방사선조사 및 고압산소요법이 미세혈관 문합술에 미치는 영향

최성원(Sung Weon Choi),김병용(Byung Yong Kim),박정현(Jung Hyun Park),윤정훈(Jung Hoon Yoon),육종인(Jong In Yook),유재하(Jae Ha Yoo),이의웅(Eui Woong Lee),차인호(In Ho Cha) 대한구강악안면외과학회 2000 대한구강악안면외과학회지 Vol.26 No.5

Malignant tumors of the head and neck frequently require treatment with both radiotherapy and surgery. Reconstruction of the defect in previously irradiated field is a challenge to surgeon, who must produce both a functional and an esthetic result. Hyperbaric oxygen therapy(HBO) has been used in an attempt to reduce the deleterious effects of radiation. But the issue of whether prior irradiation and HBO of the recipient site of a free flap affects the result of reconstruction continues to generate controversy. So, the effects of irradiation and hypergbaric oxygen therapy on microvascular anastomosis was evaluated in an experimental study in femoral vessels of rats. The experimental groups were divided into 3 groups, contorol group, irradiation group, and irradiation and HBO group. Preoperative irradiation was delivered in the left groin field with single dose corresponding 2,000cGy and total 48 hours of HBO was given 100% oxygen at 2.4 atmosphere for 4 weeks. The femoral vessels of 60 rats were anastomosed after irradiation and HBO treatment. Three days, 1 week, 2 weeks and 4 weeks after surgery, the femoral vessels were evaluated for patency and histopathologic changes. There was no notable effect of irradiation on patency of femoral vessels in rats and the radiation effects were obvious on histological examination which showed the sloughing of the endothelial cells, subintimal hyperplasia and fibrosis on the media and adventitia of femoral arteries. The histologic changes of the femoral veins were mild and not typical. But the effects of hyperbaric oxygen therapy after irradiation was seen not marked difference in irradiation group.

구강암의 임상적 진단

최성원(Sung Weon Choi) 대한치과의사협회 2011 대한치과의사협회지 Vol.49 No.3

Oral cavity cancer accounts for approximately 3-4% of all malignancies and is a significant worldwide health problem. The Korea Central Cancer Registry estimates that there will be approximately 1500 new cases of oral cancer in Korea. Oral cancer occurs most commonly in middle-aged and elderly individuals. The majority of oral malignancies occur as squamous cell carcinomas and despite remarkable advances in treatment modalities, the 5-year survival rate has not significantly improved over the past several decades, hovering at about 50% to 60%. The unfavorable 5-year survival rate may be attributable to several factors. First, oral cancer is often diagnosed at a late stage, with late stage 5-year survival rates as low as 22%. Additionally, the development of secondary primary tumors in patients with early stage disease has a major impact on survival. The early detection of oral cancer and premalignant lesions offers the promise to cure chance of oral cancer. The major diagnostics moddalities for oral cancer include oral cavity examination, supravital staining, oral cytology, and optical detection systems. But the clinical finding of oral mucosa is the most important key to confirm the oral cancer until now. The traditional clinical examination of oral cavity can be performed quickly, is without additional diagnostic expense to patients, and may be performed by health care professionals. Therefore, clinicians must be well-acquainted with clinical characteristics of oral cancer and practice routine screening for oral cancer in dental clinic to decrease the morbidity and mortality of disease.

Acidic fibroblast growth factor가 신경재생에 미치는 영향에 관한 실험적 연구

최성원(Sung Weon Choi),권종진(Jong Jin Kwon) 대한구강악안면외과학회 1997 대한구강악안면외과학회지 Vol.23 No.2

Fibroblast growth factor (FGF) is a well-known angiogenic factor and mitogen for endothelial cells, fibroblasts, and Schwann cells. An experimental study on the sciatic nerve of rat was performed to evaluate the effect and to determine the optimal concentration of exogenously-applied aFGF on nerve regeneration. Sixty adult male Sprague-Dawley rats weighing between 200 and 250 gm were divided into control group and 3 experimental groups. The experimental groups were further divided into 0.25 ug/ml, 2.5 ug/ml, and 25 ug/ml aFGF group. 10 mm segmental defect was made at right sciatic nerve and both nerve ends was connected with the polyethylene tube into which aFGF-collagen solution was instilled. After 2, 4, 8 weeks, control and 3 experimental groups were examined by clinical appearance, electrophysiological assessment, and morphologic findings using light microscope, electron microscope, and image analyzer at mid-chamber cross section. The results were as follows. 1. Nerve regeneration was seen in Group 2 (2.5 ug/ml aFGF) and Group 3 (25 ug/ml aFGF) at 2 weeks and the diameter of middle regeneration part of 3 experimental groups was larger than that of control group (p<0.05). 2. There were little differences in latency and amplitude among each group (p>0.05). 3. At 4 weeks, the diameter of myelinated nerve fiber and the thickness of myelin of 3 experimental groups at 4 weeks were larger than those of control group (p<0.05). At 8 weeks, the diameter of myelinated nerve fiber and the thickness of myelin of Group 2 (2.5 ug/ml aFGF) were larger than those of other experimental groups (p<0.05). These results suggest that aFGF enhance peripheral nerve regeneration and nerve regeneration of 2.5 ug/ml aFGF group (Group 2) is more effective than that of any other groups. But, the high concentration of aFGF may not necessarily enhance nerve regeneration. We conclude that it is necessary to examine further long term study for determining optimal concentration of aFGF.

혀의 점막하에 발생한 신경초종 환자의 치험례

박성원,전재호,박주용,최성원,김수호,Park, Sung Won,Jeon, Jae Ho,Park, Joo Yong,Choi, Sung Weon,Kim, Soo Ho 대한악안면성형재건외과학회 2012 Maxillofacial Plastic Reconstructive Surgery Vol.34 No.6

Schwannoma is a benign, slow-growing, tumor of the peripheral nerves without specific symptoms, so that early diagnosis may be difficult. Though approximately 25~40% of all schwannomas occur extracranially in the head and neck region, only 1% of schwannomas are reported in the oral cavity. An 18-years-old female patient visited our clinic with a mass on the middle-right-dorsal surface of the tongue slowly growing for 1.5 years. The patient underwent the surgical removal of the neoplasia under general anesthesia. The mass was well capsulated and a cleavage plane was easily found. There was no recidivation during the course of a one-year follow-up. The treatment for schwannoma is surgical excision of the lesion and recurrence after excision of schwannoma is rare. The final diagnosis is made after a histological examination. Differential diagnoses must be made in relation to malignant tumors and in relation to numerous benign neoformations based on epithelial and connective tissues.

구강암 환자에서 발생하는 이차암의 임상적 특징 분석

조세형,신정현,이의룡,박주용,최성원,Jo, Sae-Hyung,Shin, Jeong-Hyun,Lee, Ui-Ryoung,Park, Joo-Young,Choi, Sung-Weon 대한악안면성형재건외과학회 2010 Maxillofacial Plastic Reconstructive Surgery Vol.32 No.1

Objective: Second primary malignancy (SPM) that occur in various period and region are important factors that deteriorate long-term survival rate in patients who recovered from oral cancer. Researches such as chemoprevention are being tried to reduce occurrence of SPMs. Only if analysis of clinical features of patients who develop SPM such as period, region and factors precedes, adequate prevention and treatment of SPM is possible. But, there are few researches about clinical features of SPMs that have primary lesion in oral cavity. In this study, we analysis that occurrence rates, regions that happen, risk factors and effect to survival rates of 2nd primary malignancies in oral cancer patients. From this survey, we willing to collect basic data for prevention and early diagnosis of SPMs. Methods: The medical records of 139 patients of oral oncology clinic of National Cancer Center who had up to 2-years follow up records after surgical or radiological treatment due to squamus cell carcinoma of oral cavity were reviewed. In these patients, survey of occurrence rate of SPMs, duration, survival rate and risk factors about occurrence of SPMs such as history of smoking, body mass index, age, sex, stage of primary lesion and history of radiologic treatment were achieved. Results: There are 15 patients who developed SPM in 139 cases. The actual occurrence rate of SPM was 10.79% and SPM were more likely to occur in male patients with 11 male Vs 4 female patients. Median age of these patient is 61.47 within 32 to 74 range. The regions that develop SPM are oral cavities (2 cases), stomach (4 cases), esophagus (2 cases), lung (2 cases) and others (1 case each breast, larynx, cervix, liver and kidney). In addition, metachronous cancers were 11 cases which happened more common than 4cases of synchronous cancers. Surveys of risk factors that relate to development of SPMs, such as sex, age, history of radiologic treatment, body mass index, history of smoking and stage of primary disease were done. Among them, factor of sex is only appear statistically significant (P=0.001), but rest are not significant in statistically. Conclusion: Occurrence rates of SPMs were reported from 10% to 20% by precede study. In this study, occurrence rate of SPMs is 10.79% that is similar to results of precede research. In comparison of 5-yr survival rates of groups that develop SPMs or not, there is statistically significance between two groups. Present treatment modalities of SPMs are surgical operation, radiotherapy, chemotherapy and combination of these modalities. In choosing the treatment modality, we must consider the first treatment modality, region of primary disease, region of SPMs and general conditions of patient. Because development of SPMs have big effect on prognosis, prevention of SPMs must regard to important objective of treatments in patients of SCCa in oral cavity.

국립암센터에서 치료한 설암 환자의 생존율 분석을 통한 예후인자 분석

김태운,조세형,민승기,이종호,김명진,박주용,최성원,Kim, Tae-Woon,Jo, Sae-Hyung,Min, Seung-Ki,Lee, Jong-Ho,Kim, Myung-Jin,Park, Joo-Yong,Choi, Sung-Weon 대한악안면성형재건외과학회 2010 Maxillofacial Plastic Reconstructive Surgery Vol.32 No.6

Purpose: The objective of this study is to evaluate the survival rate and influencing factors. Patients and Methods: We studied 104 patients who were diagnosed for squamous cell carcinoma of tongue and received curative treatment in oral oncology clinic of National Cancer Center from June 2001 to December 2009. Results: We found the following results. 1. The overall 5-year survival rate of tongue cancer was 67.0% and there was no significant statistical difference between male and female. 2. A lower survival rate was shown in patients under 40 years (42.2%) than over 40 years (75.5%)(P < 0.05). 3. 5-year survival rates of patients with tongue cancer classified by pTNM classification were 87.4% in early stage and 43.3% (P < 0.05). 4. A higher survival rate was seen in patients without cervical lymph node metastasis (82.0% > 44.1%)(P < 0.05). 5. A higher survival rate was seen in patients of tongue cancer with higher differenciation grade (P < 0.05). 6. It is well known that drinking and smoking have great influence on the survival rate of patients of squamous cell carcinoma of tongue. But these was no statistical significance. Conclusion: The overall 5-year survival rate of tongue cancer was 67.0% and it was mostly influenced by factors like age, pTNM stage, cervical lymph node metastasis, differentiation of cancer cell etc.

인두주위간극으로 확장된 경부 하마종의 증례보고

신정현,박주용,지영민,송인석,방강미,최성원,Shin, Jung-Hyun,Park, Joo-Young,Ji, Young-Min,Song, In-Seok,Pang, Kang-Mi,Choi, Sung-Weon 대한악안면성형재건외과학회 2008 Maxillofacial Plastic Reconstructive Surgery Vol.30 No.6

Running title: A plunging ranula extended into parapharyngeal space Ranulas are lesion of sublingual gland origin, which occur in the floor of the mouth. Most ranulas, whether simple or plunging, are pseudocysts without and epithelial lining and ranulas have higher levels of salivary amylase and protein content. They can be classified into two types based on their extent: simple ranulas, confined to the sublingual space and plunging ranula which extend into adjacent spaces. Plunging ranula requires differential diagnosis with other lesions (neuroma, monomorphic adenoma, hemangioma, lipoma, dermoid cyst, lateral cervical cyst). The patient was diagnosed as plunging ranula. We experienced 17 years old male, visited to our department, who complain Rt. cervical swelling and in MRI view, this lesion involved sublingual, submadibular, parapharyngeal, skull base. We experienced a rare case of plunging ranula, extended into parapharyngeal space. We report the case.

구강악안면 결손부 재건에 사용한 유리피판 재건술 164증례의 임상성적 및 합병증 분석

전재호,박성원,조세형,박주용,이종호,최성원,Jeon, Jae-Ho,Park, Sung-Won,Jo, Sae-Hyung,Park, Joo-Yong,Lee, Jong-Ho,Choi, Sung-Weon 대한악안면성형재건외과학회 2011 Maxillofacial Plastic Reconstructive Surgery Vol.33 No.6

Purpose: Free flap reconstruction is performed on defects including benign and malignant tumors as well as trauma in the department of oral and maxillofacial surgery, but there are few reports of free flap reconstruction cases for oral cancer in patients in Korea. Methods: This study was designed to retrospectively analyze surgical outcomes and complications of 164 free-flap reconstructions performed at the Oral Oncology Clinic, National Cancer Center, during 2002~2011. A total of 164 free flaps were performed for reconstruction of oral and maxillofacial defects which were caused by oral cancer and osteoradionecrosis in 155 patients. Results: The present study had 162 successful cases and 2 failed cases for a total of 164 cases. The study had a success rate of 98.8% for free-flap reconstructions. Flap donor sites included radial forearm free flap (n=93), fibula osteocutaneous free flap (n=25), anterolateral thigh flap (n=18), latissimus dorsi myocutaneous flap (n=16) and other locations (n=12). Postoperative medical complications were generally pneumonia and delirium. Postoperative local complications occurred including partial flap necrosis, delayed wound healing of the donor site, infection of the recipient site and salivary fistula. The incidence of postoperative complications and patient-related characteristics including age, sex, smoking, history of radiotherapy, hypertension (HTN) and diabetes Mellitus (DM) were retrospectively analyzed. Patient age ($P$=0.003) and DM ($P$=0.000) and HTN ($P$=0.021) were significant risk factors for complications overall. Conclusion: The present study had no mortality and confirms that free-flap reconstructions are extremely reliable in achieving successful results.

고선량율 근접 방사선치료법을 이용한 원발성 및 재발된 설암의 치료

이의룡,이종호,정필훈,김명진,박주용,최성원,조관호,Lee, Ui-Lyong,Lee, Jong-Ho,Choung, Pill-Hoon,Kim, Myung-Jin,Park, Joo-Yong,Choi, Sung-Weon,Cho, Kwan-Ho 대한악안면성형재건외과학회 2006 Maxillofacial Plastic Reconstructive Surgery Vol.28 No.5

Low-dose rate brachytherapy(LDR) has been effective modality for treatment of oral cancer. But the disadvantage of LDR is radioexposure of medical staff. To overcome this problem, high dose rate(HDR) brachytherapy has been developed. Our study evaluates the outcomes of patients with tongue cancer as treated by HDR brachytherapy. Between 2002 and 2005, eight patients with carcinoma of the tongue were treated with HDR brachytherapy. Five patients had AJCC stage I or II disease and the remaining three patients had AJCC stage III or IV. The male-to-female ratio was 2:6 and the mean age was 60.1 years (range: 21-80 years).The median follow-up time was 23.8 months (range: 7-55 months). There was no local failure until now. Three patients showed some complications. Two patients showed soft tissue necrosis. There was no bone sequela in all cases. Our experience in treating tongue cancer with HDR brachytherapy is encouraging, because it gave a satisfactory local control. Prospective studies are necessary to delineate the optimum indication for this treatment modality and long-term outcome.

두경부재건을 위한 전외측 대퇴유리피판: 해부학적 연구

박주용,박현도,윤관현,곽현호,허경석,강현주,김회진,최성원,Park, Joo-Yong,Park, Hyun-Do,Youn, Kwan-Hyun,Kwak, Hyun-Ho,Hu, Kyung-Seok,Kang, Hyun-Joo,Kim, Hee-Jin,Choi, Sung-Weon 대한악안면성형재건외과학회 2005 Maxillofacial Plastic Reconstructive Surgery Vol.27 No.4

The anterolateral thigh flap was originally described in 1984 as a septocutaneous flap based on the descending branch of the lateral circumflex artery. This flap has some significant advantages for reconstruction of the head and neck. It can be raised as a subcutaneous flap, a fasciocutaneous flap, or a myocutaneous flap and can resurface large defects in the head and neck. In addition, it has a large and long vascular pedicle, and because of the distance of the donor site from the head and neck, it can easily be harvested with a 2-team approach. However, the number and locations of cutaneous perforators vary individually, and thus, it is not widely used because flap elevation is often complicated and time-consuming owing to unexpected anatomical variations. The purposes of this study are to classify the vascular anatomy and to assess the suitability of anterolateral thigh flap for head and neck reconstruction in Korean. We performed an anatomic study on cadavers and analyzed the anatomic pattern of the lateral circumflex femoral arterial system and the perforators nourishing the anterolateral thigh flap. This study suggest the characteristics of vascular anatomic patterns of anterolateral thigh flap of Korean and utility of this flap for head and neck reconstruction.