폐쇄성 수면무호흡환자에서 확대 구개수구개피판을 이용한 치험례

김지연(Ji-Youn Kim),김성민(Soung-Min Kim),명 훈(Hoon Myoung),황순정(Soon-Jung Hwang),서병무(Byoung-Moo Seo)이종호(Jong-Ho Lee),정필훈(Pill-Hoon Choung),김명진(Myung-Jin Kim),최진영(Jin-Young Choi) 대한구강악안면외과학회 2011 대한구강악안면외과학회지 Vol.37 No.1

The uvulopalatal flap (UPF) technique is a modification of uvulopalatopharyngoplasty (UPPP) for the surgical treatment of obstructive sleep apnea. In the UPF technique, an uvulopalatal flap is fabricated and sutured to the residual mucosa of the soft palate to expand the antero-posterior dimensions of the oropharyngeal inlet. In the extended uvulopalatal flap (EUPF) technique, an incision at the tonsillar fossa is added to the classical UPF technique followed by the removal of mucosa and submucosal adipose tissue for additional expansion of the lateral dimension. The EUPF technique is more conservative and reversible than UPPP. Therefore, complications, such as velopharyngeal insufficiency, dysphagia, dryness, nasopharyngeal stenosis and postoperative pain, are reduced. In the following case report, the patient was diagnosed with obstructive sleep apnea and treated with the EUPF technique. The patient’s total respiratory disturbance events per hour (RDI) was decreased to 15.4, the O 2 saturation during the sleep was increased, and the excessive daytime sleepiness had disappeared after the surgery without complications. The authors report this case with a review of the relevant literature.

구강재건을 위한 족배동맥피판의 해부학적 고찰

김성민(Soung-Min Kim),강지영(Ji-Young Kang),어미영(Mi-Young Eo),명 훈(Hoon Myoung),이석근(Suk-Keun Lee),이종호(Jong-Ho Lee) 대한구강악안면외과학회 2011 대한구강악안면외과학회지 Vol.37 No.3

The dorsalis pedis artery (DPA) was renamed from the anterior tibialis artery after it passed under the extensor retinaculum, and DPA travels between the extensor hallucis longus and extensor digitorum longus muscle along the dorsum of the foot. After giving off the proximal and distal tarsal, arcuate and medial tarsal branches, DPA enters the proximal first intermetatarsal space via the first dorsal metatarsal artery (FDMA), which courses over the first dorsal interosseous muscle (FDIM). For detailed knowledge of the neurovascular anatomy of a dorsalis pedis artery flap (DPAF) as a routine reconstructive procedure after the resection of oral malignant tumors, the precise neurovascular anatomy of DPAF must be studied along the DPA courses as above. In this first review article in the Korean language, the anatomical basis of DPAF is summarized and discussed after a delicate investigation of more than 35 recent articles and atlas textbooks. Many advantages of DPAF, such as a consistent flap vascular anatomy, acceptable donor site morbidity, and the ability to perform simultaneous flap harvest using oral cancer ablation procedures, and additional important risks with the pitfalls of DPAF were emphasized. This article will be helpful, particularly for young doctors during the special curriculum periods for the Korean National Board of Specialists in the field of oral and maxillofacial surgery, plastic surgery, otolaryngology, orthopedic surgery, etc.

구강악안면 재건을 위한 미세혈관 문합술의 종류

이정아(Jung-A Lee),강지영(Ji-Young Kang)어미영(Mi-Young Eo),명 훈(Hoon Myoung),김명진(Myung-Jin Kim),이종호(Jong-Ho Lee),김성민(Soung-Min Kim) 대한구강악안면외과학회 2011 대한구강악안면외과학회지 Vol.37 No.4

A reconstruction following a resection of malignant oral cavity tumors is one of the most difficult problems in recent oral oncology. For a better understanding of oral and maxillofacial reconstructive procedures, basic and advanced microvascular anastomosis techniques must be learned and memorized. The aim of this article was to clarify and define the microvascular anastomosis methods, such as primary closure after an arteriotomy, end to side anastomosis, end to end anastomosis, and side to side anastomosis with an artery and vein. This review article discusses the basic skills regarding microvascular anastomoses with brief schematic diagrams in the Korean language. This article is expected to be helpful, particularly to young doctors in the course of the Korean national board curriculum periods for oral and maxillofacial surgery.

광학추적항법장치를 이용한 르포씨 제1형 골절단 가상 수술의 정확성에 대한 연구

부연지(Yeon-Ji Bu)김성민(Soung-Min Kim),김지연(Ji-Youn Kim),박정민(Jung-Min Park),명 훈(Hoon Myoung),이종호(Jong-Ho Lee),김명진(Myung-Jin Kim) 대한구강악안면외과학회 2011 대한구강악안면외과학회지 Vol.37 No.2

Introduction: The aim of this study was to demonstrate that the simulation surgery on rapid prototype (RP) model, which is based on the 3-dimensional computed tomography (3D CT) data taken before surgery, has the same accuracy as traditional orthograthic surgery with an intermediate splint, using an optoelectronic tracking navigation system. Materials and Methods: Simulation surgery with the same treatment plan as the Le Fort I osteotomy on the patient was done on a RP model based on the 3D CT data of 12 patients who had undergone a Le Fort I osteotomy in the department of oral and maxillofacial surgery, Seoul National University Dental Hospital. The 12 distances between 4 points on the skull, such as both infraorbital foramen and both supraorbital foramen, and 3 points on maxilla, such as the contact point of both maxillary central incisors and mesiobuccal cuspal tip of both maxillary first molars, were tracked using an optoelectronic tracking navigation system. The distances before surgery were compared to evaluate the accuracy of the RP model and the distance changes of 3D CT image after surgery were compared with those of the RP model after simulation surgery. Results: A paired t-test revealed a significant difference between the distances in the 3D CT image and RP model before surgery.(P<0.0001) On the other hand, Pearson s correlation coefficient, 0.995, revealed a significant positive correlation between the distances.(P<0.0001) There was a significant difference between the change in the distance of the 3D CT image and RP model in before and after surgery.(P<0.05) The Pearson s correlation coefficient was 0.13844, indicating positive correlation.(P<0.1) Conclusion: Theses results suggest that the simulation surgery of a Le Fort I osteotomy using an optoelectronic tracking navigation system is relatively accurate in comparing the pre-, and post-operative 3D CT data. Furthermore, the application of an optoelectronic tracking navigation system may be a predictable and efficient method in Le Fort I orthognathic surgery.

구강 편평세포암종에서의 암줄기세포 이론과 최신 지견

김덕훈(Deok-Hun Kim),윤준용(Jun-Yong Yun),이주현(Ju-Hyun Lee),김성민(Soung-Min Kim),명 훈(Hoon Myoung) 대한구강악안면외과학회 2011 대한구강악안면외과학회지 Vol.37 No.2

Cancer stem cells have stem cell-like features, such as the ability for self-renewal and differentiation but show unlimited growth because they have the lost normal regulation of cell growth. Cancer stem cells and normal stem cells have similar features. They show high motility, diversity of progeny, robust proliferative potential, association with blood vessels, immature expression profiles, nestin expression, epidermal growth factor (EGF)-receptor expression, phosphatase and tensin homolog (PTEN) expression, hedgehog pathway activity, telomerase activity, and Wnt pathway activity. On the other hand, with cancer cells, some of these signaling pathways are abnormally modified. In 1875, Cohnheim suggested the concept of cancer stem cells. Recently, evidence for the existence of cancer stem cells was identified. In 1994, the cancer stem cells’specific cell surface marker for leukemia was identified. Since then, other specific cell surface markers for cancer stem cells in solid tumors (e.g. breast and colon cancer) have been identified. In oral cancer, studies on cancer stem cells have been performed mainly with squamous cell carcinomas. Oral cancer specific cell surface markers, which are genes strongly expressed in oral cancer and cancer stem cell specific side populations, have been identified. Cancer stem cells are resistant to radiotherapy and chemotherapy. Therefore, to eliminate malignant tumors efficiently and reduce the recurrence rate, therapy targeting cancer stem cells needs to be performed. Currently, studies targeting the cancer stem cells’specific signaling pathways, telomerase and tumor vasculatures are being done.

비스포스포네이트 관련 악골괴사에 대한 후향적 연구

한윤식(Yoon-Sic Han),이인우(In-Woo Lee),이 호(Ho Lee),서진원(Jin-Won Suh),김성민(Soung-Min Kim),명 훈(Hoon Myoung),황순정(Soon-Jung Hwang),최진영(Jin-Young Choi),이종호(Jong-Ho Lee),정필훈(Pill-Hoon Choung),김명진(Myung-Jin Kim),서병 대한구강악안면외과학회 2011 대한구강악안면외과학회지 Vol.37 No.6

Introduction: The incidence of bisphosphonate-related osteonecrosis of the jaw (BRONJ) has increased gradually in patients who have undergone surgical treatment for osteomyelitis. In this study, a retrospective analysis of BRONJ patients was carried out using the data of osteomyelitis patients treated surgically. Materials and Methods: Osteomyelitis patients, who underwent curettage, sequestrectomy, saucerization or decortications, and partial mandibulectomy at Seoul National University Dental Hospital from 2004 to 2010 were enrolled in this study. The patients were classified and categorized into two groups based on the surgical records and progress notes. One group comprised of patients with osteomyelitis and osteoporosis, and the other group included patients with osteomyelitis only. The epidemiological data of the BRONJ patients was analyzed to identify any trend in the incidence of BRONJ in osteomyelitis patients. Results: Among 200 patients who underwent surgical intervention for osteomyelitis, 64 (32.0%) were identified as having osteoporosis as the underlying disease. In these 64 patients, more than 81.3% had been prescribed bisphosphonates. Females were far more affected by BRONJ than males. The incidence of BRONJ also increased with age. The posterior part of the mandible was affected more frequently by BRONJ. Conclusion: Although the availability of potent antibiotics and increased oral hygiene care can reduce the overall incidence of osteomyelitis, BRONJ can increase the total incidence. To prevent BRONJ, it is recommended that an oral examination be performed before prescribing bisphosphonates. Moreover, the patients should be educated about the potential risks of dental procedures that might be causal factors for BRONJ. Furthermore, patient swho take bisphosphonates for the treatment of osteoporosis should undergo periodic follow up oral examinations to prevent BRONJ.