Clinical and retrospective study of costochondral rib grafting

남기원(Ki Weon Nam),김명진(Myung Jin Kim) 대한구강악안면외과학회 1993 대한구강악안면외과학회지 Vol.19 No.3

늑연골 이식술은 수년동안 오랜 경험으로 종양수술 후 하악과두 재건, 선천적 발생학적 기형의 교정, 강직중의 치료, 외상 후 재건 및 관절염시 관절 대체물로 사용되어져 왔다. 저자들은 하악과두 재건술을 위한 늑연골 이식의 임상적 소급적 분석을 토대로 그 예후에 대해 관찰하였다. 본 임상연구는 종양 절제술, 외상 또는 악관절 강직중 수술 등의 원인으로 발생된 하악과두 결손부를 자가 늑연골 이식술을 시행한 10명의 환자에서 수술 후 장기간 관찰하여 악운동 기능, 안모개선, 저작기능 및 추적조사 기간중의 하악골 성장 등에 대하여 연구, 조사하여 다소의 흥미있는 결과를 얻었다. 성인의 경우 하악과두 결손부의 재건을 시행한 4례에서는 기능적 심미적으로 양호한 결과를 얻었다. 성장중인 환자 6례에 있어서 3례는 다소 하악골 저성장을 보이고, 2례는 정상적인 하악골 성장이 관찰되었고, 1례의 경우 극심한 과성장이 초래되어 2차로 과두 절제술 및 악교정 수술을 시행한 바 있다. 결론적으로 성인에 있어 하악과두 결손을 재건하기 위해 늑연골 이식술이 추천 되어지나 성장중인 환자의 경우 수술후 하악골 성장을 예견하기 어렵기 때문에 신중히 고려되어야 할 것으로 사료되어 진다. Costochondral grafts had been used empirically for many years in the following ablative tumor surgery, correction of congenital and developmental deformities, treatment of ankylosis of joint. Anatomical or functional loss of the mandiblar condyle and eventually the ascending ramus and glenoid fossa, may be caused by trauma, infection, congenital dysplasia or surgery. Reconstruction of the temporomandibular joint (TMJ) is a challenging and sometimes frustrating aspect of oral and maxillofacial surgery. Over time, several techniques have used a variety of materials, both alloplastic and autogenous. The use of costochondral grafts for reconstruction of the TMJ was first described by Gillies in 1920. Since that time, costochondral grafting has proven to be a versatile procedure with a high rate of success. The treatment of the lost condyle must include the following requirements : 1. Restoration of vertical, protrusive and lateral movements of the mandible, to re-estabilish adequate mouth opening. 2. Restoration and maintenance of the vertical dimension, improvement of the dental occlusion and avoidance of postoperative apertognathia. 3. Restoration of facial symmetry, at rest and on movement, during and after cessation of growth. 4. Avoidance of recurrent ankylosis. This paper reports the surgical and functional reults of the restrospective analysis of costochondral grafting. This clinical study was achieved to interesting results about mandibular movement, masticatory function, improvement of facial disfigurement and mandibular growth through long term follow-up in condylar reconstruction with autogenous costochondral graft for 10 patients who had undergone tumor, trauma, and TMJ ankylosis surgery. Condylar reconstruction with costochondral graft for yields satisfactory cosmetic and functional results in 4 adult patients. The long term follow-up of 6 patients yields who had undergone costochondral grafting in the growing period was done. Three of the six patients yields more or less mandibular undergrowth. Two of the six patients developed normal mandibular growth. One of the these patients performed secondary condylectomy and orthognathic surgery because of severe mandibular overgrowth. Conclusionally, condylar reconstruction with costochondral graft is recommended in adult, but must significantly consider due to unpredictable post-operative mandibular growth in growing child.

FUNCTIONAL RECONSTRUCTION OF MANDIBULAR DEFECTS WITH FREE BONE GRAFT

김종원,남일우,김명진,정필훈,서병무,유준영,남기원,송민석,Kim, Jong-Won,Nam, II-Woo,Kim, Myung-Jin,Choung, Pill-Hoon,Seo, Byung-Moo,You, Jun-Young,Nam, Ki-Weon,Song, Min-Seok Korean Association of Maxillofacial Plastic and Re 1993 Maxillofacial Plastic Reconstructive Surgery Vol.15 No.4

양성 종양, 악성 종양, 감염, 외상 등에 의한 하악골 결손은 중대한 심미적, 생물학적 결과를 일으킨다. 재건술의 일차적 목적은 완전한 기능 회복이며 이는 이차적으로 심미적 변형의 정상화를 유도한다. 저자들은 1981년에서 1990년까지 서울대학교 치과대학 구강 악안면외과에 내원하여 하악골 재건술을 시행받고 6개월 이상 추적조사가 가능한 61증례의 임상적 자료 및 방사선 검사를 통해 부위별 임상적 성공률을 조사하였다. 본 임상 논문의 목적은 하악골 결손부위와 부위에 따른 유리골 이식의 성공률을 연구하는데 그 의의를 두겠다. 유리골 이식의 임상적 연구를 요약해 보면 유리 자가골 이식의 대부분은 장골이었고 망상피질골이었다. 6개월 이상 추적조사가 가능한 61명의 환자에 있어 전체적 성공률은 80.3% 였다. 강선고정과 구외접근법이 다른 방법보다 그 예후에 있어 훨씬 더 좋은 결과를 나타냈고 다른 부위보다 하악 정중부위가 그 예후에 있어 훨씬 나쁜 결과를 보였다. Mandibular discontinuity defect due to benign tumor, malignant tumor, infection, or truma results in major esthetic and biologic compromise. The primary goal of reconstruction is full restitution of function, which secondarily lead to normalization of the cosmetic deformity. The authors make a clinical study of 61 consecutive bone graft cases for mandibular reconstruction of discontinuity defect which were studied retrospectively using clinical data and radiographic findings. The cases were reviewed to evaluate the clinical success in the period from 1981 to 1990 in the Dept. of Oral & maxillofacial Surgery, Seoul National University Hospital. The criteria of the success in bone graft, are no residual infection, graft in with maintain its integrity, and remain over a half of its original size of graft in the radiographic features. The purpose of this clinical survey is to study of the mandibular discontinuity defects and success rate of free bone graft in mandibular defects. To summarize the clinical study of free bone graft, the main type of autogenous bone graft is iliac bone and corticocancellous type. Overall success rate is 80.3% in 61 followup cases over 6 months. Wire fixation and Extraoral approach has realtively better prognosis than other methods. It showed relatively poor prognosis in symphysis defects than other recipient site.

치조열 환자에 있어서 이차 골성형술 후의 예후에 관한 임상적 연구

김명진(Myung Jin Kim),이정근(Jeong Keun Lee),남기원(Ki Weon Nam) 대한구강악안면외과학회 1995 대한구강악안면외과학회지 Vol.21 No.2

Many kinds of anomalies have emerged in oral and maxillofacial area. Cleft lip and palate is one of the congenital anomalies of this area. Cleft alveolus appears in 75% of total cleft palate cases and various opinions are suggested for the correction of cleft alveolus. Treatment goal of the cleft alveolus is the restoration of normal function of the hard tissue, hence the bone graft is the essential procedure. But the operation timing is a matter of dispute. Primary bone graft is performed before the completion of the primary dentition, and the secondary bone graft is performed after the completion of the primary dentition. We have performed the secondary osteoplastic surgery for restoration of normal tooth-bearing function, for establishment of esthetic occlusion, and as a prerequisite to orthognatihic surgery in order to correct the undergrowth of the maxilla due to cleft palate and alveolus. The object of our study lies in the study of the alveolar bone change after secondary osteoplasty via the evaluation of bony bridge and the cleft side canine state after secondary bone graft into cleft alveolus. 29 patients between the age of 9 and 38 was the subject of this study and 21 cases were followed up. Follow up period is from immediate post-operative time to post-operative 20 months, of which the mean value is 7 months 10 days. The evaluation of bony bridge is based on the Abyholm criteria (1981), and the results were as follows : typeⅠ16, typeⅡ4, and typeⅢ1 cases, respectively. The canine state of follow up time were evaluated : Self erupting consists of 5 cases, and orthodontic guidance 4 cases of total 9 cases of unerupted canine at the time of osteoplasty. Erupting canine at the time of surgery were 5 cases.

유리골 이식을 통한 하악골 결손부의 기능적 재건술

유준영(Jun Young You),김종원(Jong Won Kim),정필훈(Pill Hoon Choung),김명진(Myung Jin Kim),남일우(Il Woo Nam),송민석(Min Seok Song),서병무(Byung Moo Seo),남기원(Ki Weon Nam) 대한악안면성형재건외과학회 1994 Maxillofacial Plastic Reconstructive Surgery Vol.15 No.4

양성 종양, 악성 종양, 감염, 외상 등에 의한 하악골 결손은 중대한 심미적, 생물학적 결과를 일으킨다. 재건술의 일차적 목적은 완전한 기능 회복이며 이는 이차적으로 심미적 변형의 정상화를 유도한다. 저자들은 1981년에서 1990년까지 서울대학교 치과대학 구강, 악안면외과에 내원하여 하악골 재건술을 시행받고 6개월 이상 추적조사가 가능한 61증례의 임상적 자료 및 방사선 검사를 통해 부위별 임상적 성공률을 조사하였다. 본 임상 논문의 목적은 하악골 결손부위와 부위에 따른 유리골 이식의 성공률을 연구하는데 그 의의를 두겠다. 유기골 의식의 임상적 연구를 요약해 보면 유리 자가골 이식의 대부분은 장골이었고 망상피질골이었다. 6개월 이상 추적조사가 가능한 61명의 환자에 있어 전체적 성공률은 80.3% 였다. 강선고정과 구외접근법이 다른 방법보다 그 예후에 있어 훨씬 더 좋은 결과를 나타냈고 다른 부위보다 하악 정중부위가 그 예후에 있어 훨씬 나쁜 결과를 보였다 Mandibular discontinuity defect due to benign tumor, malignant tumor, infection, or truma results in major esthetic and biologic compromise. The primary goal of reconstruction is full restitution of function, which secondarily lead to normalization of the cosmetic deformity. The authors make a clinical study of 6l consecutive bone graft cases for mandibular reconstruction of discontinuity defect which were studied retrospectively using clinical data and radiographic findings. The cases were reviewed to evaluate the clinical success in the period from 1981 to 1990 in the Dept. of Oral & maxillofacial Surgery, Seoul National University Hospital. The criteria of the success in bone graft, are no residual infection, graft in with maintain its integrity, and remain over a half of its original size of graft in the radiographic features. The purpose of this clinical survey is to study of the mandibular discontinuity defects and success rate of free bone graft in mandibular defects. To summarize the clinical study of free bone graft, the main type of autogenous bone graft is iliac bone and corticocancellous type. Overall success rate is 80.8% in 61 followup cases over 6 months. Wire fixation and Extraoral approach has realtively better prognosis than other methods. It showed relaltively poor prognosis in symphysis defects than other recipient site.