• Maxillofacial Plastic and Reconstructive Surgery
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• 제38권
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• pp.21.1-21.6
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• 2016

Background: The Le Fort I osteotomy is one of the most widely used and useful procedure to correct the dentofacial deformities of the midface. The changes of the maxilla position affect to overlying soft tissue including the nasal structure. Postoperative nasal septum deviation is a rare and unpredicted outcome after the surgery. There are only a few reports reporting the management of this complication. Case Presentation: In our department, three cases of the postoperative nasal septum deviation after the Le Fort I osteotomy had been experienced. Via limited intraoral circumvestibular incision, anterior maxilla, the nasal floor, and the anterior aspect of the septum were exposed. The cartilaginous part of the nasal septum was resected and repositioned to the midline and the anterior nasal spine was recontoured. Alar cinch suture performed again to prevent the sides of nostrils from flaring outwards. After the procedure, nasal septum deviation was corrected and the esthetic outcomes were favorable. Conclusion: Careful extubation, intraoperative management of nasal septum, and meticulous examination of preexisting nasal septum deviation is important to avoid postoperative nasal septum deviation. If it existed after the maxillary osteotomy, septum repositioning technique of the current report can successfully correct the postoperative septal deviation.

• Journal of Dental Anesthesia and Pain Medicine
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• 제17권2호
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• pp.135-138
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• 2017

Intraoperative airway obstruction is perplexing to anesthesiologists because the patient may fall into danger rapidly. A 74-year-old woman underwent an emergency incision and drainage for a deep neck infection of dental origin. She was orally intubated with a 6. 0 mm internal diameter reinforced endotracheal tube by video laryngoscope using volatile induction and maintenance anesthesia (VIMA) with sevoflurane, fentanyl ($100{\mu}g$), and succinylcholine (75 mg). During surgery, peak inspiratory pressure increased from 22 to $38cmH_2O$ and plateau pressure increased from 20 to $28cmH_2O$. We maintained anesthesia because we were unable to access the airway, which was covered with surgical drapes, and tidal volume was delivered. At the end of surgery, we found a longitudinal fold inside the tube with a fiberoptic bronchoscope. The patient was reintubated with another tube and ventilation immediately improved. We recognized that the tube was obstructed due to dissection of the inner layer.

• Archives of Plastic Surgery
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• 제34권6호
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• pp.799-802
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• 2007

Purpose: The masserteric space is an important tissue compartment of the face, but a disease in it is difficult to diagnose and treat. The submasseteric abscess is located between the masseter muscle and mandibular ramus with different appearances such as sepsis, infection, or tumor. Especially the common misdiagnosis of submasseteric abscess is acute or chronic parotitis. The purpose of this report is to pay special attention to the possible diagnosis of submasseteric abscess for the symptoms of unilateral cheek swelling and tenderness that accompany marked trismus. Methods: A 11-year-old boy came to our hospital because of facial swelling, tenderness, and trismus in a history of left cheek swelling and toothache. We diagnosed his case as submasseteric abscess by CT scan and surgical intervention was performed. Under general anesthesia, the abscess was opened by the intraoral incision and considerably massive pus was drained. Results: Swelling, tenderness, and trismus became to subside during postoperative 10 days and general condition and vital signs became stable. After 6 months, CT scan showed that both masseteric muscles were symmetric and there was no periosteal reaction of the mandible. Conclusion: In conclusion, submasseteric abscess is a rare infection with the symptoms of cheek tenderness and marked trismus. A detailed medical history and clinical examination of a patient as well as computed tomography(CT) are important tools in the accurate diagnosis and efficient treatment of the submasseteric abscess. Adequate drainage, removal of cause, and antibiotic infusion are the management of choice.

• Archives of Plastic Surgery
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• 제37권2호
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• pp.161-168
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• 2010

Purpose: Surgical approaches to the condylar neck and subcondyle area can cause some morbidity such as, facial nerve injury, time-consuming nature and external scar etc. So many surgeons hesitate using open reduction and internal fixation for the treatment of subcondylar fractures. We report open reduction and internal fixation of subcondylar fractures in 13 adult patients via transmasseteric approach. Methods: From 2007 to 2009, 13 adults with subcondylar fracture of mandible were treated with open reduction and internal fixation via transmasseteric approach. A preauricular incision was extended downwards in a curvilinear fashion in the cervicomastoid skin crease. Skin flap was elevated above the SMAS layer. Masseter muscle was splitted at the anteroinferior edge of the parotid gland. After the fracture was reduced, fixed with appropriate plates and screws. All operation were performed under general anesthesia. Results: Mean follow-up period was 13.3 months. There were no signs and symptoms of facial nerve injury, difficulty in mouth opening, or malocclusion. Dissection time was roughly within 30 minutes. Conclusion: Transmasseteric open reduction and internal fixation of mandible subcondylar fracture can be performed with excellent visualization, and inconspicuous scar. It also offers swift access to the subcondylar area while substatially reducing the risk to the facial nerve and eliminating the complications associated with transparotid approaches.

• Journal of Chest Surgery
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• 제31권10호
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• pp.995-998
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• 1998

비디오 흉강경하에 기포절제 후 가장 많은 합병증은 지속적인 공기 누출이다. 이러한 합병증을줄이기 위한 방법으로, 전액와선상의 제 3늑간에 3.5cm의 소절개를 만들고 이를 통해 병변을 육안으로 확인하고 자동 봉합기를 이용한 고식적인 봉합을 했으며, 기포를 절제하지 않고 봉합사로 기포를 보강 봉합하는 방법을 이용하였다. 본 술식은 기포와 소기포를 가진 기흉 환자들에서 술후 공기의 누출기간이나 그 양을 줄일수 있으며, 동측 기흉의 만기 재발을 최소화할 수 있는 방법으로 여긴다.

• Journal of Chest Surgery
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• 제50권4호
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• pp.308-311
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• 2017

A 71-year-old man was referred for an anterior chest wall mass. Chest computed tomography (CT) and positron emission tomography-CT suggested a malignant tumor. Surgical biopsy through a vertical subxiphoid incision revealed an extra-gastrointestinal stromal tumor (EGIST). En bloc resection of the tumor, including partial resection of the sternum, costal cartilage, pericardium, diaphragm, and peritoneum, was performed. Pathologic evaluation revealed a negative resection margin and confirmed the tumor as an EGIST. On postoperative day 17, the patient was discharged without any complications. At the 2-week follow-up, the patient was doing well and was asymptomatic.

• 로봇학회논문지
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• 제15권4호
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• pp.316-322
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• 2020

Endoscopic spine surgery is an advanced surgical technique for spinal surgery since it minimizes skin incision, muscle damage, and blood loss compared to open surgery. It requires, however, accurate positioning of an endoscope to avoid spinal nerves and to locate the endoscope near the target disk. Before the insertion of the endoscope, a guide needle is inserted to guide it. Also, the result of the surgery highly depends on the surgeons' experience and the patients' CT or MRI images. Thus, for the training, a number of haptic simulators for spinal needle insertion have been developed. But, still, it is difficult to be used in the medical field practically because previous studies require manual segmentation of vertebrae from CT images, and interaction force between the needle and soft tissue has not been considered carefully. This paper proposes AI-based automatic vertebrae CT-image segmentation and haptic rendering method using the proposed need-tissue interaction model. For the segmentation, U-net structure was implemented and the accuracy was 93% in pixel and 88% in IoU. The needle-tissue interaction model including puncture force and friction force was implemented for haptic rendering in the proposed spinal needle insertion simulator.

• Journal of Korean Neurosurgical Society
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• 제57권1호
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• pp.68-71
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• 2015

We report a case of non communicating hydrocephalus due to membranous obstruction of Magendie's foramen. A 37-year-old woman presented with intracranial hypertension symptoms caused by the occlusion of Magendie's foramen by a membrane probably due to arachnoiditis. As far as the patient's past medical history is concerned, an Epstein-Barr virus infectious mononucleosis was described. Fundoscopic examination revealed bilateral papilledema. Brain magnetic resonance imaging demonstrated a significant ventricular dilatation of all ventricles and turbulent flow of cerebelospinal fluid (CSF) in the fourth ventricle as well as back flow of CSF through the Monro's foramen to the lateral ventricles. The patient underwent a suboccipital craniotomy with C1 laminectomy. An occlusion of Magendie's foramen by a thickened membrane was recognized and it was incised and removed. We confirm the existence of hydrocephalus caused by fourth ventricle outflow obstruction by a membrane. The nature of this rare entity is difficult to demonstrate because of the complex morphology of the fourth ventricle. Treatment with surgical exploration and incision of the thickened membrane proved to be a reliable method of treatment without the necessity of endoscopic third ventriculostomy or catheter placement.

• Journal of Chest Surgery
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• 제49권3호
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• pp.214-217
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• 2016

Pectus arcuatum is a rare complex chest wall deformity. A 31-year-old female presented with a severely protruding upper sternum combined with a concave lower sternum. We planned a modified Ravitch-type operation. Through vertical mid-sternal incision, chondrectomies were performed from the second to fifth costal cartilages, saving the perichondrium. Horizontal osteotomy was performed in a wedge shape on the most protruding point, and followed by an additional partial osteotomy at the most concaved point. The harvested wedge-shape bone fragments were minced and re-implanted to the latter osteotomy site. The osteotomized sternum was fixed with multiple wirings. With chondrosternoplasty, a complex chest wall deformity can be corrected successfully.

• Journal of Chest Surgery
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• 제41권6호
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• pp.799-802
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• 2008

흉쇄골관절은 전신의 골관절염 중 매우 드물게 이환되는 부위로 주로 마약 중독자, 당뇨병, 만성 신부전, 폐혈증 환자, 및 중심 정맥 혈관 삽입 후에 주로 나타난다. 초기에는 항생제 치료, 단순 절제 및 배농술 등의 방법으로 치유될 수 있으나, 치료 시기를 놓치면 골수염으로 진행되어 광범위 절제가 필요하다. 그러나 재발할 가능성이 있으므로, 본원 흉부외과에서는 혈류를 유지한 대흉근판을 빈공간에 메워 넣어 재발 가능성을 줄여보고자 하였다. 골수염을 동반한 흉쇄골 관절염 환자를 성공적으로 치료하였기에 이에 보고하는 바이다.