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Kim, Sukwha,Park, Jong Lim,Baek, Seung-Hak,Chung, Ji-Hyuk,Kim, Jae Chan,Park, Chul Gyoo Mutaz B. Habal, MD 2009 JOURNAL OF CRANIOFACIAL SURGERY - Vol.20 No.3
Although distraction osteogenesis of the mandible in patients with hemifacial microsomia (HFM) before the mixed dentition period is widely performed, long-term follow-up information on dental problems is limited. We evaluated the long-term effect of distraction osteogenesis on dental development by comparing Nolla's developmental stages of the first and second molars between the affected and unaffected sides of the mandible. Forty-five patients with unilateral HFM who received distraction osteogenesis of the mandible between the ages of 5 and 8 years and whose dental status was followed for more than 2 years were selected for this study. The patients were divided into 2 groups: group I (n = 28) consisted of patients with Pruzansky types I and IIA and group II (n = 17) consisted of patients with types IIB and III. Panoramic radiographs at T0 (1 month before distraction), T1 (6 months to 1 year after distraction), T2 (2-3 years after distraction) were reviewed. Nolla's stages for the first and second molars were compared at each of the abovementioned times between the affected and unaffected sides using Wilcoxon signed-rank test. In group I, there was no differences observed in Nolla's stages of the first and second molars in comparisons between the affected and unaffected sides of the mandible. However, in group II, at T0, there was a significant difference in Nolla's stage of the first and second molars in comparisons between the affected and unaffected sides. Over time, tooth development was accelerated, and eventually, there was no difference in Nolla's stage between the affected and unaffected sides at T1 and T2. Patients with severe HFM can benefit from distraction osteogenesis of the mandible. The results of this study showed that this procedure could normalize the delayed development and eruption of the first and second molars.
Kim, Sukwha,Kwon, Juyong,Kwon, Geun-Yong,Choi, Tae Hyun by Mutaz B. Habal, MD. 2014 JOURNAL OF CRANIOFACIAL SURGERY - Vol.25 No.3
PURPOSE: The philtral column and dimple are especially important in patients with cleft lip. Recently, we have found that, at maximal puckering, the appearance of the philtrum worsens although the philtral column is well formed at rest. In this study, we explore the effectiveness of the coronal muscle splitting technique in a microform cleft lip through comparative analysis of the postoperative results between the control group (patients without coronal muscle splitting) and the study group (patients with coronal muscle splitting). METHODS: Philtral reconstruction was performed in 24 patients with microform cleft lip between March 2006 and March 2010. The philtrum was reconstructed in 12 patients using the coronal muscle splitting technique and in the other 12 patients without this technique.The convexity of the philtral column and the dimpling of the philtrum were evaluated at rest and at maximal puckering through digital photographs and videos taken preoperatively and postoperatively. In addition, we compared the postoperative results between the 2 groups using the paired t-test. RESULTS: Postoperative evaluation was done at 6 to 48 months (mean, 25 mo). There was no statistically significant difference in the shape of the philtral column and the philtral dimple between the 2 groups preoperatively (P > 0.05).Reconstruction of the philtral column in the study group rendered better results than in the control group at both rest and maximal puckering (P < 0.001 and P < 0.001). Reconstruction of the philtral dimple in the study group rendered better results than in the control group at both rest and maximal puckering (P = 0.018 and 0.035). CONCLUSIONS: The coronal muscle splitting technique offers more esthetic and functional results in the formation of the philtral column and dimple both at rest and at maximal puckering than in the control group in cases of philtral reconstruction of the microform cleft lip.
김석화,김지혁,김진환,이윤호 大韓成形外科學會 2000 Archives of Plastic Surgery Vol.27 No.2
Furlow's palatoplasty has been used as the primary treatment for cleft palate. From 1991 to 1999, 24 submucous cleft palate patients underwent Furlow's palatoplasty. The follow-up period was 3 months to 8 years(mean 24 months). Patients were selected after a thorough study for velopharyngeal insufficiency including intraoral examination, speech assessment, digital subtraction radiography(DSR). Postoperatively velopharyngeal function was reevaluated with speech assessment and digital subtraction radiography in the 7 cooperative patients. Speech parameters including hypernasality, nasal emission, and Allison scale were improved after surgery. Digital subtraction radiography provided the value of velopharyngeal gap and the degree of the motion of lateral pharyngeal wall, both of which were improved after surgery. Furlow's palatoplasty has advantage such as no impairment of nasopharyngeal physiology, no harmful effect on the hard palate and the realignment of the levator muscle which plays important role on the movement of the soft palate. The results show that a Furlow's palatoplasty can satisfactorily correct velopharyngeal insufficiency in carefully selected submucous cleft palate patients.
김석화 大韓成形外科學會 1998 Archives of Plastic Surgery Vol.25 No.4
Gradual distraction on living tissues creates stress that stimulates growth and regeneration. Timing and rate of distraction are one of the major factors affecting callus distraction. Slow rate of distraction often led to premature consolidation of the lengthening bone, while rapid rate of distraction often resulted in undesirable change within lengthening bone. Since Dr. McCarthy reported the successful lengthening of mandible in hemifacial microsomia, most of craniofacial bone lengthening has been done at a rate of 1.0 ㎜ per day. The purpose of this study is to present my experience of rapid and multidirectional distraction of mandible in hemifacial microsomia. I have performed distraction osteogenesis of mandible in 33 patients of hemifacial microsomia with an age of 2-9 years from November, 1995 to October 1997. A complete osteotomy was made at the angle of mandible posterior border of the ramus proximal to the osteotomy and two threaded wires were inserted aling the lower border of the body distal to the osteotomy. Long PennigMinifixator(Orthofix, Bussolengo, Italy) maintained the mandible in fixation for 4 days. Following this period, the device was lingthened serially 1 ㎜ every 12 hours by turning the nut. After the period of active lingthening was complicated, the mandible was maintained in external fixation until the radiological consolidation of the bone was confirmed. According to a study protocol, photographs, cephalograms(lateral and frontal), and panoramic view of mandible were obtained preoperatively, just before the active lengthening, at the time of removal of the device, and at 6 months intervals thereafter. The amount of vertical distraction along the posterior border of the ramus was from 19 to 32 ㎜ and horizontal distraction along the lower border of the body was from 3 to 18 ㎜. The total amount of distraction was from 25 to 47 ㎜. The period of rapid distraction was from 13 to 27 days. Following the period of rapid distraction the mandible was maintained in external fixation for an average of 8.5 weeks(ranging from 7 to 11 weeks). There was no preoperative complications, and the length of clinical follow-up tangles from 3 to 26 months. Early reconstruction with minimal morbidity of rapid and multidirectional mandibular distraction in the hemidacial microsomia was successful without relapse. Orthodontic treatment can begin as soon as possible after gradual distraction in order to establish normal dental occlusion.
김석화,반준섭 大韓成形外科學會 1998 Archives of Plastic Surgery Vol.25 No.1
Alveolar synechia or syngnathia is a rare anomaly showing soft tissue or bony adhesions between the alveolar ridges of maxilla and mandible. In our review of the world literature, we have identified 68 reports of alvelolar synechia. Most cases describe cleft palate and the term cleft palate and congenital alveolar synechia syndrome was coined by Verdi and 0'neal(1983). Additional anomalies such as cleft lip, micrognathia, microglossia, lower lip pits, ankyloblepharon, and limb anomalies are associated. Related syndromes may include popliteal pterygium syndrome, van der Woude syndrome, and orofaciodigital syndrome. We present a child with congenital alveolar synechia and left unilateral complete cleft lip and palate. The child had difficulty in mouth opening with a maximal anterior jaw opening of 4 mm. The fibrous synechia was resected at the age of 4 months. On dividing the fibrous band, the jaws were distracted to an opening of only 7 mm using finger dilatation. However, the maximal anterior jaw opening by passive dilatation had increased to 19.0 mm after 2 months and up to 23.1 mm after 6 months by stretching exercise of the mandible, so the child could open his mouth successfully.
KIM, JEONGEUN,KIM. SUKWHA,KIM, HEE-CHAN,KIM, KYUNG-HWAN,YANG, SEOK-CHUL,LEE, CHOON-TAEK,KONG, HYOUN-JOONG,LEE, KYUNGSOON Lippincott Williams Wilkins 2012 Computers, informatics, nursing Vol.30 No.12
<P> Through the use of ubiquitous health, or u-Health, services, medical information can be adapted and made accessible via computer and Internet to provide quality healthcare to anybody, any place, and any time. We developed and implemented u-Health services for patients with chronic obstructive pulmonary disease and studied their experiences with respect to their knowledge of chronic obstructive pulmonary disease and skill and attitude toward the u-Health devices. The u-Health services were composed of telemonitoring and teleconsultation supplemented with home visits. To determine its effectiveness, the u-Health service system was implemented for 2 years with 144 chronic obstructive pulmonary disease patients in a clinical experiment. The subjects were divided into three experimental groups, each provided with different services, compared before and after intervention, and among groups. The analysis of data gathered through the system suggested that u-Health services can support patients with chronic obstructive pulmonary disease, improve patients’ knowledge about chronic obstructive pulmonary disease self-management, build u-Health device usage skills, and foster a positive attitude toward u-Health devices. The u-Health services for the chronic obstructive pulmonary disease patients were both feasible and effective from the patients' perspective. </P>
Aspiration Pneumonia caused by Povidone-iodine (Betadine) in Cleft Palate Patient
김석화,석효현,정의철,박지웅,최태현,Kim, Sukwha,Seok, Hyo Hyun,Jeong, Eui Cheol,Park, Ji Ung,Choi, Tae Hyun Korean Cleft Palate-Craniofacial Association 2013 Archives of Craniofacial Surgery Vol.14 No.1
Povidone-iodine (PVP-I, Betadine) has many advantages as a disinfectant solution for preoperative preparations, especially for oral surgery. It is widely used because of its low toxicity and excellent bactericidal effect. The authors report a case of pneumonia secondary due to the aspiration of PVP-I, which was used as an oral disinfectant. We present a case of aspiration pneumonia that resulted from the careless use of PVP-I during preoperative preparation. The patient was a 10-month-old female scheduled for elective surgery to correct a complete cleft of secondary palate. During the preparation of the oral cavity for that cleft palate patient, PVP-I was incidentally aspirated to the airway. The lung resistance was noted with positive pressure and pneumonic infiltration on chest radiograph was seen. The operation was postponed and the patient underwent respiratory care. Three months later, elective palatoplasty under general anesthesia was performed without complication. Based on the experiences of this case, the authors advise that throat-packing should be placed before oral preparation to prevent serious pulmonary complications.