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증예보고 : 하악골에 발생된 방사선골괴사증의 증예보고 2 예 및 문헌적 고찰
김용각(Yong Kack Kim) 대한악안면성형재건외과학회 1983 Maxillofacial Plastic Reconstructive Surgery Vol.5 No.1
Osteoradionecrosis is that pathologic process which sometimes follows heavy radiation of bone and is characterized by a chronic, painful infection and necrosis accompanied by late sequestration and sometimes permanant deformity. The author has treated two patients who had complication of osteoradionecrosis in mandible after radiation therapy for malignant tumor in head R neck area. 1. A sixty-two year old man experienced osteoradionecrosis in the right mandibular body portion after irradiation of total 12,835 rads for the treatment of squamous cell carcinoma in the tongue, and was treated with conservative sequestrotomy. 2. The other, 22 year old man, experienced osteoradionecrosis in the bi lateral mandibular angle portion after irradiation of 6000 rads for the treatment of nasopharyngeal carinoma with metastatic cervical lymphnodes, and was treated with block ostectomy of the mandible. 3. The direct contributing cause of osteoradionecronis in these two cases was trauma followed by infection i.e., extraction in the former case and acupuncture in the latter. 4. The time interval between the completion of radiation therapy and the onset of osteoradionecrosis was 2 months in the former case, and 2 years and 8 months in the latter. 5. It is important to prevent trauma and infection in irradiated patient lest the patient should be complicated with osteoradionecrosis.
상악골 악성종양절제술환자의 생존율 및 상악폐쇄보철물 등에 관한 임상적 연구
김용각(Yong Kack Kim),박형국(Hyung Kook Park) 대한구강악안면외과학회 1997 대한구강악안면외과학회지 Vol.23 No.1
During 10 years (from 1986 to 1995), 54 patients were diagnosed as maxillary cancer and undergone maxillectomy in department of Oral and Maxillofacial Surgery, Korea Cancer Center Hospital. We studied clinically about their age and sex distribution, TNM staging, histopathologic diagnoses, treatment modalities, overall survival rates, survival rates according to stages and treatment modalities. In them, 23 patients were delivered maxillary obturators, we also studied clinically about them and their obturators. The overall 3-year and 5-year survival rates of these maxillectomized patients were 59.0% and 55.0%. The 5-year survival rates of stage II and stage III patients was 63.0%, and that of stage IV patient was 50.0%. According to treatment modalities, The 5-year survival rates in cases of surgery only was 66.7%, in cases of preoperative chemotherapy and/or radiaiotherapy was 63.5%, in cases of postoperative radiotherapy and/or chemotherapy was 50.4%. The 5-year survival rate of obturator delivered patients was 56.8%, and that of no-obturator delivered patients was 51.8%. The using rates of obturator were 70.5% at 1 year, 59.7% at 2 years, and 53.0% at 3 years.
사이버나이프를 이용한 수술 불가능한 재발성 구강암의 치험례
김용각(Yong-Kack Kim),이태희(Tae-Hee Lee),김철(Chul Kim),김성진(Sung-Jin Kim),김혁(Hyuk Kim) 대한구강악안면외과학회 2004 대한구강악안면외과학회지 Vol.30 No.1
CyberKnife is a stereotactic radiosurgery system which could be used to treat many tumors and lesions. It provides the surgeon unparalleled flexibility in targeting using a compact light linear accelerator mounted on a robotic arm. Advanced image guidance technology tracks patient and target position during treatment, ensuring accuracy without the use of an invasive head frame. CyberKnife with Dynamic Tracking Software is cleared to provide radiosurgery for lesions anywhere in the body when radiation treatment is indicated. It has often been used to radiosurgically treat otherwise untreatable tumors and malformations. Moreover, this instrument treats tumors at body sites, most of which are unreachable by other stereotactic systems. Compared with conventional radiotherapy, it is fundamentally different that using non-invasive, frameless, no excessive radiation exposure to normal tissue. In oral malignant \ neoplasm, surgical excision and radiation therapy should be tried first, additionally chemotherapy could be considered. However, after failure of conventional therapies, patients had poor systemic condition and surgical limitation. So, CyberKnife could be a suitable therapy. A 49 years man was referred in recurred mandibular cancer treated by radiotherapy. The tumor was considered inoperable, because of extensive invasion and was not expected to good response to conventional therapies. We experienced a case of CyberKnife after 4 cycle chemotherapies, so we report it with review of literature.
구강악안면 암환자의 초진시와 추적검사시 양전자 방출 단층촬영의 임상적 유용성
김용각(Yong Kack Kim),박형국(Hyung Kook Park),현재훈(Jae Hoon Hyun),김재환(Jae Hwan Kim),조병호(Byung Ho Cho) 대한구강악안면외과학회 1999 대한구강악안면외과학회지 Vol.25 No.3
BACKGROUND : Positron Emission Tomography(PET) with [18F]-fluorodeoxyglucose (FDG) is a new imaging technique that has the advantage of imaging metabolic changes linked to malignancy. PET-FDG can provide a functional image of the regional biochemistry which may be more sensitive and accurate for detecting the presence of tumor in early stage. Recently, the clinical use of PET scan has been studied in many cancers but, there is a few clinical reports in oral and maxillofacial cancers. We have evaluated the ability of PET-FDG for initial diagnosis and detection of early subclinical recurrent malignancies in follow up check. PATIENTS AND METHODS : PET-FDG studies were performed in 33 patients from october, 1997 to september, 1998. 14 patients underwent PET-FDG evaluation for initial diagnosis and 19 patients for follow up check. RESULTS : Evaluated for initial diagnosis, PET-FDG was found to have an overall accuracy of 79%, sensitivity of 90%, specificity of 60%, positive predictive rate of 80% and negative predictive rate of 75%. Evaluated for follow up check, PET-FDG demonstrated accuracy of 84%, sensitivity of 91%, specificity of 75%, positive predictive rate of 83% and negative predictive rate of 86%. CONCLUSION : These data indicate that PET-FDG scan appears to be effective in initial diagnosis and detection of early recurrent oral and maxillofacial malignancies. The informations gained with PET-FDG can be included for essential treatment planning because of possibility of detection for early subclinical malignancies and distant metastases.
김용각(Yong Kack Kim),박형국(Hyung Kook Park),권혁진(Hyuk Jin Kwon),현재훈(Jae Hoon Hyun) 대한구강악안면외과학회 1997 대한구강악안면외과학회지 Vol.23 No.2
Radiation therapy, in addition to its therapeutic effects, cause several complications in oral region. As a result of radiation, the blood supply to bone is decreased, and large areas of hypcellular, hypovas-cular, hypoxic tissue arc created that are devoid of functioning fibroblasts and osteoblasts. Therefore, the extraction of teeth after irradiation to the jaws has generally been regarded as a potentially hazardous procedure because of the possible initiation of osteoradionecrosis. Hyperbaric oxygen therapy appears to assist in salvaging irradiated tissue by tissue angioneogenesis in marginally viable tissue induced by high oxygen tissue level. Hyperbaric oxygen therapy is beneficial for patients at risk for the development of osteoradionecrosis, such as irradiated patients requiring tooth extraction We obtained good results when extraction is performed with hyperbaric oxygen therapy in 17 cases with head & neck malignancy and present results with review of literatures.
상악골 악성종양의 외과적 절제후 안면 보철물을 이용한 치험례
김용각(Yong Kack Kim),정붕희(Boong Hee Chung),유현석(Hyeon Seok Yu),곽재근(Jae Kean Kwak) 대한구강악안면외과학회 1990 대한구강악안면외과학회지 Vol.16 No.1
The current treatment Philosophy for maxillary cancer is an excision of tumor in combination with X-ray radiation. Orbital exenteration is required when invasion of the orbit has occurred from a maxillary cancer. Orbitomaxillary resection results in functional and esthetic problems. There are many limitation to the surgical reconstruction after radiation therapy. And cosmetic results are less satisfactory when surgical reconstruction follows orbitomaxillary resection. This article reports squamous cell carcinoma of maxilla which occurred in a 52-year-old man. PNS CT showed soft mass occupying entire Lt. maxillary antrum, invading the ethmoid air cell and medial aspect of Lt. orbit. This presented the stage Ⅲ(T₃N₀M₀) malignacy. Agter induction chemotherapy, total maxillectomy with orbital exenteration in combination with radiation therapy was performed. Facial prosthesis with prosthetic eye was fabricated with silicone. Esthetic and functional results have been good. And there is no sign of recurrence for the present. But he must be followed for life.