한국인에서의 상악골 교정수술후 안면중부 연조직 변화에 관한 연구

박형식,최진호,김영수,Park, Hyung-Sik,Choi, Jin-Ho,Kim, Young-Soo 대한악안면성형재건외과학회 1991 Maxillofacial Plastic Reconstructive Surgery Vol.13 No.3

Prediction of the sop tissue changes following hard tissue movements is very important in the preoperative analysis of surgical changes of the patient who have orthognathic surgery. This study examined post operative changes of the mid-facial sop tissues in Koreans depending upon two major positional changes of the maxilla following Le Fort - I type osteotomy for orthognathic purposes. Sixty patients(41 males and 19 females) of Koreans were selected and divided into two groups according to directional change of movement of anterior bony structures of the Maxilla as follows : Group I (44 patients) was mooed anteriorly and/or inferiorly, and Group II (16 patients) was mooed posteriorly and/or superioly. Postoperative changes of the sop tissue measurements following hard tissue changes were examined on pre - and post - operative cephalometrics by means of computerized digitation methods and the ratios of changes were analysed. The results were obtained as follows : 1. In Group I, all of the sop tissue measures except the Pn was closely followed by the changes of the hard tissue measures in the horizontal plane, but the Sn and the Cm were only correlated to the vertical changes(p<0.001). In group II, all of the sop tissue measures excluding of the N' and the Pn were significantly correlated to the hard tissue measures in horizontal plane(p<0.001), but the Ls and Stm were only correlated relatively to the vertical changes of the ANS(p<0.01). 2. Predictable ratio of the Sn was 66% of the ANS or 56% of the A in the horizontal plane and 89% of the A in the vertical plane in Group I. In Group II, the Sn was predictable as 85% of the ANS or 70% of the A in the horizontal plane but was not predictable in vertical plane. 3. Predictable ratio of the Cm was 28% of the ANS or 50% of the A in the horizontal plane and 56% of the ANS or 36% of the A in the vertical plane in Group I. In Group II, the Cm was predictable horizontally as 74% of the A. Predictable ratio of the Pn was 30% of the ANS or 38% of the A in horizontal plane in Group I, but it was not predictable both horizontally and vertically in Group II. 4. Predictable ratio of the Ls was 52% of the Pr in Group I and 77% in Group II in the horizontal plane. The Stm was predictable as 34% of the pr or 22% of the I in the horizontal plane in Group I, and was also predictable as 55% of the pr or 68% of the I horizontally and 21% of the pr or 65% of the I vertically in Group II. 5. All ratios of change in the thickness. length and area of the upper lip following maxillary movement were statiscally correlated, however, mangitudes of them were meaningful clinically.

다발성 타석증 2예

박형식,윤현중,최우환,Park, Hyung-Sik,Yoon, Hyun-Joong,Choi, Wo-Whan 대한악안면성형재건외과학회 1992 Maxillofacial Plastic Reconstructive Surgery Vol.14 No.1

This is a report of two rare cases, that authors have experienced, one being four sialoliths within a wharton's duct, which is a relatively frequent site of sialolith, and the other a multiple occurrance of 16 sialoliths at the orifice of stensen's duct, which has very low frequency of sialolith occurance. Both pathosis were removed using transoral sialolithotomy.

보험범죄의 보안대책에 관한 연구

박형식,Park, Hyung Sik 한국융합보안학회 2016 융합보안 논문지 Vol.16 No.6

현재의 보험범죄에 대한 보안대책은 보험금 지급심사단계에서 적발중심적인 사후대응에 치중하고 있다. 그러나 사후 처벌만으로는 치유할 수 없는 피해를 남기기 때문에 보험범죄를 사전에 예방할 수 있는 대책을 강구할 필요가 있다. 따라서 이 논문에서는 보험범죄의 특성과 사례분석을 통하여 문제점을 규명해보고, 이에 대한 대안을 제시해보고자 한다. 현행 보험제도의 문제점은 첫째, 보험계약 체결시에 보험계약자의 신용상태, 중복가입여부, 자발적 가입여부 등에 대한 확인이 허술하다는 것이다. 둘째, 보험사고 발생시 철저한 조사나 형사고발이 제대로 이루어지지 않고 있다. 셋째, 악성보험계약자에 대한 정보교환이나 관리가 미흡하다. 따라서 보험범죄부터 국민을 지키기 위해서는 첫째, 보험계약시에 보험계약자들에 대한 신용상태, 사고경력 등에 대한 심사를 강화해야 할 것이다. 둘째, 보험사기인지시스템과 사회관계망의 지속적인 업그레이드를 통하여 보험범죄를 사전에 차단할 수 있도록 해야 할 것이다. 셋째, 보험사간에 정보를 공유하여 보험범죄에 대한 감시시스템을 강화하여야 할 필요가 있다. Security measures for the current insurance crime has focused on the capture oriented and reactive response in the screening stage of insurance payments. However, since leaving the damages that can not be healed by post-punishment, it is necessary to take measures to prevent the insurance crimes in advance. In this paper, I would like to try to identify problems through analyzing the characteristics and cases of the insurance crimes, and to present alternatives to it. The problems with the current insurance system that causes the insurance crimes are, First, When signing the insurance contract, it is too inattentive to confirm about the credit status of the policyholder, duplicate join or not, whether voluntarily sign up etc. Second, a thorough investigation or criminal charges in case of insurance accident is not being done properly. Third, information exchange and management to malicious policyholders is not being done properly. Therefore, in order to guard people from insurance crimes, First, it should strengthen the audit of such credit conditions, accident experiences in the insurance contract at the policyholders. Second, we need to block insurance crimes in advance through the continuous upgrades of insurance fraud analysis systems and social network. Third, it is necessary to strengthen the surveillance systems for the insurance crimes by the information sharing.

구내 접근법에 의한 하악골 골수염의 치료에 대한 임상적 고찰

박형식(Hyung Sik Park),이상휘(Sang Hwy Lee),권준호(Jun Ho Kwon) 대한구강악안면외과학회 1989 대한구강악안면외과학회지 Vol.15 No.1

Osteomyelitis of the mandible is a perplexing disease to both patients and surgeons because of curability, longterm period of treatment and functional and esthetic problems related to disease and/or surgical treatments. Classical extraoral approach for surgical treatment of osteomyelitis of the mandible has many advantages in surgical field, drainage and healing time etc, however, its resultant scar tissues and risk of facial nerve damages are sometimes difficult to use in patients who are afraid of esthetic damage of the face. This is a retrospective clinical study on osteomyelitis of the mandible treated by transoral approaches related to irevitable factors of patients. We reviewed 5 patients and the obtained results are as follows: 1. Primary closure with transoral decortication and saucerization gave a possibility of good healing process without any recurrence or complications in case of chronic osteomyelitis which had not active pus discharge. 2. Even though patient had severe osteomyelitis associated with comminuted fracture of the mandible and uncontrolled diabetic mellitus, we could obtain good results by transoral approaches. 3. Transoral approaches for surgical care of osteomyelitis of the mandible offered excellent cosmetic and functional results in all of our cases, however, proper selection of patients and antibiotics should be important.

하악골 전돌증 환자의 구내 상행지 수직 골절단술을 이용한 하악골 후방 이동후 치유경과에 대한 임상적 연구

박형식(HYUNG SIK PARK) 대한구강악안면외과학회 1997 대한구강악안면외과학회지 Vol.23 No.4

Intraoral Vertical Ramus Osteotomy(IVRO) is a typical osteotomy procedure to setback the mandible for the prognathic patients and has many advantages functionally and morphologically, however, available data to predict the progressive prognosis on the functional rehabilitation of the mandible and the morphological change of the rami of the mandible after IVRO has been less reported. This is a prospective study for the progressive changes on the functional rehabilitation and the morphology of the rami of the mandible after IVRO for the Korean Prognathisms. 38 patients were studied for the functional rehabilitation and 21 patients were for the morphological change. Maxillo-Mandibular Fixation(MMF) was maintained for two weeks after IVRO and active physiotherapy was applied by means of Park s Protocol for next two weeks. Progressive change of the range of motion after release of MMF at maximum mouth opening, protrusion, lateral excursion(right and left) was recorded daily for 15days, and also recorded at 1st, 3rd, 6th, 12th, 18th months on the flow charts in the group for functional rehabilitation study. Nine measurements were measured to check morphological changes of the rami of the mandible at Immediate, 1, 3, 6 and 12 months postoperative period on Panex, P-A and Lateral Cephalometrics. The results were obtained as followings : 1. Mandibular function was returned rapidly during early 5 days after release of MMF, and reached to the almost normal range within 15days. And then slowly and progressively increased more and more afterward. 2. Recovery rate of the mandibular function after IVRO was depended upon the forcible application of a well-oriented protocol for active physiotherapy during early stage(within 15 days) after release of MMF. 3. Evidences of cortex-to-cortex healing between proximal and distal segments of the Mandible(CNS, CA, DOA on Panex) were definitely observed. They were changed slowly from immediate to 3 months but changed remarkably from 3 to 6 months of postoperative period, and then showed continuous but very slow changes afterward. 4. Vertical lengths of the proximal segments(RL, LL) were reduced remarkably from immediate to 3 month of postoperative period, and more slowly reduced from 3 to 6th month period, and then constantly reduced afterward as mimic rate. 5. Transverse distance between proximal segments(TL) was reduced rapidly within one month postoperatively and showed more slow and stable changes until one year follow-up period. 6. The gap between proximal and distal segments was disappeared rapidly within 6 month postoperatively, and then reduced very slowly afterward. 7. The change of Gonial angle(GA) was rapidly increased within one month of postoperative period and then increased very slowly afterward. In summary, mandibular function was returned to almost normal within two weeks after release of MMF, and osseous union was completely established between the proximal and distal segments without any complications in spite of early functional movement of the mandible without fixation between fragments. Morphological changes on the rami of the mandible was remarkable within 3 month period of postoperative and then continuously remodeled until one-year follow-up period. The application of a forcible and well-oriented protocol of active physiotherapy immediate after release of MMF may be the most important factor for prognosis of rehabilitation and morphological changes in IVRO.

비대칭 하악전돌증 환자에서의 구내 하악골 상행지 수직 골절단술(IVRO) 시행후 우각부 비대칭 개선의 평가

박형식(Hyung Sik Park),허진영(Jin Young Huh),이우정(Woo Jung Lee) 대한구강악안면외과학회 1997 대한구강악안면외과학회지 Vol.23 No.1

We treated 14 cases of facial asymmetry with mandibular prognathism from January 1993 to December 1994. In deviation prognathism cases, bilateral IVRO was performed in 11 patients, and 3 patients recevied SSRO on one side and IVRO on the contralateral side. Difference between Rt. gonial angle and Lt. gonial angle measurement from the midsagittal plane was calculated on Cephalograms and facial photos. Furthermore changes between preoperative and postoperative were evaluated three months later. The following results were obtained. 1. The patients with deviation prognathism who were opertated by bilateral IVRO can be classified as cases with unilateral overlapping and bilateral overlapping between osteotomized bony segments. 2. There are two kinds of deviation prognathism. One kind is composed of patients who had bulky angle on the ipsilateral side of chin devation, and the other kind is composed of patients who had bulky angle on the contralateral side of chin deviation. 3. In case of the overlapping between the osteotomized bony segments, more bulky angle is induced. 4. In bilateral IVRO cases, the side which has larger amount of setback shows less increase of prominence in gonial angle area. 5. Because the change of prominence in soft tissue is not proportionate to the change in bone structure, accurate preop. prediction of the soft tissue change on gonial angle area is difficult.

Hamster 협낭점막 DMBA-유도 구강상피암의 二相발암과정(Two-Phase Carcinogenesis)에 관한 세포학적 연구

박형식(Hyung Sik Park) 대한구강악안면외과학회 1984 대한구강악안면외과학회지 Vol.10 No.2

Studies related to two-phase mechanism of carcinogenesis have been rarely carried out on oral mucosa. The present study was undertaken to investigate the histopathological and ultrastructural changes during two-phase carcinogenesis of 9, 10-Dimethyl-1,2-Benzanthracene (DMBA)-induced oral carcinoma on the mucosa of hamster buccal pouch. The purposes of this study were to demonstrate two-phase mechanism of chemical carcinogenesis on oral mucosa, and to investigate histopathological changes on early potential changes of oral carcinoma. Golden Syrian Hamsters-6 week old-were used in this experimental study, and divided into control and four experimental groups, and experimental groups were painted with DMBA in heavy mineral oil on left buccal pouch three times weekly as follows: Experimental Group Ⅰ(32): Painting with 0.5 % DMBA for 16 weeks. Experimental Group Ⅱ(32): Painting with 0.1 % DMBA for 10 weeks, no-treatment for a following 6 week period. Experimental Group Ⅲ(20): Painting with 0.1 % DMBA for 10 weeks after prior treatment as Group Ⅱ. Experimental Group Ⅳ(20): Painting with 0.5 % DMBA for 10 weeks after prior treatment as Group Ⅱ. The animals were sacrificed every week serially, and chemical-treated buccal mucosae were excised and examined grossly, light-microscopically and electron-microscopically. The obtained results were as follows.: 1. In Group Ⅰ, hyperkeratosis, squamoid (differentiated) and basaloid (undifferentiated) epithelial hyperplasia, dysplasia, papillomatous growth, carcinoma in situ, and invasive carcinoma were all seen on light microscope. Early carcinoma was detected in the 8th. week experimental group initially. 2. In Group Ⅱ, hyperkeratosis, squamoid and basaloid epithelial hyperplasia were observed, but dysplasia or papillomatous growth etc. were not seen. 3. In Group Ⅱ, any specific changes were not observed on light-microscope after cessation of chemical treatment, but continuous changes of nuclear, intercellular space and basement membrane were seen on electron-microscope. 4. In Group Ⅲ, hyperkeratosis, squamoid and basaloid epithelial hyperplasia, dysplasia, and papillomatous growth were observed, and carcinoma in situ was also detected in the 9th. week. These changes were much significant than in Group Ⅱ, but far less than in Group Ⅳ. 5. In Group Ⅳ, dysplasia, carcinoma in situ and invasive carcinoma had been detected two weeks earlier, and basaloid epithelial hyperplasia were markedly presented than in Group Ⅰ. In this study, the author suggest that Initiation-Promotion Phases were presented on experimental carcinogenesis of buccal mucosa, initiation phase had definite cellular changes, and also these changes were irreversible and had cancer-potentiality.

심한 안모비대칭을 야기한 편측성 하악과두의 osteochondroma와 osteoma의 치험예

박형식(Hyung Sik Park),권준호(Jun Ho Kwon),이상휘(Sang Hwy Lee),박소연(So Yeon Park) 대한구강악안면외과학회 1989 대한구강악안면외과학회지 Vol.15 No.1

Osteochondroma and osteoma are benign bone tumors occurred rarely on the condyle of the mandible. Although they grow very slowly and have no specific malignant signs or symptoms in ealy stage, they can cause severe dentofacial deformities and/or functional disturbances as facial asymmetry, malocclusion, posterior open-bite and temporomandibular joint dysfunctions when they are increased markedly on the condylar head of the mandible. This is a report of 2 cases of osteochondroma and osteoma which occurred unilaterally in the condylar head of the mandible and resulted in severe facial asymmetry, malocclusion and functional disturbances due to large expansion of tumor masses. We obtained successful functional and esthetic results by simple surgical excision of tumor mass, intermaxillary fixation for short duration and active physical therapy.

구강악안면외과 영역에서의 자가수혈에 관한 고찰

박형식(Hyung Sik Park),강승민(Seung Min kang),최진호(Jin Ho Choi),차인호(In Ho Cha),이충국(Choong Kook Yi),김현옥(Hyeon Ok Kim) 대한구강악안면외과학회 1993 대한구강악안면외과학회지 Vol.19 No.1

Autologous blood tranfusion(ABT) is the safest method for blood transfusion to avoid any risks associated with the homologous blood transfusion(HBT). We reviewed ninety patients retrospectively who had been received ABT at Department of Oral and Maxillofacial Surgery, Yonsei University, SEOUL, KOREA form March 1990 to December 1992. Twenty patients received HBT were used for control group to compare with ABT patients. Age distribution was 14 to 48 years old, the major procedure was orthognathic surgery(96.7%), 7.8% of all ABT-schedulled patients were cancelled to perform ABT bacause of positive HBs-Ag or VDRL in screen tests. An average interval of donation was 5.5 days. And there was no remakable complications associated with blood donation except for 4.4% patients. The hemoglobin level was on the decrease gradually following as sequences of each donation, however it was increased unusually during 3rd. to 4th. Schedule in females. The reticulocyte count was on the increase regularly following as schedules, but it was increased dramatically during 3rd. to 4th. schedule in females. The Hb./Hct. Level of ABT group was decreased more than those of HBT group after sugery. As our results, ideal preparation of blood for severe cases of orthognathic surgery may be 4 pints of ABT plus 1 pint of HBT or 3 pints of ABT plus 2 pints of HBT, however strong efforts must need to avoid HBT during surgery.

Osteoperiosteal flap 을 이용한 내측접근법에 의한 장골 이식술

박형식(Hyung Sik Park),김일현(Il Hyun Kim),정세용(Sei Yong Chung),조문건(Moon Keun Cho) 대한악안면성형재건외과학회 1987 Maxillofacial Plastic Reconstructive Surgery Vol.9 No.1

The ilium is a widely used site for obtaining cortical and cancellous bone and marrow for use as autogenous donor material in reconstruction of the maxillofacial bony defects. Two limitations has been mentioned when the ilium is used as a donor site. One is the disturbances of cartilagenous growth centers of the iliac crest due to surgical trauma, and the other is the post-operative morbidity. This is a report of two cases of the iliac bone graft to minimize post-operative morbidity of the ilium by the modified medial approach using osteoperiosteal flap which designed by Grillon G Let al. The results are as follows; 1. The surgical procedure was simple and the operation time could be shortened by easy reflecting of medial periosteum without stripping of the periosteum on the abdominal muscles and the iliac crst. 2. The post-operative pain on the donor site was minimized and return to ambulatory status could be hastened by which the gluteal muscles and their bony origin were not disturbed at all and rigid bony fixation & rebuilding of the iliac crest were establishe.