• Archives of Plastic Surgery
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• 제36권5호
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• pp.629-636
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• 2009

Purposes: Wide scars occurring on the lower face and neck are a source of both functional and esthetic problems. Consequently, we can use skin grafts, pedicled flaps, free flaps, and tissue expansion for the reconstruction of this area. Compared with other reconstruction techniques, tissue expansion is advantageous in that it enables the maintenance of a color and texture similar to that of the adjacent tissue. However, the conventional method of tissue expansion has been reported to lead to an unnatural cervicomental angle and to the deformity of adjacent structures. We have therefore made efforts to prevent these problems through the use of several operative procedures. Methods: Forty-one patients with lower facial and cervical scars underwent tissue expansion. The tissue expansion was performed using a rectangular-shaped Nagosil$^{(R)}$ tissue expansion device. On insertion of the tissue expander, the intermediate area of superficial fat layer was dissected and then the tissue expander was inserted to make a flap that was as thin as possible. In advancement of the flap, a capsule-formed by the tissue expander-was used for the interrupted fixed suture of the flap to the fascia of the platysma muscle of the neck. This procedure was performed multiple times and also performed between the flap and the periosteum of the mandible, such that the tension was removed during the suture of the flap margin. Finally, the patients were fitted with a Jobst$^{(R)}$ facial garment in order to stabilize the operation site at least twelve months. Results: The most prevalent location of the scar was the cheek (15 cases), followed by the chin in 14 cases and the neck in 12 cases. The mean size of scar was $55.7{\pm}39.4cm^2$. Conclusions: Using our procedures, we have experienced no significant deformities and have also achieved a more natural cervicomental angle in the patients.

• Maxillofacial Plastic and Reconstructive Surgery
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• 제30권1호
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• pp.1-10
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• 2008

Purpose: This study was aimed to examine the resorption rate, the healing pattern, and the response of the surrounding tissue after the graft of the acellular dermal matrix ($AlloDerm^{(R)}$) and the autogenous dermis, and to report the clinical result of the use of $AlloDerm^{(R)}$ in order to restore the soft tissue defects. Methods: Twenty mature rabbits, weighing about 3 ㎏, were used for the experimental study. The $10\times10$ mm-size autogenous dermis and the $AlloDerm^{(R)}$ were grafted to the space between the external abdominal oblique muscle and the fascia of the rabbits. And the $AlloDerm^{(R)}$ was grafted to the pocket between the skin and the underlying perichondrium of rabbit ear. The resorption rate of the grafted sites was calculated, and the tissue specimens were histologically examined at 1, 2, 4, and 8 weeks after the graft. The five patients with the cleft-lip nasal deformity and the one patient with the saddle nose deformity, who received the $AlloDerm^{(R)}$ graft to restore the facial soft tissue defects, were reviewed for the clinical study. Results: The resorption rate at 8 weeks after the graft was 21.5% for the autogenous dermis, and 16.0% $AlloDerm^{(R)}$. In microscopic examinations, the infiltration of the inflammatory cells and the epidermal inclusion cyst were observed in the autogenous dermis graft. However, the neovascularization and the progressive growth of the new fibroblasts were shown in the $AlloDerm^{(R)}$ graft. And the six patients, who received the $AlloDerm^{(R)}$ graft, demonstrated the good stability of the grafts and improved appearance. There were no remarkable complications such as inflammation, rejection, dislocation, and severe absorption in the clinical cases. Conclusion: These results suggest that $AlloDerm^{(R)}$ can be an useful graft material for restoration of soft tissue defects because of the good stability and the tissue response without the remarkable clinical complications.

• Journal of Genetic Medicine
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• 제7권2호
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• pp.145-150
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• 2010

선단이골증(acrodysostosis)은 매우 드문 골격계 이형성 질환의 하나로, 말단골 이형성을 보이는 짧은 손가락과 발가락, 코뼈의 저형성 및 정신지체를 그 특징으로 한다. 본 증례에서 저자들은 전형적인 임상 양상을 보이면서 신경 증상 및 징후와 경추관 협착을 동반한 선단이골증 16세 남아를 경험하여 보고 하고자 한다. 환아는 양쪽 상지의 간헐적인 통증과 위약감을 호소하였으며 양팔을 높이 들어올리는 것이 불가능함을 주소로 내원하였다. 신체 검진상 저신장을 보였으며 넓으면서도 낮은 콧등, 작고 위로 들려 올라간 코끝, 양쪽 눈의 안쪽 눈구석 주름 및 경한 양안격리증 등 특징적 안면 소견을 보였다. 신경심리검사상 중등도의 정신지체가 확인되었으며 청력검사상 양측의 신경성 난청 소견이 동반되어 있었다. 방사선학적 검사에서는, 원뿔 모양의 골단을 보이는 넓으면서도 짧은 중수골 및 지골, 양측 전와부의 마델룽 변형(Madelung deformity), 과형성된 첫 번째 중족골과 두꺼워진 두개골이 확인되었다. 뇌 및 척추 자기공명영상검사에서는 경추관 협착, 경추-연수 접합부의 압박을 동반한 편평두개저 및 소뇌 편도의 하방 이동 소견을 보였다. 선단이골증에서 동반되는 경추관 협착증은 시간이 지남에 따라 진행하는 경향을 보이므로, 6개월 후 추적 영상검사에서 진행되는 소견을 보이거나 증상이나 징후가 악화될 경우에는 수술적 갑압술을 실시할 계획이다. 본 증례는 선단이골증의 국내 보고로는 두 번째이나, 경추관 협착증의 증상 및 징후를 동반한 선단이골증의 첫 번째 보고이다. 선단이골증에서의 척추관 협착증은 시간이 지남에 따라 진행하는 증상이며 심각한 합병증이 초래될 수 있기 때문에, 특징적 임상 양상을 보이는 환자를 조기에 진단할 수 있다면 이러한 합병증에 대한 적절한 치료로서 치명적인 신경학적 후유증의 발생을 피할 수 있다. 따라서, 말단골의 이형성을 보이는 환자의 중요한 감별 질환 중 하나로 선단이골증은 반드시 고려되어야 할 것이다.

• 대한두개안면성형외과학회지
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• 제12권2호
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• pp.81-85
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• 2011

Purpose: Nasal bone fracture is the most common facial fracture. Although nasal bone fractures are considered to be minor injuries, the incidence of post-traumatic nasal deformity remains high. This study is designed to support management and patient satisfaction by classifying the simple nasal bone fracture, and survey the care method and result, which is compared with other studies. Methods: From May 2008 to April 2010, 334 patients with simple nasal bone fractures visited our hospital. The incidence, cause, types of nasal bone fracture, treatment, and complications are analyzed according to clinical examination, patient's record and radiographic images. Results: The mean age of patients was 30 years old, with 74% of the patients having been male, and 26% were female. The highest incidence of this fracture was between late teens to late twenties. The causes of nasal bone fracture were the following: having slipped or fallen down (39%), violence (16%), sports accident (14%), traffic accident (11%), industrial accident (6%), and others (16%). Patient's radiographic images were analyzed by Stranc and Robertson classification, frontal impact plane I was 38%, plane II was 16%, plane III was 1%, lateral impact plane I was 21%, plane II was 21%, and plane III was 3%. On average, surgical treatment was performed 7.2 days after trauma under general anesthesia. Closed reduction of nasal bone fracture was performed in 99% of patients. In patients with septal injuries, septal management was performed in 76.7% of cases. Aesthetic surgery was done on same time in 24% of patients. There were some complications, such as residual nasal deformity (7.2%), nasal obstruction (0.9%) and hyposmia (0.3%). Conclusion: According to this study, nasal bone fractures occurred commonly in physically active age groups (age 15~29 years), as a result of having slipped or fallen down, at afternoon and at night time. And it could be treated successfully by closed reduction and septoplasty by 7 days after trauma.

• Archives of Plastic Surgery
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• 제35권5호
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• pp.597-602
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• 2008

Purpose: Presently, silicone rubber is chosen most frequently for nasal augmentation. However, there is a possibility of extrusion with this material. Sometimes, noses are prone to be traumatized, and then silicone rubber has a possibility of deformity or deviation resulting in trauma. We experienced cases with complications and traumatic deformities after the augmentation rhinoplasty. Methods: A retrospective review was performed to determine the characteristics of the implanted nasal silicone prosthesis after trauma. The patients' data such as deviation of implant, shape of fracture, age and sex of the patient, time of treatment, operative methods were reviewed. From March 2001 to March 2008, this study was performed in 30 patients. The patients were 25 females and 5 males, from 24 to 60 years of age, with an average of 42. All patients had previous augmentation rhinoplasty with silicone implant. Results: All of the 30 patients were confirmed as deviation of silicone and nasal bone fractures in the facial bone CT scan. The most common cause of fracture was traffic accident. The classification of nasal trauma after augmentation was done by facial bone CT. Class I: Deviation of silicone without nasal bone fracture without extrusion(12 cases, 40%), Class II: Deviation of silicone without nasal bone fracture and with extrusion(4 cases, 13%), Class III: Deviation of silicone with nasal bone fracture and without extrusion(8 cases, 27%), Class IV: Deviation of silicone with nasal bone fracture and with extrusion(3 cases, 10%), Class V: Mild deviation of silicone with nasal bone fracture(3cases, 3%). Specially, the comminuted or trapezoid nasal fracture was confirmed in 11 cases(Class III, IV). Conclusion: The problems of silicone implant have generally been related to foreign body reactions, rigidity of the material, encapsulation, infections, and extrusion. We experienced 11 cases of comminuted or comminuted trapezoid shaped fracture below nasal implant. So, we think this phenomenon could be used in late problem of silicone implant.

• 대한구순구개열학회지
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• 제6권1호
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• pp.1-15
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• 2003

이차골 이식술을 시행 받은 구순 구개열을 가지는 성인 남자 20명의 두부계측방사선 사진을 McNamara씨 분석법을 중심으로 하여 계측한 결과는 다음과 같다. 구순 구개열 환자에서 Na. perpendicualr to point A칼은 글.98±5.70, SWh angle 값은 76.45±4.69, Pogonion to Na. perpendicular간은 -6.38± 6.73을 나타내었다. Effective maxillary length는 85.6±4.42, effective mandibular length 값은 123.88±7.10을 보였고 하악각은 29.9±5.09, facial axis angle은 5.53±2.03으로 관찰되었다. Point A에 대해 상악 전치의 돌출도는 3.95±2.74의 값을 보였다.

• 대한소아치과학회지
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• 제28권1호
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• pp.166-170
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• 2001

Rubinstein-Tabyi syndrome은 드물게 나타나는 기형증후군으로 정신 발달지연, 넓은 손가락과 발가락, 작은 키, 특징적인 안모 등의 증상들을 주 증상으로 하는 여러 계통의 형태이상이 비 특정 양상으로 나타나는 선천적 증후군이다. 1963년 Rubinstein과 Tabyi에 의해 처음 보고된 이 증후군은 많은 연구에도 불구하고 명확한 원인이 알려져 있지 않고 있으며, 1990년 이후 Rubinstein-Tabyi syndrome에 대한 특정소인 연구에서 이 증후군의 임상적 특징을 보이는 소수의 환자에게서 16번 염색체의 16p13.3의 유전학적 단절이 보고되었다. 그러나, 이 증후군의 특정병인으로 보기는 힘들고, 여전히 이 증후군의 진단에는 특징적인 임상증상들로 인해 가능하다. 이 증후군의 치과적 증상으로는 높게 위치한 구개, 소하악증 다발성 우식증 등이 보고되고 있다. 다발성 우식증을 주소로 내원한 6세 5개월된 남아가 넓은 엄지손가락과 발가락, 정신 및 운동발달지연과 안검하수증, 이상형태의 귀 등을 포함하는 안면부 이상 등의 증상들을 보였다 저자들은 환자가 보이는 특징적인 임상 증상들로 인해 Rubinstein-Tabyi syndrome으로 진단을 내리고 환자의 전신 상태를 고려하여 모든 치과 치료를 전신마취 하에 시행하였다.

• 대한소아치과학회지
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• 제38권3호
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• pp.270-275
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• 2011

섬유성이형성증은 골격 계통의 국소화된 양성 발육장애로서 해면골 내에서 섬유조직이 증식되며 불규칙한 골소주가 형성되는 질환이다. 섬유성이형성증의 두개안면부 병소는 안면동통, 두통, 두개비대칭, 안면기형, 치아이동, 부정교합, 시각이상, 청각이상 등의 증상이 나타날 수 있다. 본 증례는 섬유성이형성증으로 진단된 혼합치열기 환아로서 이환 부위에서 영구치의 맹출지연이 관찰되었다. 병소에 이환되지 않은 환아의 하악 좌측 측방 치열군은 교합위까지 맹출을 완료하였으나 병소에 이환된 하악 우측 측방 치열군은 현재 치조골 내에서 느린 속도로 맹출 중이며 치근 형성이 완료되지 않아 계속 경과 관찰 중이다. 맹출이 정지되었다고 판단될 시 상부 치조골 제거를 통한 맹출유도나 교정적 정출을 고려할 수 있을 것이다.

• Maxillofacial Plastic and Reconstructive Surgery
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• 제40권
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• pp.27.1-27.8
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• 2018

Purpose: Various complications occur when a maxillofacial fracture is malunionized or improperly resolved. Malocclusion is the most common complication, followed by facial deformity, temporomandibular joint disorder (TMD), and neurological symptoms. The purpose of this study was to evaluate the dental treatment of postoperative complications after maxillofacial fracture. Materials and methods: In this study, nine patients with a postoperative complication after maxillofacial fracture who had been performed the initial operation from other units and were referred to the authors' department had been included. Of the nine patients, six had mandibular fractures, one had maxillary fractures, one had maxillary and mandibular complex fractures, and one had multiple facial fractures. All the patients had tooth fractures, dislocations, displacements, and alveolar bone fractures at the time of trauma, but complications occurred because none of the patients underwent preoperative and postoperative dental treatment. Malocclusion and TMD are the most common complications, followed by dental problems (pulp necrosis, tooth extrusion, osteomyelitis, etc.) due to improper treatment of teeth and alveolar bone injuries. The patients were referred to the department of dentistry to undergo treatment for the complications. One of the nine patients underwent orthognathic surgery for a severe open bite. Another patient underwent bone reconstruction using an iliac bone graft and vestibuloplasty with extensive bone loss. The other patients, who complained of moderate occlusal abnormalities and TMDs such as mouth-opening limitation, underwent occlusal treatment by prosthodontic repair and temporomandibular joint treatment instead of surgery. Results: One patient who underwent orthognathic surgery had complete loss of open bite and TMD after surgery. One patient who underwent reconstruction using an iliac bone graft had a good healing process. Other patients were treated with splint, injection, and physical therapy for mouth-opening limitation and temporomandibular joint pain. After treatment, the TMDs were resolved, but the remaining occlusal abnormalities were resolved with prosthetic restoration. Conclusions: Considering the severity of malocclusion and TMJ symptom and the feasibillity of reoperation, nonsurgical methods such as orthodontic and prosthodontic treatments and splint therapy can be used to manage the dental and TMD complication after the trauma surgery. However, reoperation needs to be strongly considered for severe malocclusion and TMD problem.

• Journal of Yeungnam Medical Science
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• 제18권1호
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• pp.112-122
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• 2001

구순 구개열을 가지는 성인 남자 17명의 두 부계측방사선 사진을 McNamara씨 분석법을 중심으로 하여 정상 대조군과 비교하여 다음과 같은 결론을 얻었다. 구순 구개열 환자에서 Na. perpendicular to point A. SNA angle이 통계적으로 유의하게 작게 나와 두개저에 대해 상악이 후방에 위치하였다(p<0.01). Effective maxillary length, Maxillomandibular differential, Wit's appraisal 등이 구순 구개열 환자와 대조군에서 통계적으로 유의하였으나 Effective mandibular length, Mandibular plane angle, Facial axis angle, Lower anterior facial height 등은 유의하지 않았다. 이는 하악의 경사도, 성장방향 등은 정상이나 상악의 절대적인 길이가 작으며 이로 인하여 상하악간의 부조화가 생긴 것으로 사료된다. 구순 구개열 환자에서 pogonion to Na. perpendicular가 95% 신뢰구간에서 통계적으로 유의하게 작게 나와 하악이 두개저에 대해 상대적으로 후방에 위치하였다. 교정치료에도 불구하고 point A에 대해 상악 전치가 상대적으로 후방에 위치하였다.