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선천성 기형환자에서의 악교정수술 적용과 수술 증례 분석
정휘동(Hwi-Dong Jung),정영수(Young-Soo Jung) 대한치과의사협회 2012 대한치과의사협회지 Vol.50 No.11
Distraction osteogenesis and orthognathic surgery are the widely used surgical methods for treating hemifacial microsomia and cleft lip and palate, the representative forms of congenital deformity. Distraction osteogenesis is an outstanding treatment of choice when more traction is needed than what can be achieved by general orthognathic surgery. However, the stability of distraction osteogenesis has not yet been established, and in most of the cases, additional orthognathic surgery is mandatory. Moreover, the difficulty in precise control of the traction directions is another disadvantage of distraction osteogenesis. Therefore, it would be desirable not to conduct distraction osteogenesis when the patient is suitable for an orthognathic surgery. Also, distraction osteogenesis should be recognized as an accessorial method of treatment, and be used restrictively.
편측 구순열비의 교정술: Rotation Advancement 원칙에 근거한 Mulliken의 방법
정영수,이규태,정휘동,Jung, Young-Soo,Lee, Gyu-Tae,Jung, Hwi-Dong,Mulliken, John B. 대한악안면성형재건외과학회 2012 Maxillofacial Plastic Reconstructive Surgery Vol.34 No.2
모든 환자들은 구순접합술을 시행 받았고 구순 및 구개열 유아들은 악정형장치인 Latham을 사용하였다. 수술의 기술적 변화들은 앞서 설명하였다. Columella 부위의 높은 rotation과 releasing incision은 내측 입술 부위를 충분히 길게 해주고, advancement flap이 phitral column 상방으로 최소로 침범되게 하여 균형적인 입술을 만들 수 있다. 또한 구륜근을 외번시켜 philtral ridge를 형성하고, 작은 unilimb Z-plasty을 구순측 Cupid's bow handle 높이에 맞게 시행 후, vermilion-cutaneous junction에서부터 상방으로 cutaneous closure 시행한다. 변위된 alar cartilage는 nostril rim incision을 통해 동측 upper lateral cartilage에 매달며, Alar base는 anterior-caudal septum의 위치, sill의 설정 그리고 외측 vestibular web 제거를 포함하여 3차원적으로 설계하여 치료해야 한다. 이번에 소개한 Mulliken의 치료법이 환자들과 외과의사들에게 많은 도움이 되기를 바란다. This is a review regarding Mulliken's Modification using the Millard rotation-advancement principle for the repair of unilateral complete cleft lip and nasal deformity. All patients underwent prior labionasal adhesion and dentofacial orthopedics with a pin-retained (Latham) appliance used for infants with a cleft of the lip and palate. Technical variations concerning the operation are described. A high rotation and releasing incision in the columella lengthens the medial labial element and produces a symmetric prolabium with minimal transgression of the upper philtral column through the advancement flap. The orbicularis oris muscle is everted, from caudad to cephalad, to form the philtral ridge. A minor variation of unilimb Z-plasty is used to level the cleft side of Cupid's bow handle, and cutaneous closure proceeds superiorly from this junction. The dislocated alar cartilage is visualized though a nostril rim incision and suspended to the ipsilateral upper lateral cartilage. Symmetry of the alar base is addressed in three dimensions, including maneuvers to position the deviated anterior-caudal septum, configure the sill, and efface the lateral vestibular web. The authors believe the technical refinements described herein contribute favorably to the outcome of repair regarding unilateral cleft lip and nasal distortion.
박혜정,정휘동,정영수,Park, Hye Jeong,Jung, Hwi-Dong,Mulliken, John Butler,Jung, Young-Soo 대한악안면성형재건외과학회 2013 Maxillofacial Plastic Reconstructive Surgery Vol.35 No.3
Cleft lip arises from congenital underdevelopment with various degrees and patterns. Mulliken named a unilateral incomplete cleft lip with no severe cleft as a lesser-form cleft lip and categorized it into three subgroups. Anatomically categorized subgroups are minor-form, microform, and mini-microform cleft by the extent of vermilion-cutaneous dysjuntion. The vermillion cutaneous notch is more than 3 mm from the regular Cupid's bow peak for minor-form, less than 3 mm for microform, and almost no gap with discontinuity on the vermillion cutaneous border for mini-microform. The treatments are rotational advancement flap for minor-form, double unillimb Z-plasty for microform, and vertical lenticular excision for mini-microform, respectively. This article aims to present the literature review about the incomplete lesser form cleft lip classified by Mulliken and to report our experiences.
협소한 상악과 상악 전치부 선천 결손을 가진 양측성 불완전 구순구개열 환자에서 임플란트 보철 수복을 동반한 수술교정 치험례
최은학(Eun-Hack Choi),박진이(Jin-Yi Park),정영수(Young-Soo Jung),정휘동(Hwi-Dong Jung),황충주(Chung-Ju Hwang),차정열(Jung-Yul Cha) 대한구순구개열학회 2019 대한구순구개열학회지 Vol.22 No.2
Purpose: We report a case of a skeletal Class III patient with bilateral incomplete cleft lip and palate who successfully underwent orthodontic treatment with orthognathic surgery and dental implant restoration. Case Report: An 11-year-old girl with cleft lip and palate showed narrow maxilla and congenital missing of upper anterior teeth. To solve transverse deficiency of premaxilla and provide sufficient space for implant restoration, maxillary segmental osteotomy and transverse distraction osteogenensis with fan-type expander was operated. After growth, the patient took orthodontic treatment for orthognathic surgery. For implant restoration on the cleft site, tertiary alveolar bone graft with autogenous & alloplastic bone was performed. After revision surgery and filler injection on retruded upper lip, patient’s lateral facial profile was improved with balanced upper and lower lip profile. Conclusions: For successful implant restoration on alveolar cleft site, sufficient space needs to be regained and tertiary bone graft should be considered. Normal function and esthetic profile can be achieved by multidisciplinary treatment approach for the patient with cleft lip and palate.
양측성 비대칭 구순열 환자의 치료 : 증례 보고 및 문헌 고찰
최한솔(Han-Sol Choi),김준영(Jun-Young Kim),박지호(Jiho Park),박진후(Jin Hoo Park),정휘동(Hwi-dong Jung),정영수(Young-Soo Jung) 대한구순구개열학회 2020 대한구순구개열학회지 Vol.23 No.2
The correction of asymmetrical bilateral cleft lip is challenging because of its high variability in the lip and nasal tissues. It is the first principle to establish symmetry in bilateral cleft lip of which is indisputable. However, staging and timing in treatment of asymmetrical bilateral cleft including lesser form cleft is controvertible issue. This article aims to report a case about synchronous bilateral nasolabial repair for the patient with asymmetrical bilateral cleft lip with incomplete left and minor form right. and to compare the staging and timing of the repair of asymmetrical bilateral cleft lip including lesser form cleft between the techniques of Mulliken and Fisher.
구순구개열 환자의 골격 기형 수술 후 안정성 : 문헌 고찰
박지호(Jiho Park),이환규(Hwangyu Lee),김준영(Jun-Young Kim),박진후(Jin Hoo Park),정영수(Young-Soo Jung),정휘동(Hwi-dong Jung) 대한구순구개열학회 2020 대한구순구개열학회지 Vol.23 No.2
Successful treatment of cleft lip and palate requires a high level of understanding of the complexity of anomalies and insights for predicting the four-dimensional change of growth. In addition, the surgeon needs to take responsibility for the life-long step-by-step operation that has profound effect on the patient. Alveolar cleft, which occurs in about 75% of cleft lip and palate patients, cannot be recovered without surgical treatment and can cause complications in various areas. However, there remains a lot of debate about the timing of the treatment of alveolar cleft. As a result of an intrinsic defect or previous surgery, patients with cleft lip and palate develop maxillary deficiency in all 3 dimensions with constricted maxillary arch. Therefore maxillary advancement surgery is indicated in about most patients with cleft lip and palate undergoing orthognathic surgery. Therefore, the authors will introduce the consensus of treatment and principles that must be observed in corrective surgery for skeletal abnormalities occurring in cleft lip and palate patients through literature review.