SURGICAL MANAGEMENT OF VELOPHARYNGEAL INCOMPETENCE USING SUPERIORLY BASED PHARYNGEAL FLAP

안재진,장세홍,박지희,우성도,Ann, Jye-Jynn,Chang, Se-Hong,Park, Chi-Hee,Woo, Sung-Do Korean Association of Maxillofacial Plastic and Re 1991 Maxillofacial Plastic Reconstructive Surgery Vol.13 No.3

선천성 혹은 술후성 기형으로 발생하는 구개인두 부전증은 구강과 비강사이의 부적절한 폐쇄기능으로 인해 과비음 등의 발음장애를 초래한다. 그 원인으로는 구개파열, 인두비대증, 편도선절제술후의 구개와 인두의 비율 부조화, 구개인두 괄약근의 기형, 구래부전마비, 연구개 결손, 상악골 전진 절단술 등이 있다. 구개인두 부전증의 진단에는 임상적, 방사선학적 검사와 더불어 섬유광학 비내시경을 이용한 구개인두의 기능검사가 강조된다. 수술방법으로는 구개성형술, 인두증강술, 인두성형술, 인두피판술 등이 있다. 근자에는 상부기저형 인두피판술이 널리 사용되고 있는데, Hogan등이 개선시킨 술식에 의하면, 넓고 긴 피판을 얻을 수 있고 피판의 Raw surface를 연구개의 비강측 점막으로 덮을 수 있으며 측방 통로를 조절할 수 있다는 장점이 있다. 이에 저자등은 본인에 내원한 구개인두 부전증 환자 7례에서 상부기저형 인두피판을 이용하여 구강과 비강 사이의 측방 통로를 적절히 조절함으로서 발음을 개선시켜 본 바 양호한 임상성적을 얻었기에 보고하는 바이다. Velopharyngeal incompetence (VPI) is a condition of inadequate functional valving between the oral and nasal cavities that results in hypernasal speech and nasal air escape. VPI is caused by the following factors ; cleft palate, soft palate defect, pharyngomegaly, velopharyngeal sphincter muscle anomaly and maxillary advancement surgery, etc. Velopharyngeal function is assessed by a variety of measures that include speech evaluation, cephalogram, airflow study, videofluoroscopy and nasoendoscopy. The management of VPI is classified into four main groups ; prosthesis, insertion of implant, palatoplasty and pharyngoplasty. Pharyngeal flap is the most common surgical procedure for correcting VPI since Schoenborn's report in 1875. We report seven cases of VPI which were treated by modified modified superiorly based pharyngeal flap with good results.

A SURGICAL CORRECTION OF TMJ INTERNAL DERANGEMENT

안재진(Ann Jye jynn) 대한구강악안면외과학회 1984 대한구강악안면외과학회지 Vol.10 No.2

악관절 내장증은 중심교합위에서 관절원판이 전방으로 전위되고 과두는 관절와에서 후상방으로 전위된 상태라고 정의할 수 있으며, 간혹 관절원판 후방부착 조직부위에 천공이 있는 경우도 있다. 이 질환의 진단은 상세한 병력과 환자검진 및 방사선학적 검사등에 기초를 두며 관절조영촬영술을 실시하여 수술의 적응여부 및 수술시 필요한 제반정보를 얻을 수 있다. 본 증례는 23세된 사병으로서 운동경기중 턱부위에 외상을 입고 약 1 년 이상 악관절 기능장애로 입원가료중 후송계로를 통해 국군대구병원 치과부로 전원된 환자인데 제반 검사 및 관절조영 촬영술(Arthrography)을 실시하여 악관절 내장증으로 진단하였으며 악관절융기 절제술(Eminectomy)을 시행하여 양호한 결과를 얻었기에 문헌고찰과 함께 보고하는 바이다.

Open Splint를 이용한 Hydorxylapatite 하악 치조제 증강술

안재진(Jye Jynn Ann),박지희(Chi Hee Park),우성도(Sung Do Woo) 대한구강악안면외과학회 1992 대한구강악안면외과학회지 Vol.18 No.3

Progressive residual ridge resorption following loss of the natural dentition produces clinical problems in the denture. Vestibuloplasty, lowering of the mouth floor, bone grafting, osteotomy method, osseointegrated implants, and hydroxylatpatite implantation are generally accepted as the reconstructive methods of the alveolar ridge. Nowadays osseointegrated implant technique has been widely spreaded, but ridge augmentation using hydroxylapatite can be a good candidate if the ridge condition of the patient, economic situation and his preference are considered. But technical difficulties in confining the hydroxylapatite particles into the desired ridge form and shape, and in preventing migration of the particles are commonly experienced. So we represent a somewhat modified method of surgical incision using the open splint technique that obviates the need of vestibuloplasty and lowering of mouth floor.

외상으로 절단된 안면신경의 재건

안재진(Jye Jynn Ann),장세홍(Se Hong Chang),박지희(Chi Hee Park),우성도(Sung Do Woo) 대한구강악안면외과학회 1992 대한구강악안면외과학회지 Vol.18 No.1

Although a major cause of facial nerve lesion is surgical removal of extracranial and intracranial tumors, injuries to the skull or facial tissues may also place this nerve at considerable risk. Extratemporal facial nerve damages result mainly from deep injuries to the lateral face region including the parotid gland. In the past there was much discussion on the question of the best time for neural intervention during treatment of deep injuries in the lateral face region with facial nerve damage. In contrast to immediate primary nerve reconstruction early secondary reconstruction is also successfully carried out 3 to 4 weeks after the accident. A 35 year old woman came to our emergency room after having sustained the deep laceration injury in her left face, and primary closure of the soft tissue injury was done immediately. It was evident that her left upper lip and cheek lost their mimic muscular function 1 month after the accident. She underwent secondary reconstruction of facial nerve using transplantation of the greater auricular nerve to bridge a gap in the buccal branch of this nerve. In 12 months of follow-up the buccal smile muscles of injured side restored their mimic muscular function.

In-Ceram Alumina Bridge Restoration의 단기예후에 관한 임상적연구

조병완,박재범,안재진,Jo, Byung-Woan,Park, Jae-Bum,Ann, Jye-Jynn 대한치과보철학회 1997 대한치과보철학회지 Vol.35 No.3

All ceramic restorations except In-Ceram Alumina system gave a good esthetics and an exellent marginal fidelity. The flexural strength of them had about 150MPa, so the indication is only single crown. By using In-ceram Alumina System(450Mpa), it is thought to be possible to construct bridge for its high flexural strength. But the prognosis is unclear, The purposes of this study are to clear short term prognosis of In-Ceram bridge restorations, to elucidate its clinical significance. Among 22 In-Ceram Bridge restored in our department, 11 In-Ceram bridges with follow up were used. The period of placement is from 1 to 18 months. The results were as follows : 1. Among follow up 11 bridges, 2 bridges were fractured. One is 4 unit in maxillary lateral incisors, the other is 3 unit bridge in maxillary canine and premolar. Including 11 bridge without follow up, failure rate is very low(2/22). 2. The fracture sites are connector areas between abutment and pontic. To maintain In-Ceram bridge for long term period, it is needed to remove the nonphysiologic occlusal force and to have sufficient thickness of alumina core. For estabilishing clinical use of In-Ceram bridges, it is thought to need clinical research during long term period.

상악골 악성종양에 대한 외과적 처치

장세홍(Se Hong Chang),안재진(Jye Jynn Ann),박성배(Seong Bae Park) 대한구강악안면외과학회 1986 대한구강악안면외과학회지 Vol.12 No.1

Surgical treatment is the choice of treatment for the maxillary malignant tumors. Conventional maxillectomy technique dosen t allow the easy approach to the pterygomaxillary plate area and leads to the troublesome problems such as the ptosis of oribital content. Through some technical modifications of the maxillectomy as preservation of the infraorbital rim and use of zygomaticomasseter and coronoidotemporalis flaps, we obtained good results as follows; prevention of the ptosis of the oribital content, easy exposure of the pterygoid plate, reduction of the interoperative bleeding and easy ligation of the internal maxillary artery under direct vision.

자가장골 및 늑연골의 복합이식을 통한 하악골 재건술

장세홍(Se Hong Chang),안재진(Jye Jynn Ann),소재정(Jae Jung Soh),박지희(Chi Hee Park) 대한악안면성형재건외과학회 1991 Maxillofacial Plastic Reconstructive Surgery Vol.13 No.1

외상이나 감염 또는 종양의 적출에 의해 발생한 하악골 결순부는 심미적, 기능적으로 많은 문제를 야기한다. Sykoff 가 1900 년에 자가골 이식으로 하악골 결손부를 수복한 이후 현재까지 많은 이식물과 이식방법이 이용되어져 왔으며 특히 늑연골은 1920 년에 Gillies 에 의해서 TMJ 수복에 처음 사용된 이후 성장기 아동의 과두결손부 수복에 많이 이용되고 있다. 또한 자가장골은 안면부의 수복에 보편적으로 이용되고 있는 공급부위이며 특히 많은 양의 망상골이 필요한 경우에는 후방 접근법을 이용함으로서 충분한 양의 골을 얻을 수 있다.수복의 시기는 환자마다 차이가 있어서 나이, 과거력, 초기질병의 상태, 성장발육정도 및 심미적, 정신적인 면을 고려하여야 하며 악성종양의 제거시에는 재발여부와 방사선 치료 등을 고려하여 적절한 시기를 선택하여야 하나, 일반적으로 술후 약 1 - 2 년 후에 시행할 수 있다.본원에서는 하악골 골육종으로 진단된 15 세 남자 환자에서 과두를 포함하는 좌측 하악골 절단술후 임시로 레진수복물을 장착한뒤 약 20 개월간의 주기적인 검진결과 재발의 기미가 없어 늑연골과 장골의 복합이식을 통하여 심미적, 기능적으로 양호한 결과를 얻었기에 그 증례를 보고하는 바이다. Loss of mandibular continuity due to neoplasm, trauma, or infection results in major esthetic and biologic compromise. The use of costochondral grafts for reconstruction of temporomandibular joint, described first by Gillies in 1920 has been accepted as a suitable method for replacing the mandibular condyle, especially in growing children. Autogenous iliac bone graft has been a satisfactory source of mandibular reconstrucion since Sykoffs report in 1900. Autogenous bone grafts the posterior aspects of the ilium provide large amount of PMCB with acceptable donor site morbidity. In timing of reconstruction, initial disease, age, medical history, growth and development esthetic and psychlogic factors. should be considered. We present a case of osteosarcoma in the mandible that was treated by a hemimandibulectomy and the defect was reconstructed 20 months later with composite method of costochondral and posterior iliac bone graft.

늑연골 이식술을 이용한 하악관절 유착증 치험례

장세홍(Se Hong Chang),안재진(Jye Jynn Ann),황경룡(Kyung Ryong Hwang) 대한구강악안면외과학회 1987 대한구강악안면외과학회지 Vol.13 No.1

Trismus and disharmony of facial growth were the usual results of injury to the mandibular condyle in growing children. Early replacement of ankylosed condyle with a costochondral joint was recommended as best approach to management of such problems. A detailed review of the literature supports the principle that cartilagenous growth site was responsible for the growth and maturation of facial skeleton. A case of true bony ankylosis of the TMJ was treated by condylectomy and autogenous costochondral grafting. Results were encouraging functionally and esthetically, but continued observation of this patient is necessary to evaluate the growth of transplanted graft.

악골에 발생한 거대 법랑아 세포종

김도균(Kim Doe Gyeun),안재진(Ann Jye Jynn),장세홍(Chang Se Hong) 대한구강악안면외과학회 1986 대한구강악안면외과학회지 Vol.12 No.2

This is to report 2 cases of giant ameloblastomas of the jaws which were successfully treated by surgical method. The obtained results were summarized as follows. 1. In case of mandibular giant ameloblastoma, the lesion involved the entire right mandible and left body, which was radically resected and the defect was reconstructed with resin graft. 2. In case of maxillary giant ameloblastoma, the lesion involved left maxilla and left ethmoid sinus, extending to right inferior turbinate beyond the nasal septum, which was radically resected and the left inferior orbital floor defect was reconstructed with silastic block to prevent ptosis and facial deformity. 3. The platysma myocutaneous flap was used to reconstruct the intraoral defect following the previous operation. The flap has several advantages; first it is relatively thin, second it has few technical difficulties, third it is easily mobilized and rotated to the intraoral defect, fourth it causes no esthetic problem.

원발병소불명의 경부임파절 전이암

장세홍(Se Hong Chang),안재진(Jye Jynn Ann),김도균(Doe Gyeun Kim) 대한구강악안면외과학회 1988 대한구강악안면외과학회지 Vol.14 No.1

Metastasis to the lymph nodes of the head and neck is not an unusual occurrence. In most cases, the primaiy will be found, Occasionally, however, in approximately 5 per cent of cases, even the most exhaustive history and physical examination as well as special roentgenologic studies and even biopsies of all suspected sites will not disclose the primary tumor. Metastatic cervical malignancy with an unknown primary source is termed occult primary. The treatment of cervical lymph node metastases in patients with unknown primary lesions has long been controversial. But even though the primary lesion remained occult, definitive treatment to the cervical metastases was advocated and carried out. Treatment modality for metastatic cervical lymph nodes with an unknown primary tumor may be surgery, radiotherapy, chemotherapy, or a combination of the three. The selection is based on the histologic findings, site, and clinical stage of the cancer. We report a case of squamous cell carcinoma in the right submandibular lymph node. Even with thorough clinical and radiological examinations, it was not possible to find the primary in any other part of the body. The lesion was removed by radical neck dissection and there is no evidence of the primary and/or recurrence for 11 months.