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Mandibular midline osteotomy for correction of bimaxillary transverse discrepancy: a technical note
Mrunalini Ramanathan,Rie Sonoyama-Osako,Yukiho Shimamura,Taro Okui,Takahiro Kanno 대한구강악안면외과학회 2023 대한구강악안면외과학회지 Vol.49 No.3
Bimaxillary transverse width discrepancies are commonly encountered among patients with dentofacial deformities. Skeletal discrepancies should be diagnosed and managed appropriately with possible surgical corrections. Transverse width deficiencies can present in varieties of combinations involving the maxilla and mandible. We observed that in a significant proportion of cases, the maxilla is normal, and the mandible showed deficiency in the transverse dimension after pre-surgical orthodontics. We designed novel osteotomy techniques to enhance mandibular transverse width correction, as well as simultaneous genioplasty. Chin repositioning along any plane is applicable concomitant with mandibular midline arch widening. When there is a requirement for larger widening, gonial angle reduction may be necessary. This technical note focuses on key points in management of patients with transversely deficient mandible and the factors affecting the outcome and stability. Further research on the maximum amount of stable widening will be conducted. We believe that developing evidence-based additional modifications to existing conventional surgical procedures can aid precise correction of complex dentofacial deformities.
Akira Umemura,Hiroyuki Nitta,Takeshi Takahara,Yasushi Hasegawa,Hirokatsu Katagiri,Shoji Kanno,Megumi Kobayashi,Taro Ando,Taku Kimura,Akira Sasaki 한국간담췌외과학회 2020 Annals of hepato-biliary-pancreatic surgery Vol.24 No.4
A 57-year-old Japanese female was considered for living donor liver transplantation (LDLT) due to end-stage liver cirrhosis caused by primary biliary cholangitis with portal vein thrombosis (PVT) formation. A 26-year-old daughter of the patient was selected as a living donor; however, a computed tomography examination revealed trifurcated-type portal vein anomaly (PVA). Preoperative liver volumetry showed that the right lobe graft was necessary for the recipient; therefore, reconstruction of the portal vein bifurcation during LDLT was necessary. We planned to extract the recipient’s own hepatic vein grafts after total hepatectomy, and these would be attached with anterior and posterior portal branches as jump grafts. We performed laparoscopic donor hepatectomy as usual, and the recipient’s hepatic vein grafts were anastomosed on the bench. Then, the liver graft was inserted, and the hepatic vein reconstruction was routinely performed. We confirmed the alignment between the recipient’s portal vein and the bridged hepatic vein graft of the liver graft’s posterior branch, and anastomosed these two vessels. Moreover, we confirmed the front flow and expansion of the reconstructed posterior branch by declamping only the suprapancreatic side of the portal vein. The decision regarding the punch-out location was crucial. We confirmed the alignment between the reconstructed posterior branch and the bridged hepatic vein graft of the anterior branch, and anastomosed these two vessels employing the punched-out technique. In LDLT, liver transplant surgeons occasionally encounter living donors with PVA or recipients with PVT. Our contrivance may be useful when the liver graft needs reconstruction of portal vein bifurcation.