하악과두부 골절 치료시 다양한 외과적 접근법에 대한 임상적 고찰

김지혁,김성민,권광준,박영욱,Kim, Ji-Hyuck,Kim, Soung-Min,Kwon, Gwang-Jun,Park, Young-Wook 대한악안면성형재건외과학회 2008 Maxillofacial Plastic Reconstructive Surgery Vol.30 No.1

Various surgical approaches in the mandibular condyle fracture have been reported and many advantages of intraoral reduction were also introduced. But there are still controversies about surgical method of condylar fractures up to date. To establish the surgical approach protocol of condylar fracture, from May 2001 to December 2004, total 65 patients with 74 fractures of the mandibular condyle were reviewed during 2 years, retrospectively. All cases were classified according to the treatment considering factors, such as the level of fracture, degree and direction of displacement of fractured segment, patient’s age and gender, surgical approach methods, and their complications. Especially, advantages and surgical limitations of extraoral surgical approach, such as direct reduction and fixation via submandibular approach, Nam’s method, and endaural approach, were compared with those of intraoral surgical approach, such as direct intraoral reduction with transbuccal fixation or right angle driver system, and intraoral reinsertional approach after extraoral fixation of fractured fragment. The guidelines of surgical approach of condylar fracture based on our clilnical retrospective experiences and literature reviews can be suggested.

Skeletal Anchorage System의 식립을 위한 한국인 악골의 피질골 두께에 대한 연구

김지혁(Ji-Hyuck Kim),주재용(Jae-Yong Joo),박영욱(Young-Wook Park),차봉근(Bong-Kuen Cha),김성민(Soung-Min Kim) 대한구강악안면외과학회 2002 대한구강악안면외과학회지 Vol.28 No.4

Recently, Skeletal Anchorage System (SAS) has been focused clinically with the view point that it could provide the absolute intraoral anchorage. First, it began to be used for the patient of orthognathic surgery who had difficulty in taking intermaxillary fixation due to multiple loss of teeth. And then, its uses have been extended to many cases, the control of bone segments after orthognathic surgery, stable anchorage in orthodontic treatment, and anchorage for temporary prosthesis and so on. SAS has been developed as dental implants technique has been developed and also called in several names; mini-screw anchorage, micro-screw anchorage, mini-implant anchorage, micro-implant anchorage (MIA), and orthosystem implant etc. Now many clinicians use SAS, but the anatomical knowledges for the installed depth of intraosseous screws are totally dependent on general experiences. So we try to study for the cortical thickness of maxilla and mandible in Korean adults without any pathologic conditions with the use of Computed Tomography at the representative sites for the screw installation.

하악정중부에서 자가골 채취시 절치관의 해부학적인 변이에 대한 평가

김지혁(Ji-Hyuck Kim),김세호(Se-Ho Kim),권광준(Kwang-Jun Kwon),김성민(Soung-Min Kim),박영욱(Young-Wook Park) 대한구강악안면외과학회 2006 대한구강악안면외과학회지 Vol.32 No.3

The interforaminal region is usually considered as a safe region in the chin bone graft without important vital anatomical structures to be damaged. But the accurate anatomy of the interforaminal region, with its potential clinical relationships, is controversial. Moreover some complications suggesting damage of incisive terminal branches after chin bone harvesting are reported such as sensory discomfort and pain etc. In order to verify incisive innervation of symphyseal area, we examined the cross-sectional CT scan images taken for preoperative planning of implant placement with chin bone graft and some parameters were measured; (1) visuality rating of incisive canal (2) vertical and horizontal diameter of canal (3) distance from lower border of the incisive canal to the lower border of the mandible (4) shortest distance from anterior border of the incisive canal to the anterior border of the mandible. We report the positive outcome that decrease the complications related with the damages of incisive branch during bone harvesting from the chin.

하악정중부 골채취시 술후 합병증을 최소화하기 위한 변형“gull-wing”형 절개법

김지혁(Ji-Hyuck Kim),이종호(Jong-Ho Lee),이석근(Suk-Keun Lee),김성민(Soung-Min Kim) 대한구강악안면외과학회 2005 대한구강악안면외과학회지 Vol.31 No.2

In the reconstruction of the hard tissue defect of the oral cavity, the usefulness of the chin bone graft, one of the intraoral donor site, is gradually increased. The advantages include reduced resorption rate after graft due to its membranous bone nature, relatively ease to harvest under local anesthesia, reduced operative time because of the same operative field, decreased morbidity, and relatively large amount of bone can be harvested compared to other intraoral donor site. It has also postoperative complications including paresthesia of the lip or chin area, discomfort of lower anterior teeth, and facial swelling around chin area. Of these complications, facial swelling occurs more frequently, is more severe as a early postoperative discomfort, and prevents fast recover of patient’s social activity since this procedure is generally accomplished in the outpatient base under local anesthesia. So we applied a modified“ gull-wing”type incision to minimize this complication, and now we report this simple but effective surgical technique with clinically favorable result.

만성 미만성 경화성 골수염을 동반한 개화성 백악질-골 이형성증의 면역조직화학적 연구

김지혁(Ji-Hyuck Kim),조정애(Joung-Ae Jo),김성민(Soung-Min Kim),박영욱(Young-Wook Park),허진영(Jin-Young Huh),이석근(Suk-Keun Lee) 대한구강악안면외과학회 2003 대한구강악안면외과학회지 Vol.29 No.5

Florid cemento-osseous dysplasia (FCOD) is a benign, non-neoplastic lesion characterized by multiple sclerosing masses only within jawbones. It is frequently confused with chronic diffuse sclerosing osteomyelitis (CDSO) in previous literatures. In our study, two cases of FCOD were examined to know the characteristics of their calcifying tissues. The first case was non-infected, while the second case was severely infected, displaying the typical features of CDSO in clinico-radiologic findings. The infected FCOD case showed a lot of bacterial colonies in the main lesion with relatively rare inflammatory reaction. The globular cementum-like materials of FCOD showed woven bone pattern and was positive for Alcian blue stain, and also positive for the antibodies of ameloblastin, bone morphogenetic protein (BMP) -2 and -4. On the other hands, in the immunostains of matrix metalloproteinase (MMP) -3, -9, -10, and TNF-α, macrophage infiltrated in the FCOD lesion was rarely observed. These data suggest that the cementum-like materials of FCOD contain various matrix proteins, and that the cementum-like materials are relevant to the overgrowth of the bacterial colonies by inhibition of the regional inflammatory reactions.

구강 내 소수술에 있어 Midazolam을 이용한 의식하진정 치료원칙

김성민,김지혁,박영욱,장재현,권광준,김세정,남대우,권기열,Kim, Soung-Min,Kim, Ji-Hyuck,Park, Young-Wook,Jang, Jae-Hyun,Kwon, Kwang-Jun,Kim, Se-Jung,Nam, Dae-Woo,Kwon, Ki-Yeul 대한치과마취과학회 2003 Journal of Dental Anesthesia and Pain Medicine Vol.3 No.1

Background: Conscious sedation is a minimally depressed level of consciousness that retains the patient's ability to maintain the airway continuously and to respond appropriately to physical stimulation and verbal command at any time, produced by a pharmacologic or nonpharmacologic method or a combination thereof. In dental anesthesia, a state of sedation in which the conscious patient is rendered free of fear, apprehension, and anxiety through the use of pharmacologic agents. Midazolam is a useful drug of benzodiazepine on minor operation of dentistry. The purpose of this study is to estimate the appropriate dosage protocol of midazolam to the patient receiving intravenous sedation at the department of oral and maxillofacial surgery. Methods: Total subject was fifty-one patients and fifteen patients of this subject were decided to control group (Group I) that they were not received intravenous sedation. The experimental group was randomly subdivided into two groups and each of those groups was administrated to 0.05 mg/kg (Group II) and 0.08 mg/kg (Group III) each other. All patients of the subject were surveyed with postoperative one day questionaire to evaluate the level of sedation. Results: In view of antegrade amnesia, 1. Group II and III were statistically different compared to Group 1, respectively. 2. Group II and III were not statistically different. Conclusions: Apparent antegrade amnesia was found in both groups 0.05 mg/kg and 0.08 mg/kg intravenously administered. So we present the protocol of the department of oval and maxillofacial surgery, Kangnung National University Dental Hospital. But further studies concerning patient's age, body weight, and general condition will be carried out.

선천성 치조점막 유착에 대한 문헌고찰 및 증례보고 -증례보고-

김성민,김지혁,박영욱,권광준,이종호,이석근,Kim, Soung-Min,Reddy, SG,Kim, Ji-Hyuck,Park, Young-Wook,Kwon, Kwang-Jun,Lee, Jong-Ho,Lee, Suk-Keun The Korean Dental Society of Anesthsiology 2007 Journal of Dental Anesthesia and Pain Medicine Vol.7 No.1

상악과 하악이 선천적으로 붙어서 태어나는 선천성 유합증은 드문 선천성 기형으로 단순히 점막이 붙은 점막유합증에서 악골이 붙은 골유합증까지 다양하게 나타난다. 이중 상악골과 하악골의 골자체가 붙는 골유합증은 아주 드물어서 현재까지 26증례만 보고되고 있는데, 보고된 대부분의 증례는 편측에만 발생하는 불완전형으로 알려져 있다. 7세 된 여아환자가 인디아의 GSR 병원에 입이 벌어지지 않는다는 주소로 내원하였는데 환아의 턱은 완전히 움직이지 않았으며, 2-3 mm 정도 벌어지는 앞니부위에서는 2.5 cm 폭경의 3.0 mm 두께의 단단한 치조점막이 관찰되었다. 전기메스로 전방부의 부착성 섬유밴드를 잘라준 후 즉각적인 개구정도는 16 mm 정도까지 가능하여 구강으로의 기관삽관이 가능하였다. 삽관후 양쪽 후방부 협측점막의 두꺼운 밴드들을 모두 제거하여 개구량을 33 mm까지 증진시킨 후 수술을 종결하였다. 환아의 보호자에게 거즈 블록과 설압자를 이용하여 개구 연습을 능동적으로 시키도록 강조하여 교육하였으며 술후 16개월 경과시까지 특별한 합병증이나 개구량 감소는 관찰되지 않았다. 독립적으로 발생한 선천성 치조점막 유합증 환자에서 비정상적으로 커져있는 과두와 설골이 관찰되었는데, 설-하악 구조의 비정상적인 발육에 기인하여 지속적인 비정상적 운동으로 인한 이차적인 치은과 협점막의 섬유성 부착이 생긴 것으로 추측되었다. 이에 마취과와의 효율적인 협진으로 기관절개술 등의 부가적인 마취방법 없이 효과적으로 치료할 수 있었다.

장골의 복합유리피판 이식 후 두 개의 타이타늄 금속판을 이용한 공여부의 심미적 재건

김성민,인연수,김지혁,박영욱,Kim, Soung-Min,In, Yeon-Soo,Kim, Ji-Hyuck,Park, Young-Wook 대한악안면성형재건외과학회 2006 Maxillofacial Plastic Reconstructive Surgery Vol.28 No.6

Deep circumflex iliac artery (DCIA) flap can be harvested as a composite free flap and is often used to adequately reconstruct wide mandibular defects. However, the harvesting of this DCIA flap can result in severe osseous defect of the donor site causing a morphologic defect in the iliac crest. To reconstruct this defect of the iliac donor site, several innovative techniques using bioactive ceramic spacers, autogenous rib bone, polylactic acid mesh, or titanium plates have been introduced. Nonetheless, these methods have not been widely used due to high cost, secondary donor site morbidity, difficulty of use, and postoperative dissatisfaction. We used two titanium plates to reconstruct the donor iliac site defect at the harvesting time of primary DCIA flap surgery in the 30-year old female with an ameloblastoma in the left mandible. Postoperatively, both iliac sites were relatively balanced and there were few complications. At the 2 years follow-up, there were no specific abnormal radiographic findings and the patient was very satisfied with her esthetic iliac contouring. In our report, we evaluate the effect of two titanium plates on the reconstruction of the iliac donor site in the aspects of esthetics and usefulness. This technique has many advantages, such as reduced cost, simplicity, decreased postoperative pain or discomfort, and improved bilateral balance of both anterior iliac crest contours, especially in young female patients.

하악 과두골절에 관한 임상적 연구: 효과적인 체외고정법

권광준,정지훈,김지혁,박영욱,Kwon, Kwang-Jun,Chung, Ji-Hun,Kim, Ji-Hyuck,Park, Young-Wook 대한악안면성형재건외과학회 2008 Maxillofacial Plastic Reconstructive Surgery Vol.30 No.4

Purpose: Fractures of the mandibular condyle accounts for 15% to 30% of all the mandibular fractures and lots of complications are reported. Among these complications, condylar resorption is the most important one to be taken into account. The purpose of this study is evaluating condylar resorption pattern in relation to extracorporeal fixation technique. Patients & methods: Thirty four patients with 42 mandibular condylar fractures were retrospectively examined with an average follow-up of 18.5 months (6-66 months). Male/female ratio is 27 males (7 bilateral cases) and 7 females (1 bilateral case). Applicated surgical techniques were extracorporeal fixation via submandibular approach and extracorporeal fixation via intraoral approach. We compared radiographic views of post-operative periods with that of most long term follow up in 34 operated sites respectively. Result: There were 2 generalized condylar resorption sites and 3 partial resorption sites with clinical implications. Others (29 joints) showed good healing or satisfactory adaptive state of temporomandibular joints clinically. Radiologically, signs of partial condylar resorption and/or osteoarthrosis were diagnosed in 11 patients. But, 8 out of the 11 patients didn't show significant clinical symptoms, which means successful adaptive remodeling of the surgically located condylar head. Conclusion: From the above results, intentional ramal osteotomy, temporary detachment of the fractured condyle and extracorporeal fixation technique seems to be effective and useful in those cases of condylar fractures in which reduction of the dislocated condyle is very difficult or virtually impossible.

Model Repositioning Instrument를 이용한 악교정 수술의 치험례

이남기,최동순,차봉근,박영욱,김지혁,Lee, Nam-Ki,Choi, Dong-Soon,Cha, Bong-Kuen,Park, Young-Wook,Kim, Ji-Hyuck 대한악안면성형재건외과학회 2006 Maxillofacial Plastic Reconstructive Surgery Vol.28 No.3

Moderate to severe dentofacial deformities usually require combined orthodontic treatment and orthognathic surgery to obtain the most stable result with optimal function and facial esthetics. Accordingly, the orthodontist and oral maxillofacial surgeon must be able to exactly diagnose existing deformities, establish an appropriate treatment plan, and execute the recommended treatment. Especially, to obtain optimal result of the maxillary surgery, model surgery is essential. But, the preoperatively planned position of the maxillary dental arch often cannot be sufficiently achieved during actual surgery, and deviations in the sagittal and vertical dimensions are common. To achieve three dimensional repositioning of the maxilla exactly, several methods have been introduced so far. Recently Model Repositioning Instrument (MRI, SAM, Inc., $M\ddot{u}nchen$, Germany), one of these methods, has been introduced and applied clinically, which is reported as accurate, effective and prompt method for three dimensional repositioning of the maxilla. This article describes an introduction and a clinical application of this MRI.