구강 결손부에 적용된 요골 유리전완 피부피판 적용례 분석

김욱규,이광호,송원욱,황대석,김용덕,신상훈,김종렬,정인교,Kim, Uk-Kyu,Lee, Kwang-Ho,Song, Won-Wook,Hwang, Dae-Seok,Kim, Yong-Deok,Shin, Sang-Hun,Kim, Jong-Ryoul,Chung, In-Kyo 대한악안면성형재건외과학회 2010 Maxillofacial Plastic Reconstructive Surgery Vol.32 No.4

The radial forearm free flap (RFFF) has become a workhorse flap as a means of reconstructing surgical defects in the head and neck region. We have transferred 12 RFFFs with fasciocutaneous type on oral cavity defects in 12 patients after cancer resection and submucous fibrotic lesion ablation from 2005 to 2007 at Department of oral and maxillofacial surgery, Pusan National University Hospital. We reviewed retrospectively patients' charts and followed up the patients. Clinical analysis on the cases with RFFFs focusing on flap morbidity, indications and available vessels was done. The results of study are follows: 1. RFFF could be applied for all kind of defects after resection of tongue, floor of mouth, buccal mucosa, denuded bone of palate, maxilla, and mandible. 2. All free flaps could be used for primary reconstruction. The survival rate of 12 RFFFs was 92%. Partial marginal loss of the flaps was shown as 3 cases among 12 cases. Large size-vessels like superior thyroid artery, facial artery, internal jugular vein were favorable for microvascular anastomosis. 3. Parenteral nutrition instead of nasal L-tube also can be favorable for postoperative a week for better healing of the flap if the patients couldn't be tolerable with nasal tubing. 4. Donor sites with thigh skin graft were repaired with wrist band for 2 weeks. The complications included scarring, abnormal sensation on hand, and reduced grip strength in few patients, but those didn't induce major side effects. 5. Most RFFFs were well healed even if mortality rate of cancer patients was shown as 50% (5/10 persons). The mortality of patients was not correlated with morbidity of the flaps. We could identify the usefulness of RFFF for restoration of oral function, esthetics if the flap design, tissue transfer indications, and well controlled operation are proceeded.

악골내 섬유조직성-골성병소에 관한 임상연구

김욱규,차승만,황대석,김용덕,신상훈,김종렬,정인교,Kim, Uk-Kyu,Cha, Seong-Man,Hwang, Dae-Seok,Kim, Yong-Deok,Shin, Sang-Hun,Kim, Jong-Ryoul,Chung, In-Kyo 대한악안면성형재건외과학회 2005 Maxillofacial Plastic Reconstructive Surgery Vol.27 No.3

The challenging task of classifying the fibro-osseous(FO) lesions has been previously attempted but only in the past 15 years has the entire spectrum of diversity been appreciated. For the clinicians, it is hard to clearly diagnose the lesions before operations. The purpose of this study was to review the literature about fibro-osseous lesions of the jaws and to analyse our clinical cases. As the results of the review of clinical features, radiography and histopathologic findings of sixteen cases of fibro-osseous lesions, we could elucidate diagnostic aids for treatment of benign FO lesion in jaws. Six patients involving fibrous dysplasia complained the facial swelling and facial asymmetry. The radiographic features of the lesions showed ground-glass radiopacity mostly and the histologic findings showed typically Chinese character-shaped trabeculae without osteoblastic rimming in the fibrous stroma. Six patients with ossifying fibroma were notified as swollen buccal cheek state. Their radiographic findings showed cortical expanded radiolucent lesion with sclerotic defined border, which was contrast to the normal adjacent bone. The lesions showed variant radiolucent lesions. Histological findings were revealed as cellular fibrous stroma with woven bones, variable patterns of calcifications. Three patients with cemental dysplasia didn't have specific complaints. Well circumscribed radiopaque lesions on mandibular molar area were observed. Cementum-like ossicles with fibrous stroma were found on microscopic findings. A osteoblastoma case with jaw pain was found. The radiographic feature was a mottled, dense radiopacity with osteolytic border on mandibular molar area. Under microscopy trabecule of osteoid with vascular network were predominantly found. Numerous osteoblast cells with woven bone were found. These clinical, radiographic and microscopic findings of benign fibrous-osseous lesions would suggest diagnostic criteria for each entity of FO lesions.

구강내 결손부에 적용된 연조직 재건술식들에 대한 임상적 고찰

김욱규,이승환,황대석,김용덕,신상훈,김종렬,정인교,Kim, Uk-Kyu,Lee, Seung-Hwan,Hwang, Dae-Suk,Kim, Yong-Deok,Shin, Sang-Hun,Kim, Jong-Ryoul,Chung, In-Kyo 대한악안면성형재건외과학회 2007 Maxillofacial Plastic Reconstructive Surgery Vol.29 No.6

To evaluate criteria, indications, and prognosis of the various reconstructive methods on the patients with intraoral soft tissue defect who had been treated at Dept. of Oral and Maxillofacial Surgery, Pusan National University Hospital from 2003 to 2005, we have reviewed the clinical data of the patients and analysed. The results were as follows: 1. Tongue flaps have been mainly applied on anterior portion of palate and maxilla. The survival rate was high percent, but the cooperation of patient was inevitable for the success. 2. Palatal mucosa rotational flaps were available on relative large defect on palate, oroantral fistula site. The side effect was a scaring band from secondary healing on denuded donor palate site. Sometimes the band came to be a hinderance to swallowing, phonation. 3. Forearm free flap was a workhorse flap for everywhere in intraoral defects. We had used the flap on cheek, floor of mouth, tongue without any significant complications. But the application of the flap was required for long operation time, which was disadvantageous to the old, weak patients. 4. Cervical platysmal flap could be easily applicable for buccal cheek, floor of mouth after excision of the cancer lesion. The design of the flap could be made simultaneously on neck dissection, but the danger of cancer remnants on the flap always might be remained. 5. Buccal fat pad pedicled flap must have been a primary flap for repair of oroantral fistula especially on posterior maxilla. The flap survival will be expected if the considerations for above reconstructive methods on site, size, condition of defects primarily could be made.

수축력과 신장력을 병용한 골신장술에서의 다양한 힘의 비와 부여시기에 따른 신연골 반응

김욱규,신상훈,정인교,김철훈,허준,윤일,Kim, Uk-Kyu,Shin, Sang-Hun,Chung, In-Kyo,Kim, Cheol-Hun,Huo, Jun,Yun, Il 대한악안면성형재건외과학회 2005 Maxillofacial Plastic Reconstructive Surgery Vol.27 No.5

The purpose of this study was to identify the effectiveness of the modified distraction osteogenesis (DO) method with the concept of overdistraction and compression stimulation which have been previously suggested by the authors in 2002 and to explore the optimal distraction-compression ratio and appropriate latency period for the compression force application during consolidation. The experimental specimens were assessed with radiography, histologic findings, and dual energy x-ray absorptiometry (DEXA) after the conventional DO method and the modified DO technique had been applied on rat mandibles. Total 60 rats were used for the study. In experimental group of 54 adult rats, mandibular osteotomies between the first and second molar areas were performed and customized external distractors were applied. The surgeries on 6 rats of control group also were done with same osteotomy technique and DO device application. Final amount of distraction was set-up as 2 mm on both groups. But, in a experimental group of 54 rats, distraction osteogenesis with a compression force were performed with the different distraction-compression ratio and variant latency periods for compression. The three ratio-subgroups were made as distraction 4 mm group with compression 2 mm, distraction 3 mm group with compression 1 mm, and distraction 2.5 mm group with compression 0.5 mm. In addition, The three subgroups with 3, 7, 11 days latency period prior compression were allocated on each ratio-subgroups. Total 9 subgroups consisted of 6 rats on each subgroup. In control group of 6 rats, conventional distraction technique were routinely performed. The rats of control groups were sacrificed on postoperative 3, 6 weeks after 2 mm distraction. The rats in the experimental groups also were sacrificed on the same euthanasia days of control groups to compare the wound healing. Final available specimens were 55 rats except 5 due to osteomyelitis, device dislodgement. Distraction-compression combined group on 6 weeks generally had showed increased bone mineral density than the same period group of conventional distraction technique on the DEXA study. More matured lamellar bone state and extended trabecular pattern in the combined group than those of control group were also observed in the histologic findings on 6 weeks. In the distraction-compression combined groups, the bone density of 2.5 mm distraction subgroups with 0.5 mm compression showed the highest value on the DEXA study among various force ratio groups. In the distraction-compression combined groups, the bone density of 3 day latency period subgroups showed the highest value on the DEXA study among various latency period groups for the compression application. From this study, we could deduce that 1/5 force ratio for the compression versus distraction, 3 day latency period prior compression application would be the most effective condition if modified distraction osteogenesis technique might be applicable. The modified DO method with a compression force may improve the quality of bone regenerate and shorten total treatment period in comparison with conventional DO technique clinically.

다양한 방법으로 적용한 미세혈관문합술간의 개존율연구

김욱규(Uk-Kyu Kim),김용덕(Yong-Deok Kim),변준호(June-Ho Byun),신상훈(Sang-Hun Shin),정인교(In-Kyo Chung) 대한구강악안면외과학회 2003 대한구강악안면외과학회지 Vol.29 No.5

Several microvascular anastomotic techniques have been described with methodical effectiveness, patency rates, healing state of microscopic findings. This experimental study presents the comparison of three types of arterial microvascular anastomotic techniques: end-to-end(ETE) anastomosis, end-in-end(EIE) anastomosis, and continuous technique. Sixty male Sprague-Dawley rats, 60 femoral arteries were used for this study. Twenty rats per each technique were used and sacrificed at post-operation 1 day, 3 days, a week, 2 weeks for scanning electromicroscopic findings. The patency was monitored by miniDoppler throughout total experimental periods. The anastomotic time on each method was measured to compare the technical effectiveness. The final results were as follows: 1. The anastomotic time for the end-in-end technique was significantly shorter than another techniques. The average time for each technique was measured as 15 minutes on EIE technique, 20 minutes on continuous technique and 25 minutes on ETE technique. 2. The patency rate for the end-in-end technique at 2 weeks also was superior to another techniques. The patency rate for each technique was demonstrated as 90 % on EIE technique, 85 % on ETE technique and 80 % on continuous technique. 3. The scanning electromicroscopic findings on healing condition of vessel endothelium during the observation period showed that the end results of EIE technique, ETE technique and continuous technique in sequence were good. The end-in-end technique proved to be the superior with regard to anastomotic time and patency rate when compared to end-to-end technuqe, so EIE techniqe might be well available for the case of large discrepancy of vessel size. The patency rate, microscopic healing findings in continuous technique were seen as the lowest level among the three anastomotic techniques, therefore the application of continuous technique was recommended only on the inevitable case.

지방기질유래 줄기세포의 골 분화 시 성장인자의 효과

김욱규(Uk-Kyu Kim),최연식(Yeon-Sik Choi),정진섭(Jin-Sup Jung) 대한구강악안면외과학회 2006 대한구강악안면외과학회지 Vol.32 No.4

Future cell-based therapies such as tissue engineering will benefit from a source of autogenous pluripotent stem cells. There are embryonic stem cells (ESC) and autologous adult stem cells, two general types of stem cells potentilally useful for these applications. But practical use of ESC is limited due to potential problems of cell regulation and ethical considerations. To get bone marrow stem cells is relatively burden to patients because of pain, anesthesia requirement. The ideal stem cells are required of such as the following advantages: easy to obtain, minimal patient discomfort and a capability of yielding enough cell numbers. Adipose autologus tissue taken from intraoral fatty pad or abdomen may represent such a source. Our study designed to demonstrate the ability of human adipose tissue-derived stromal cells (hATSC) from human abdominal adipose tissue diffentiating into osteocyte and adipocyte under culture in vitro conditions. As a result of experiment, we identified stromal cell derived adipose tissue has the multilineage potentiality under appropriate culture conditions. And the adipose stromal cells expressed several mesenchymal stem cell related antigen(CD29, CD44) reactions. Secondary, we compared the culture results of a group of hATSC stimulated with TGF-β1, bFGF with a hATSC group without growth factors to confirm whether cytokines have a important role of the proliferation in osteogenic differentiation. The role of cytokines such as TGF-β1, bFGF increased hATSC’s osteogenic differentiation especially when TGF-β1 and bFGF were used together. These results suggest that adipose stromal cells with growth factors could be efficiently available for cell-based bone regeneration.

하악전돌증 환자의 양악 수술 시 상악골 후상방 회전이동 여부에 따른 안면부 경조직 변화량에 대한 비교 연구

김욱규(Uk-Kyu Kim),이성탁(Sung-Tak Lee),김태훈(Tae-Hoon Kim),송재민(Jae-Min Song),황대석(Dae-Seok Hwang),·정인교(In-Kyo Chung) 대한구강악안면외과학회 2011 대한구강악안면외과학회지 Vol.37 No.4

Purpose: This study evaluated retrospectively the postsurgical facial hard tissue profile of a Le Fort I osteotomy with/without posterior impaction and rigid internal fixation to correct mandibular prognathism. After observing a difference between the two groups, this measurement was used to prepare a treatment plan for 2-jaw surgery. Patients and Methods: Thirty patients who had undergone orthognathic surgery in Pusan National University Dental Hospital were enrolled in this study. Fifteen patients were treated using a Le Fort I osteotomy with posterior impaction and mandibular setback bilateral sagittal split ramus osteotomy, and the other fifteen patients were treated without posterior impaction. The preoperative (T0), immediate postoperative (T1) and six-month follow-up period (T2) cephalograms were taken and difference between T1-T0 and T2-T2 was analyzed. Results: Both groups was FH-ABp, SNB and ANB showed significant changes in the measurement, whereas only the posterior impaction group showed a change in the SN-U1, occlusal plane, posterior facial height, surgical movement difference from the L1 and B-point. There was no significant statistical change between the immediate postoperative (T1) and six-month follow-up (T2) hard tissue analysis in the two groups. Conclusion: A Le Fort I osteotomy with posterior impaction is considerable for patients with a flat occlusal plane angle, large posterior facial height, prominent B-point, pogonion and labioversed incisal inclination if the indications are well chosen.

백서 하악골에서 신연골형성술시 신장력과 수축력 복합적용후의 조직반응

김욱규(Uk-Kyu Kim),신상훈(Sang-Hun Shin),정인교(In-Kyo Chung),이광호(Kwang-Ho Lee),박봉수(Bong-Soo Park) 대한구강악안면외과학회 2002 대한구강악안면외과학회지 Vol.28 No.2

Distraction osteogenesis is a biologic process of new bone formation between the surfaces of bone segments that are gradually separated by incremental traction. Distraction osteogenesis is clinically applied as a new treatment modality of mandibular hypoplasia or bony defect area in maxillofacial area by many studies of distraction devices and method. But, disadvantages of distraction osteogenesis shows unfavorably long consolidation period and relapse tendency. Therefore, this experiment was designed to investigate the effectiveness of combined application of distraction and compression force for improving of bone quality and shortening of treatment period during distraction osteogenesis. Twenty-five Sprague-Dawley rats with 300-350gm were used. These were divided into two group as distraction group and combination group. The distraction group was added with conventional method during distraction osteogenesis, but the combination group was applied with compression force in the consolidation period. The rats were sacrificed for gross finding, radiographic and histologic findings at 3, 6 weeks after distraction. The results were as follow: 1. On radiographic finding, all combination of distraction and compression force group appeared more radiopacity than distraction group both at 3 weeks and 6 weeks after distraction group. 2. On histologic finding, the formation of mature lamellar bone were showed increasingly in combined group at 6weeks after distraction group. From this study, we may suggest that compression force application in consolidation period during distraction osteogenesis can be useful method to improve bone quality and to shorten the treatment period. But more experimental and clinical studies is necessitated on ideal application timing and method of compression force application during distraction osteogenesis.

종양수술전 화학요법이 미세수술시 피판생존율에 미치는 영향

김욱규(Uk-Kyu Kim),김용덕(Yong-Deok Kim),변준호(June-Ho Byun),신상훈(Sang-Hun Shin),정인교(In-Kyo Chung) 대한구강악안면외과학회 2003 대한구강악안면외과학회지 Vol.29 No.6

Purpose: Neoadjuvant chemotherapy is commonly used to treat cancer patients as adjunct treatment, but if the microvascular tissue transfer is performed simulataneously with cancer resection surgery, the induction chemotherapy might affect the survival rate of vascularized free flap. Our study will focus on the effect of induction chemotherapy on the free flaps which were made on white rat abdomen after injection of 5-FU. Materials and Methods: The experimental rat groups were divided into three groups (total 24 rats) as a normal control group, 24 hrs group after 5-FU injection, 3 days group after 5-FU injection. Inferior abdominal island flaps of 8 Sprague Dawley rats on each group were made and immediately were induced into an ischemic state by clamping the supplying inferior epigastric artery and vein with microvascular clamp for a hour to induce a similiar free flap circumstance, then the inferior abdominal skin flaps were reperfused by releasing the clamps. The flaps on abdomen were repositioned and sutured. The experimental data for flap survival rate was collected by digital photo taking, analysed by computer image program to compare with the flap luminosity. The rats were sacrificed at 3 days, 5 days, 7 days after flap preparation and specimens of the flap were taken and stained with H-E staining. The microscopic finding was made under magnification of 200 and 400. Results: 1. Gross findings on each groups showed the healing condition was good as following sequences; normal, 24 hrs group after chemotherapy, 3 days group after chemotherpy. 2. The values of flap luminosity for evaluation of flap survival rate also showed the same sequences as gross findings of healing state. 3. The microscopic findings of epidermis necrosis, inflammation state, dermis fibrosis, vessel change, fatty tissue layer thinning were compared with each group. The 3 days group after chemotherapy showed remarkably poor healing condition compared to other groups. Conclusion: Chemotherapy agents affected the healing process of free flap, but healing condition was recovered spontaneously as post-injection periods passed out. In opposite to our expectation, 3 days group showed the bad flap condition in comparing with 24 hours group which was considered as immatured body circulation state of chemotherapy agent. It showed that 3 weeks in human being after chemotherapy was not proper as timing of microvascular tissue transfer if 3 days group in rat was considered as same healing period of 3 weeks in human being. More delayed healing timing than 3 weeks might be required in clinical application of free tissue transfer.

악관절원판의 인위적 전방변위술시행후 악관절구성조직에서 Fibronectin의 분포변화

김욱규(Uk Kyu Kim),정인교(In Kyo Chung),박봉수(Bong Soo Park) 대한구강악안면외과학회 1999 대한구강악안면외과학회지 Vol.25 No.4

The extracellular matrix(ECM) is a complex network of different combination of collagens, glycosaminoglycans, laminin, fibronectin, and many other glycoproteins including proteolytic enzymes. The composition and organization of the ECM contributes to the uniques physical or biomechanical properties of a tissue. Fibronectins(FN) are dimeric glycoproteins located on cell surfaces, in the matrix of connective tissue, and in blood. Fibronectins mediate cell attachment to collagen substratum and have been implicated in a variety of important biological processes, including embryogenesis and cell differentiation. The purpose of this study was to determine the effects of surgical induction of anterior disk displacement(ADD) on distribution of fibronectin in the rabbit temporomandibular joint(TMJ) tissues included the articular cartilage, disc, retrodiscal tissue, articular eminence using an immunohistochemical technique. The left TMJ was exposed surgically, and all discal attachments were severed except for the posterior attachment. The disk was then repositioned anteriorly and sutured to the zygomatic arch. The right TMJ served as a shamoperated control. Normal joints were used as a nonoperated control. Fourty-five rabbits were used for experiments in total. For fibronectin immunohistochemical study, eighteen rabbits (one normal group and 5 experimental groups, each group consists of 3 rabbits) were used. The experimental rabbits, were sacrified after operation period of 2, 3, 4, 6 and 8 weeks on fibronectin. The obtained results were as follows ; 1. Fibronectin immunoreaction on all TMJ tissues(mandibular condyle, articular disc, retrodiscal tissue, articular eminence) in the normal rabbit was observed. Especially the reverse cell layer and proliferation zone of articular cartilage of condyle show strong positive reaction. 2. Depletion of fibronectin in the all TMJ tissues except hypertrophic zone of articular cartilage occurred at 2 weeks following induction of ADD. 3. The restoration of immunoreaction at 4 weeks was observed and a progressive increasing reaction at 6 weeks, 8 weeks also was found. Our study generally showed degenerative changes in TMJ tissues after ADD although TMJ tissues adapted or degenerated to abnormal loads and stress distribution according to the remodeling capacity of TMJ tissues.