• Maxillofacial Plastic and Reconstructive Surgery
• /
• v.38
• /
• pp.47.1-47.8
• /
• 2016

Background: The paradigm of tonsillectomy has shifted from a treatment of recurrent throat infection to one of multi-discipline management modalities of sleep-disordered breathing (SDB). While tonsillectomy as a treatment for throat problems has been performed almost exclusively by otorhinolaryngologists, tonsillectomy as a part of the armamentarium for the multifactorial, multidisciplinary therapy of sleep-disordered breathing needs a new introduction to those involved in treating SDB patients. This study has its purpose in sharing a series of tonsillectomies performed at the Seoul National University Dental Hospital for the treatment and prevention of SDB in adult patients. Methods: Total of 78 patients underwent tonsillectomy at the Seoul National University Dental Hospital from 1996 to 2015, and 23 of them who were operated by a single surgeon (Prof. Jin-Young Choi) were included in the study. Through retrospective chart review, the purpose of tonsillectomy, concomitant procedures, grade of tonsillar hypertrophy, surgical outcome, and complications were evaluated. Results: Twenty-one patients diagnosed with SDB received multiple surgical procedures (uvulopalatal flap, uvulopalatopharyngoplasty, genioglossus advancement genioplasty, tongue base reduction, etc.) along with tonsillectomy. Two patients received mandibular setback orthognathic surgery with concomitant tonsillectomy in anticipation of postoperative airway compromise. All patients showed improvement in symptoms such as snoring and apneic events during sleep. Conclusions: When only throat infections were considered, tonsillectomy was a procedure rather unfamiliar to oral and maxillofacial surgeons. With a shift of primary indication from recurrent throat infections to SDB and emerging technological and procedural breakthroughs, simpler and safer tonsillectomy has become a major tool in the multidisciplinary treatment modality for SDB.

• Journal of Gastric Cancer
• /
• v.15 no.3
• /
• pp.151-158
• /
• 2015

Purpose: Obesity is associated with morbidity following gastric cancer surgery, but whether obesity influences morbidity after laparoscopic gastrectomy (LG) remains controversial. The present study evaluated whether body mass index (BMI) and visceral fat area (VFA) predict postoperative complications. Materials and Methods: A total of 217 consecutive patients who had undergone LG for gastric cancer between May 2003 and December 2005 were included in the present study. We divided the patients into two groups ('before learning curve' and 'after learning curve') based on the learning curve effect of the surgeon. Each of these groups was sub-classified according to BMI (<$25kg/m^2$ and ${\geq}25kg/m^2$) and VFA (<$100cm^2$ and ${\geq}100cm^2$). Surgical outcomes, including operative time, quantity of blood loss, and postoperative complications, were compared between BMI and VFA subgroups. Results: The mean operative time, length of hospital stay, and complication rate were significantly higher in the before learning curve group than in the after learning curve group. In the subgroup analysis, complication rate and length of hospital stay did not differ according to BMI or VFA; however, for the before learning curve group, mean operative time and blood loss were significantly higher in the high VFA subgroup than in the low VFA subgroup (P=0.047 and P=0.028, respectively). Conclusions: VFA may be a better predictive marker than BMI for selecting candidates for LG, which may help to get a better surgical outcome for inexperienced surgeons.

• Journal of Korean Foot and Ankle Society
• /
• v.19 no.4
• /
• pp.171-175
• /
• 2015

Purpose: Tibiotalocalcaneal arthrodesis has been used as a treatment option for severe deformity including Charcot arthropathy, avascular necrosis of the talus, and severe osteoarthritis of the ankle and subtalar joint. The purpose of this study was to evaluate the result of the surgical outcome of tibiotalocalcaneal arthrodesis using a retrograde intramedullary nail. Materials and Methods: Tibiotalocalcaneal arthrodesis using a retrograde intramedullary nail was performed by one surgeon in 36 cases. Clinical and radiological finding was evaluated using assessment of fusion time, 5th metatarsal-tibial angle, possibility of postoperative complication, visual analogue scale for pain and American Orthopaedic Foot and Ankle Society (AOFAS) score. Results: Union was achieved in 33 cases at an average of 23 weeks (11~29 weeks). There were 3 cases of nonunion and 1 case of reoperation. Nail-tibial angle tended to be larger in nonunion cases. AOFAS score showed significantly poor outcome at malalignment (${\geq}5^{\circ}$), negative value of 5th metatarsal-tibial angle. Conclusion: Tibiotalocalcaneal arthrodesis using a retrograde intramedullary nail is considered a useful treatment option for severe destruction and deformity involving ankle and subtalar joint.

• Journal of the Korean Association of Oral and Maxillofacial Surgeons
• /
• v.30 no.1
• /
• pp.65-68
• /
• 2004

CyberKnife is a stereotactic radiosurgery system which could be used to treat many tumors and lesions. It provides the surgeon unparalleled flexibility in targeting using a compact light linear accelerator mounted on a robotic arm. Advanced image guidance technology tracks patient and target position during treatment, ensuring accuracy without the use of an invasive head frame. CyberKnife with Dynamic Tracking Software is cleared to provide radiosurgery for lesions anywhere in the body when radiation treatment is indicated. It has often been used to radiosurgically treat otherwise untreatable tumors and malformations. Moreover, this instrument treats tumors at body sites, most of which are unreachable by other stereotactic systems. Compared with conventional radiotherapy, it is fundamentally different that using non-invasive, frameless, no excessive radiation exposure to normal tissue. In oral malignant neoplasm, surgical excision and radiation therapy should be tried first, additionally chemotherapy could be considered. However, after failure of conventional therapies, patients had poor systemic condition and surgical limitation. So, CyberKnife could be a suitable therapy. A 49 years man was referred in recurred mandibular cancer treated by radiotherapy. The tumor was considered inoperable, because of extensive invasion and was not expected to good response to conventional therapies. We experienced a case of CyberKnife after 4 cycle chemotherapies, so we report it with review of literature.

• Imaging Science in Dentistry
• /
• v.43 no.3
• /
• pp.135-143
• /
• 2013

Purpose: This study was performed to obtain a quantitative evaluation of the cortical and cancellous bone graft harvestable from the mental and canine regions, and to evaluate the cortical vestibular thickness. Materials and Methods: This study collected cone-beam computed tomographic (CBCT) images of 100 Italian patients. The limits of the mental region were established: 5 mm in front of the medial margin of each mental foramen, 5 mm under the apex of each tooth present, and above the inferior mandibular cortex. Cortical and cancellous bone volumes were evaluated using SimPlant software (SimPlant 3-D Pro, Materialize, Leuven, Belgium) tools. In addition, the cortical vestibular thickness (minimal and maximal values) was evaluated in 3 cross-sections corresponding to the right canine tooth (3R), the median section (M), and the left canine tooth (3L). Results: The cortical volume was $0.71{\pm}0.23mL$ (0.27-1.96 mL) and the cancellous volume was $2.16{\pm}0.76mL$ (0.86-6.28 mL). The minimal cortical vestibular thickness was $1.54{\pm}0.41mm$ (0.61-3.25 mm), and the maximal cortical vestibular thickness was $3.14{\pm}0.75mm$ (1.01-5.83 mm). Conclusion: The use of the imaging software allowed a patient-specific assessment of mental and canine region bone availability. The proposed evaluation method might help the surgeon in the selection of the donor site by the comparison between bone availability in the donor site and the reconstructive exigency of the recipient site.

• Journal of Periodontal and Implant Science
• /
• v.32 no.2
• /
• pp.339-350
• /
• 2002

Recently the esthetic demands of clinicians and patients made the surgeon try to regenerate bone defects and gingival tissue after extraction. For that, many surgical methods were used and socket preservation have been evaluated simple, effective and good prognosis in the implant placement. Bone grafting was one of the methods for socket preservation. This study was to evaluate the histologic view of the effects on healing of the extraction sockets when deproteinized bovine bone mineral and tetracycline coated deproteinized bovine bone mineral was implanted 1. In control group, at 4 weeks after implantation, the extraction sockets were filled with connective tissue. And after 8 weeks, osteoblasts were observed in newly formed trabecular among the fibrous connective tissue in the extraction sockets. 2. In experimental 1 group, there was connective tissue and new bone trabecular around newly formed woven bone at 4 weeks. And many osteoblasts were observed in various direction at 8 weeks. 3. In experimental 2 group, there was a lot of new bone made around the bone powder after 4 weeks, and the thicker bone trabecular, lamellar bone and irregular osteoblasts arrangement were observed at 8 weeks. From the results of this study, tetracycline coated BBP would be better than the other groups in the lamellar bone formation and be faster in the bone formation rate.

• Advances in pediatric surgery
• /
• v.1 no.2
• /
• pp.133-139
• /
• 1995

Because rectal prolapse in pediatric age was known to have a self-limitting natural history in weeks to years, this disease is prone to be regarded as a minor condition to the most of surgeons. But to the children and the parents who have to be suffered each time could be a heavy distress. Even though operative or nonoperative methods can be applicable for treatment, the main problem is in surgeon's side, whose preference is based on the experiences of adult patients. The authors have experienced 16 cases of ano-rectal prolapse for 9 years since 1986. Eleven of them were true rectal prolapses. In 7 cases of true type, injection therapy has been tried. One ml of five percent phenol in glycerine was injected into the submucosal layer of the ano-rectal angle level at both lateral and posterior sides. After first trial of each cases, 5 of them were cured completely so far. Recurrences were in two cases, but one of them was temporary to be subsided afterward. Complete bowel cleansing and adequate sedations were required as preoperative preparations. Two days' oral antibiotics and two weeks' laxatives for free of defecation straining were recommended after the procedure. The safety of sclerosis was supported by the experimental histology. In pediatric rectal prolapse, sclerosis seems to be a safe and effective treatment of choice without any significant morbidity.

• Journal of the korean academy of Pediatric Dentistry
• /
• v.37 no.4
• /
• pp.545-550
• /
• 2010

Freeman-Sheldon Syndrome (FSS, also known as "Whistling Face Syndrome") is a rare genetic condition which characteristically includes a small "whistling" mouth, a flat mask-like face, club feet, joint contractures usually involving the fingers and hands, and under-development of the cartilage of the nose. Intelligence is usually normal. Most of the features of this syndrome are due to muscle weakness. The patient, 11 years old boy was consulted from pediatrics to pediatric dentistry due to dental management. After clinical & radiographic examinations, severe multiple problems were found. Dental problems were microsomia(whistling mouth) & micrognathia, perioral muscle contracture, restricted mouth opening, poor oral hygiene & care, generalized dental caries, high palatal vault, severe malocclusion & crowding. And Orthopedic problems, ophthalmic & respiratory, anesthetic problems were found. Then He also had psychiatric problem, hospital(dental) phobia due to previous medical history(frequent hospitalization). And he had genital problem, cryptochidism, too. Due to these intricate problems, he suffered with feeding, swallowing difficulties and showed growth retardation. For enhancing patient's oral health, pediatric dentist, orthodontist, oral surgeon, pediatrician, psychiatrist, orthopedist, they all agree with early, cautious intervention and treatment. So, he has been treated by multidisciplinary care, now he is recovering general health maintenance.

• Korean Journal of Head & Neck Oncology
• /
• v.11 no.2
• /
• pp.119-124
• /
• 1995

Traditionally, wound drainage after thyroid or parathyroid surgery has been widely used to prevent airway obstruction due to accumulation of hematoma or seroma within the paratracheal dead space. Recently, however, the routine use of drains after thyroid or parathyroid surgery has become a matter of controversy. To determine whether the rouine use of drains after thyroid or parathyroid surgery is warranted, a prospective study on the complications after various types of thyroid or parathyroid surgery without wound drains was conducted. Three hunded sixty-six consecutive patients underwent thyroid or parathyorid surgeries by one surgeon from January through December 1994 were included in this study. Of these, only 38 patients (10.4%) required the wound drains. Indications for drainage included the patients with a large dead space(n=9) or wet operative field at the conclusion of surgery(n=11), and patients with radical neck disection(n=18). In the remaining 328 patients(89.6%), the wounds were closed without drains after thyroid lobectomy and isthmusectomy(n=226), bilateral subtotal thyroidectomy(n=21), total or near-total thyroidectomy(n=62), isthmusectomy(n=9) and parathyroid surgery(n=l0). Histologic findings revealed benign tumors in 214(65.2%), carcinoma in 89(27.1%), Graves' disease in 15(4.7%), hyperparathyroidism in 7(2.1%) and parathyroid cyst in 3(0.9%). Among the 328 patients without drain used, wound related complications were seen in only 15 patients(4.6%); 12 patients with seroma and 3 patients with hematoma. All but one complications could be controlled by two or three aspirations, and the remaining one patient required re-exploration. There were no instances of laryngeal nerve palsy or wound infection. The mean length of hospital stay after surgery was 2.8 days with a range of 1 to 11 days. These results support the routine use of drains is not warranted in most thyroid or parathyroid surgeries.

• Korean Journal of Head & Neck Oncology
• /
• v.28 no.2
• /
• pp.122-124
• /
• 2012

Introduction : No drain technique during parotidectomy had been introduced to reduce postoperative morbidity and to minimize hospital stay in a few previous publications. Since the authors have applied this technique in select patients for several years, we wanted to evaluate the feasibility and usefulness of no drain parotidectomy. Material & Methods : We retrospectively reviewed the medical records of 96 patients who underwent superficial or total parotidectomy by one surgeon from May 2005 to July 2012. The decision on drain insertion was made by the operator at the end of the surgery. The patients were categorized as drain insertion group and no drain group. Results : The patients who have smaller tumors and benign lesions were more frequently chosen into no drain group. Hospital stay was shorter in no drain group than in drain insertion group. Although no drain group showed increased number of acute complications such as seroma and hematoma, the complications were mild and could be controlled easily at the outpatient clinic. Conclusion : No drain technique during parotidectomy could be done relatively safely in select patients and it could reduce hospital stay.