측부 인두강 조절 피판술(Lateral port Control Postrior Pharyngeal Flap)의 임상적 고찰

마흥수,정중길,함기선 大韓成形外科學會 1983 Archives of Plastic Surgery Vol.10 No.2

In 1973, Hogan first reported the lateral port control(L.P.C.) pharyngeal flap surgery, modification of the superiorly based posterior pharyngeal flap, introducing the concept of positive port control utilizing a “catheter technique”. This modification is superior to the classical posterior pharyngeal flap for speech improvement, but there have been some reports that complications occurred during the postoperative period. This method of operation has not been fully accdepted by plastic surgeons throughout the world, even though it has many advantages for better speech improvement. So, there are still many unclarified clinical problems: what are the reasons for the occurrence of complications following the surgery, how long the insertion of the catheter should be kept or how the complications can be reduced. There are some recent interesting reports about the reduction of these complications to the same level as in the classical flap when operation is performed after a complete preoperative study including nasopharyngoscopy and lateral or basal cineradiography for an accurate evaluation of velopharyngeal function. The authors caried out this analysis based on a retrospective review of clinical recordings of 217 patients operated on during the past 5 years from 1977 to 1982 at St. Mary's Hospital in Seoul. 142 patients out of the 217 underwent nasoendoscopy and lateral cineradiography study, and 87 patients of the 142 were subjected to complete speech evaluation by the above examinations. The study of complications was made on the 142 patients by two objective fimls, and the speech evaluation was conducted for the 87 patients by means of two objective films and a subjective examination. The patients were divided into three groups preoperatively according to the width & distance of velophavryngeal gap on endoscopy and lateral cineradiography. The incidence of complications was observed as to the duration of cthete insertion, with the catheter remoed within three days after operation in one group and fie days in another group. The following results were obtained. 1. Speech improvement has no relation with the degree of the preoperative V.P.I., but L.P.C. has a higher frequency of speech improvement and the frequency of complications is similar to that in the clasical posterior pharyngeal flap surgery. 2. Based on endoscopic findings and a long-term follow-up study, it is recommendable that the catheter by inserted for five days for the acquisition of an adequate port size and resulting speech ability. 3. The most frequent complications were nasal obstruction, oral breathing and snoring.

Fiberscopic Appearance of Velopharyngeal Closure in Normal and Velopharyngeal Incompetent Patient

Ham, Kee Sun,Lim, Poong,Cho, Moon Je,Wee, Sung shin CATHOLIC MEDICAL CENTER 1980 Bulletin of the Clinical Research Institute Vol.8 No.1

The results were summarized as follow; 1. Among the 103 cases with normal speakers, 67 cases showed mixed type, 20 with coronal type and 16 with circular type. 2. In 57 velopharyngeal incompetent patients, the type C was most frequent in 28 cases, type B in 13 cases, type D in 12 cases and each type A and B in 2 cases. Type A and C could be categorized to mixed type in classification for normal speakers. Type B correspond to coronal type and type D and E to circular type. The type E was the circular pattern with Passavant's ridge (spotted area) when velopharynx was fully closed. 3. Passavant's ridge was revealed in 21 cases (37%) among 57 velopharyngeal incompetent patients.

A Study on Intelligence of the Children with Cleft Lip and Palate

Ham, Kee Sun,Cho, Moon Je,Kang, Se Yoon,Ahn, Yong Pal CATHOLIC MEDICAL CENTER 1979 Bulletin of the Clinical Research Institute Vol.7 No.1

1. The average I.Q of tested group showed 48.2% and standard group was 46.5% in normal range of 90 to 109. The other hand, while 77.2% of the standard group was above the normal intelligent borderline of 90, the tested group was 64.5%. So we can not be said that their I.Q are inferior to comparing with normative expectancy. 2. In comparison between the type of cleft and intelligence, the combined group of cleft and intelligence, the combined group of cleft lip and palate had higher score as 78.58% than 64.7% for cleft lip and 47.5% for cleft palate in above normal borderline. 3. In minor test items, the score showed no specific relationship to each anomaly group as Table 5.

An Analysis of Speech Problems in Patient with Cleft Palate(Ⅱ)

Ham, Kee Sun,Liim, Poong CATHOLIC MEDICAL CENTER 1976 Bulletin of the Clinical Research Institute Vol.4 No.1

Therapeutic effects of rifampicin (300 ㎎ per day) were observed both clinically and bacteriologically on 13 lepromatous leprosy patients for 2 to 25 months. It was evident that the fall of BI was gradual and the decrease of MI was very rapid in all cases. From the results of clinical signs, 6 out of the 13 patients improved markedly, 2 moderately, and 5 slightly. One of the most favourable signs of clinical improvement was that nodules and raised skin became absorbed and flattened in a short time. Erythema nodosum leprosum (ENL) and neuritis were seen in 6 out of the 13 patients (moderate ENL 3 cases and mild ENL 3 cases) but each symptoms were controlled with thalidomide and prednisolone. The patients with ENL required treatment of a rather prolonged period and showed a tendency of gradual fall in BI and MI during the course of treatment. There were no significant changes in the complete blood count, platelet count, SGOT, SGPT, except in the lymphocyte count, which slightly increased during the treatment. No side effect was observed in any case.

國內棲息 아노훼레스屬 모기의 말라리아 媒介能力에 關한 實驗的 硏究

咸基善(Kee Sun Ham) 서울대학교 보건환경연구소 1970 보건학논집 Vol.7 No.2

마라리아根絶을 爲한 Case Detection 活動의 諸問題點에 關한 考察

咸基善(Kee Sun Ham) 서울대학교 보건환경연구소 1967 보건학논집 Vol.4 No.1

구개열 환자의 단순두개촬영에 의한 계측

함기선,이덕주 大韓成形外科學會 1981 Archives of Plastic Surgery Vol.8 No.2

In maxillofacial congenital defect, such as Cleft Palate with an obscure etiology, has unknown patterns of growth & development. The facial growth can be affected either by a congenital factor or enviromental factor such asinfection & trauma. The surgical repair is the only known enviromental contribution to the subsequent behavior of the structures involved in deformity due to injury of growth center, inappropriate blood supply, scar contracture after surgery. The prime purpose of this study is to evaluate the possible effect that surgical repair may have on the subsequent growth of the congenitally cleft maxilla-particulary in the anterior-posterior direction, with reference to the state of occlusion of anterior teeth. Author carried out cephalometry to 64 children of Cleft Palate and velopharyngeal incompetent children following cleft palate surgery who visited St. Mary Hospital in Seoul from June, 1979 to June, 1981. The results were as follows; 1. There was no significant difference between repaired and unrepaired cleft palate group in all cephalometric measurements. 2. The mean value of SNB(84.4˚±7.03)in repaired Cleft Palate before 4 years old was higher than that (76.68˚±4.03) of repaired Cleft Palate after 4 years old and distance of UI-NB in repaired Cleft Palate before 4 years old was smaller than repaired Cleft Palate after 4 years old. 3. There was a significant sex difference in repaired Cleft Palate. SNB of male was higher than female and lower in distance of UI-NA and LI-NB. 4. There was no significant difference in the type of Cleft Palate except SNA. SNA of complete Cleft Palate was lower than incomplete Cleft Palate.

정상인 및 연구개 인후간 부적합 교합한자에서의 폐쇄형태에 대한 내시경적 조사

함기선,조문제,임풍,위성신 大韓成形外科學會 1980 Archives of Plastic Surgery Vol.7 No.1

Visual assessment of the velopharyngeal port is the most effective way determining portal function during phonation. The visualization test can be divided into direct and indirect methods. Direct methods involve viewing the movement of the velum and pharyngeal walls either via nasal endoscopy or panendoscopy. Indirect methods utilize radiographic, ultrasound and electromyorgraphic test. While the enface view of contact or gap between velum and pharyngeal wall can be visualized more effective in former, the sagittal image can be shown well in radiographic technique. So the combination of endoscopy and multiview radiofluoroscopy should be more appropriate method for evaluation velopharyngeal incompetent patients. among above the assesments, the authors carried out endoscopic examination to evaluate motilities and closure patterns of velopharynx in 103 normal speakers and 57 velopharyngeal incompetent patients with age between 7 to 32. They were all seen at St. Mary's Hospital cleft lip and palate clinic during the last 3 years. The closure patterns of velopharynx are not uniform an can be divided to several types depend upon the relative contribution of the velar and pharyngeal components to the closure mechanism. When velar and pharyngeal components either contributed relatively equally, we categorized to mixed type. coronal type was confined to somewhat greater velar than pharyngeal motion and circular type to greater pharyngeal than velar motion. It was more difficult to defined the types in normal speaker than velopharyngeal incompetent patients. The results were summarized as follow 1. Among the 103 cases with normal speakers, 67 cases showed mixed type, 20 with coronal type and 16 with circular type. 2. In 57 velopharyngeal incompetent patients, the type C was revealed most frequent in 28 cases, 13 in type B, 12 in type D and 2 in each type A and B. Type A and C could be categorized to mixed type in normal speaker's classification. Type B corresponded to coronal type and type D and E definded to circular type. The type E was the circular narrowing pattern with Passavant's ridge (spotted area). 3. Passavant's ridge was revealed 21 cases(37%) in 57 velopharyngeal incompetent patients.

인두피판 수술후 발생한 이차성 인후강 부전교합증의 교저예

함기선,원영택 大韓成形外科學會 1982 Archives of Plastic Surgery Vol.9 No.1

In assessing portal function, we have to use both direct and indirect objective methods. Among the direct measures of endoscopic, radiological and ultrasound studies, the endoscopic examination may be more reasonable one. Surgeons seem to be well aware of wide variety of ways to treat velopharyngeal incompetence. It is more complex problem to lead normal speech in cleft palate patients with distorted speech, because it includes not only physiological and anatomical prerequisites but also habitual and environmental factors. On the aspect of anatomical and physilogical factors the size of port plays an important role to achieve normal port function in surgery of pharyngeal flap. Even skillful surgeons could have been experienced occasionally inappropriate portal function following secondary surgery. In this case, the patient had complained about speech disturbance and hypernasality despite of previous pharyngeal flap operation for velopharyngeal incompetence. The nasendoscopic examination revealed marked discrepancy in size between the right and left lateral ports. We had applied a newly designed surgical procedure, bilateral muco-salpingopharyngeal muscle transfer, to correct the size discrepancy of lateral ports. Although further evaluation and follow-up study with accumulation of cases are necessary to reach a conclusion, the objective evaluation assessed by nasendoscopic, aerodynamic and articulatory tests were good enough to recommand trial of this procedure to the patients with uncontrolled velopharyngeal incompetence following pharyngeal flap operation.

마라리아根絶을 爲한 Case Detection 活動의 諸問題點 關한 考察

咸基善 서울大學校 保建大學院 1967 公衆保健雜誌 Vol.4 No.1

When anti-malaria programs changed from control method to eradication by total insecticide coverage, it was found that with rapid reduction of the volume of malaria cases the parasite rates furnished by malariometric method of sample surveys were no more sensitive enough to measure further progress. It then became necessary to measure malaria in a continous manner, and no longer in a sample but in the whole population. The method used for this purpose has been given the general name of case detection. In korea, the results of the malariometric surveys, which were conducted throughout the contry in 1960 and 1962, indicated that routine prevalence surveys were not sensitive enough for an overall assessment of the malaria situation. It was felt necessary to establish case detection procedures as a better method to obtain an approximation of the true malaria incidence in the contry. In the period from 1960 through 1965, the national malaria eradication service trained medical and voluntary groups all over the country with the passive case detection (PCD) procedures. As active case detection (ACD) is very costly a small number of ACD workers were employed each year in some selected areas of the country. The author, in an attempt to evaluate the efficacy of two case detection measures-passive and active-and of the usefullness of various category of PCD units, made analysis of the data obtained by the national malaria service as follows: 1. Since the collaboration of the PCD workers are voluntary basis and no reporting fee is paid at the moment, there is a general trend that the PCD units are liable to loose gradually their interest in malaria notification after they received the PCD training. The main reason for the decrease in the number of fever case reports after the PCD training campaigns is the lack of proper supervision and follow-up of the PCD units due to the limited size of the malaria project. 2. In view of almost no difference of the slide positive rates (SPR) which obtained by the professional health-medical group (SPR 51%) and by laymen group (SPR 54%), it can be said that the ability of the laymen group in the indentificaion of fever cases are definitely not inferior to that of the professional group. Moreover, the school teachers and the village chiefs reported about 71% of total fever cases in 1966 (up to the end of August). Thus, the importance of the role played by the laymen group in malaria detection is clearly demonstrated. 3. In comparison with the experience with PCD in other countries, the high SPR found in Korea are remarkable. For explanation of this the author has considered two or three factors that may have a bearing on this phenomenon. As malaria symptoms with a distinct fever periodicity which are characteristics of Korean strain of plasmodium vivax, are well known to the rural population, the farmer suffering from a disease will not go to a PCD unit for help if he is not suspecting himself to have malaria as a rule. Therefore, in the majority of fever case reports which are the primary screening based on the clinical symptoms is already made by the side of patients. 4. As the author mentioned above, the high SPR obtained though passive case detection indicate that in korea the "fever case" reporting is of exeptional value for the detection of malaria cases. It is, however, very difficult to obtain the collaboration of PCD workers contantly in area where almost no malaria transmission occurs as well as in those area where the malaria transmission has decreased for one reason or another. To obtain an approximation of the true malaria incidence in a locality additional evidence which will be obtained through ACD procedures will be important.