구강내 조기편평상피암의 경부임파절후발전이의 임상적, 병리조직학적 예측요소에 관한 연구

Hyoun Chull Kim(金賢哲),Jingo Kusukawa(楠川仁悟),Tadamitsu Kameyama(亀,山忠光) 대한구강악안면외과학회 1992 대한구강악안면외과학회지 Vol.18 No.3

A retrospective study of ninety patients with early squamous cell carcinoma of the oral cavity was undertaken to evaluate clinical and histopathologic parameters in predicting cervical lymph node metastasis. Medical records were examined for age, sex, primary site, growth pattern and size. The specimens of biopsy and surgical excision were examined for degree of differentiation, mode of invasion, tumor thickness and muscular invasion. The results were as follows; 1. Occult cervical nodal metastasis was 22.2 percent for patients with early squamous cell carcinoma. (18.2 percent in stage Ⅰ, 28.6 percent in stage Ⅱ) 2. The primary site, maximal surface diameter and histologic differentiation of tumor had no significant relationship with nodal metastasis. 3. Although maximal surface diameter showed little correlation with cervical nodal involvement, it is noteworthy that there were low incidence (7.7%) of cervical nodal metastasis in lesions with less than or equal to 10mm. 4. Clinical growth pattern was a important parameter relatively in predicting cervical nodal metastasis. Four (57.1%) of seven patients with indurative typed tumor had nodal metastasis. 5. Tongue carcinoma have a propensity to infiltrate the skeletal muscle than lesions at other oral sites, due to the difference of anatomical structure. Therefore, tongue carcinoma may related to a greater tendency of cervical nodal metastasis compared to the carcinoma of floor of the mouth. 6. Mode of invasion was important histopathologic parameter in assesing the ability to metastasized. Grade 4 had twice risk of cervical nodal metastasis than Grade 2 and 3. Tumors with papillary or indurative type and Grade 4 had a cervical metastasis of sixty percent. 7. Tumor thickness showed an strong correlation with the appearance of later cevical nodal metastasis. The lesions less than or equal to 1.5mm had not evidence of cervical nodal metastasis. On the other hand, this incidence increased to 20.5, 37, 50% when the lesion was 1.6 to 3.0mm, 3.1 to 6.0mm, more than 6.0mm in thickness, respectively. 8. Tumors with Grade 4 and more than 3mm in the thickness, and with Grade 3 and more than 6mm in thickness had a cervical metastasis of fifty percent.

Direct bonding of orthodontic attachment in the management of maxlillomandibular injuries

김현철(Hyoun Chull Kim) 대한구강악안면외과학회 1990 대한구강악안면외과학회지 Vol.16 No.4

악골골절에 대한 비관혈적 정복술을 시행하기 위해 Arch bar, multiple loop wiring 및 cast metal splint 등의 여러가지 방법이 사용되어진다. 이런 방법 시행시 치은손상, 장치고정시 마취의 필요성, 치료중 고정장치의 재고정시 동통유발등의 여러가지 문제점이 야기된다. 저자는 이런 문제점들을 해결하기 위한 방법으로 통상 교정치료시 사용되는 교정용 bracket와 0.018 round stainless steel wire를 사용하여 다소의 장점을 경험하여 이에 보고하는 바이다.

rhBMP-2를 이용한 상악동거상술의 성공적인 치료 전략

김현철(Hyoun Chull, Kim),김수남(Soo Nam, Kim),이장렬(Jang Yeol, Lee),김욱천(Uk Cheon, Kim) 대한치과의사협회 2015 대한치과의사협회지 Vol.53 No.1

BMPs are multi functional growth factors which are members of the transforming growth factor beta super family and their ability is that plays a pivotal roll in inducing bone. About 18 BMP family members have been identified and characterized. Among of them, BMP 2 and BMP 7 have significant importance in bone development. In this case reports, patients of maxillary sinus graft were received who visited LivingWell Dental Hospital. We focused on the results of the surgical intervention. We suggest that new strategy of treatment used to rhBMP 2 and TCP scaffold for patients of sinus graft. The purpose of this paper is to give a brief overview of BMPs and to critically review the clinical data currently available on rhBMP 2 and synthetic bone scaffold.

Choriocarcinoma metastatic to mandibular gingiva

김현철(Hyoun Chull Kim) 대한구강악안면외과학회 1989 대한구강악안면외과학회지 Vol.15 No.1

전신질환과 관련된 구강내 증상의 옳바른 인식은 진단과 치료시 매우 중요하다. 특히 구강내 증상만 나타나고 다른 부위의 증상이 나타나지 않는 악성종양의 경우 구강조직의 생검은 진단에 많은 도움을 준다. 융모성상피암은 포기상태, 자연유산, 인공유산, 자궁외 임신, 사태아분만 및 정상분만 등 어떤 경우의 임신 수태산물에서도 발생할 수 있는 영양배엽의 악성질환으로 침윤성 성향은 동맥혈관을 침범하여 혈류를 따라 급속히 다른 장기로 전이하며 심한 조직괴사와 출혈성 혈종을 형성하여 조직을 파괴하고 심한 출혈을 유발시키기 때문에 초기에도 환자에게 치명적일 수 있다. 이 종양은 골반강내 자궁주위조직은 물론 뇌, 간, 위장관, 신장, 골조직 및 피부조직까지도 전이될 수 있다. 융모성상피암의 치료는 methotrexate 또는 Actinomycin D를 사용한 화학요법이 추천된다. 이 종물에 의한 사인은 출혈, 뇌전위로 인한 뇌부종 및 범발성의 혈관내 응고 등을 생각할 수 있다. 본 증례는 호흡곤란을 주소로 내과에서 결핵치료를 시행하던 중 치은종창을 주소로 본과에 내원하여 생검시행후 하악골로 전이된 융모성상피암으로 진단하여 methotrexate를 이용한 화학요법시행 중 사망한 증례로 융모성상피암의 매우 희귀한 하악골전이를 경험하여 이에 보고하는 바이다.

顔面部에 發生된 動靜脈性 畸形의 一例 및 文獻考察

Sang Chull Lee(李相喆),Yeo Gab Kim(金麗甲),Jae Hee Ahn(安在羲),Hyoun Chull Kim(金賢哲) 대한구강악안면외과학회 1984 대한구강악안면외과학회지 Vol.10 No.1

An arteriovenous malformation (AVM) may be defined as a condition in which arteries communicate with veins through channels other than the normal capillary networks. The common unifying clinical element is severe bleeding which can result from this type of lesion. Most sophisticated diagnostic studies include selective arteriogram and ultrasound flowmeter. The treatment for such mass is predicated upon a total elimination of all diseased tissue. AVM in location such as the spinal cord and cerebral vessel are particular poorly treated with surgical excision. Therefore, the technique of intraarterial embolization was first used for these lesions. Certain extensive lesions that are considered inoperable may be treated with embolization alone. The author had managed a patient, 15 year old male, with arteriovenous malformation of the left face involving mandible. Through femoral artery, embolization with polyvinyl alcohol (PVA) was performed. At 1st embolization (1983-12-30), PVA were embolized into his left facial, lingual and internal maxillary arteries. In March 1984, he had repeated gingival bleeding. An angiographic study of the carotid arteries demonstrated the AVM fed by left external carotid artery and right facial artery. At that time, PVA were embolized into his left facial, lingual arteries and right facial arteries. Sixty days postoperatively, no signs of AVM had recurred.

레이저를 이용한 임프란트 이차수술시 온도변화에 관한 실험적 연구

안현정,김현철,최병갑,송언희,김래경,Ahn, Hyun-Jeong,Kim, Hyoun-Chull,Choi, Byeong-Gap,Song, Eon-Hee,Kim, Rae-Gyoung 대한치과보철학회 1999 대한치과보철학회지 Vol.37 No.2

Submerged implants require secondary surgical uncovering of implants after healing period of 3-6 months. In surgical methods, there are surgical scalpel, tissue punch, electro-surgical, and laser-used uncovering, and so forth The objectives of this study are investigation and assessment of 1) thermal change in clinical application for uncovering of HA-coated implant and pure titanium implant irradiated by pulsed Nd-YAG, $CO_2$, and Er-YAG laser. 2) surface change of cover screws aaer irradiation using laser energy. The temperature of apex & side wall of implants were recorded at 10sec, 20sec, 30sec after 30sec irradiation to implant healing screw; 1) pulsed Nd-YAG laser; 2W, 20pps, contact mode 2) $CO_2$ laser; water-infused & non-water infused state, 2.5-3.5W, contibuous mode, noncontact mode 3) $CO_2$ laser ; non-water infused state, 3W, superpulse, noncontact. mode 4) Er-YAG laser; (1) non-water infused state, 10pps, 60mj, contact mode (2) water-infused state, 10pps, 60mj, 80mj, 101mj, contact mode. According to the results of this study, pulsed Nd-YAG laser is not indicated because of increased thermal change and pitting of metal surface of implant cover screw. By contrast, $CO_2$ laser & Er-YAG laser are presumed to indicate because of narrow range of thermal change & near abscence of thermal damage of metal surface. Dental laser is thought to be much helpful to surgical procedure when it is used as optimal power and time condition considering characteristics and indications of each laser. Further research is needed to verify that these techniques are safe and beneficial to implant success.

成長期 患者의 下顎頭 骨折時 顎關節의 再形成에 關한 考察

Sang Chull Lee(李相喆),Yeo Gab Kim(金麗甲),Jae Hee Ahn(安在羲),Seon Sik Kong(孔宣植),Hyoun Chull Kim(金賢哲) 대한구강악안면외과학회 1984 대한구강악안면외과학회지 Vol.10 No.2

This is a case report that deals with TMJ remodeling after both condylar fractures in a puberty child. Patient, 14 years old boy, was referred to our department from local hospital for the evaluation of the traumatic injuries on the face which was developed by traffic accident 10 days ago. On the basis of clinical and radiographic examinations, he was diagnosed as both mandibular condyles and symphysis fractures, right maxillary alveolar fracture, and multiple teeth injury. The mandibular and maxillary fractures were treated with closed reduction and intermaxillary fixation with arch bar and multiple loop wiring. IMF was applied for two weeks and early movement of jaw was carried out to prevent TMJ ankylosis. Endodontic and prosthodontic treatments were performed for the restoration of the missing teeth. Patient was examined periodically for the evaluation of TMJ function and remodeling. On the 10th day after trauma (on the admission day), the intracapsular both condylar fractures were observed in the panormaic view. The both fragments were displaced anteriorly which were located below the articular emnences. The contour of fragments was superimposed with condylar stump in the panormaic view. In the P-A mandible view, both fragments was slightly displaced to the medial side. On the 3rd week after trauma (after removal of IMF), the contour of condylar fragments were slightly disappeared and the radiopacity of both TMJ was observed, but the sigmoid notches and coronoid processes were seen as normal contour. On the 3rd month after trauma, the fragments of condylar heads resorbed completely and the articular surfaces of condyle became round in shape. Both coronoid processes were elongated and the articular space was observed distinctly. On the 9th month after trauma, condylar processes similar to normal were repositioned anterior to glenoid fossae. The deepening of sigmoid notch and elevation of coronoid process to zygomatic arch were noted. Articular fossa became to be shallow and articular eminence was flattened. On the 18th month after trauma, the complete resorption of condylar fragments and remodeling of condyle were observed. Deepended sigmoid notch and elongated coronoid process were apparently recognized. Condylar heads were repositioned anterior to articular fossae in the panoramic view. In the P-A mandible view, left condyle was seen as normal, but the neck portion of right condyle was markedly curved to lateral side. In spite of the changes of TMJ function and structures, viz elongation of coronoid process, deepending of sigmoid notch, flattening of articular fossa and eminence, and anterior repositioning of condylar process, patient complained nothing and could function absolutely.

翼突窩部에 發生된 粘液腫의 治驗例 및 文獻考察

Sang Chull Lee(李相喆),Yeo Gab Kim(金麗甲),Hyoun Chull Kim(金賢哲),Jong Jae Lee(李宗泰) 대한구강악안면외과학회 1984 대한구강악안면외과학회지 Vol.10 No.2

Myxomas are rare tumor that probably arise from the mesenchymal portion of the dental papilla, dental follicle, or periodontal membrane. This is to report a case of myxoma occurred in the left maxillary alveolar portion, maxillary sinus and pterygomaxillary fossa. The patient, 28 years-old female, was admitted to Dept, of Oral & Maxillofacial Surgery, Kyung Hee University Medical Center with the chief complaint of painless mass on the upper left molar area. In this case, the roentgenographic findings revealed sun-ray appearance, root resorption, displacement of involved tooth and destruction of lateroposterior wall of maxillary sinus. The histopathological findings revealed a soft tissue covered by hyperplastic stratified squamous epithelium with prominent rate ridge and no cellular atypia, The upper portion of underlying connective tissue is composed of fibrous collagenous tissue with numerous proliferating fibroblasts and infiltration of large numbers of chronic inflammatory cells and deep portion is made up of loosely arranged, spindle shaped and stellate cells with long fibrillar process. Conservative local curettage is the preferred treatment. Removal of the maxilla or mandible should be avoided if at all possible. Removal should be done only when pathologic fracture or extension of the tumor into the vital anatomical structures is inevitable. In this case, we performed curettagement of the tumor via intraoral approach.

구강ㆍ악안면부위의 감염시 치명적인 신경학적 합병증에 관한 증례보고 및 문헌고찰

이상철(Sang Chull Lee),김여갑(Yeo Gab Kim),류동목(Dong Mok Ryu),김현철(Hyoun Chull Kim) 대한구강악안면외과학회 1986 대한구강악안면외과학회지 Vol.12 No.2

A number of neurologic complications may accompany acute odontogenic infections. The signs and symptoms of these conditions should be looked for and recognized as early as possible because some of the complication can be fatal. The advent of antibiotics has caused a definite reduction in mortality from this condition. There are few reported case of death due to intracranial lesions resulting from primary oral and maxillofacial infection. The following is a report of two cases seen recently at Kyung Hee Medical Center. The purpose of reporting these two cases is to stress the possible dangers of primary oral and maxillofacial infection and importance of early and adequate treatment.

하치조신경전위술을 병행한 구강악안면외과영역의 수술

변숙(Sook Byun),김현철(Hyoun Chull Kim),백성진(Seung Jin Baek) 대한구강악안면외과학회 1997 대한구강악안면외과학회지 Vol.23 No.2

The inferior alveolar or mental nerves may be damaged during several routine surgical procedures on the madible These include removal of wisdom teeth, various grafting for mandibular augmentation and implantation procedures, etc. Therefore, intentional reposition of the inferior alveolar nerve doesn t only facilitate various surgery but also minimizes damage to infeior alveolar nerve which has been indicated as adjunctive techniques for orthognathic surgery, vestibuloplasty, and implantation of atrophied posterior mandible. We have done that repositioning of the inferior alveolar nerve for mandibular body osteotomy, rigid internal fixation ot fractured mandible, en bloc resection of ameloblastoma, enucleation of radicu-lar cyst, and implantation of the atrophied posterior mandible. So, it was possible for us to facilitate RIF for immediate repair of the continuity defect near the mental foramen without retraction of mental nerve We could lessen the risk of iatrogenic nerve damage and complete removal of lesion during the enucleation of intrabony lesion approximated neurovascular bundle. The effect of vertical height augmentation of mandible tor implant has made superior functional restorative rehabilitation during the implantation of atrophied posterior mandible. Neurosensory evaluation was performed using the two-point discrimination test. All patients have immediated neurosensory alteration associated with the neurovascular bundle manipulations. 5 Patients with unilateral reposition had good recovery and returned to normal neurosensory function in 12 to 21 months postoperatively. As for the case of one patient with bilateral reposition only 4 months of followup period has passed. So the result remains to be seen. The approach mentioned above has got a good result in minimzing the long-term neurosensory disturbances and facilitating various mandibular surgery. This paper, therfore, reports on the literature on the matter.