Coronal approach 시행 후 발생한 측두부 함몰의 재건

김일규,류승현,김재우,김동수,최진호,Kim, Il-Kyu,Ryu, Seong-Hyun,Kim, Jae-Woo,Kim, Dong-Soo,Choi, Jin-Ho 대한악안면성형재건외과학회 2005 Maxillofacial Plastic Reconstructive Surgery Vol.27 No.2

관상접근법 후 발생한 측두부 함몰의 기전은 아직 명확하지는 않으나 중측두동맥의 손상에 의한 측두지방대의 소실과 변위, 측두근의 부피감소, 봉합시의 잘못된 위치에 의해 발생된다. 이에 저자등은 관상접근법 후 발생한 측두부 함몰을 빠른 혈관화와 골조직의 성장, 낮은 합병증을 보이는 $Medpor^{(R)}$를 이용하여 심미적인 개선을 얻을 수 있었고 이후 현재까지 양호한 경과를 보이기에 문헌고찰과 함께 보고하는 바 이다. The coronal approach has been used for over a century by neurosurgeons to access to the anterior cranium. Indications for the coronal approach expanded from use in the correction of congenital skeletal anomalies to applications in acute maxillofacial trauma and secondary deformity correction, oncologic surgery and reconstruction, and esthetic surgery. Complications were such as injury to frontal branch of the facial nerve, motor nerve paralysis, hematoma under flap, trismus, ptosis, epiphora, infection and anterior temporal depression. $Medpor^{(R)}$ is made up of dense polyethylene connected in porous structures. It is easily shapable without collapsing the pores due to it's hardness and tissue growth takes place at the porosities. Based on these advantages, $Medpor^{(R)}$ has been used in augmentation and restoration in craniofacial defect. A temporal depression after the coronal approach for treatment of Le Fort III fracture was successfully reconstruction with $Medpor^{(R)}$ and we report this case with review of literature.

구강악안면부위에서 발견된 이물질

김일규,신주호,오성섭,최진호,오남식,임영일,김왕식,Kim, Il-Kyu,Sihn, Joo-Ho,Oh, Sung-Seop,Choi, Jin-Ho,Oh, Nam-Sik,Rim, Young-Il,Kim, Wang-Sik 대한구강악안면외과학회 2001 대한구강악안면외과학회지 Vol.27 No.3

구강악안면 영역에 발생한 foreign body impaction은 흔하지 않지만, 일단 발생하면 즉시 제거되어야 하며 술후 후유증을 충분히 방지하기위해 주의깊은 병력청취, 임상 검사, 방사선 사진을 이용한 localization이 꼭 필요하다. 그리고 수술시에는 조심스럽게 조직을 박리하고 전체 손상부위를 철저히 탐진해서 foreign body를 제거해야 한다. 저자등은 침구용 바늘, nasolacrimal ductoplasty용 silicone tube, 산탄 총알등 다양한 구강 악안면영역에서 발견된 이물질을 제거한 경험후 문헌고찰과 함께 보고하는 바이다. Foreign bodies in the maxillofacial area are not commonly seen. If occurred, the immediate removal of foreign bodies is recommended to avoid further complications. The most important thing is a exact localization of foreign bodies using X-rays such as plain radiography, computed tomography, magnetic resonance imaging and ultrasound before treatment. During removal of foreign bodies, tissue should be dissected carefully and complete exploration of the whole wound required.

OK-432$(Picibanil^{(R)})$와 외과적 절제술을 이용한 선천성 림프관종의 치험례

김일규,이성호,오성섭,최진호,오남식,김왕식,임영일,양동환,Kim, Il-Kyu,Lee, Seong-Ho,Oh, Seong-Sub,Choi, Jin-Ho,Oh, Nam-Sik,Kim, Wang-Sik,Rim, Young-Il,Yang, Dong-Whan 대한악안면성형재건외과학회 2001 Maxillofacial Plastic Reconstructive Surgery Vol.23 No.3

림프관종의 치료에 있어 전통적으로 수술적요법만이 선호되어져 왔으나 최근 Ogita 등에 의해 소개된 OK-432는 안전성과 효과면에서 기존의 경화제에 비해 뚜렷이 구별되는 효과를 지니고 있는 것으로 여러 저자등에 의해 보고되고 있다. 특히 수술이 매우 어려운 부위에 존재하는 경우라든지 수술후 재발된 증례등에서 일차 혹은 이차적으로 투여하여 높은 성공률을 보였다고 하였고 더불어 OK-432 투여후 시행된 수술시에도 섬유성유착등의 어려움없이 병소를 절제할 수 있다고 하였다. 본 증례의 경우도 일차적인 OK-432 투여후 8개월째 시행된 이차적인 수술에서 큰 어려움없이 병소를 절제할 수 있었다. 이에 저자등은 좌측 혀 및 구강저와 경부의 급성 부종으로 인한 호흡부전 및 대설증의 증상을 보여 본원 소아과에서 의뢰된 생후 5개월된 환자에게 병력 및 임상검사와 방사선적 검사를 시행한 결과 림프관종으로 진단하고 일차적으로 흡입천자를 통한 감압술과 OK-432 를 통한 경화요법을 시행하였고 이차적인 연속수술을 시행하여 병소를 완전히 절제하였으며 술후 현재까지 재발소견없이 양호한 결과를 보였기에 이에 보고하고자 한다. Lymphangiomas are relatively rare benign tumors of the lymphatic system, characterized by congenital lymphatic malformation such as anastomosis or obstuction of the lymphatic channels. There are most frequently diagnosed in children younger than 3years. In contrast to that of the hemangioma, the sex distribution of the lymphangioma is nearly evenly divided. The head and neck lymphangioma represents about $70{\sim}75%$ of all lymphangiomas, and they are difficult to manage. Spontaneous regression is rare, and rapid intermittent enlargement occurs secondary to infection or trauma. Enlargement may cause serious sequelae such as airway obstruction, feeding difficulties, and cosmetic problems. Treatments previously used for lymphangiomas include surgical excision and intralesional injection of sclerosants. Problems associated with surgical excision include the risk of cosmetically unacceptable scarring and the risk of damage to surrounding vital stricture and the high risk of incomplete excision. The sclerosants previously used have numerous other local and systemic side effects. This report describes a case that was successfully treated using OK-432 as a new sclerosant drug and secondary surgical excision for congential cavenous lymphangioma extensively enlarged to tongue, mouth floor and submandibular region.

A Clinical Study of the Severe Degenerative Diseases of Temporomandibular Joint

김일규,오성섭,최진호,김형돈,오남식,Kim, Il-Kyu,Oh, Seong-Seob,Choi, Jin-Ho,Kim, Hyung-Don,Oh, Nam-Sig Korean Association of Maxillofacial Plastic and Re 1999 Maxillofacial Plastic Reconstructive Surgery Vol.21 No.3

저자등은 1996년 5월 부터 1999년 4월까지 인하대병원 치과에 악관절 질환을 주소로 내원한 958명의 환자 중 병력, 임상소견, 방사선학적 검사 결과 퇴행성 악관절 질환으로 진단된 68명에서 병록지 상에 기록된 환자의 성별, 나이, 주소, 병력, 현증상, 방사선학적 소견 및 치료방법 등에 관해 검사 후 다음과 같은 결론을 얻었다. 1. 남녀 발병 비율은 1:2로 여성에서 높았다. 2. 발병나이는 20대, 30대. 40대, 10대 순이었다. 3. 병력기간은 2년이상, 6개월이하, 1 - 2년 순이었다. 4. 전 환자에서 악관절 동통을, 44명의 환자에서 관절잡음을, 26명의 환자에서 개구제한을 호소하였다. 5. 그밖에 26명의 환자에서 관절부위에 민감성을, 5명의 환자에서 안면 비대칭을, 또한 개교합, 섬유성 악관절강직의 소견이 각각 2명의 환자에서, 양측성질환의 소견이 4명의 환자에서 관찰되었다. 6. 방사선학적 소견상, 15명 환자의 과두부에서 증식성 재성형소견(progressive remodeling)이, 51명의 환자에서 침식성 재성형소견(regressive or erosive remodeling)이 관찰되었으며, 침식성 재성형 환자 중 11명에서 과두주변부 증식성 재성형소견(peripheral remodeling or marginal lipping)이 관찰되었다. 7. 골증식체(osteophyte) 및 소성체(loose body)의 소견이 각각 2명의 환자에서 관찰되었다. 8. 약물에 의한 보존적 치료방법이 1차로 모든 환자에서 시행되었으며, 이중 12명의 환자는 교합안정장치를 병행하여 치료하였다. 9. 관절강내 스테로이드 주사요법에 의한 치료환자가 2명, 관절원판절제술 및 이개연골 이식술을 동반한 악관절성형술 환자가 각각 1명 및 2명이었다.

비순낭종의 치험례

김일규,조현영,백민규,장금수,박승훈,박종원,Kim, Il-Kyu,Cho, Hyun-Young,Baek, Min-Kyu,Chang, Keum-Soo,Park, Seung-Hoon,Park, Jon-Won 대한악안면성형재건외과학회 2008 Maxillofacial Plastic Reconstructive Surgery Vol.30 No.2

Nasolabial cyst is a rare non-odonotogenic, soft-tissue, developmental cyst arising inferior to the nasoalar region of the face. The most common clinical finding of the nasolabial cyst is that of a slowly enlarging asymptomatic swelling typically without radiographic abnormalities. This case report describes a 25-year-old man in which the clinicopathologic findings and an erosive finding on the computed tomographic scan on maxilla were consistent with nasolabial cyst. The histopathologic features, differential diagnosis, treatment and prognosis are discussed. 비순낭은 비루관의 상피 잔사에 의해 발생하는 드문 발육성 낭종으로 상순의 종창과 비익부의 음기를 야기시킨다. 치료 방법으로는 구내접근법에 의한 낭종의 완전 절제술로 재발율은 거의 없다. 25세 남환으로 상악골의 흡수를 야기시킨 좌측부 비순낭종을 외과적 완전 절제술로 치료하고 양호한 결과를 얻어 문헌 고찰과 함께 보고하는 바이다.

임프란트 나사형태와 치조골 흡수에 따른 응력분산의 3차원 유한요소법적 분석

김일규,손충렬,장금수,조현영,백민규,박승훈,Kim, Il-Kyu,Son, Choong-Yul,Jang, Keum-Soo,Cho, Hyun-Young,Baek, Min-Kyu,Park, Sheung-Hoon 대한악안면성형재건외과학회 2008 Maxillofacial Plastic Reconstructive Surgery Vol.30 No.1

The objective of this study is to evaluate the stress distribution according to the thread design and the marginal bone loss of a single unit dental implant under the axial and offset-axial loading by three dimensional finite element analysis. The implants used had the diameter of 5mm and 4mm with 13mm in length and prosthesis with a conical type which is 6mm in height and 12mm in diameter. The thread designs were triangular, square and buttress. In the three dimensional finite element model with $15\times15\times20mm$ hexahedron and 2mm cortical thickness, implants were placed with crown to root ratio 7:12, 10:9, 13:6 and 16:3. And additionally the axial force of 100N were applied into 0mm, 2mm and 4mm away from the center of the implants. The results were as follows 1. The maximum von-Mises stress in cortical bone was concentrated to cervical area of implant, and in cancellous bone, apical portion. 2. Comparing the von-Mises stresses in cortical bone of 2mm and 4mm offset loading with central axial loading, it were increased to 3 and 5 times in diameter 4mm implant, and 2 and 4 times, in diameter 5mm implant. 3. The square threads were more effective than the triangular and butress as the longer diameter, the offset loading, and the worse crown to root ratio. 4. The von-Mises stresses were relatively stable until crown to root ratio 13:6, but it was suddenly increased at 16:3. From the results of this study, minimum requirement of crown to root ratio of implant is 2:1, and in the respect of crown to root ratio, diameter and offset loading, square threads are more effective than triangular and buttress threads.

두개저까지 확장된 악하선 점액류

김일규,양정은,장재원,주상현,편영훈,김루시아,Kim, Il-Kyu,Yang, Jung-Eun,Chang, Jae-Won,Ju, Sang-Hyun,Pyun, Young-Hun,Kim, Lucia 대한악안면성형재건외과학회 2011 Maxillofacial Plastic Reconstructive Surgery Vol.33 No.2

The mucocele is a mucus extravasation cyst arising from the salivary gland. Although it is a common?lesion of the minor salivary gland, it is uncommon when it originated from the submandibular gland. The ranula is a form of mucocele which specifically occurs in the floor of the mouth and the sublingual gland is generally accepted as the origin of ranula. They can be classified into two types based on extent: simple ranula are confined to the sublingual space and plunging ranula extend into the adjacent space. It is difficult to differentiate the submandibular gland mucocele from the plunging ranula because both of them can occupy the submandibular space. A 37-year old male visited our clinic with the chief complaint of left facial swelling. The patient's history revealed that he had suffered from a cystic lesion on the left side of the floor of the mouth 10 months previously. He supposed the cystic lesion had come from trauma at other dental clinics. Using CT and MRI, we diagnosed a simple ranula on the sublingual space and a submandibular gland mucocele. We then excised the mucocele with the submandibular gland by an extraoral approach and the sublingual gland by an intraoral approach under general anesthesia. We report a rare case of an enormous submandibular gland mucocele which extended into the pterygoid plate and parapharyngeal space with good surgical results.

구강 악안면 영역의 생체 흡수성 고정판 사용에 관한 임상 연구

김일규,박승훈,장금수,양정은,장재원,사시카라 바라라만,Kim, Il-Kyu,Park, Seung-Hoon,Jang, Keum-Soo,Yang, Jung-Eun,Jang, Jae-Won,Sasikala, Balaraman 대한구강악안면외과학회 2009 대한구강악안면외과학회지 Vol.35 No.6

Metallic bone plates and screws have been commonly used in oral and maxillofacial surgery for internal fixation. However, there are several disadvantages such as atrophy of cortical bone inherent to excessive rigid fixation systems, growth disturbance in growing individual, allergy reaction, interference with radiographic imaging, palpability, thermal sensitibity and the need for subsequent removal. To overcome these disadvantages and avoid additional surgery of removal of plates and screws, there have been many studies of biodegradable plates and screws. But, It also has complication such as foreign body reactions. We have undertaken a clinical and retrospective study on 140 patients in Dept. of Oral and Maxillofacial Surgery, Inha University Hospital from February 2006 to March 2009. The purpose of this study is to report the clinical cases and review of the literatures with biodegradable plates and screws. And we concluded following results. 1. 6 cases(3.4%) of the 177 operation sites(140 patients) experienced complications. 1 case(0.6%) was a failure of initial fixation, 1 case(0.6%) was a postoperative infection, 4 cases(2.3%) were inflammations or foreign body reaction. 2. Postoperative infections, inflammations and foreign body reactions were completely recovered with incision and drainage, supporative care with antibiotic coverage and removal of biodegradable plates. 3. Biodegradable plates and screws provide acceptable rigidity and stability clinically. But, long-term observation is required for the tissue reactions around the biodegradable plates and screws because of long resorption periods of the biodegradable materials.

상하악에 동시 다발성 골신장술을 이용한 반안면왜소증의 치험례

김일규,박종원,이언화,양정은,장재원,편영훈,주상현,왕 붕,Kim, Il-Kyu,Park, Jong-Won,Lee, Eon-Hwa,Yang, Jung-Eun,Chang, Jae-Won,Pyun, Yeong-Hun,Ju, Sang-Hyun,Wang, Boon 대한악안면성형재건외과학회 2010 Maxillofacial Plastic Reconstructive Surgery Vol.32 No.5

The hemifacial microsomia is characterized by variable underdevelopment of the craniofacial skeleton, external ear, and facial soft tissues. So, patients with hemifacial microsomia have an occlusal plane canting and malocclusion with facial asymmetry. Distraction osteogenesis (DO) with an intraoral or extraoral device is a technique using tension to generate new bone with gradual bone movement and remodeling. DO has especially been used to correct craniofacial deformities such as a hemifacial microsomia, facial asymmetry, and mandible defect that could not adequately be treated by conventional reconstruction with osteotomies. It has a significant advantage to lengthen soft and hard tissue of underdeveloped site without bone graft and a few complication such as nerve injury or muscle contracture. A 13-years old girl visited our clinic for the chief complaint of facial asymmetry. She had a left hypoplastic maxilla and mandible, occlusal plane canting and malocclusion. We diagnosed hemifacial microsomia and lanned DO to lengthen the affected side. Le Fort I osteotomy, left mandibular ramus and symphysis osteotomy were performed. The internal distraction devices fixed with screw on maxillary and mandibular ramus osteotomy sites. External devices were adapted to lower jaw for DO on symphysis osteotomy site and to upper jaw for rapid maxillary expansion (RME). At 7days after surgery, distraction was started at the rate of 1mm per day for 13days, and after 4months consolidation periods, distraction devices were removed. Simultaneous multiple maxillo-mandibular distraction osteogenesis with RME resulted in a satisfactory success in correcting facial asymmetry as well as occlusal plane canting for our hemifacial microsomia.

상악골 괴사를 동반한 베게너 육아종증: 증례보고

김일규,장재원,주상현,편영훈,정범상,한지영,Kim, Il-Kyu,Chang, Jae-Won,Ju, Sang-Hyun,Pyeon, Young-Hoon,Jung, Bum-Sang,Han, Ji-Young 대한악안면성형재건외과학회 2012 Maxillofacial Plastic Reconstructive Surgery Vol.34 No.3

Wegener's granulomatosis (WG) is an autoimmune disease of unknown etiology characterized by the triad of necrotizing granulomatous lesion in the upper and lower respiratory tracts or both, disseminated vasculitis involving both small arteries and veins, and necrotizing glomerulonephritis. The most common oral lesions associated with WG are ulceration and strawberry gingivitis. A 47-years old man in medical care associated WG was consulted our Division of Oral and Maxillofacial Surgery for the chief complaint of toothaches. Pre-operative panorama showed the alveolar radiolucency and the loss of lamina dura regarding the left upper teeth. An oropharyngeal magnetic resonance imaging also revealed the increased bone marrow signal intensity on the left maxilla. Under the impression of maxillary osteonecrosis due to WG, maxillary saucerization with removal of involved teeth was performed. We obtained good results and report the first case of WG in Korea, with the review of literatures regarding oral and general systemic features.