가토에서 하악골신장술시 신장부에 대한 가골압축의 효과

박홍주,안진석,국민석,오희균,유선열,조진형,Park, Hong-Ju,An, Jin-Suk,Kook, Min-Suk,Oh, Hee-Kyun,Ryu, Sun-Youl,Cho, Jin-Hyoung 대한악안면성형재건외과학회 2007 Maxillofacial Plastic Reconstructive Surgery Vol.29 No.1

Purpose: To evaluate the effect of compression on the distracted area in new bone formation during mandibular distraction osteogenesis in rabbits. Materials and method: Sixteen rabbits, weighing approximately 2 Kg, and the prefabricated distraction device were used. With the rabbits under general anesthesia, we performed vertical osteotomies between the anterior and posterior mandibular teeth and then placed the distraction device. After a 5 -day latency period, the mandible was distracted to a length of 10.0 mm at a rate of 1 mm/day and then immediately compressed 4 mm in the experimental group (n=8). In the control group (n=8), the mandible was distracted to a length of 6.0 mm at a rate of 1 mm/day. Rabbits in the control group were killed at 2 and 8 weeks during the consolidation period. The specimens were evaluated with light microscope after H & E stain. Histomorphometric analysis was done at 8 week specimens. Results: All experimental animals showed mandibular elongation on the macroscopical and radiographic evaluations. At 2 week, immature bone formation was observed from the surface of the host bone margins with collagen fibers arranged parallel to the direction of distraction in the control group; in the experimental group, immature bone formation was observed adjacent to the host bone, and the collagen fibers were not arranged uniformly. At 8 week, spindle-shaped new bone formation was seen in the direction of distraction in distracted area of the control group, while in the experimental group, the newly formed bone was arranged in a multidirectional manner, like the pattern of trabeculae. In the histomorphometric analysis of 8 weeks, the area of bone deposition was $2.12{\pm}\;0.75\;inch^2$ in the experimental group and $0.87{\pm}0.51\;inch^2$ in the control group (p<0.01). The bone deposition ratio was $29.60{\pm}10.50%$ in the experimental group and $12.10{\pm}7.17%$ in the control group (p<0.01). Conclusion: These results suggest that compression after over-distraction during the mandibular distraction osteogenesis is an effective method of increasing the amount of newly formed bone in distracted area.

외과적 급속상악확장술시 익돌상악 접합부의 분리 유무에 따른 치열궁 변화

한인호,안진석,구홍,국민석,박홍주,오희균,Han, In-Ho,An, Jin-Suk,Gu, Hong,Kook, Min-Suk,Park, Hong-Ju,Oh, Hee-Kyun 대한악안면성형재건외과학회 2006 Maxillofacial Plastic Reconstructive Surgery Vol.28 No.4

Purpose: The aim of this study was to evaluate the effects of pterygomaxillary separation on dimensional changes of dental arch following surgically-assisted rapid maxillary expansion (SARME). Patients and Methods: Eighteen adults who had been treated by SARME for transverse maxillary deficiency from May 2000 to August 2005 were evaluated. Thirteen patients (Group 1) were treated with subtotal Le Fort I osteotomy including pterygomaxillary separation and anterior midpalatal osteotomy. The same operation was performed in five patients (Group 2) except pterygomaxillary separation. Dental study casts were taken before operation and after removal of expansion device. And then, skeletal and dental parameters were measured pre- and post-operatively. Results: 1. Changes of mean interdental width 1) In group 1, mean maxillary interdental width was increased 70%($47{\sim}99%$), 95%($84{\sim}115%$), and 77%($57{\sim}94%$) of total expansion on canine, first premolar, and first molar region, respectively after retention. 2) In group 2, mean maxillary interdental width was increased 77%($59{\sim}100%$), 78%($45{\sim}107%$), and 86%($57{\sim}116%$) of total expansion on canine, first premolar, and first molar region, respectively after retention. 3) There was a statistical difference between the change of interdental width of group 1 and group 2 at first premolar(p<0.05). 2. Changes of mean interalveolar width 1) In group 1, mean maxillary alveolar bone width was increased 66%($42{\sim}84%$), 74%($42{\sim}104%$), and 57%($31{\sim}78%$) of total expansion on canine, first premolar, and first molar region, respectively after retention. 2) In Group 2, mean maxillary alveolar bone width was increased 73%($55{\sim}98%$), 67%($36{\sim}89%$), and 59%($48{\sim}73%$) of total expansion on canine, first premolar, and first molar region, respectively after retention. 3) There were no statistical differences between group 1 and group 2 at each teeth area. Conclusion: These results suggest that SARME without pterygomaxillary separation may allow the relatively equal expansion at both anterior and posterior teeth area and most amounts of maxillary interdental expansions were acquired with the expansion of the maxilla by SARME.

Porous polyethylene을 이용한 관골증대술의 임상연구

국민석,안진석,김영준,박홍주,오희균,Kook, Min-Suk,An, Jin-Suk,Kim, Young-Joon,Park, Hong-Ju,Oh, Hee-Kyun 대한악안면성형재건외과학회 2008 Maxillofacial Plastic Reconstructive Surgery Vol.30 No.3

The malar mound defines the contour of the lateral face between the inferior orbital rim and the mandible, and hypoplasia or asymmetry of this region is readily noticeable. A flat, hypoplastic malar eminence can make the face blunt and wearisome, which contributes to a premature aged appearance. Patients with congenital or traumatic flattening of the malar eminence can obtain esthetic improvement with implants. Indications for placement of malar implants to improve the appearance of subtle flattening or to enhance the esthetic harmony of a patient's face have been suggested in several studies. Many augmentation materials, such as silicone, proplast, polyamide, and porous polyethylene implants have been used. Many methods of localization have been described, the key to proper placement of the implants lies in a through understanding of the esthetics of the malar mound. From August 2001 to June 2007, 12 patients with malar depression who visited the Department of Oral and Maxillofacial Surgery, Chonnam National University Hospital were treated by augmentation malarplasty with Porous polyethylene. The location and amount of augmentation are determined by preoperative interview, physical examinations, facial models and radiographic findings. 12 patients were satisfied with the results of augmentation malarplasty and severe complications were not occurred.

소형금속판에 고정나사의 삽입시 drilling의 위치 및 각도에 따른 시편의 이동량에 대한 효과

오현철,안진석,구홍,국민석,박홍주,오희균,Oh, Hyun-Chul,An, Jin-Suk,Gu, Hong,Kook, Min-Suk,Park, Hong-Ju,Oh, Hee-Kyun 대한악안면성형재건외과학회 2006 Maxillofacial Plastic Reconstructive Surgery Vol.28 No.3

Purpose This study was aimed to evaluate the effect of the location and angle of drilling on the changes of the distance between the two block specimens. Materials and methods In experimental group 1, the screw holes were prepared by drilling in the distal portion of compression part of the plate at $90^{\circ}$. In experimental group 2, the drilling was performed at an angle of $30^{\circ}$ proximal to the miniplate, and in experimental group 3, at $30^{\circ}$ distal respectively. In control group, the drilling was performed to the center of hole at $90^{\circ}$. The fixation screw length was 5 mm, 7 mm, and 9 mm in all groups. The results were as follows. Results 1. In control group, the mean changes between two specimens were 0.01 mm, 0.02 mm, and 0.00 mm in 5 mm, 7 mm, and 9 mm screws respectively. 2. In experimental group 1, the compression part was moved toward the retention part. The range of mean changes were from -0.39 mm to -0.43 mm. 3. In experimental group 2, the compression part was moved toward the retention part. The range of mean changes were from -0.51 mm to -0.56 mm. 4. In experimental group 3, the compression part was moved apart from the retention part and the range of mean changes were from 0.55 mm to 0.56 mm. 5. The changes were significantly different between all groups(p<0.01). Conclusion These results suggest that 0.4$\sim$0.5 mm of compressive effect can be achieved by drilling on the distal area of the screw hole at an angle of $90^{\circ}$ and by the proximal angulation to the miniplate, and the gap between specimens can be increased by distal angulation to the miniplate during drilling.

하치조신경 마취시 하악공으로의 접근을 위한 전산화단층촬영을 통한 방사선적 연구

김지광(Ji-Kwang Kim),구홍(Hong Gu),안진석(Jin-Suk An),국민석(Min-Suk Kook),박홍주(Hong-Ju Park),오희균(Hee-Kyun Oh),조진형(Jin-Hyoung Cho) 대한구강악안면외과학회 2006 대한구강악안면외과학회지 Vol.32 No.6

Purpose : This study was performed to provide an anatomical information of the mandibular ramus for the successful inferior alveolar nerve block. Three dimensional images were reconstructed from the computerized tomography (CT) and the anatomical evaluation of the mandibular ramus was done. Materials and methods : Sixty-four patients who had been taken the facial CT scans from 2000, Jan to 2003, June was selected. The patients who had the anterior or posterior teeth misssing, edentulous ridge, and jaw fracture were excepted. In the occulusal plane, the lingual surface angle (LSA) between the mid-sagittal plane and the mandibular molar lingual surface from the 2nd premolar to the 2nd molar, the inner ramal surface angle(IRSA), the maximum inner ramal surface angle (MxIRSA), and the outer ramal surface angle (ORSA) to the-mid sagittal plane were measured. The inner ramal surface angle in the ligular tip level (IRSA-L) and the outer ramal surface angle in the ligular tip level (ORSA-L), the ramal length (RL), and the anterior ramal length (ARL) were also measured in the lingular tip level. Results : In the lingular tip level, the mean IRSA-L and ORSA-L were 28.6±6.3􀆆and 17.9±4.9􀆆respectively. The larger was the IRSA, the larger was the ORSA. In the lingular tip level, the mean ramal length was 35.8±3.4 mm. The larger was the IRSA-L, the shorter was the ramal length. On the lingular tip level, the mean anterior ramal length from anterior ramus to lingular tip was 19.6±3.3 mm. when the ramal length was longer, the anterior ramal length was also longer. On the lingular tip level, there was positive correlation vetween the IRSA and the ORSA, negative correlation between the IRSA and the ramal length, and positive correlation between the ramal length and the lingular tip level to the anterior ramus. There was no statistical meaning of data between sex and age. Conclusion : In the clinical view of the results so far achieved, if the direction of needle is closer to posterior it is able to contact bone on lingular tip when the internal surface of ramus is wided outer.

이하선 종양에 대한 변형된 이내 및 경부접근법

유선열(Sun-Youl Ryu),국민석(Min-Suk Kook),김선국(Sun-Kook Kim),한창훈(Chang-Hun Han),구홍(Hong Gu),권준경(Jun-Kyung Kwon),안진석(Jin-Suk An) 대한구강악안면외과학회 2005 대한구강악안면외과학회지 Vol.31 No.6

Generally we use the preauricular incision to access and remove the parotid gland tumor. But the preauricular approach has some complications such as damage of facial nerve and sensory nerve, Frey’s syndrome, and postoperative scar. Especially, the postoperative scar can often cause an unesthetic result and mental stress in young patients. Therefore, if we avoid preauricular incision to be performed outside of tragus, the postoperative scar would be hardly remarkable, and patients would be satisfied cosmetically. We performed surgical excision using a modified endaural and neck approach in a 21-year-old female with a pleomorphic adenoma and 15-year-old male with a neurofibroma occured in the parotid gland. A new, modified endaural and neck approach is a combined method of the modified endaural incision by Starck et al and Gutierrez’s neck extension. We obtained an adequate access and the cosmetically acceptable postsurgical scar. The postoperative scars were hidden in the external ear and the hairline. Moreover, except the neck dissection can this approach be applied to the surgery of temporomandibular joint as well as the parotid gland tumor.

방사선 사진을 이용한 하악 제3대구치와 하치조신경의 관계에 대한 연구

김종협(Jong-Hyoup Kim),구홍(Hong Gu),안진석(Jin-Suk An),국민석(Min-Suk Kook),박홍주(Hong-Ju Park),오희균(Hee-Kyun Oh) 대한구강악안면외과학회 2006 대한구강악안면외과학회지 Vol.32 No.5

Purpose: This study was performed to evaluate relationship between the inferior alveolar nerve injury and the findings of panoramic and tomographic images for preventing inferior alveolar nerve injury after the 3rd molar extraction. Material and Method: From April, 2005 to June, 2005, The 190 patients who visited in the Department of Oral and Maxillofacia Surgery, Chonnam National University Hospital and the panoramic radiographies were taken for extraction of the mandibular third molar, was selected. Among 215 mandibular third molars, Scanora tomographic imagings were taken in the 90 teeth which were overlaped to the mandibular canal in the panoramic imagies. In panoramic radiographies, the angulation, the level, the root morphology, and the superimposition sign of the mandibular third molars with the mandibular canal were evaluated. In the tomographic radiographies, the location and distance of the mandibular third molar from the canal were also evaluated. The relationships between these findings and the inferior alveolar nerve injury were examined. Results: In the panoramic findings, the inferior alveolar nerve injuries were occurred in the darkened roots (5 molars, 7%), the uncontinuous radiopaque image (3 molars, 7%), and the depositioned mandibular canal (2 molars, 10%). In the tomographic findings of 90 molars, 20 molars also had the superimposition imagies. Five molars in those molars (25%) had the inferior alveolar nerve injury after extraction. There were 10 patients who had the inferior alveolar nerve injury. The sensory was began to be recovered in 9 patients, except 1 patient, within 2 weeks, then fully recovered within 3 months. Conclusion: These results indicate that the depth mandibular third molar and the superimposition sign may be related with the risk of the inferior alveolar nerve injury after extraction

Abbe 피판을 이용한 이차성 구순열비변형의 교정 4예

유선열,김태희,황웅,구홍,권준경,안진석,박홍주,Ryu, Sun-Youl,Kim, Tae-Hee,Hwang, Ung,Koo, Hong,Kwon, Jun-Kyung,An, Jin-Suk,Park, Hong-Ju 대한악안면성형재건외과학회 2007 Maxillofacial Plastic Reconstructive Surgery Vol.29 No.1

구순열의 일차 수술 또는 이차 수술 후에 발생하는 상순의 지나친 긴장은 상하순 간의 부조화, 상악열성장, 골격성 III급 부정교합 등 안모추형을 초래한다. 상순의 긴장이 매우 심한 경우에는 하순의 여유 있는 조직을 이용하여 상순을 수정하는 Abbe 피판을 고려할 수 있다. 상순의 긴장이 큐피드궁의 2/3 이상의 조직 손실을 동반할 경우 Abbe 피판의 적응증이 된다. Abbe 피판은 상순과 하순의 반흔, 색상의 부조화, 그리고 상순의 불완전한 운동을 초래하는 단점을 가진다. 그러므로 Abbe 피판은 신중하게 사용되어야 한다. 우리는 편측성 구순열 1예와 양측성 구순열 3예에서 상순의 과도한 긴장과 큐피드궁의 조직 결핍 그리고 비변형이 심한 이차성 구순열비변형을 교정하기 위해 세 가지 형태의 Abbe 피판을 이용한 이차 교정술을 경험하였다. Abbe 피판수술을 시행한 결과 상순의 반흔과 긴장이 해소되고 큐피드궁이 재건되고 비주의 길이가 증가되어 이차 구순열비변형을 교정할 수 있었다. Abbe 피판은 신중을 기해 적용한다면 구순열 수술 후에 발생되는 상순의 수평적 긴장감이나 편평함을 해결하는 데 유용한 술식임을 알 수 있었다. Radical paring of the cleft edge during primary cleft lip operation or repeated secondary surgeries can result in tightness of the upper lip. In case, the degree of the resulting side-to-side tension is very severe, the possibility of a lip switch flap must be considered. When the lip tightness accompanies a loss of more than two-thirds of the Cupid's bow, an Abbe flap is an alternative. The disadvantages of Abbe flap are scar formation on the lower lip, design of incision line on the upper lip, disharmony of colors, and the dysfunction of the orbicularis muscle. These problems have been recognized in the literature and extreme discretion has been advised in its application. We experienced four cases of Abbe flap operation which were designed differently to correct the secondary unilateral or bilateral cleft-lip nasal deformities. The Abbe flap operations resulted in removal of the scars and tightness of the upper lip, reconstruction of the Cupid's bow, lengthening of the columella, and therefore secondary cleft-lip nasal deformity could be corrected. It is thought that carefully applied Abbe flap is an appropriate method to relieve horizontal tightness or flattening of the upper lip which occured after primary operation of cleft lip.