• Maxillofacial Plastic and Reconstructive Surgery
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• v.37
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• pp.38.1-38.6
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• 2015

Background: The posterior movement of mandible was known as the main cause of the changes in the pharyngeal airway space (PAS) and the postoperative obstructive sleep apnea (OSA). The purpose of this study was to know the changes of PAS and position of hyoid bone. Methods: Lateral cephalographies of 13 patients who had undergone sagittal split ramus osteotomy (SSRO) setback surgery were taken preoperatively (T1), postoperatively within 2 months (T2), and follow-up after 6 months or more (T3). On the basis of F-H plane, diameters of nasopharynx, oropharynx, and hypopharynx were measured. The movements of the soft palate, tongue, and hyoid bone were also measured. Results: The amount of mandible setback was $7.5{\pm}3.8mm$. In the measurements of PAS, there was a statistically significant decrease of $2.8{\pm}2.5mm$ in nasopharynx (P < 0.01), and $1.7{\pm}2.4mm$ in oropharynx (P < 0.01) were observed after surgery. The hypopharynx decreased $1.0{\pm}2.1mm$ after surgery and continuously decreased $1.0{\pm}2.8mm$ at follow-up. The changes in hyoid bone position showed the posterior movement only after surgery and posteroinferior movement at follow-up. Conclusions: The PAS such as nasopharynx, oropharynx, and hypopharynx showed relatively high correlation with the amount of mandibular setback. The change of resistance in upper airway may be important for the prevention of OSA after mandibular setback surgery.

• Maxillofacial Plastic and Reconstructive Surgery
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• v.36 no.4
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• pp.161-167
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• 2014

Purpose: The reconstruction of mandibular defects poses many difficulties due to the unique, complex shape of the mandible and the temporomandibular joints. With development of microvascular anastomosis, free tissue transplantation techniques, such as deep circumflex iliac artery (DCIA) flap and fibular free flap (FFF), were developed. The DCIA offers good quality and quantity of bone tissue for mandibular segmental defect and implant for dental rehabilitation. Virtual surgical planning (VSP) and stereolithography-guided osteotomy are currently successfully applied in three-dimensional mandibular reconstruction, but most use FFF. There are only a few articles on reconstruction with the DCIA that assess the postoperative results. Methods: Three patients admitted during a five month period (April of 2013 to August of 2013) underwent resection of mandible and DCIA musculo-osseous reconstruction using a VSP and stereolithographic modeling and assessment of outcomes included technical accuracy, esthetic contour, and functional outcomes. Results: This technique yielded iliac bone segment with excellent apposition and duplication of the preoperative plan. Flap survival was 100 percent and all patients maintained preoperative occlusion and contour. Conclusion: Based on our experience, we offer considerations and logically consistent protocols by classification of mandibular defects, and demonstrate the benefits in VSP and stereolithographic modeling of mandibular reconstructive surgery with DCIA flap.

• Journal of the Korean Association of Oral and Maxillofacial Surgeons
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• v.43 no.4
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• pp.239-246
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• 2017

Objectives: This paper proposes Han's ratio as an objective and quantitative comparative result obtained from pre and postoperative data in patients with a mandibular angle reduction. Materials and Methods: Thirty patients, 12 men and 18 women, who visited the Department of Oral and Maxillofacial Surgery with the chief complaints of skeletal mandibular prognathism and prominent mandibular angle were selected. The subjects were classified into 3 groups according to the types of surgical procedures involved. Group A consisted of patients who underwent mandibular angle resection and mandibular setback. Group B was comprised of patients with mandibular angle resection, mandibular setback and genioplasty. Group C consisted of patients with mandibular angle resection, mandibular setback, Le Fort I osteotomy, and genioplasty. The landmarks placed in pre and postoperative frontal photographs were used to obtain the Han's ratio in each group. The Han's ratios were compared pre- and postoperation and according to the surgical techniques applied. Results: Of the 3 groups who had undergone a mandibular angle resection, all showed a statistically significant increase in Han's ratio. On the other hand, there was no statistically significant difference based on the surgical techniques used. Conclusion: The ratio of the lateral lower face proposed in this study is a potential indicator of postoperative esthetic enhancement in mandibular angle reduction surgery.

• Journal of Korean Foot and Ankle Society
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• v.13 no.1
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• pp.40-45
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• 2009

Purpose: End-stage ankle arthritis is frequently combined with ankle-hindfoot deformity or ankle instability and therefore additional surgical procedures are often required when performing total ankle arthroplasty. We report the short term clinical and radiographic results of the total ankle arthroplasty with/without the combined adjunctive surgical procedures. Materials and Methods: The study is based on the 17 ankles (16 patients) of end-stage ankle arthritis that were treated with $HINTEGRA^{(R)}$ Total ankle prosthesis (Newdeal, Lyons, France) total ankle arthroplasty (TAA) from 2004 to 2007 with at least 12 months follow-up. The combined adjunctive procedures as well as the VAS pain score, AOFAS score, radiographic measurements and patient satisfactions were evaluated. Results: Average follow-up period was 29 months (13${\sim}$55 months), and the age was average 62 years (39${\sim}$75 years) old. Among total of 17 ankles, varus deformity and lateral ankle instability were found in 4 cases and 3 cases respectively. Twenty additional procedures such as Achilles triple hemisection (9), calcaneal displacement osteotomy (4) and lateral ankle ligament reconstruction (3) were performed in adjunct to TAA in 13 ankles. VAS pain score improved from preoperative average 8.4 (7${\sim}$10) to 2.0 (0${\sim}$5) and the AOFAS functional score improved from 41.8 points (13${\sim}$71 points) to 90.6 (77${\sim}$100 points) at final follow-up. Ninety-four percent of the patients were satisfied with the surgery. Conclusion: We confirmed that many adjunctive combined surgical procedures are often necessary in addressing the end-stage ankle arthritis (74%) with total ankle arthroplasty. We also achieved quite good clinical and radiographic short term results, although the long term follow-up study with larger number of cases are needed in the future.

• Journal of Korean Foot and Ankle Society
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• v.22 no.1
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• pp.16-20
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• 2018

Purpose: To evaluate the clinical and radiographic results of surgical treatment for patients with sinus tarsi pain due to accessory talar facet impingement. Materials and Methods: Between July 2013 and July 2015, nine patients who underwent surgery for the accessory talar facet impingement were reviewed. The mean follow-up period was 18.6 months (12~36 months), and the mean age was 33.1 years (19~60 years). Previous trauma history, duration of symptom, and types of surgery were analyzed. The clinical results were evaluated using the American Orthopaedic Foot and Ankle Society (AOFAS) ankle-hindfoot score and visual analogue scale (VAS). Radiographic results were assessed using Meary's angle, calcaneal pitch angle, heel alignment angle, and heel alignment ratio. Results: All patients had evident trauma history prior to the initial symptom. The mean duration of symptoms was 25.6 months (6~120 months). Four patients received only accessory anterolateral talar facet (AALTF) excision, and four patients received medial sliding calcaneal osteotomy (MSCO). One patient underwent both AALTF excision and MSCO. The AOFAS ankle-hindfoot score was significantly improved from 73 (62~77) preoperatively to 93 (67~100) postoperatively. The VAS score was decreased from 6 (5~7) preoperatively to 1 (0~5) postoperatively. The Meary's angle and calcaneal pitch angle showed no significant difference after surgery. The heel alignment angle and ratio increased from $-3.6^{\circ}$ ($-10^{\circ}{\sim}5^{\circ}$) and 0.22 (-0.15~0.6) preoperatively to $2.8^{\circ}$ ($1^{\circ}{\sim}5^{\circ}$) and 0.42 (0.3~0.6) postoperatively, respectively. Conclusion: If there is persistent sinus tarsi pain in patients with hindfoot valgus, accessory talar facet impingement caused by AALTF could be considered as a cause of chronic sinus tarsi pain.

• Journal of Korean Foot and Ankle Society
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• v.20 no.3
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• pp.135-139
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• 2016

Purpose: Modified Mau and Akin osteotomy for hallux valgus is followed by moderate to severe postoperative pain. Ultrasound-guided sciatic nerve block can be an effective option for pain control. We attempted to evaluate the efficacy of the ultrasound-guided sciatic nerve block in controlling postoperative pain. Materials and Methods: The charts of 59 consecutive patients were retrospectively reviewed between December 2014 and August 2015. Twenty-eight patients (the patient group) has received the ultrasound-guided sciatic nerve block after surgery, and 31 patients (the control group) has not received such procedure. The primary outcome was the satisfaction scale for postoperative pain control and postoperative visual analogue scale (VAS) score. Results: The VAS score at postoperative day one was significantly lower in the patient group than in the control group. The satisfaction scale for pain control for postoperative 1 day was significantly different between the two groups. In patient group, most patients have rated positively ('strongly agree' 42.9%, 'agree' 42.9%); however, in the control group, the rating scales were distributed relatively negatively ('strongly agree' 9.7%, 'agree' 22.6%, 'neutral' 29.0%, 'disagree' 25.8%, 'strongly disagree' 12.9%). The number of postoperative rescue analgesics injection was significantly lower in the patient group than in the control group. Conclusion: Postoperative ultrasound-guided sciatic nerve block was effective for pain relief after hallux valgus surgery.

• Archives of Plastic Surgery
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• v.35 no.2
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• pp.152-158
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• 2008

Purpose: Mandibulotomy approach and mandible sparing approach are most common methods for oropharyngeal cancer surgery. Good surgical view and convenience of flap inset are advantages of mandibulotomy approach but deformity of mandible contour, postoperative malocclusion and radionecrosis are its limitations. To make up for the limitations, mandible sparing method is commonly performed, but limited surgical view and difficulties of flap inset are the weak points of this approach. The purpose of the study is to compare mandibulotomy and mandible sparing approaches in postoperative complications and progression of the treatment in oropharyngeal cancer operation and reconstruction. Methods: Single reconstructive microsurgeon operated for oropharyngeal cancer patients with different surgeons of head and neck department who prefer mandibulotomy and mandible sparing approach respectively, and we compared the frequency of postoperative complication, operation time, duration of hospitalization and recurrence rate between two different surgical approaches. Results: Mandibulotomy approach was used in 18 patients and mandible sparing approach was used in 15 patients. In mandibulotomy approach, there happened one case of teeth injury and one case of necrosis of skin and gingiva, but there happened no malocclusion and radionecrosis. In mandible sparing approach, there were 3 cases of fistula and 2 cases of infection which are significantly higher than mandibulotomy approach. There were no significant differences between early regional recurrence and duration of hospitalization. Conclusion: In this study we compared two different methods for the surgical approach in oropharyngeal cancer surgery. As mandible sparing approach has difficulties of limited surgical view, it can be used for the limited indications of anterior tongue and mouth floor cancer. Mandibulotomy approach has advantages of good surgical view and convenience of flap inset. In this method preservation of gingival tissue, watertight fashion suture, delicate osteotomy and plate fixation to maintain occlusion are the key points for the successful results.

• Archives of Plastic Surgery
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• v.36 no.1
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• pp.105-108
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• 2009

Purpose: Epidermoid cyst may be congenital or acquired. Acquired cysts are most commonly of traumatic origin and result from an implantation or downward displacement of an epidermal fragment. Traumatic epidermoid cysts are rare tumors occurring on the nasal tip, especially resulting aesthetic procedure. So, we report a rare case of an iatrogenic epidermoid cyst in the nasal tip following rhinoplasty. Methods: A 44 - years old man had undergone rhinoplasty for several times. First time, the previous augmentation rhinoplasty and wedge osteotomy were performed nineteen months ago, lastly implant removal and unknown filler injection were performed one year ago at another local clinic. He had induration and tenderness on nasal tip and dorsum continued for 3 months. We thought that it caused by foreign body reaction with residual alloderm in nose. For removal of residual alloplastic material, open approach using transcolumellar incision was done. But, incidentally we found cystic mass on the nasal tip. Results: The findings were of an $0.8{\times}0.5{\times}0.5cm$ sized round cystic mass containing cream coloured material with a thick cheese - like consistency. The mass was completely excised and submitted for histology. This confirmed the diagnosis of an epidermoid cyst lined by keratinizing squamous epithelium. There was no induration, tenderness and sign of recurrence after excision of the mass. Conclusion: Epidermal cyst of the nasal tip region represents an unusual clinical lesion and it presents as foreign body reaction. And then, our case demonstrates that meticulous surgical approach and suture technique are the keys to prevention against iatrogenic nasal epidermoid cyst, especially in secondary rhinoplasty.

• Archives of Plastic Surgery
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• v.44 no.1
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• pp.53-58
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• 2017

Background Adequate fixation of replanted digits is essential not only for short-term healing but for long-term function. Various bony fixation methods using Kirschner (K-) and intraosseous wire are available in replantation. We examined clinical and radiographic outcomes of fixation methods on bone union after digital replantation. Methods A single institutional retrospective review identified 992 patients who had undergone 1,247 successful replantations between July 2009 and September 2015. Exclusion criteria included amputations of the distal phalanx, comminuted fractures, and intra-articular fractures. Patients were classified according to 5 categories of fixation methods: single K-wire, double longitudinal K-wires, cross K-wires, wire with, and wire without K-wire support. Bone union was evaluated by 5-month postoperative X-ray and fixation outcomes were compared across the 5 groups. Results The exclusion criteria were applied, and 88 patients with 103 replanted digits remained for analysis. Single K-wire fixation was used in 40 digits, double longitudinal K-wires in 30, and cross fixation in 14. Wire with and without K-wire support was required in 15 and 4 digits. Nonunion was observed in 32 digits (31.1%), of which 13 required additional operations such as bone graft or corrective osteotomy. The highest percent of nonunion was observed after cross fixation (35.7%) and the lowest after wire alone (25.0%). Conclusions In this study, contrary to general knowledge, we found that single K-wire fixation was not associated with poorer outcomes. Successful bone union outcomes may be achieved by careful selection of bone fixation methods. This study provides useful information for planning bone fixation in digital replantation.

• Journal of Veterinary Clinics
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• v.33 no.6
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• pp.340-345
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• 2016

The present study determined the normal reference ranges for the femoral and tibial joint orientation angles of small-breed dogs. For this purpose, 60 each of cadaveric canine femurs and tibias from normal small-breed dogs (Maltese, Poodle, Shih Tzu, Yorkshire Terrier) were examined with radiographs and photographs. Axial and frontal radiographs and photographs of each bone were obtained, from which anteversion and inclination angles, anatomic lateral proximal and distal femoral angles (aLPFA and aLDFA), mechanical lateral proximal and distal femoral angles (mLPFA and mLDFA), and mechanical medial proximal and distal tibial angles (mMPTA and mMDTA) were measured. The 95% CI for radiographic values of all femurs and tibiae were anteversion angle, $23.4-27.4^{\circ}$; inclination angle, $128.4-130.4^{\circ}$; aLPFA, $117.8-122.1^{\circ}$; aLDFA, $93.7-95.2^{\circ}$; mLPFA $113.8-117.3^{\circ}$; mLDFA $99.2-100.5^{\circ}$; mMPTA $96.8-98.5^{\circ}$; mMDTA $89.4-90.7^{\circ}$. The Maltese had a larger anteversion angle than the Poodle and the Yorkshire Terrier and a larger mLPFA than the Poodle. In the comparison between the radiographs and the photographs, significant differences were found in the anteversion angle, mLPFA, mMPTA, and mMDTA. The established normal reference values might be useful for determining whether a valgus or varus deformity of the femur or the tibia is present and if so, the degree of angular correction needed.