경부도상피판을 이용한 구강내 결손부의 재건 - 13증례분석

김종렬,강영기,서종천,성일용 대한악안면성형재건외과학회 2001 Maxillofacial Plastic Reconstructive Surgery Vol.23 No.3

The celvical flap, comprising skin, fascia, and platysma muscle, has significant application in the head and neck region after radical ablative surgery for cancer of the oral cavity. The flap may be used for recon-struction of the cheek, floor of the mouth, and lateral side of the tongue. This flap minimizes donor morbidity by use of cervical operation wound and flap size available is adequate for most oral defects and the procedure is relatively simple and time-saving. However the flap is not applicable in patients where there are large tissue defects and metastasis is suspected. We have used the celvical flap for its rapid, simple, and effective closure of oral defects after cancer ablation and found it is very useful for the reconstruction of relatively small oral defects.

구개인두 부전증 16증례의 임상적ㆍ방사선학적 연구

김종렬,박봉욱 대한악안면성형재건외과학회 2000 Maxillofacial Plastic Reconstructive Surgery Vol.22 No.5

Velopharyngeal adequacy is the ability of speech mechanism to create a seal between the oral and the nasal cavities during speech. The basic components of the velopharyngeal mechanism are the soft palate, the lateral pharyngeal wall, the posterior pharyngeal wall, associated musculature of the soft palate and pharyngeal wall, and the adenoid mass. If velopharyngeal inadequacy exists, the complete seal cannot be obtained during speech, resulting in hypernasal speech quality. This report is the clinical and cephalometric study of 16 consecutive cases of velopharyngeal inadequacy which were corrected by superiorly based pharyngeal flaps with lateral port control. The summarized results were as follows; 1.The total number of patients was 16(11 males, 5 females). They all showed hypernasality and nasal emission at preoperative period. 2.Hypernasality and nasal emission were shown in 13 and 5 patients respectively at immediate after operation, and decreased as 4 and 2 respectively at 6 months after operation. 3.Most patients showed snoring after operation and slowly decreased during follow-up periods. 4.During follow-up periods, the pharyngeal flap was slightly elongated at its horizontal length and moved inferiorly at its attached base. But this change was not as significant as it influenced on the clinical results.

구순구개열환자에서 자기늑골을 이용한 일차성 골이식

김종렬,정기돈,진성준,조영철,변준호,손우성 대한악안면성형재건외과학회 2000 Maxillofacial Plastic Reconstructive Surgery Vol.22 No.5

Alveolar bone grafting is an essential component of successful surgical rehabilitation in many common cleft deformities. Primary alveolar bone grafting is defined as alveolar bone grafting which takes place before eruption of the primary dentition or before 1 years of age. The major objective in primary alveolar bone grafting is to prevent significant maxillary segmental collapse and arch disturbances. If severe, this can make secondary rehabilitation difficult, costly, and protracted. Such early stabilization may eliminate or, at least, decrease the amount of orthodontic arch expansion required during the transitional dentition period. Furthermore, early obliteration of alveolus fistulae improves speech and dental hygiene. It is critical that abutting maxillary segmental alignment be achieved(generally when the patient is 8 to 10 months of age) before grafting. Otherwise, the amount of dissection necessary to develop mucosal flaps for bone graft coverage will be more extensive, thus risking increased scar formation with potential adverse effects on growth. We report a preliminary result of 4 cases of primary alveolar bone graft using rib bone, performed by limited dissection and onlay graft technique at 8 to 10 months of age. They showed satisfactory clinical results especially in terms of growth up to now.

최근 5년간 응급실을 내원한 구강악안면외과 환자에 대한 임상적 연구

김종렬,정인교,양동규,박봉욱 대한악안면성형재건외과학회 2001 Maxillofacial Plastic Reconstructive Surgery Vol.23 No.2

his is a clinical study on patients who had visitied the Emergency Room of Pusan National University Hospital and then been treated in the Department of Oral and Maxillofacial Surgery during recent 5 years, from 1992 to 1996. The results were as follow ; 1. The total number of patients was 2,680 and the ratio of male to female was 1.96:1, The highest monthly incidence was shown in September(12.1%) and October(10.5%) and the age distribution peaks was the third decade(24.3%) , followed by the first(23.1%) and the fourth decade(17.2%). 2. Soft tissue injury group(29. 1%) was the most prevalent, followed by tooth injury group(16. 1%), facial bone injury group (16.0%), toothache group(11.2%), socket bleeding group(11.1%), infection group(9.8%) and TMJ dislocation group(5.9%). 3. The percentage of in-patients and out-patient were 21.6% and 78.4%, respectively. The frequent causes of admission were facial bone fracture(73.8%) , infection(20.8%) and soft tissue injury(4.8%) in order. However, soft tissue injury was the most frequent cause in out-patient, followed by tooth injury(20.5%), toothache(14.3%), socket bleeding(14.2%) and TMJ dislocation(7.6%). 4. In the facial bone injury group, the mandibular fractures(70.6%) showed the highest incidence, followed by zygomatic bone and arch fractures(7.5%), maxillary bone fractures(4.0%) and nasal bone fractures(4.0%). 5. In the mandibular bone fracture, the most common location was symphysis(36.7%), followed by the mandibular angles(33.1%) and the condyles(21.8%) 6. The common causes of facial bone fractures were violence, fall and traffic accident in order. 7. The common causes of soft tissue injury were fall down, fight and traffic accident in order and the highest incidence was observed in infants before the age of 10 years(44.0%). 8. In the group of tooth injury, tooth luxation(38.5%) showed the highest incidence followed by tooth fracture(33.2%) and tooth loss(17.1%). The common causes of tooth injury were fall, fight and traffic accident in order. 9. In infected patients group, the ratio of in-patients to out-patients was 1 : 1.28, Buccal(24,7%) and infraorbital space abscess(23.3%) showed the highest incidence. 10. The pain caused by dental caries(39.0%) and pericoronitis(26.6%) showed high incidence in the toothache group. 11. The high incidence was observed during third(34.0%) and fourth (24.5%) decades in TMJ dislocation group. 12. In the group of socket bleeding patients, 92% was post-operative hemorrhage and 8% was accompanied with other systemic hemorrhagic diseases.

타액선의 점액유상피암에 관한 임상병리학적 연구

김종렬,정인교,성일용 대한악안면성형재건외과학회 2001 Maxillofacial Plastic Reconstructive Surgery Vol.23 No.2

The authors analyzed retrospectively the 19 patients with mucoepidermoid carcinoma of salivary glands who were treated at Department of Oral and Maxillofacial Surgery, Pusan National University Hospital from June, 1986 to September, 1998. The results obtained were as follows : 1. There were 4 males(21%) and 15 females(79%). Age distribution was wide and the mean age was 45.2. 2. Of all mucoepidermoid carcinomas of salivary gonads, 4 cases arose in the major salivary glands and 15 cases in the minor salivary glands. The incidence according to the anatomic primary site for minor salivary glands was 8 cases in the palate, 2 cases each arising in the tongue and floor of mouth and 1 case each arising in the mandible, buccal mucosa and the lower lip. 3. In histopathological classfication of mucoepidermoid carcinoma, 5 cases were low grade. 9 cases, intermediate grade and 5 cases, high grade. 4. Perineural invasion was observed 40% (2/5) in high grade and 22% (2/9) in the intermediate grade of mucoepidermoid carcinoma. 5. The incidence of cervical lymph node metastasis according to histopathologic grade was 40% (2/5) in high grade and 11%(1/9) in intermediate grade of mucoepidermoid carcinoma. 6. The lung was the commonest site for metastasis comprising 3 cases among 3 cases of distant spread of which 2 cases in high grade and 1 case in intermediate grade of mucoepidermoid carcinoma.

봉합재료에 따른 백서 미세혈관문합의 조직병리학적 연구

김종렬,성일용 大韓顎顔面成形再建外科學會 2000 Maxillofacial Plastic Reconstructive Surgery Vol.22 No.1

Purpose : Histopathologic observation was performed in order to determine which type of suture material is superior in microvascular anastomoses. Materials & Methods : The interrupted end to end anastomosis of the transected carotid arteries of 105 Sprague-Dawley rats, weighing 180 to 200g, were performed using 9-0 polypropylene (Prolene??, Ethicon, U.K), 9-0 polyglactin 910 monofilament (Vicryl??, Ethicon, U.K), and 9-0 polyamide( Ethilon??,Ethicon, U.K) under intramuscular Ketamine and Xylazine anesthesia(5mg/100g). In all cases, 10 to 12 sutures were placed to complete the anastomoses. The specimens were obtained at 1, 2, 3 days, and 1,2,4 and 6 weeks after the surgery and prepared with H&E and Van-Gieson stains and investigated the histologic changes in anastomotic sites under light microscope. The histologic changes we were concerned about were followings- thrombus formation, intimal edema, infiltration of inflammatory cells in media and adventitia, proliferation of endothelial cells and subintimal hyperplasia. Results :1. All of the anastomosed arteries were patent when they were exposed for examination. 2. Thrombus formation and intimal edema were most severe in Vicryl group, followed by Ethilon, Prolene group in order. 3. The inflammatory cells infiltrated to the media and the adventitia most severely in Ethilon group, followed by Vicryl, Prolene group in order. 4. There was little difference in proliferation of endothelial cells in each group. 5. Subintimal hyperplasia was greater in Vicryl group than the others, but there was no significant difference between the Prolene and Ethilon groups. Conclusions : On the basis of these observations, we could conclude that Prolene may be the better suture material for microvascular anastomoses regarding the tissue responses than Ethilon and Vicryl.

구순구개열환자에서 자가입자망상골을 이용한 이차성 치조골이식에 관한 임상적 연구

김종렬,진성준,조영철,표세정,변준호 대한악안면성형재건외과학회 2001 Maxillofacial Plastic Reconstructive Surgery Vol.23 No.2

Purpose : This study is conducted to evaluate the clinical success of secondary alveolar bone grafting using autogenous iliac particulate cancellous bone marrow in cleft maxilla. Materials and methods : We evaluated 107 cleft patients who had been admitted to the Dept. of Oral and Maxillofacial Surgery of Pusan National University Hospital from January 1, 1991 to January 31, 1999 and had been performed secondary alveola bone grafting with autogenous particulated cancellous bone marrow from iliac crest. Results : 1. Men were 70 and women were 37, which shows 65.4% and 34.6% and the proportion of males to females was 1.9: 1. Unilateral cases were 89(83.2%) and bilateral cases were 18(16.8%). 2, Age of bone grafting is widely distributed from 7 to 29, and the average was 13.2. 3. Success rate was 97.8% in unilateral cases, 94.4% in bilateral cases. Overall success rate was 96.7%. 4. We evaluated the bone graft contour by the percentage of bone attachment level adjacent to the alveolar cleft and the menial side showed 82.4% and the distal 87.7%. 5. The amount of notching the alveolar ridge at the grafted site through the ratio of notching length up to the most apical base to the length of proximal segment anatomic root was 0.19.

난소 절제 백서에서 17β-Estradiol 투여가 골조직에 미치는 영향

장원석,김종렬,박봉수,성일용 대한악안면성형재건외과학회 2002 Maxillofacial Plastic Reconstructive Surgery Vol.24 No.4

This study was focused on the changes of mineral density and histopathologic features of osseous tissue when ovariectomized rats were administered with 17β-Estradiol. Forty-eight rats, 11 weeks of age, were divided into four groups, which are a normal control group, an ovariectomized control group, an experimental group 1 which was given 17β-estradiol immediately after the ovariectomy and an experimental group 2 which was given 17β-Estradiol 3 weeks after the ovariectomy. They were sacrificed at different time intervals (1, 3, 4 and 8 weeks) for histopathologic observation, histo-morphometric analysis and immunohistochemistry with fibronectin and CD34 antibody. Most rats showed the increase in bone density, which was the least in the ovariectomized control group. In histopathologic features of both the mandible and the tibia, the osteoclasts in bone marrow increased in the ovariectomized control group of more than 3 weeks. In histomorphometric analysis, the osteoclasts increased in both the mandible and the tibia in length of time. In comparison of the increase of osteoclast between four groups, it decreased as following order: the ovariectomized control group, the expermiental group 2 the experimental group 1, the normal control group. Especially the experimental group 1 and experimental group 2 at 4 weeks showed remarkable changes both in the mandible and in the tibia in comparison with the ovariectomized control group. In immunohistochemical anaylsis with fibronectin, the more week-ovariectomized control groups of both the mandible and the tibia showed weaker fibronectin expression in osteoblast and bone marrow. Among the experimental group 1 and 2, 4-week group showed the strongest expression. In immunohistochemical analysis with CD34, the mandible showed generally weak expression but 8-week experimental group 1 and 2 showed relatively moderate expression in osteoblast and bone marrow. In case of the same groups of tibia, 4-week group show the strongest expression. With all these results, it is assumed that 17β-Estradiol has more effect on the development and differentiation of osteoclasts than those of osteoblasts and contributes to the initial bone formation most efficiently by inhibiting osteoclastic action and stimulating osteoblasts.

구순열 환자의 이차 구순 성형술

변준호,김종렬 大韓顎顔面成形再建外科學會 1999 Maxillofacial Plastic Reconstructive Surgery Vol.21 No.4

Secondary deformities of the lip and nose in individuals with repaired unilateral and bilateral clefts may vary in severity, depending on the state of the original defect, the care taken in the initial surgical procedure, the pattern of the patient's facial growth, and the effectiveness of interceptive orthodontic technique. Because each patient has a unique combination of deformities, their surgical reconstruction usually requires the modification and combination of several surgical techniques. Residual lip deformities after primary repair may be esthetic or functional and include scars, skin shortage or excess(vertical and transverse), orbicularis oris muscle malposition or diastasis. The key to accurate repair of secondary cleft lip deformities is a precise diagnosis. This requires observation of the patient in animation and repose. The quality of the scar is not the only factor determining the overall appearance of the lip. Observing the patient in the animated position is critical to assess muscular function. Factors that require precise analysis include lip length, the appearance of the Cupid's bow and philtrum, and nasal symmetry. Only after this detailed analysis can a decision be made as to wether a major or minor deformity exists. We report successful cases using various techniques for the secondary lip deformities.

유리 복직근 피판을 이용한 중안모 결손부 재건의 2 치험례

이성근,김종렬,성일용 大韓顎顔面成形再建外科學會 2000 Maxillofacial Plastic Reconstructive Surgery Vol.22 No.1

Expansion in the scope and technique of head and neck tumor resection during the past two decades has paralleled precise tumor localization with advanced radiographic imaging and the availability of microvascular free tissue transfer. Especially, the defect reconstruction utilizing free flap results in improvement of patient survival due to decrease of local recurrence by wide resection of cancer. The rectus abdominis free flap has been used widely in reconstruction of th breast and extremities. However, the report of cases on its applications in the head and neck, based on the deep inferior epigastric artery and vein, is rare. This flap is one of the most versatile soft-tissue flaps. The deep inferior epigastric artery and vein are long and large-diameter vessels that are ideal for microvascular anastomosis. The skin area that can be transferred is probably the largest of all flaps presently in use. The versatility of the donor site is due to the ability to transfer large areas of skin with various thickness and amounts of underlying muscle. This article is to report reconstruction of midface defects utilizing the rectus abdominis free flap in 2 patients with maxillary squamous cell carcinoma and discuss briefly considerations in flap design and orbital exenteration, and healing of irradiated recipient site by hyperbaric oxygen therapy with literature review.