동종골 이식에 의한 하악골 재건

엄인웅 대한치과의사협회 1992 대한치과의사협회지 Vol.30 No.11

혀에 발생한 선편평세포암의 증례보고

민승기,방만혁,권혁도,김은철,이동근,엄인웅 大韓顎顔面成形再建外科學會 1994 Maxillofacial Plastic Reconstructive Surgery Vol.16 No.2

One case of an unsual form of carcinoma involving the submucosal gland and duct of tongue was reported and reviewd. According to Gerughty et al(1968) four distinct component parts were classified: ductual carcinoma in situ(invovlement of the ductal epithelium by in situ carcinomatous changes), squamous cell carcinoma, and a mixed carcinoma(combination of glandular and squamous characteristics and occasionally consisted of large nests composed of "glassy" cell). This tumor was fond to be extremely aggressive and highly malignant. The histopathologic features and the clinical behavior of this tumor were sufficiently distinctive to warrant the designation adenosquamous carcinoma: exhibit concomitant glandular and squamous neoplasm. The mode of therapy was evaluated and the treatment of choice appears to be radical surgery. So, we has done the radical neck dissection and partial glossectomy. However, the limited number of cses indicated that collection and subsequent analysis of additional cases must be performed before any definitive conclusion can be drawn.

동결 건조한 한국인 상하악골에 대한 실험적 연구 : Ⅰ. A microbiologic study of the sterility on the fresh-frozen and freeze-dried bone of human Ⅰ. 단순냉동 및 냉동 건조된 동종골의 멸균에 관한 실험적 연구

엄인웅 大韓顎顔面成形再建外科學會 1991 Maxillofacial Plastic Reconstructive Surgery Vol.13 No.4

To determine the sterility of the prepared allogeneic bone of the human, culture of the allografts prior to implantation was performed on fresh-frozen and freeze-dried bone. Before the use of ailografts to the patients, it must be confirmed about the sterility, cellular cytotoxicity, immune reaction, and osteoinductive potential as a biomaterials. Oral and maxillofacial surgeons demand for allograft bone will be increased in the future. Wonkwang Bone Bank attempted to meet this demand, has performed series of experimental study on the allograft bone of the Koreans to evaluate the physical and chemical suitability of the bone since the surgeons applications will have broadened from benign cystic lesions to fracture malunions and non-unions, large segmental defects, and whole-bone allorgrafts after tumor surgery. The results obtained were as follows: 1. Freeze-drying(FD) only shoed some bactericidal effects of the normal and osteo bone but in cases of performing EO gas sterilization, the FD effects was not clear. 2. The fact that FD has little effect than theEO gas sterilization on normal bone postulated that the presence of microbiota may be due to an operation and bone processing procedure. 3. FD and EO gas sterilization had a remarkable effect on the osteo bone. 4. The sterilization effect were EO gas, Freeze-drying, Fresh-Frozen with descending order. But all sterilization method were not complete to preserve and implant allograft bone. We are now performing further continuous study on the radiation and chemical sterilization procedure to make safe and complete allograft bone.

조직이식의 현황 및 의학적 문제점

嚴仁雄 대한의료법학회 2001 의료법학 Vol.2 No.2

冷凍 乾燥 및 脫灰 骨의 組織 反應에 關한 實驗的 硏究

嚴仁雄,閔丙一 서울大學校 齒科大學 1992 齒大 論文集 Vol.16 No.1

이하부에 발생한 침습성 섬유종증이 하악체에 침범한 증례 보고

민승기,김영조,정창주,김은철,이동근,엄인웅 大韓顎顔面成形再建外科學會 1994 Maxillofacial Plastic Reconstructive Surgery Vol.16 No.2

Fibromatosis is benign fibroblastic proliferative lesion with abundant collagenous neo-formation located principally in the abdominal wall and in the upper and lower extremities (Masson & Soule, 1966). Wilkins and Waldron, in 1975, suggested that the title aggressive fibromatosis was a more appropriate term, relfecting the invasive characteristics of the disease. Synonyms listed were extra-abdominal desmoid, juvenile fibromatosis, aggressive infantile fibromatosis and congenital fibrosrcoma. A total of 12% of all fibromatosis arise in head and neck. Fibromatosis of the oral cavity is uncommon and is even more rare when in involve the mandibule. It is a locally aggressive fibrous tissue tumor, generally does not metastasize, but may cause consideralbe morbility nd even death due to local infiltration. The degree of microscopic celluarity is vrialbe, not only from tumor to tumor but also from area to rea in the same tumor. Some tumors present with prolifertion of mature fibroblasts and a dominating collagenous component: others may show a lack of the tumor in both types. The common histologic denominator appears to be celluar interlacing bundles of elongated fibroblasts, showing little or no mitotic activity and no pleomorphism. Mitosis are not a consistent index of malignancy when found in younger age groups. Fibromatosis still posses difficult problems of diagnosis and treament. It is frequently recurrent and inflitrates neighbouring tissues. These lesion inflitrate widely and replce muscle, fat, and even bone with fibrous tissue of varying cellularity. Lesion representing fibromatosis in the oral cavity must be carefully evaulated by both surgeon and pahtologists to ensure proper diagnosis and treatment planning. When these lesions involve bone, surgeon must be aware of the lesion's potential to perforate the cortex and expand while remaining hidden from the surgeon's view. Careful and precise clinical correlation with histologic appearance is essential to preclude misdiagnosis of fibroscrocma yet provide sitrgical treatment plan that provides adequate local excision and long-term follow up.As regards cause,little is known. It is attribufed to trauma or alteration in the sex hornone(Carlos,et al,1986).Clinially,the lesion is reported to be not painful in most cases,but capable of rapid growth. The treatment is essentially surgical excision with wide margin of adjacent uninvolved tissue.Radiotherapy,hormone treatment or chemotherapy are of no use (Wikins et al,1975:Majumudar and Winiarkl,1978). We report a case of aggressive fibromtosis of 15-year-old with a lesion in the soft tissue of the parotid area that invaded the underlying bone of the mandibular body.

A CASE REPORT OF SURGICAL CORRECTION OF NASOMAXILLARY HYPOPLASIA DUE TO CONGENITAL SYPHILIS BY LE FORT II OSTEOTOMY WITH CORONAL APPROACH

엄인웅,김창수,Um, In-Woong,Kim, Chang-Soo Korean Association of Maxillofacial Plastic and Re 1991 Maxillofacial Plastic Reconstructive Surgery Vol.13 No.1

Le Fort II 골절단술 및 전방 이동술은 비상악골의 형성 부전증이나 짧은 코, 또는 상악골에 대비하여 상대적인 하악 전돌증 환자에 있어 고려 대상이 되어 왔다. 이러한 비상악골 형성 부전증의 원인으로는 외상, 토순 또는 구개열로 인한 발육부전, 선천성 매독증과 같은 감염 증상 등을 들 수 있다. Le Fort II 골절단술 및 전방 이동술은 1973년 Henderson 과 Jackson 에 의해 처음으로 보고되었고, 그 후 1980년 Steinhauser, Kinnebrew 등에 의해 변화되어 왔다. Le Fort II 골절단술에 있어서의 관상 절개술은 paranasal incision에 비해 안면부 술후 반흔이 남지 않아 심미적으로 우수하며, 두부의 상부 1/2까지 노출이 가능하여 수술시야가 좋으며, 안면 신경 손상 및 lacrimal apparatus 손상의 위험이 적다는 장점 이 외에도 nasofronatal osteotomy site와 pterygomaxiliary osteotomy site를 위한 bone graft의 donor site로서 skull bone을 immediate로 사용할 수 있다는 장점이 있다. 본 교실에서는 선천성 매독의 후유증의 하나인 비상악골 형성부전증을 가진 23세의 여자 환자에 있어서 관상 절개술을 통한 Le Fort II 골절단술을 통한 전하방 이동 및 하악지의 시상골 절단술을 시행하여 양호한 결과를 얻었기에 이에 보고하는 바이다. Maxillofacial deformities are not considered to be a trouble in social life but function. So many maxillofacial plastc surgeons has made efforts to overcome these troubles and bring out more positive life. The proper proportion and shape decide esthetic quality. Lower third of face was consist with lip, cheek, mandibular lower border and mandibular angle. Widening lower third of face give a impression with muscular and recklessness. And lower and wide mandibular angle makes face square shape. Unilateral involvement cause asymmestric face. These face is considered unfavorable, especially in Korea or Japan. We prevent a number of with mandibular angle Bulging which was corrected with mandibular osteotomy or masseter myotomy.

악골 및 연조직에 발생한 혈관종 치험례 : 5증례 보고

엄인웅,김명진,김종원,민병일 대한악안면성형외과학회 1986 대한악안면성형외과학회지 Vol.8 No.1

하악골 과두돌기 골절시 개구범위에 관한 임상적 연구

엄인웅,김수남,우승철,이동근 大韓顎顔面成形再建外科學會 1992 Maxillofacial Plastic Reconstructive Surgery Vol.14 No.4

Functional recovery associated with mouth opening after mandibular condyle fracture was a contradictory result of many authors. The treatment goal of condyle fracture has been not only the good reduction and fixation but also the rapid functional recovery with mouth opening capacity. The purose of this study is to evaluate the mouth opening capacity after surgical or non-surgical treatment of condyle fracture according to the site, level, maxillomandibular fixation(MMF) and operation method based on 39 patents with condyle fracture who were admitted to the department of oral and maxillofacial surgery, Wonkwang Unversity Hospital from May.1, 1990 to Aug.31, 1992. The results were as follows. 1. The most common fracture site was level IV (17 cases : 42.2%) and level Ⅰ (14 cases : 36.8%), level Ⅱ(5 cases: 13.2%) and level Ⅲ(3 cases : 7.9%) were in decreasing order of frequency. Compound fracture with symphysis was more frequent (69.2%) than simple fracture(30.8%). 2. The mouth opening capacity was increased in the level Ⅰ compared with level Ⅳ. 3. The mouth opening capacity was increased in the group of segment removal. 4. The mouth opening capacity was increased in the MMF period was decreased. 5. Better mouth opening capacity was recorded in the physical therapy group of more than 3-4 weeks of treatment period.

Open reduction of fractured mandibular condyles: overview

엄인웅(In Woong Um),강상규(Sang Kyu Kang) 대한구강악안면외과학회 1991 대한구강악안면외과학회지 Vol.17 No.2

하악과두골절에 대한 외과적 치료에 있어서 Nam s method가 흔히 사용되어져 왔으며 비교적 좋은 결과를 보였다고 보고되고 있으나, 골편흡수의 가능성을 가지고 있다. 측두하악관절장애는 골편의 정확한 정복후에도 외상에 의한 관절원판의 변이나 손상에 의해 야기될 수 있다. 최근에는 과두골절후 발생되는 관절질환을 줄이기 위해 관혈적 정복술와 동시에 관절원판의 관찰 및 수복술을 시행하는 술식이 시도된 바있다. 저자등은 전이개절개 혹은 전이개 및 악하복합절개를 이용하여 골편의 정복과 함께 관절원판의 관찰 및 복위술을 시행하였다. 이러한 시술이 관절에 미치는 영향에 대한 평가는 장기간의 관찰후에 이루어져야할 것이다. 경험한 바에 따르면 하악과두 골절의 처치에 있어서 전이개접근법의 장ㆍ단점은 다음과 같다. 1. 관절원판의 상태를 관찰할 수 있으며 필요에 따라서는 부가적인 관절수술이 가능하다. 2. 골편의 고정후에 과두의 위치 및 운동상태를 평가할 수 있으며, 과두고경이 유지되는 경우에 골편의 제거가 타당화될 수 있다. 3. level 3까지 적용이 가능하다. 4. 내이쪽으로 변형시킬 경우 술후 반흔은 과히 눈에 띄지 않는다. 5. 안면신경에 대한 손상이 가능성이 있으나, 이는 오히려 악하절개 보다 더 잘 피할 수도 있을 것이다. 6. 수술시야가 좁다는 단점이 있으나, 이는 술자의 기술에 의해 극복될 수 있다. 7. 상부골절에 있어서는 연조직의 박리와 조작 및 손상에 의한 혈류차단으로 골편이 흡수될 가능성이 높다. 8. 전이개 및 악하복합절개법이 Nam s method와 함께 시행된 경우에 있어서 골편흡수의 가능성은 보다 커질 수 있다. 상기한 장점 외에도 외상처치를 통한 전이개접근법에 대한 경험은 다른 관절질환에 이 접근법을 이용해야할 때에 많은 도움이 될 것이다.