• Imaging Science in Dentistry
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• 제44권1호
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• pp.81-84
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• 2014

This report described a case in which diagnostic radiographs showed irregular dense radiopaque strings and curved lines in the head and neck area. These artifacts could lead to misinterpretation since they may obscure anatomical structures and/or mask critical structures/pathologies. A more detailed history of the patient indicated that these strings originated from a facelift procedure in which a gold-wire technique was used. Considering that such intervention may cause a radiodiagnostic burden, it should be included in the anamnesis prior to radiography.

• Journal of the Korean Association of Oral and Maxillofacial Surgeons
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• 제31권4호
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• pp.316-321
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• 2005

Ameloblastoma is the most common odontogenic tumor of the jawbones, but the origin of this tumor has been remained to be unproven. Cytokeratins (CKs) are specific intermediate filament of epithelial cells, and vimentin is expressed in mesenchymal cells. The immunohistochemical detection of different CKs and vimentin has made it easier to know the origin of tumor. Paraffin-embedded tissue sections from 15 ameloblastomas and 1 ameloblastic carcinoma were used for immunohistochemical evaluation of CK 7, 8, 13, 14, 19 and vimentin. Their expression is evaluated in different tumor cells, which are observed in different type of tumors. In the follicular and reticular subtype, central stellate cells of tumor nests expressed CK 8, 14, 19 and peripheral columnar cells expressed CK 14. CK 7, and 13 were not expressed. Vimentin was detected in fibrous stroma around tumor nest, not in tumor cells. The tumor cells of ameloblastic carcinoma expressed CK 7, 14 and 19, but CK 8 was more weakly stained than that in ameloblastoma. Central stellate cells and peripheral columnar cells of acanthomatous subtype showed same expression pattern with others. Meta plastic squamous cells expressed CK 8, 14, 19 and keratinizing squamous cells expressed CK 13, 19. CK 7 and vimentin were not detected in tumor cells and vimentin was expressed in fibrous stroma. Most of the tumor cells of ameloblastoma showed CK 14 and CK 19 and did not express CK 7 and vimentin. These findings were similar to the immunophenotype of dental lamina. And these results will be beneficial to differential diagnosis of odontogenic tumors and other kind of tumors arising at the oral cavity.

• Journal of the Korean Association of Oral and Maxillofacial Surgeons
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• 제50권3호
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• pp.123-133
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• 2024

Dentoalveolar (DA) trauma, which can involve tooth, alveolar bone, and surrounding soft tissues, is a significant dentofacial emergency. In emergency settings, physicians might lack comprehensive knowledge of timely procedures, causing delays for specialist referral. This systematic review assesses the literature on isolated DA fractures, emphasizing intervention timing and splinting techniques and duration in both children and adults. This systematic review adhered to PRISMA guidelines and involved a thorough search across PubMed, Google Scholar, Semantic Scholar, and the Cochrane Library from January 1980 to December 2022. Inclusion and exclusion criteria guided study selection, with data extraction and analysis centered on demographics, etiology, injury site, diagnostics, treatment timelines, and outcomes in pediatric (2-12 years) and adult (>12 years) populations. This review analyzed 26 studies, categorized by age into pediatrics (2-12 years) and adults (>12 years). Falls were a common etiology, primarily affecting the anterior maxilla. Immediate management involved replantation, repositioning, and splinting within 24 hours (pediatric) or 48 hours (adult). Composite resin-bonded splints were common. Endodontic treatment was done within a timeframe of 3 days to 12 weeks for children and 2-12 weeks for adults. Tailored management based on patient age, tooth development stage, time elapsed, and resource availability is essential.

• Maxillofacial Plastic and Reconstructive Surgery
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• 제22권4호
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• pp.430-435
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• 2000

Cleft lip and palate is one of the congenital anomalies which need comprehensive and multidisciplinary treatment plan because 1) oral cavity is an important organ with masticatory function as a start of digestive tract, 2) anatomic symmetry and balance is esthetically important in midfacial area, and 3) it is also important to prevent psycho-social problems by adequate restoration of normal facial appearance. There are many different protocols in the treatment of cleft lip and palate, but our department has adopted and modified the $Z{\"{u}}rich$ protocol, as published in the Journal of Korean Cleft Lip and Palate Association in 1998. The first challenge is feeding. Type of feeding aid ranges from simple obturators to active orthopedic appliances. In our department we use passive-type plate made up of soft and hard acrylic resin which permits normal maxillary growth. We use Millard's method to restore normal appearance and function of unilateral complete cleft lip. In consideration of both maxillary growth and phonetic problems, we first close soft palate at 18 months of age and delay the hard palate palatoplasty until 4 to 5 years of age. When soft palate is closed, posterior third of the hard palate is intentionally not denuded to allow normal maxillary growth. In hard palate palatoplasty the mucoperiosteum of affected site is not mobilized to permit residual growth of the maxilla. We have treated a patient with unilateral complete cleft lip and palate by Ajou protocol, which is a kind of modified $Z{\"{u}}rich$ protocol. It is as follows: Infantile orthopedics with passive-type plate such as Hotz plate, cheiloplasty with Millard's rotation-advancement flap, and two stage palatoplasty. It is followed by orthodontic treatment and secondary osteoplasty to augment cleft alveolus, orthognathic surgery, and finally rehabilitation with conventional prosthodontic treatment or implant installation. The result was good up to now, but we are later to investigate the final result with longitudinal follow-up study according to master plan by Ajou protocol.

• Maxillofacial Plastic and Reconstructive Surgery
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• 제19권1호
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• pp.109-114
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• 1997

악성고열증은 마취중 혹은 마취 후에 나타나는 마취 합병증으로 발병률은 매우 희귀하나 높은 치사율 때문에 일단 발현하면 치명적인 결과를 초래하므로 예방 및 조기 발견에 의한 조기 치료가 매우 중요하다. 예방을 위해서는 보유자의 감별이 무엇보다 중요하고 이를 위해서는 철저한 개인력 및 가족력 조사와 술전 감수성 검사가 이루어져야 한다. 의심이 되는 환자는 마취 전후에 dantrolene sodium을 투여하여야 하고 마취시 유발 마취제 및 유발 인자를 피하며 emotional stress를 피하기 위해 충분한 sedation이 요구된다. 그러나 우리 나라에는 특수 치료제인 dantrolene sodium의 확보가 어려워 조기 발견을 하고도 효과적인 치료를 하지 못하는 경우가 흔히 있으므로 dantrolene sodium을 상비약으로 비치하는 것이 좋을 것으로 사료된다. 저자들은 32세의 건강한 젊은 남자 환자가 악성형수술도중 갑작스런 체온 상승과 빈맥근강직등이 발현하여 술 후 5일만에 급성 신부전증 및 파종성혈액내응고병증(DIC)으로 사망한 악성고열증 환자를 경험하였기에 문헌고찰과 함께 보고하는 바이다.

• Maxillofacial Plastic and Reconstructive Surgery
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• 제15권4호
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• pp.253-268
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• 1993

법랑아세포종의 109증례(원발성 77증례, 재발성 32증례)의 병상일지 방사선사진, 생검보고서 등을 참고하여 임상소견(성별, 연령, 부위, 주소, 병 기간, 방사선소견, 재발유무, 병소크기)과 치료방법과의 관련성을 연구한 결과 다음과 같다. 남자에서 보존적 치료방법이 44.6% 근치적 치료 방법이 55.4%, 여자에서는 보존적 치료방법이 31.8% 근치적 치료방법이 68.2% 시행되었으며, 20세 미만에서는 보존적 치료방법이 62.9% 근치적 치료 방법이 37.1%, 20세 이상에서는 보존적 치료방법이 31.7% 근치적 치료방법이 68.3% 시행되었고, 상악에서는 보존적 치료방법이 16.7% 근치적 치료방법이 83.3%, 하악에서는 보존적 치료방법이 42.3% 근치적 치료방법이 57.7% 시행되었다. 동통이 있는 경우에는 보존적 치료방법 33.3% 근치적 치료방법 66.7%, 동통이 없는 경우에는 보존적 치료방법이 42.5% 근치적 치료방법이 57.5% 시행되었으며, 평균병력기간(31 34개월) 미만의 경우에는 보존적치료방법 48.6% 근치적 치료방법이 51.4%, 평균병력기간 이상의 경우에는 보존적 치료방법인 20% 근치적 치료방법이 80%가 시행되었고, 단방형에서는 보존적 치료방법 55.3% 근치적치료방법이 44.7%, 다방형에서는 보존적치료방법 27.4%, 근치적 치료방법 72.6%가 시행되었다. 평균크기 미만의 경우에는 보존적 치료방법이 45.7% 근치적 치료방법이 54.3%, 평균크기 이상의 경우에는 보존적 치료방법이 28.2% 근치적 치료방법이 71.8%가 시행되었고, 원발성 경우에는 보존적 치료방법이 46.8% 근치적 치료방법이 53.2% 시행되었으며, 재발된 경우에는 보존적 치료방법이 21.9% 근치적 치료방법이 78.1% 시행되었다. 이상의 성적을 Chi-square test를 이용하여 통계처리하여 보면 성별, 부위, 주소, 병소크기와 치료방법 사이에는 관련성이 없었으나, 20세 이상의 연령층, 다방성 방사선소견, 31 34개월 이상의 병력기간 및 재발된 경우에서는 근치적 치료방법이 선호되었다.

• Maxillofacial Plastic and Reconstructive Surgery
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• 제28권6호
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• pp.499-510
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• 2006

인간 타액선 선양낭성암종 조직 18례에 대한 면역조직화학적 염색을 시행하여 종물 주변의 정상 타액선 조직과 비교, 분석하여 다음과 같은 결과를 도출하였다. 1) EGF는 타액선 도관세포와 암종 조직의 50%에서 발현 되었으며, 정상 타액선 조직과 비교하여 암종 조직에서 발현이 증가되어 있지 않았다. 2) $TGF-{\alpha}$는 타액선 도관세포와 선포세포, 그리고 거의 모든 암종 조직에서 발현되었으며, 정상 타액선 조직과 비교하여 암종 조직에서 그 발현이 유의하게 증가되었다(P<0.05). 3) EGFR은 타액선 도관세포와 대부분의 암종 조직에서 발현되었으나, 발현의 강도에서 정상 타액선 조직과 암종 조직간의 차이는 없었다. 4) pEGFR은 정상 타액선 조직에서는 발현되지 않았으며, 암종 조직의 종양세포에서 그 발현이 증가되었다(P<0.05). 5) ErbB2/HER2는 타액선 도관세포와 거의 모든 암종 조직에서 발현되었으며, 정상 타액선 조직과 비교하여 암종 조직에서 그 발현이 유의하게 증가되었다 (P<0.05). 6) 검색된 인자들 중 $TGF-{\alpha}$와 ErbB2/HER2는 관사상체형 암종 조직에서와는 달리 충실형 암종 조직에서 100% 발현되어, 충실형 선양낭성암종의 증가된 악성도에 중요한 역할을 함을 암시하였다. 7) 종물 내의 종양관련 혈관내피세포에서도 위의 인자들이 모두 발현되어 종양관련 혈관내피세포는 선양낭성암종의 증식과 전이에 중요한 역할을 함을 알 수 있었다. 8) 종양 기질 내의 면역관련 세포들에서도 역시 위의 인자들이 발현되어 이들 세포들이 종양의 증식과 생존에 영향을 미칠 것이라는 추론을 가능하게 하였다. 위의 연구결과들을 종합하면 상피성장인자 신호전달계에 관여하는 인자들 중 $TGF-{\alpha}$, pEGFR, 그리고 ErbB2/HER2가 타액선 선양낭성암종에서 과발현 되었다. 따라서 이들 인자들이 타액선 선양낭성암종의 증식과 생존, 그리고 전이 과정에서 중요한 역할을 할 것이라는 추론을 가능하게 하였다. 추후 면역조직화학적 연구의 한계와 오류를 극복할 수 있는 기법으로 이들 인자들에 대한 재검색이 필요하리라 생각된다. 또한 과연 이들 인자들이 암생물학적으로 뿐만 아니라 임상적으로도 전이 및 환자 생존율과 관계된 인자로서의 가치가 있는지 평가해 보아야 할 것이다.

• Maxillofacial Plastic and Reconstructive Surgery
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• 제23권4호
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• pp.295-305
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• 2001

구강은 흡연이나 음주와 같은 화학적 발암물질이 쉽게 접촉할 수 있는 화학적 발암물질의 표적장기이며 구강암을 포함한 대부분의 암 발생의 근원이 되는 세포는 상피세포이다. 따라서 본 연구는 인체상피세포를 화학적 발암물질인 MNING에 노출시켜 발암화를 유도하고 이에 따른 작용 기전을 분석함으로써 구강암과 같은 상피세포 기원의 종양 발생기전을 이해하는 데 기여하고자 하였다. 인체 상피세포에 $0.001{\mu}g/ml$에서 $1{\mu}g/ml$ 용량의 MNNG를 투여한 결과 용량 의존적인 세포발암성을 나타내었으며 $0.01{\mu}g/ml$ 투여군이 가장 높은 암세포의 지표를 보였다. MNNG투여후 TPA를 처리한 결과 발암세포의 지표인 saturation density, soft agar colony formation, cell aggregation 등에서 MNNG의 단독 투여시보다 높은 발암성을 나타내었으며 최초의 foci출현시기도 단축되었다. 이와같은 결과는 Phorbol ester binding assay에서도 나타나 세포 발암화 촉진에 PKC활성이 관여함을 추정할 수 있다. PKC translocation 현상은 세포외 칼슘이 있을 경우에만 나타나 MNNG에 의한 PKC활성에 classical PKC가 관여함을 추정할 수 있었다. MNNG에 대한 초기반응으로 cPKC의 경우 $PKC-{\alpha}$와 $PKC-{\gamma}$가 고농도에서 활성의 증가를 보였으며 nPKC의 경우 $PKC-{\varepsilon}$가 뚜렷한 활성을 보여 이들 isoform이 MNNG에 의한 발암화 초기단계에 관여함을 암시하였다. 반면 aPKC는 어느 형태도 MNNG에 반응하지 않아 화학적 발암화 과정에 isoform의 특이성이 존재함을 입증하였다. MNNG에 의해 발암화 특성을 나타낸 세포는 $PKC-{\alpha}$ 및 $PKC-{\gamma}$의 지속적인 활성증가를 나타내어 발암의 초기단계부터 지속적이 활성을 유지하고 있는 isoform으로 추정된다. 본 연구결과 인체상피 세포의 모든 PKC isoform에 대한 발현을 분석하고 화학적 발암화에 관여하는 isoform을 선별해냄으로써 특정한 inhibitor 등을 상요한 발암화 억제제의 개발에 필요한 기초자료를 제공하였을 뿐만 아니라 구강암과 같은 상피세포 기원의 암발생 기전을 이해하는 데 기여할 것으로 사료된다.

• Maxillofacial Plastic and Reconstructive Surgery
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• 제28권5호
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• pp.404-416
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• 2006

Purpose : This study was to clarify the changes in mandibular condyle after unilateral mandibular distraction osteogenesis throughout histological changes and expression of matrix metalloproteinase-2 (MMP-2) and tissue inhibitor of matrix metalloproteinase-2 (TIMP-2). Materials & Methods : Intraoral distractors were placed via submandibular incision in 8 dogs. Two unoperated animals served as controls. Distraction was performed five days after osteotomy as a rate of 0.5 mm twice per day for 10 days. Two animals were sacrificed on 7, 14, 28, and 56 days after completion of distraction, respectively. Ipsilateral condyles were harvested and processed for histological and immunohistochemical examinations. Results : The condyle cartilage is separated into four layers: fibrous layer, proliferative layer, hypertrophic layer, and calcified layer. At 7 days and 14 days after distraction, the condylar cartilage showed the decreased thickness of the articular cartilage and reduced cellularity. At 28 days after distraction, there was an increase in cellularity of fibrous, proliferative, and hypertrophic layer. However, it demonstrated reduced cellularity compared to the control. At 56 days of after distraction, the articular cartilage was an almost normal histologic structure. Positive Safranin-O staining, indicative of sulfated proteoglycans, was examined in the condylar cartilge of nonloaded control. At 7 days and 14 days after distraction, the sulfated proteoglycans is almost completely depleted from the noncalcified part of the condylar cartilage. At 28 days after distraction, there was an increase in Safranin-O staining intensity. However, the staining intensity of the experimental condyle was weaker than that of the control. At 56 days of after distraction, the condylar cartilage showed almost normal Safranin-O staining pattern. In control condyle, MMP-2 immunostaining was seen in fibrous, proliferative, and hypertrophic layer of condylar cartilage, however, it demonstrated lack of staining in fibrous and proliferative layer. At 7 days and 14 days after distraction, strong MMP-2 immunoreactivity was seen in the fibrous, proliferative and hypertrophic layer of the condylar cartilage. At 28 days after distraction, MMP-2 immunostaining was seen in the fibrous and hypertrophic layer of condylar cartilage, however, their immunoactivity was reduced. At 56 days after distraction, MMP-2 immunoreactivity showed almost normal immunostaining pattern. In control condyle, TIMP-2 immunostaining was primarily seen in fibrous and hypertrophic layer of condylar cartilage, however, it demonstrated lack of staining in proliferative layer. At 7 days after distraction, very weak TIMP-2 immunoreactivity appeared in fibrous, proliferative and hypertrophic layer of the condylar cartilage. At 14 days after distraction, weak TIMP-2 immunoreactivity was seen in the fibrous, proliferative and hypertrophic layer of the condylar cartilage. At 28 days after distraction, TIMP-2 immunoreactivity was increased in the fibrous and hypertrophic layer of condylar cartilage. At 56 days after completion of distraction, TIMP-2 immunoreactivity showed almost normal immunostaining pattern. Conclusions : The results show that short-term outcome of physiologic distraction osteogenesis may lead to degenerative changes in the condylar cartilage. These alterations in the condylar cartilage may be considered as a pressure-related degeneration of the cartilage tissue. However, the long-term results suggest that the condylar cartilage display repair activity after mandibular distraction osteogenesis.

• Maxillofacial Plastic and Reconstructive Surgery
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• 제17권4호
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• pp.447-455
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• 1995

Cavernous sinus thrombosis is one of the major complications of abscesses of the maxillofacial region. The initial symptoms of CST are usually pain in the eye and tenderness to pressure. this is associated with high fluctuating fever, chills, rapid pulse, and sweating. Venous obstruction subsequently causes edema of the eyelids, lacrimation, proptosis, chemosis and retinal hemorrhages. Blindness is sometimes an accompaniment of cavernous sinus thrombosis when the infection also involves the orbit. There is also cranial nerve involvement (oculomotor, troclear, abducence) and ophthalmoplegia, diminished or absent corneal reflex, ptosis, and dilation of the pupil occur. The terminal stages bring signs of advanced toxemia and meningitis. Infections of the face can cause a septic thrombosis of the cavernous sinus. Furunculosis and infected hair follicles in the nose are frequent causes. Extractions of maxillary anterior teeth in the presence of acute infection and especially curettage of the sockets under such circumstances can cause this condition. The infection is usually staphylococcal. The inflection may spread directly through the pterygoid plexus of veins and the pterygomaxillary space and then ascend into the sinus or it may spread directly from the pterygopalatine space to the orbit. This is possible because of the absence of valves in the angular, facial, and ophthalmic veins. The treatment is empirical antibiotic therapy followed by specific anbibiotic therapy based on blood or pus culture. The inflection usually involves one side, however, it may easily spread to the opposite side through the circulus sinus. Unless it is treated early, the prognosis is poor even in this doses. Occasionally the antibiotics will not adequately resolve the septic thrombus, and death ensues. the use of anticoagulants to prevent venous thrombosis has been recommended, but the efficacy of such therapy has not been substantiated. Surgical access through eye enucleation has been suggested. We report a case which demonstrates cavernous sinus thrombosis by the infection after the functional neck dissection and the intraoral reconstruction with auriculomastoid fascio-cutaneous island flap.