제3대구치 발치시 단계별 생체징후(vital sign)의 변화에 대한 연구

오해수(Hae-Soo Oh),강희인(Hee-In Kang),최빈(Bin Choi),박준우(Jun-Woo Park),신성수(Sung-Soo Sin),최제원(Je-Won Choi),이선근(Sun-Keun Lee),김미자(Mi-Ja Kim) 대한구강악안면외과학회 2006 대한구강악안면외과학회지 Vol.32 No.2

PURPOSE : The 3rd molar extraction of mandible is common in out-patient office of oral and maxillofacial surgery. And it is dynamic minor operation with changes of vital signs. most of patients are already sensitive about their dental treatment. The changes of emotion are reached to the highest level when patients is laid down to be treated on unit chair. It can be induced to undesirable accidents as to this fear. The undesirable complications are nausea, vomiting, hyperventilation, dyspnea, syncope, shock and so on. The severe changes of vital signs may influence their behavior and make serious medical malpractice or suit such as fracture of dental instruments and injury of proximal area. METHOD AND PATIENTS : A total of 99 selected normal patients were reviewed. Among this, 70 patients(43 men , 27 women with statistical significance) were included in this study. Each steps(pre-anesthesis, 5 minutes after anesthesis, just after mucogingival incision, just after tooth section, just after suture and gauze biting) were investigated for a change of a vital signs. It is analyzed to 2 categories,“ Means”and“ Tendency”. The “Means”is the amount of vital signs changed in comparison with pre-step during operation. That means is the amount of vital changes by each step operation. Next“, Tendency”is changes of vital signs in comparison with step1 during operation. RESULT : This is the changing tendency of vital signs with time. That is active effect of fear and pain. Thus this“ Means”and“ Tendency”will present a sudden changes of vital signs and it can lead to more safe treatment. CONCLUSION : Thus, the purpose of this study is, through careful operation in each step, to less on patients’complication and increase trust between patient and OMFS. This study is a first article shown with the amount of “Means”and “Tendency”in vital signs, when a third molar of mandible is extracted . This study will be base study of patients with general diseases, because it selected only patients without general diseases.

피질골 절단술을 이용한 수평면에서의 임플란트의 위치 교정에 대한 치험례

최빈,오해수,김진철,길용갑,김경수,김좌영,Choi, Bin,Oh, Hae-Soo,Kim, Jin-Chul,Kil, Yong-Gab,Kim, Kyoung-Soo,Kim, Jwa-Young 대한악안면성형재건외과학회 2007 Maxillofacial Plastic Reconstructive Surgery Vol.29 No.3

Preface: Dental implant is important method that may solve the mastication, occlusion, esthetic, temporomandibular joint, and psychologic problem in oral and maxillofacial surgery. It is ideal that all of the implant are well positioned by adequate technique. By the way it‘s not always possible because of some anatomic, physiologic factor. In this case, If the implant can be moved to adequate position, it may be possible more esthetically and implanted patients more satisfied, but the majority of Implantists and orthodontists have thought that it is not possible. However, Implant, in fact, can be moved. and thus we can overcome the limit of implantation more. The aim of the present study was to evaluate the possibility of implant movement after corticotomy. Case report: Patient missed the upper right first molar. and implantation was done after completion of socket healing. We wait six months for osseointegration. Then, corticotomy was done under local anesthesia and close coil was used for orthodontic force. After traction during 3 weeks, we find the change of implant position at horizontal plane. we can not see the degenerative change on adjacent structure and tracted implant. there is a clinical mobility on upper right second premolar that used for anchorage but it subside spontaneously at the timing of prosthetic restoration without additional treatment. Discussion: As we could have some knowledge with this experiment, we report the case of implant movement after corticotomy and suggest a method about more esthetic implant treatment with a review of literature.

증례보고 : 특별히 고안된 감압술 장치를 이용한 하악의 치성 낭종의 치료

김경수 ( Kyoung Soo Kim ),김진철 ( Jin Cheol Kim ),오해수 ( Hae Soo Oh ),최빈 ( Bin Choi ),길용갑 ( Yong Kab Kil ),홍용재 ( Yong Jae Hong ) 대한악안면성형재건외과학회 2007 Maxillofacial Plastic Reconstructive Surgery Vol.29 No.2

안면부에 발생한 각화극세포종의 치험례

강희인,이원학,오해수,김동석,김상중,Kang, Hee-In,Lee, Won-Hak,Oh, Hae-Soo,Kim, Dong-Suk,Kim, Sang-Joong 대한악안면성형재건외과학회 2005 Maxillofacial Plastic Reconstructive Surgery Vol.27 No.6

Keratoacanthoma is a benign, self-limited epithelial lesion that closely resembles Squamous cell carcinoma(SCC). Keratoacanthoma occur primarily exposed skin in male patients over 45 years of ages. although etiology is unknown, sunlight, genetic, and human papillomavirus factor have been considered. in clinical feature, rapid enlargement occurs over 4$\sim$8 weeks, resulting ultimately in a hemispheric, firm, elevated, asymptomatic nodule that contains a central plug of keratin. When fully developed, the keratoacanthoma contains a core of keratin surrounded by a concentric collar of raised skin. Over the next 4$\sim$8 weeks, static lesion persists. Then undergoes spontaneous regression over the next 6$\sim$8weeks period by expulsion of the keratin core with resorption of the mass. In histologic feature, Keratoacanthoma consists of hyperplastic squamous epithelium growing into the underlying connective tissue. The surface is covered by a thickened layer of parakeratin with central plugging. Epithelium cell shows dysplastic features and the margins the normal adjacent epithelium is elevated. The differential diagnosis includes SCC. Keratoacanthoma present as a exophytic lesion with horny keratin occupying a depression on the top of the lesion, persists static period and undergoes rapid growth compared with SCC. Keratoacanthoma is usually treated by surgical excision or curettage of the base, spontaneous regression does not occur in every case. A 60 years old male who present facial lesion visit our hospital and surgical excision was done. Biopsy result was keratoacanthoma. We report case with review of literatures.

특별히 고안된 감압술 장치를 이용한 하악의 치성 낭종의 치료: 증례보고

김경수,김진철,오해수,최빈,길용갑,홍용재,Kim, Kyoung-Soo,Kim, Jin-Cheol,Oh, Hae-Soo,Choi, Bin,Kil, Yong-Kab,Hong, Yong-Jae 대한악안면성형재건외과학회 2007 Maxillofacial Plastic Reconstructive Surgery Vol.29 No.2

A cyst is a pathologic lesion characterized by a cavity filled with fluid, celluar products, air, or a combination of these. Dentigerous cysts were formed around the crown of unerupted teeth. The reduced enamel epithelium persists around the crown after it has formed. Proliferation of the epithelium in a fluid-filled sac may be induced by osmotic pressure. In the first decade the most frequent location is the premolar site. In each subsequent decade the largest number of cysts are in the mandibular third molar site, with the second most frequent site being the maxillary canine. The treatment of odontogenic cyst can be mostly classified into three types of cyst enucleation, marsupialization and decompression. We should consider age of patient, anatomic structure, location and size for choosing a treatment method. Advantage of cyst enucleation is fast healing, but a injury of a surrounding structure is highly. Marsupialization is conservative treatment that can reduce the damage of a adjacent structure, but it is only limited at superficial lesion. Decompression also is conservative treatment, but it has the difficulty of the oral hygiene and the troublesome of the lavage. We present the possibility that reduces the defect of decompression and cures the lesion efficiently. We report a male patient with the dentigerous cyst developed at left mandibular third molar in this study. We used the decompression for a treatment and created special appliance to treat the lesion efficiently. We report a case of the cyst treatment that is association with efficiency of decompression appliance.

하악골상행지 시상분할골절단술, 소파술 및 적출술을 이용한 법랑아세포종 치료에 대한 치험례

길용갑,김진철,홍용재,오해수,최빈,김경수,Kil, Yong-Kab,Kim, Jin-Cheol,Hong, Yong-Jae,Oh, Hae-Soo,Choi, Bin,Kim, Kyoung-Soo 대한악안면성형재건외과학회 2007 Maxillofacial Plastic Reconstructive Surgery Vol.29 No.2

An ameloblastoma is one of the most common odontogenic tumors. Ameloblastoma is cytologically a benign tumor, but is clinically characterized by infiltrative growth and high recurrency. The treatment of ameloblastoma has been controversial. The aim of this paper is to consider effectiveness of curettage and enucleation after SSRO in the small-sized multilocular intraosseous ameloblastomas that have been treated more frequently by radical treatment. They were radiographically characterized by the cortical bone that was expanded or eroded locally and histopathologically by solid multilocular ameloblastomas. It is considered that curettage and enucleation after SSRO and long-term follow-up enable the small-sized multilocular intraosseous ameloblastomas that were characterized by almost destroyed cancellous bone and expanded cortical bone to treat minimizing facial disfigurement and masticatory dysfunction and sociopsychological impact produced by radical treatment. We recommend that the small-sized multilocular intraosseous ameloblastomas without involvement to the surrounding soft tissues be first treated by curettage and enucleation after SSRO.

Gerbil 삼차신경절에서 허혈-재관류 후 calbindin D-28k와 calretinin 면역반응의 경시적 변화

황인구(In Koo Hwang),박정훈(Jeong-Hoon Park),최우제(Woo-Je Choi),박노진(Noh-Jin Park),오해수(Hae-Soo Oh),안성진(Sung Jin An),박승국(Seung-Kook Park),윤대근(Dae-Kun Yoon),이원학(Won-Hak Lee),강태천(Tae-Cheon Kang),원무호(Moo Ho Won) 대한해부학회 2002 Anatomy & Cell Biology Vol.35 No.5

허혈에 대한 연구는 중추신경계통에서 대부분을 차지하고 있다. 그러나 허혈은 중추신경 뿐 아니라, 말초신경에도 많은 영향을 미칠 것으로 생각된다. 특히 머리 부분에 있는 대부분 장기들의 일반감각을 담당하는 삼차신경절은 매우 중요할 것으로 생각한다. 신경전달물질의 분비와 감각의 조절 등에 중요한 칼슘결합단백질은 세포질내 칼슘을 조절하여 감각의 전달에 매우 중요하다. 따라서 본 연구는 Mongolian gerbil의 삼차신경절에서 인위적으로 허혈-재관류를 유발하여 calbindin D-28k (CB)와 calretinin (CR)의 경시적인 변화와 그 의미를 연구해 보고자 하였다. 정상군에서 CB과 CR 면역반응은 큰 크기, 중간 크기, 작은 크기의 신경세포에서 관찰되었다. 허혈-재관류 후 12시간까 지는 면역반응세포 수의 변화에 큰 차이를 관찰할 수 없었다. 허혈-재관류 후 1일 경에는 CB과 CR을 함유한 큰 신경세 포의 수가 급격하게 증가하였으며, 그 이후부터 CB 면역반응세포는 감소하였고, CR 면역반응세포는 허혈-재관류 후 4일 경에 중간 크기 신경세포가 정상군보다 3배 가량 증가하였다. 이상의 연구 결과는 허혈-재관류 후 1일 경에 큰 신경세포에서 CB와 CR 면역반응의 증가가 있었는데, 큰 신경세포들 은 A fibers를 함유하고 있으므로, 이 시기에 CB와 CR이 기계적 자극의 전도에 영향을 줄 것으로 생각이 된다. 또한 허 혈-재관류 후 4일 이후에 중간 크기의 신경세포에서 CR 면역반응 세포의 증가는 이들이 Aδ 또는 C fiber를 함유하고 있 으므로, 이 시기에는 통증이나 온도 감각에 CR이 관여할 것으로 생각된다. Many researches have focused upon temporal changes of neurotransmitters and/or neuromodulators in the central nervous system after ischemic insult. In sensory neurons, the spatial and temporal alterations of neurotransmitters have been little studied. Calbindin D-28k (CB) and calretinin (CR) have been suggested to play a role in the transmission of neurotransmitters. Therefore, in the present study we investigated the chronological alteration of CB and CR immunoreactivity in the trigeminal ganglion cells of the Mongolian gerbil after ischemic insult. In the sham operated group, CB and CR immunoreactivities were found in small-, medium- and large-sized neurons. One and two days after ischemia-reperfusion, small and large-sized CB immunoreactive neurons increased significantly. Thereafter, number of the CB immunoreactive neurons decreased markedly. Furthermore, five days after ischemia-reperfusion, CB immunoreactivity was detected in a few neurons, and its immunoreactivity was also very weak in the cytoplasm. Number of the large-sized CR immunoreactive neurons increased significantly one day after ischemia-reperfusion. Thereafter, the number of the large-sized CR immunoreactive neurons decreased. Especially, the number of the medium-sized CR immunoreactive neurons increased dramatically 4 days after ischemia-reperfusion. These results suggest that an increase of CB and CR may play an important role in modulating the mechanoception 1 day after ischemia-reperfusion, because the immunoreactivities increased in large-sized neurons which have the myenlinated A fibers. These results also suggest that significant increase of CR expression in medium-sized neurons 4 and 5 days after ischemia-reperfusion may provoke CR in modulating the nociception or thermoception because the medium-sized neurons which have the myenlinated Aδ or C-fibers.