말기 구강암 환자의 통증 관리

표성운(Sung woon Pyo),민성기(Sung ki Min),정무혁(Moo hyuk Chung),김창현(Chang hyun Kim) 대한구강악안면외과학회 1997 대한구강악안면외과학회지 Vol.23 No.4

Pain from cancer is a major problem of managing the oral cancer patients in terminal stage. Overall, pain is reported by about 50% of patients at all stages of cancer and by over 70% with advanced neoplasms. Unrelieved pain can be incapaciting and preclude a satisfying quality of life. But, pain is often poorly assessed, and many clinicians lack sufficient knowledge to optimize cancer pain treatment. There are three basic approaches to the control of pain : modifying the source of pain, altering the central perception of pain, and blocking the transmission of pain to the central nervous system. The optimal use of these approaches and an individualized plan for pain control can maximize both quality and duration of life in dying patients. Opioid analgesics are are the mainstay of pharmacologic treatment. Practical opioid therapy include selection of both drug and route, dose titration, and management of side effects. We present our experienced pharmacologic treatment protocol for cancer pain management that collaborated by Dept. of Hospice, Catholic Medical Center. It will acts as a guideline for our colleague to facilitate the translation of current knowlegde into the clinical practice.

Circum-mandibular wiring for pediatric mandibular fracture : Case report

표성운(Sung Woon Pyo) 대한구강악안면외과학회 1995 대한구강악안면외과학회지 Vol.21 No.4

소아와 악골골절은 성인에 비하여 매우 드물다. 상대적으로 적은 발생 빈도는 골의 연성, 두부 전체의 크기에 비하여 작은 안면, 그리고 위험한 환경에 노출되는 기회가 적은 이유로 이해될 수 있다. 그러나 연령의 증가 및 성장 과정에 따라 하악골의 위치가 안면 구조에서 돌출된 위치를 차지하게 됨에 따라 그 발생 빈도가 증가하는 경향이 있다. 소아 하악골절의 처치는 잘못된 치료후 심각한 후유증을 유발할 가능성과 치료시 환아의 협조를 얻기 힘드는 등의 치료 자체의 어려움으로 매우 중요한 의미를 갖는다. 처치 방법은 연령과 골절 위치에 따라 다르나, 대개의 경우 비관혈적 정복 및 악간고정으로 충분하다. 최근에는 미세 금속판등을 이용한 관혈적 정복술 및 내고정술도 널리 시행되고 있는 형편이나, 아직 악골 성장에 대한 영향의 유무가 확립되지 않았고 제거 여부에 대한 논란의 여지가 있으며, Rowe등은 소아 안면골의 높은 재개조 성향으로 과도한 정복과 처치가 요구되지는 않는다고 주장한 바 있다. 가장 효과적인 방법은 적절한 골절 정복과 치유기간중 안정성을 제공하는 가장 보존적인 방법을 사용하는 것이다. 이에 저자는 소아 하악골절 환자에게 아크릴릭 레진 상부자와 환악걸찰술올 이용하여 양호한 결과를 얻었기에 이에 보고하는 바이다. Pediatric mandibular fractures are generally regarded as uncommon. The relative low incidence has been explained by the resilent nature of the bones, the bones, the small facial size in relation to head size, and the fact that children are not as frequently exposed to major trauma. But, correlated to the maturational growth pattern of the pediatric facial skeleton, and entities that are placed in a more prominent position, the frequency of a mandibular fracture increases with increasing age during childhood. The treatment of mandibular fractures in chidren has great significance owing to the serious deformities consquent to poor treatment and the problems of therapy that are peculiar to children. At present, management of a fracture by means of open reduction using mini-or microplate and screw was frequently reported, however, most often consisted of closed reduction and intermaxillary fixation. The idal management of a mandibular fracture in chidren is the simplest method which will produce adequate reduction and stabilization. So, the author presents two cases of treatment of the pediatric mandibular fractures using an acrylic resin splint and circummandibular wiring with satisfactory results.

구강 편평세포암에서 E-cadherin 유전자의 과메틸화

표성운(Sung-Woon Pyo),김영실(Young-Sill Kim),박지영(Ji-Young Park),김창현(Chang-Hyen Kim),이원(Won Lee),박민규(Min-Kyu Park) 대한구강악안면외과학회 2009 대한구강악안면외과학회지 Vol.34 No.2

Loss of E-cadherin (E-cad) expression has been found in multiple cancers and is postulated to facilitate tumor cell dissociation and metastais. Promotor methylation may provides an alternative pathway for loss of gene function. This study evaluated the role of hypermethylation in the downregulation of E-cad in oral squamous cell carcinoma (OSCC). We examined the E-cad expression by immunohistochemical staining and detected methylation status by methylation-specific polymerase chain reaction (MSP) in 20 OSCC tissues. Overally, 12 (60%) cases of hypermethylation of Ecad were detected and we found there were no correlation between methylation and age, histologic grade, lympn node metastasis, tumor size and clinical stage. However, Eleven (73.3%) of 15 samples which was negative for E-cad staining showed hypermethylation of E-cad promotor region. On the other hand, only one (20%) of 5 E-cad positive sample was observed with methylated status. The underexpression of E-cad was found to be related to promotor hypermethylation (p=0.035). In conclusion, we suggest that hypermethylation play a role in inactivation of E-cad gene and may be a appreciable biomarker for diagnosis and treatment of OSCC.

협부지방에서 성체 줄기세포의 분리와 골모 세포로의 분화

표성운(Sung-Woon Pyo),박장우(Jang-Woo Park),이일규(Il-Kyu Lee),김창현(Chang-Hyen Kim) 대한구강악안면외과학회 2006 대한구강악안면외과학회지 Vol.32 No.6

For the repairing of bone defect, autogenous or allogenic bone grafting remains the standard. However, these methods have numerous disadvantages including limited amount, donor site morbidity and spread of diseases. Tissue engineering technique by culturing stem cells may allow for a smart solution for this problem. Adipose tissue contains mesenchymal stem cells that can be differentiate into bone, cartilage, fat or muscle by exposing them to specific growth conditions. In this study, the authors procured the stem cell from buccal fat pad and differentiate them into osteoblast and are to examine the bone induction capacity. Buccal fat-derived cells (BFDC) were obtained from human buccal fat pad and cultured. BFDC were analyzed for presence of stem cell by immunofluorescent staining against CD-34, CD-105 and STRO-1. After BFDC were differentiated in osteogenic medium for three passages, their ability to differentiate into osteogenic pathway were checked by alkaline phosphatase (ALP) staining, Alizarin red staining and RT-PCR for osteocalcin (OC) gene expression. Immunofluorescent and biochemical assays demonstrated that BFDC might be a distinguished stem cells and mineralization was accompanied by increased activity or expression of ALP and OC. And calcium phosphate deposition was also detected in their extracelluar matrix. The current study supports the presence of stem cells within the buccal fat pad and the potential implications for human bone tissue engineering for maxillofacial reconstruction.

구강 및 구인두종양수술시 구순-하악골이단 접근법의 이용에 관한 임상적 연구

표성운,Pyo, Sung-woon 대한악안면성형재건외과학회 1999 Maxillofacial Plastic Reconstructive Surgery Vol.21 No.2

The labiomandibulotomy approch to the oral cavity and oropharygeal region was first described by Roux in 1836 and become popular for oral and oropharyngeal tumors in cases where there are no clinical and radiological signs of mandible invasion. Anterior labiomandibulotomy and swing procedure provides excellent access and facilitate a mandibular resection and subsequent repair. In last two years, 8 cases of oral and oropharyngeal tumors were treated by this approach at the Dept. of Oral & Maxillofacial Surgery, Holy Family Hospital, Catholic University of Korea. And we analyzed postoperative complications as well as functional evaluations, and the results were as follows; In 4 cases, marginal mandibulectomy were combined with labiomandibulotomy and in case of malignancies, neck dissection was performed simultaneously. In almost case, plate and miniscrew fixation was used for osteotomy sites. Histologic evaluation of the resection margins of the specimens revealed tumor free in all cases. The postoperative complications were occured in 3 cases, one case of nonunion, one case of orocutaneous fistula, and one case of wound dehisence. Occlusal stability, jaw movement and swallowing function were acceptable postoperatively in 3 months. From above results, we concluded that, this approach not only provides wide exposure, permitting radical removal of benign and malignant lesions but also preserves function with minimal complications.

악안면 부위에 발생한 섬유성 골이형성증에 대한 임상조직병리학적 연구

표성운,남일우,PYO, Sung-Woon,Nam, Il-Woo 대한악안면성형재건외과학회 1992 Maxillofacial Plastic Reconstructive Surgery Vol.14 No.1

Fibrous dysplasia is a benign pathologic condition of bone in which fibrous tissue gradually expands and replaces normal bone into fibro-osseous lesion. It is a primary developmental abnormality of bone-forming mesenchyme in origin. This study shows clinical history, radiological and histopathological feature of fibrous dysplasia with the intention of establishing correct diagnosis, treatment plan and evaluation of prognosis. This paper reviews and summarizes the materials from 57 fibrous dysplasias submitted to the Department of Oral and Maxillofacial Surgery in College of Dentistry, Seoul National University. Conclusions obtained were as following : 1. Fibrous dysplasia developed mainly in teenagers and shows female predeliction. 2. Fibrous dysplasia developed much on the maxilla 3. Monostotic fibrous dysplasia was most popular form. 4. Main symptom of fibrous dysplasia was painless swelling. 5. Radiological feature of fibrous dysplasia was ground-glass appearance, 6. Histopathological feature of fibrous dysplasia was irregular immature bony trabeculae(woven bone). 7. Treatment of fibrous dysplasia was mainly conservative contouring surgery.

치성낭에서 c-erbB-2 종양 단백의 발현에 관한 면역조직화학적 연구

표성운,김창현,이원,김영실,Pyo, Sung-Woon,Kim, Chang-Hyen,Lee, Won,Kim, Young-Sil 대한구강악안면외과학회 2001 대한구강악안면외과학회지 Vol.27 No.1

To investigate epithelial cell proliferation reactivity in the odontogenic cysts, the expression of c-erbB-2 oncoprotein by epithelial lining was studied in odontogenic keratocyst(OKC, n=10), dentigerous cyst(DC, n=12), radicular cyst(RC, n=12) and normal dental follicle(n=7). The c-erbB-2 immunoreactivity was studied using a streptavidine- biotin- peroxidase method with polyclonal rabbit antihuman antibody to c-erbB-2 oncoprotein which is known to react with formalin fixed, paraffin-embedded sections and the intensity of staining was determined by manually. In all of 10(100%) OKCs, showed positive expression for c-erbB-2 oncoprotein compared with 10/12(83.3%) in DCs, 11/12(91.7%) in RCs and 5/7(71.4%) in normal dental follicles. The expression within OKC was higher than that of DC, RC and dental follicle but statistically not significant(p>0.05) and but may reflects underlying genetic defect. These results demonstrate differences in c-erbB-2 expression between the epithelial linings of the three major odontogenic cyst types, indicating differences in proliferation activity and differentiation processes within these lesions. And, in particular, these results are able to explain the peculiar aggressive growth pattern of OKC.

구강 편평세포암종에서 E-cadherin과 ${\beta}-catenin$의 발현과 임상병리학적 특징

표성운,이광배,김영실,이상화,Pyo, Sung-Woon,Lee, Kwang-Bae,Kim, Young-Sill,Lee, Sang-Hwa 대한악안면성형재건외과학회 2006 Maxillofacial Plastic Reconstructive Surgery Vol.28 No.5

Changes in cell adhesion molecules are associated with infiltration and metastatic progression of cancer. Reduced expression of E-cadherin and ${\beta}-catenin$ complex in some carcinomas has been reported. The changes in the expression in oral squamous cell carcinoma (OSCC) is not fully understood and it also remains undetermined whether the expression of these adhesion molecules in metastatic lesions differs from that in the primary lesions. In the present study, therefore, we immunohistochemically examined the expression of E-cadherin and ${\beta}-catenin$ in 45 primary OSCCs and 19 metastatic lymph nodes. We compared the expression of these molecules between primary and metastatic lesions and investigated the correlation between the expression and clinicopathologic parameters. The expression of E-cadherin and ${\beta}-catenin$ was reduced in 35/45 (78.2%), 14/45 (31.2%) of primary tumors respectively, but 18/19 (94.7%) and 17/19 (89.4%) of lymph nodes showed preserved expression. The reduced expression of the E-cadherin was associated with lymph node metastasis, invasive mode and marginal status but no significant relationship was not found with ${\beta}-catenin$. In conclusion, the loss of E-cadherin and ${\beta}-catenin$ complex function is associated with progression of OSCC and suggest that the expression of this complex will be a supplementary prognostic tool.

소타액선 선양낭성암종의 두피 전이 : 증례 보고

조성민,표성운,박지영,김진아,이경지,Cho, Sung-Min,Pyo, Sung-Woon,Park, Ji-Young,Kim, Jean-A,Lee, Kyung-Ji 대한악안면성형재건외과학회 2009 Maxillofacial Plastic Reconstructive Surgery Vol.31 No.4

Adenoid cystic carcinoma(ACC) is the second most common malignant neoplasm in the salivary gland. In spite of ACC shows slowly growing nature, it is sometimes highly detrimental that it readily invades adjacent tissues and metastasize to distant organs at the early stage of disease. Hence, treatment outcome may be misfortunate due to wide regional infiltration, pathognomonic perineural spread and the tendency of hematogenous metastasis. We present a unusal case of ACC of the scalp in which the patient initially presented with bumpy mass of the scalp who had been diagnosed as the primarily developed ACC of the right hard palate that extended to infratemporal fossa, nasal cavity, and paranasal sinuses and had been treated by total excision and post-operative chemotherapy and radiation therapy for 10 years ago. Although this lesion occured at the scalp, which is a frequent site of primary dermatologic ACC, its histomorphology was the same with that of previous tumor. Complete clinical examination showed no recurrence sign at the primary site and suggested the scalp as a sole treatment failure site. Accordingly, it would be reasonable to consider the present case as either a scalp metastasis or a second primary lesion of salivary gland ACC.

치주질환으로 인해 유발된 하악의 만성 화농성 골수염의 치험 일례

임요한,표성운,한은영,Lim, Yo-Han,Pyo, Sung-Woon,Han, Eun-Young 대한치주과학회 2002 Journal of Periodontal & Implant Science Vol.32 No.4

Osteomyelitis is an exhaustive disease whose main feature is an inflammation of inner part of bone, bone marrow. In oral and maxillofacial area, we have maxillary and mandibular osteomyelitis and the latter is dominant because of its impaired blood supply. The main cause of osteomyelitis is a bacterial infection and the ways of infections are by periapical odontogenic infection, fracture, post-operative complication, and periodontal disease. The predominant etiologic factor is periapical odontogenic infection mostly caused by advanced dental caries. It is generally believed that periodontal disease could be a cause of osteomyelitis. But periodontal disease is usually confined to the alveolar bone area and not extends to the underlying bone marrow. Accordingly periodontal infection per se rarely cause produce oseomyelitis. Even though osteomyeltis could be occurred by periodontal disease, its virulence of infection is milder than periapical odontogenic infection. So it usually provokes sclerosing or hyperplastic osteomyelitis rather than suppurative type. We had a case of suppurative osteomyelitis caused by periodontal disease and treated it with periodontal and oral and maxillofacial surgical method.