pattern to determine the timing for definitive enucleation. Clinical relevance: The volume reduction rate and pattern of decompression of the OKC can be predicted and clinicians should be considered when treating OKC via decompression.

• Archives of Plastic Surgery
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• v.48 no.6
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• pp.630-634
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• 2021

To date, there have been no reports of patients showing a Tessier number 7 cleft with unilateral complete cleft lip and palate. Furthermore, no studies have established the sequence, plan, or timing of surgical methods for treating patients presenting the above anomalies simultaneously. We report a case of a Tessier number 7 cleft with unilateral complete cleft lip and palate. Two months after birth, lip adhesion was performed on the unilateral complete cleft lip and total excision was performed on the skin tag. At 4 months of age, Tessier number 7 cleft was corrected. At 6 months of age, surgery involving two small triangular flaps was performed on the unilateral incomplete cleft lip after performing lip adhesion. At 13 months of age, two-flap palatoplasty with a vomer flap was performed on the complete cleft palate. At 6 years of age, open rhinoplasty was performed on the unilateral cleft lip nose deformity. At 9 years of age, bone grafting was performed for the alveolar cleft. At follow-up appointments up to 13 years of age, there were no major complications. Here, we present this patient, surgical procedures and timelines, and show our results demonstrating good postoperative outcomes.

• Archives of Hand and Microsurgery
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• v.22 no.3
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• pp.137-146
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• 2017

Brachial plexus injury is regarded as one of the most devastating injuries of the upper extremity. Accurate diagnosis is important to obtain the successful results. Basic preoperative evaluation includes simple radiography, cervical myelography. Magnetic resonance imaging, angiography, electrophysiologic studies and intraoperative studies. Furthermore, proper timing of surgery, surgical indication, plan and sufficient understanding of patients about the prognosis are the key for the satisfactory outcomes. This article provides an overview of the evaluation, diagnosis, intraoperative monitoring, and proper surgical planning for the treatment of posttraumatic brachial plexus injuries.