두개안면 섬유성 이형성증의 임상적 고찰

백롱민,오갑성,윤성호,백세민,황민호 大韓成形外科學會 1994 Archives of Plastic Surgery Vol.21 No.3

Fibrous dysplasia is a benign pathologic condition of bone and causes facial deformities as well as functional problems. We have managed 32 craniofacial fibrous dysplasia form March 1989 to December 1993. The most common age distribution of surgery was second decade(34%) and third decade(53%). In our patients, the desease process usually begins in childhood and progresses throughout puberty and adolescence. Treatment was aimed at preventing and correcting functional problems and achieving normal facial aesthetics. The reconstruction with other combined surgery, i.e., mandibular and maxillary osteotomies, reduction malar plasty, malar augmentation and orbit, nasal reconstruction with bone graft. Postoperative results were satisfactory in most cases. In some patients, repeated contouring(16%) surgery might produce less morbidity than a single massive resection. In evaluating the extent of the lesion, computerized tomography prooved to be a good diagnostic tool. Aethetically and functionally satisfactory surgical results were achieved by bone shaving in combination with reconstructive surgery.

이개 재건술 후 늑연골 공여부의 분석

백승준,임재호,백룡민,오갑성,백세민 大韓成形外科學會 1997 Archives of Plastic Surgery Vol.24 No.5

The harvesting of costal cartilage for the total ear reconstruction elicits various functional and aesthetic problems such as pneumothorax, atelectasis, pain, scar and chest contour deformities. Although the costal cartilage has been the most popular autogenous tissue for the total ear reconstruction, the studies about problems of donor site after harvesting the costal cartilage were relatively rare. From March 1989 to October 1996, 153 cases of total ear reconstruction by the costal cartilage framework insertion were done in our hospital and 61 cases whose follow up were done over 6 months were analysed for donor site scar, contour deformity and rate of satisfaction. The optimal age of microtia reconstruction was considered as over the age of 8, because of the growth of the ear and the volume of costal cartilage. Through a small incision, 3 ~ 4 cm, on the contralateral chest, the 6th, 7th and 8th costal cartilage were harvested with the outer layer of perichondrium for survival of the costal cartilage framework, the inner layer of perichondrium was remained for the growth of costal cartilage. There were 4 cases of uneventful pleural perforation, and remained no problems on the patients. The state of chest donor site were analyzed on 61 patients by use of medical records, medical photos and interview with the patients. Mean length and width of chest scar were 5.2 cm and 2.3 mm 79% of patients classified as excellent or acceptable. Chest contour deformity was observed on 39% and 85% of patients were satisfied with the result of donor site.

반안면 왜소증의 수술적 교정: 5년간 65례의 고찰

백승준,김진오,백롱민,오갑성,백세민 大韓成形外科學會 1997 Archives of Plastic Surgery Vol.24 No.5

Hemifacial microsomia is a descriptive term for the developmental anomaly affecting the tissues derived from 1st and 2nd branchial arches, expressed as asymmetric underdevelopement in facial bony skeleton. Conventional strategy of surgical correction for hemifacial microsornia consists of leveling though maxillary LeFort osteotomy and rotation, advancement and recession through bilateral sagittal split us osteotomy, which was reinforced by ancillary procedures such as mandibular augmentation with onlay bone graft, mandibular angle ostectomy, temporomandibular dibular joint (TMJ) reconstruction and malar reconstruction. But these like conventional methods for correction of hemifacial microsomia were emphasized on the correction of vertical asymmetry primarily, overlooked the asymmetry of horizontal plane, namely hypoplastic malar deformity. In general, correction of malar hypoplasia was achieved by rib or calvarial bone graft. These methods remain donor site deformity and the result can not be precisely predicted due to progressive resorption of bone. Moreover, the natural appearance of zygomatic complex could not be established by bone graft. Malar expansion by zygomatic osteotomy and spread-out technique was applied on correction for 34 case in total 65 cases of hemifacial microsomia from March 1991 to February 1996. We could get more natural appearance of malar complex and facial symmetry in the correction of hemifacial microsomia at one stage operation than conventional malar reconstruction methods.

유리피판술을 이용한 진행성 반안면 위축증(Romberg's Desease)의 치험

백롱민,정두성,백세민 大韓成形外科學會 1999 Archives of Plastic Surgery Vol.26 No.5

Romberg's disease is an uncommon condition manifested by progressive hemifacial atrophy of the skin, soft tissue and bone. Facial asymmetry with soft tissue deficiency in Romberg's disease causes a significant disability affecting the social life and can bring about many psychological problems. The aim of surgical treatment is cosmetic amelioration of the defect. Several conventional reconstructive procedures have been used for correcting facial asymmetry. They include fat injections, dermal fat grafts, silicone injections, cartilage and bone grafts, pedicled flaps and free flaps. We report our experience with 6 patients involving 6 free flaps with a minimun of 1 year follow-up who were treated from October 1989 to March 1998. All patients were classified as having moderate to severe atrophy. The average age of disease onset was 4.5 years. The average duration of atrophy was 5.2 years. No patient was operated on with a quiescent interval of less than 1 year. The average age at operation was 14.1 years, ranging from 10 to 24 years. Follow-up ranged from 1 to 9 years. Reconstruction was performed using 2 groin dermofat free flaps and 4 latissimus dorsi muscular free flaps. To achieve the finest symmetrical and aesthetic results, several ancillary procedures were performed in 4 patients. These procedures included Le-Fore 1 ½ leveling osteotomy, sagittal split ramus osteotomy, reduction malarplasty and angleplasty, rib and calvarial bone graft, correction of alopecia and additional dermofat graft. All patients were satisfied with the results. We believe that free flap is one of the best choices for contoured restoration of facial asymmetry in Romberg's disease.

대구증의 수술적 요법

백롱민,박종철,허찬영 大韓成形外科學會 2003 Archives of Plastic Surgery Vol.30 No.5

관골 축소술에 대한 임상적 고찰

백세민,함정욱,백롱민,오갑선 大韓成形外科學會 1997 Archives of Plastic Surgery Vol.24 No.6

Orientals with prominent cheek bones are aesthetically unpleased. So we have performed reduction malarplasty which consists of medial and lateral malar osteotomies, mobilization of malar complex to more attractive point, and wire fixation through coronal incision on 288 patients from March, 1988 to February, 1997. Results have shown symmetry, natural contour, good patient acceptance, and no significant complication. The concept of 'mobilization of malar eminence to more attractive point' is important because the goal of surgery is not to achieve merely 'flat' malar complex. At the same time various procedures have been also performed to improve facial aesthetics. The simultaneous subperiosteal face life was advantageous especially to aged patients and to those with severe anterior projection of malar eminences. Reduction malarplasty combined with reduction angleplasty and face life is one of the useful way to restore the youthful appearance.

상악 및 하악의 전방 분절 절골술을 이용한 안면 프로파일 성형술의 임상적 고찰

백세민,오갑성,윤은성,백롱민,임재호 大韓成形外科學會 1996 Archives of Plastic Surgery Vol.23 No.5

Mid and lower facial convexity is more common in Oriental people than in Caucasian and it is thought to be caused by a more anterior position of dental and skeletal structures rather than soft tissue structures, a more procumbent dentition, and a more acute interincisial angle. To improve their lower facial profile, we performed maxillary and mandibular anterior segmental osteotomies in 96 patients, by way of using palatal mucoperiosteal flap for vascular circulation of the antrior segment and plates and screws for rigid fixation. We also used wafer splint which had been made through model surgery which dental cast and tracing of cephaloghram had been needed. We could get the accurate diagnosis and know how much and which direction the anterior segment should move to get the satisfactory result or improved lower facial profile and corrected occlusal relationship with the teeth. No major complications occurred throughout the followup period except three of over0recessed lip and two of septal deviation, otherwise most of the patients were satisfied with the result.

HYDROXYAPATITE를 이용한 전두부 성형술

백롱민,박재현,김진환,백세민,오갑성,정연철 大韓成形外科學會 1993 Archives of Plastic Surgery Vol.20 No.5

The shape and contour of the upper third of the face is provided basically by the frontal bone. A relatively thin soft tissue coverage, which consists of the skin and frontalis muscle, readily shows subtle changes on the underlying frontal bone. The forehead represents the fortune of one's youth from the viewpoint of physignomy, and a broad forehead with minimal supraorbital bossing and round curvature is preferrd in the Orient. The forehead with a deficient, flat contour or asymmetry could be indicated for augmentation. The exact site and amount of augmentation are dicided preoperatively using clinical assessment, medical photographs, and cephalometric analysis. Hydroxyapatite(Pyrost), because of its nonresorbability, seems to have advantages over other alloplastic materials for forehead augmentation. From March 1989 to February 1992 forehead augmentation has been performed in 60 patients. Through a coronal incision, the dissection was carried over the periosteum to the supraorbital ridge and the lateral orbital rim. The subperiosteal pocket was made through a small incision, and was packed with Pyrost. When indicated, facial rhytidectomy, or reduction malar plasty was performed simultaneously. The result had been satisfactory and long lasting. There had been no implant shifting, infection, or bony erosion when examed from 1 year to 4 years after surgery.

심한 안검하수에 있어서 측두근막과 Tutoplast Dura를 이용한 전두근 현수법

허찬영,백롱민,백세민 大韓成形外科學會 1999 Archives of Plastic Surgery Vol.26 No.4

Patients with a poor or total absence of levator function require correction of their ptosis by a sling procedure. The aim of the procedure is to utilize the action of the frontalis muscle to mechanically raise a droopy eyelid Frontalis suspension procedure using a temporalis fascia or Tutoplast Dura was performed on 36 ptotic eyelids of 23 patients(age range 2-37 years) with a poor or absent levator function. The author used a surgical technique based on a modified Fox`s method. Satisfactory results were achieved in 42 lids according to the criteria of Jordan after an average follow-up of 23 months. No serious complication was seen immediately postoperative and during the follow-up period. Temporalis fascia and Tutoplast Dura appear to be effective and safe alternative sling materials for frontalis suspension surgery.

하악각축소술시 절제된 골의 간치이식을 이용한 턱끝증대술

이태일,백룡민,오갑성,백세민 大韓成形外科學會 1997 Archives of Plastic Surgery Vol.24 No.5

The square face or the box face appearance is quite common in orientals as well as occidentals and consists of flaring at the mandible angle areas with exaggerated posterior inferior projection of the mandibular angle in combination with a small and weak chin, resulting in widened bigonial distance and shortened lower third of face. Such patients complain of unbalanced and masculine appearance and may regard themselves as unaesthetic. To correct these deformities simultaneously, the mandible angles were resected (angled osteotamy) and the bone fragment from these ostectomized mandibular angles were used to augment the chin as an autogenous interpositional bone graft. At the Institute of Plastic and Reconstruction Craniofacial Surgery(IPRCS), Ice University Collage of Medicine, twenty eight cases were successfully operated in this manner during a six-year period from June 1989 to May 1995. Patient's satisfaction was high and improved esthetics were noted in all patients with minimal complications. The advantages are: l. Simultaneous correction of prominent mandible angle and augmentation of the deficient chin area. 2. Provides vertical elongation of the chin and lower face, which gives visual compensation for agittal weakness of the lower face. 3. Improves upper and lower facial balance. 4. Another donor site for bone is not necessary, thus avoiding unnecessary donor site morbidity. 5. Homogenous autologous bone is used thus reducing the chance of resorption. 6. Minimal chance of infection.