• Archives of Plastic Surgery
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• 제33권2호
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• pp.144-148
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• 2006

The velopharyngeal dysfunction usually occurs in patients with previous operation of the cleft palate or with submucosal cleft palate. In case of velopharyngeal dysfunction without cleft palate, no study has been made when it comes to operative method and postoperative results. Here, we would like to present the operative methods and the postoperative results with the cases we've experienced. This study is based on seven cases of velopharyngeal dysfunction without cleft palate from 1999 to 2004. Analysis of age, sex, etiology, operative methods, satisfaction rate and speech evaluation was done. The patients were 3 males and 4 females, with an age ranged from 10 to 28 at the time of surgery. The follow-up period was more than six months. One case had bifid uvula, another had atypical anomaly in palate, and five cases had no anatomical abnormality. The palatal lengthening was done on one patient, the levator muscle repositioning on another patient and to the rest of them, the superiorly based posterior pharyngeal flap was done. It was difficult to determine the etiology of the velopharyngeal dysfunction without cleft palate. The speech improvement and the satisfaction rate of the patients and parents were diverse. Although the authors had a problem with statistical analysis between the operative age and the speech improvement, it was reasonable to perform a surgical operation because postoperative speech improvement was observed in most cases regardless of age. There is little statistical correlation, but significantly higher outcomes were observed in palatal lengthening and levator muscle repositioning than in pharyngeal flap.

• 대한소아치과학회지
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• 제38권1호
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• pp.56-61
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• 2011

Cornelia de Lange 증후군(Cornelia de Lange Syndrome)은 성장지연, 정신지체, 골격과 외모의 이상을 특징으로 하는 선천성 희귀병이다. 대표적 합병증으로는 위-식도 역류증이 있는데, 이로 인한 구토증은 기도를 폐쇄하여 질식의 우려가 있으므로 전신마취 시 특별한 주의가 요구된다. 10세 4개월 Cornelia de Lange 증후군 환아가 치아우식증을 주소로 서울대학교 치과병원 소아치과에 내원하였다. 임상적으로 하악 왜소증, 치열 총생, 왜소치, 치아우식증, 치아부식증, 구개수열의 소견을 보였으며, 중증의 정신지체 및 청각장애로 인해 환자 협조도가 부족하여 외래 전신마취 하에 치과치료를 시행하였기에 보고하는 바이다.

• 대한기관식도과학회지
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• 제17권1호
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• pp.57-60
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• 2011

Spontaneous tonsillar bleeding is a rare condition in ENT unit. Almost reported cases have been related to infection of tonsils. Prior to introduction of antibiotics, spontaneous tonsillar bleeding was usually related to superficial capsular bleeding due to acute or chronic tonsillitis. The presented case is a 36-year old healthy man without history of acute, chronic tonsillitis, and coagulation disorder who complained of dyspnea and oropharyngeal foreign body sensation after vomitting. Examination revealed a reddish polypoid mass of the right tonsil. Furthermore, the mass pushed uvula and tongue base, caused nearly total obstruction of oropharynx. All rountine laboratory test results were within normal limits. Computed tomography (CT) showed low density mass of attached in upper pole of right tonsil without enhancement. We performed tonsillectomy including the reddish polypoid mass under general anesthesia. The pathology revealed lymphoepithelial tissue with reactive hyperplasia. This is the first reported tonsillar hematoma presenting as a large oropharyngeal mass which was caused by vomitting.

• 대한두개안면성형외과학회지
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• 제13권1호
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• pp.54-56
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• 2012

Purpose: Dandy-Walker syndrome is a rare congenital brain malformation that occurs one in every 25,000-35,000 live births, mostly in females. It is characterized by cystic enlargement of the fourth ventricle, agenesis or hypogenesis of the cerebellar vermis and enlargement of the posterior fossa. In this report, the authors aimed to address a rare case of a 14-months-old female Dandy-Walker syndrome patient that is presented with submucous cleft palate. Methods: A 14-months-old female patient admitted to our outpatient clinic, via the department of pediatrics, with the complaints of nasal regurgitation, choking and breathing difficulties. She was diagnosed as Dandy-Walker syndrome by magnetic resonance imaging evaluation, at another hospital and underwent a shunt operation for the hydrocephalus continuing treatments. On physical examination, she had structural abnormality of bifid uvula, and palpable notch in the posterior surface of the hard palate. Her submucous cleft palate was corrected, which used a double opposing Z-plasty under general anesthesia. Results: In a follow-up period of 2 months, no complications, such as wound dehiscence, necrosis and infection occurred, which shows satisfactory results. She consulted with pediatric neurologists and physical therapists for further evaluation and management of the abnormalities in the central nervous system. Conclusion: Dandy-Walker syndrome patient with a cleft palate is a very rare case to find, which only a few cases are reported around the world. Authors would like to share this case of Dandy-Walker syndrome patient, with submucous cleft palate, who underwent a double opposing Z-plasty that shows satisfactory results.

• Neonatal Medicine
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• 제15권1호
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• pp.89-93
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• 2008

염색체 12번 단완의 중복(첨가)는 매우 드문 질환이며 선천성 기형과 발육 장애를 동반하는 것으로 생각된다. 저자들이 경험한 증례는 다발성 이형성 특색과 선천성 기형을 가지고 태어난 남아로 핵형은 46,XY,add(12) (p13.3)이었다. 출생 시 자궁내 성장부진과 소두증, 소하악증, 구개열, 낮은 변형 귀와 같은 비정상 두개 안면소견을 보였으며, 소음경증, 양발의 rocker bottom 변형 소견을 보였다. 추후 확인한 검사에서 심장 및 신장기형, 신경성 난청 등의 다발성 기형을 보였으며 이후 경련성 질환과 발달 지연 소견으로 외래에서 추적 관찰중이다. 염색체 12번의 첨가에 관련된 증례를 경험하였기에 저자들은 문헌고찰과 함께 보고하는 바이다.

• 대한한방내과학회지
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• 제12권1호
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• pp.105-113
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• 1991

The results of the investigation of literature were summerized as follows ; 1. Information of voice, the pharynx, the larynx, the epiglottis, the uvula and the hyoid bone were concerned. 2. In disorders of voice and speech, Lung channel, Stomach channel, Spleen channel, Heart channel, Liver channel, Kidney channel, Im channel (任脈), and Chung channel (衝脈) were concerned. 3. The disorders of voice and speech were showed as follows ; aphonia, ashasia, seong-shi (?嘶), seom-eo(?語) kwang-eo (狂語), jeong-seong (鄭?), dok-eo (獨語) and chak-eo (錯語). 4. The cause of Aphonia and Aphasia were freauently as follows ; abnormal rising of Liver energy (肝邪暴逆), excessive heart fire (心火太過), deficiency of heart-blood (心血太虛), apoplexy of heart spleen (心脾俱中風), consumption of lung fluid caused by heat evil (肺津被灼), deficiency of lung energy (肺氣虛寒) and dificiency of kidney energy (腎虛). 5. The cause of seom-eo, kwang-eo, Jeong-seong were as follows ; the heart of stomach (胃中熱), the heat evil attach the blood chamber (血人血室) and the consumption of healthy energy (精氣奪). 6. In disorders of voice and speech, flaceid tong with aphasia (舌?) and aphasia due to throat disease (喉?) were divided.

• 대한치과보철학회지
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• 제57권4호
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• pp.475-482
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• 2019

본 증례는 서울대학교 치과병원 치과보철과로 내원한 76세 남성 환자의 총의치 기능을 겸하는 연구개 폐색 장치의 제작에 관한 증례이다. 상환은 편도암으로 인해 연구개 및 편도 부위 절제 후 발음이 잘 되지 않고 음식물이 코로 넘어간다는 주소로 내원하였다. 제작과정에서 CT를 3차원으로 재구성하여 연구개 결손부위의 형태를 관찰하고, 비성도 검사와 비내시경 검사를 통해 발음 및 연하의 개선여부를 확인하였다. 환자는 발음과 저작 및 연하에 있어서 만족할만한 결과를 보여 본 증례를 보고하는 바이다.

• Journal of Dental Anesthesia and Pain Medicine
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• 제22권6호
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• pp.427-435
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• 2022

Background: This study aimed to investigate the relationship between pharyngeal morphology and the success or failure of blind nasotracheal intubation using standard lateral cephalometric radiography and to analyze the measurement items affecting the difficulty of blind nasotracheal intubation. Methods: Assuming a line perpendicular to the Frankfort horizontal (FH) plane, the reference point (O) was selected 1 cm above the posterior-most end of the hard palate. A line passing through the reference point and parallel to the FH plane is defined as the X-axis, and a line passing through the reference point and perpendicular to the X-axis is defined as the Y-axis. The shortest length between the tip of the uvula and posterior pharyngeal wall (AW), shortest length between the base of the tongue and posterior pharyngeal wall (BW), and width of the glottis (CW) were measured. The midpoints of the lines representing each width are defined as points A, B, and C, and the X and Y coordinates of each point are obtained (AX, BX, CX, AY, BY, and CY). For each measurement, a t-test was performed to compare the tracheal intubation success and failure groups. A binomial logistic regression analysis was performed using clinically relevant items. Results: The items significantly affecting the success rate of blind nasotracheal intubation included the difference in X coordinates at points A and C (Odds ratio, 0.714; P-value, 0.024) and the ∠ABC (Odds ratio, 1.178; P-value, 0.016). Conclusion: Using binomial logistic regression analysis, we observed statistically significant differences in AX-CX and ∠ABC between the success group and the failure group.

• Imaging Science in Dentistry
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• 제54권2호
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• pp.181-190
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• 2024

Purpose: This study compared sequential changes in skeletal stability and the pharyngeal airway following mandibular setback surgery involving fixation with either a titanium or a bioabsorbable plate and screws. Materials and Methods: Twenty-eight patients with mandibular prognathism undergoing bilateral sagittal split osteotomy by titanium or bioabsorbable fixation were randomly selected in this study. Lateral cephalometric analysis was conducted preoperatively and at 1 week, 3-6 months, and 1 year postoperatively. Mandibular stability was assessed by examining horizontal (BX), vertical (BY), and angular measurements including the sella-nasion to point B angle and the mandibular plane angle (MPA). Pharyngeal airway changes were evaluated by analyzing the nasopharynx, uvula-pharynx, tongue-pharynx, and epiglottis-pharynx (EOP) distances. Mandibular and pharyngeal airway changes were examined sequentially. To evaluate postoperative changes within groups, the Wilcoxon signed-rank test was employed, while the Mann-Whitney U test was used for between-group comparisons. Immediate postoperative changes in the airway were correlated to surgical movements using the Spearman rank test. Results: Significant changes in the MPA were observed in both the titanium and bioabsorbable groups at 3-6 months post-surgery, with significance persisting in the bioabsorbable group at 1 year postoperatively (2.29°±2.28°; P<0.05). The bioabsorbable group also exhibited significant EOP changes (-1.21±1.54 mm; P<0.05) at 3-6 months, which gradually returned to non-significant levels by 1 year postoperatively. Conclusion: Osteofixation using bioabsorbable plates and screws is comparable to that achieved with titanium in long-term skeletal stability and maintaining pharyngeal airway dimensions. However, a tendency for relapse exists, especially regarding the MPA.

• 수면정신생리
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• 제7권1호
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• pp.18-26
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• 2000

목적 및 방법 : 수면무호흡증 환자들에서 상기도 압력 측정법을 이용하여 수면 중 기도협착의 형태를 연구하고, 각성시와 수면 중에 실시한 상기도 CT scan의 수면무호흡 중 기도 협착 부위의 예측도를 평가하기 위하여, 11명의 수면무호흡증 환자에서 4 압력 센서 또는 2 압력 센서가 달린 도관을 상기도로 삽입하여 상기도의 압력을 측정하면서 수면다원검사를 시행하고, 이 환자들에서 각성시와 수면 중에 상기도의 다섯 곳(high-retropalatal, low-retropalatal, retroglossal, hypopharynx, esophagus)에서 cine CT를 시행한 후 각 방법에 의하여 기도 협착 부위를 진단하고, 수면 중 상기도 압력 측정 결과에 의거하여 상기도 cine CT의 정확도를 평가하였다. 결 과: 상기도 압력 측정 결과 4명(36%)만이 수면 중에 단일 형태의 기도 협착을 보였고, 나머지 7명(64%)은 여러 가지 형태의 기도 협착을 보였다. Velopharynx가 수면무호흡시에 가장 흔히 관찰되는 기도 협착 부위였다(63.6%). 그러나, 상기도 cine CT결과는 수면무호흡 중에 8명이 단일 형태의 기도 협착을 보였다(72.7%). Apneic CT에서도 Velopharynx가 가장 흔한 기도 협착 부위였다. 상기도 압력 측정법과 상기도 CT 촬영법 사이의 기도 협착 진단의 일치율은 단 5명에서만 잘 일치하였고(high-concordant), 5명은 잘 일치하지 않았으며(low-concordant), 나머지 1명은 전혀 일치하지 않았다. 결 론: 대부분의 수면무호흡증 환자는 수면 중 여러 번 발생하는 수면무호흡에서 2가지 또는 그 이상의 기도 협착 형태를 보이므로, 단 1회의 수면무호흡의 상태만을 반영하는 상기도 CT는 수면무호흡의 기도 협착 부위를 적절히 반영하지 못한다고 생각된다.