구강 및 악안면 영역의 연조직 손상에 관한 임상적 연구

유준영,김용관,배준수,장현석,You, Jun-Young,Kim, Yong-Kwan,Bae, June-soo,Chang, Hyun-Seok 대한악안면성형재건외과학회 1997 Maxillofacial Plastic Reconstructive Surgery Vol.19 No.4

The soft tissue injuries of Oral & Maxillofacial region include abrasion, contusion, simple laceration, laceration of skin with underlying tissue, soft tissue injuries combined with facial bone fracture and involving functional structures such as facial nerve and vessel, orbit, lacrimal duct and salivary gland and so on. The results obtained were as follows ; 1. The age range was 1 to 97, and the highest incidence occured in the 3rd decade(23.4%), followed by the 1st decade(20.2%), 4th decade(18.1%), 4th decade(18.1), and 5th decade(14.3%) 2. The sexual ration was 4 : 1(M : F). 3. The most common cause of facial laceration was a accident(54.5), followed by blow(17.8%), traffic accident(15.9%) and unknown(10.8%). 4. The most frequently occurred site of injury was a forehead(24), followed by oral cavity(16.9%), lip(15%), eyebrow(14.5%), cheek(14%), chin(11.8%), nose(2%), scalp(1.4%) and neck(0.9%). 5. Most of wound size was less than 3cm in length. 6. 28 patients suffered facial bone fracture, representing 7%. 7. The major complications following facial laceration were infection and facial paralysis caused by facial nerve injuries, representing 4.5% and 1.9%.

유리골 이식을 통한 하악골 결손부의 기능적 재건술

유준영(Jun Young You),김종원(Jong Won Kim),정필훈(Pill Hoon Choung),김명진(Myung Jin Kim),남일우(Il Woo Nam),송민석(Min Seok Song),서병무(Byung Moo Seo),남기원(Ki Weon Nam) 대한악안면성형재건외과학회 1994 Maxillofacial Plastic Reconstructive Surgery Vol.15 No.4

양성 종양, 악성 종양, 감염, 외상 등에 의한 하악골 결손은 중대한 심미적, 생물학적 결과를 일으킨다. 재건술의 일차적 목적은 완전한 기능 회복이며 이는 이차적으로 심미적 변형의 정상화를 유도한다. 저자들은 1981년에서 1990년까지 서울대학교 치과대학 구강, 악안면외과에 내원하여 하악골 재건술을 시행받고 6개월 이상 추적조사가 가능한 61증례의 임상적 자료 및 방사선 검사를 통해 부위별 임상적 성공률을 조사하였다. 본 임상 논문의 목적은 하악골 결손부위와 부위에 따른 유리골 이식의 성공률을 연구하는데 그 의의를 두겠다. 유기골 의식의 임상적 연구를 요약해 보면 유리 자가골 이식의 대부분은 장골이었고 망상피질골이었다. 6개월 이상 추적조사가 가능한 61명의 환자에 있어 전체적 성공률은 80.3% 였다. 강선고정과 구외접근법이 다른 방법보다 그 예후에 있어 훨씬 더 좋은 결과를 나타냈고 다른 부위보다 하악 정중부위가 그 예후에 있어 훨씬 나쁜 결과를 보였다 Mandibular discontinuity defect due to benign tumor, malignant tumor, infection, or truma results in major esthetic and biologic compromise. The primary goal of reconstruction is full restitution of function, which secondarily lead to normalization of the cosmetic deformity. The authors make a clinical study of 6l consecutive bone graft cases for mandibular reconstruction of discontinuity defect which were studied retrospectively using clinical data and radiographic findings. The cases were reviewed to evaluate the clinical success in the period from 1981 to 1990 in the Dept. of Oral & maxillofacial Surgery, Seoul National University Hospital. The criteria of the success in bone graft, are no residual infection, graft in with maintain its integrity, and remain over a half of its original size of graft in the radiographic features. The purpose of this clinical survey is to study of the mandibular discontinuity defects and success rate of free bone graft in mandibular defects. To summarize the clinical study of free bone graft, the main type of autogenous bone graft is iliac bone and corticocancellous type. Overall success rate is 80.8% in 61 followup cases over 6 months. Wire fixation and Extraoral approach has realtively better prognosis than other methods. It showed relaltively poor prognosis in symphysis defects than other recipient site.

성장 중인 가토에서 기능적 하악운동이 골절된 하악두의 치유과정에 미치는 영향에 관한 실험적 연구

유준영(Jun Young You),김종원(Jong Won Kim) 대한구강악안면외과학회 1992 대한구강악안면외과학회지 Vol.18 No.1

The purpose of this experiment was to study effect of fuctional jaw movement to fractured condyle in growing individuals. The experimental materials were 20 rabbit aging 4weeks and weighting about 900g. Both control and experimental group were devided as 1week, 1weeks, 4weeks, 6weeks and 8weeks and each week groups consisted of 2 rabbits. The condyle neck fracture in the left temporomandibular joint was performed by fissure bur via preauicular approach. Every specimen was made by midsagittal section of the skull and taken soft x-ray radiogram by standardization. Measurements were measured after tracing of x-ray. The temporomandibular joint and their surrounding tissues were obtain to microscopic specimens stained with Hematoxilin-Eosin method. The results as follows. 1. The change of weight and measurements through the time follow, was simillar pattern in both control and experimental group as well as both side of experimental group. 2. The fracture site was gradually taken healing process and healing was completely in 8weeks. 3. The author concluded that the results were proven to be accepted clinical application of functional jaw movement in condylar fracture which was occured in growing individuals.

악교정 수술시 출혈량과 수혈에 관한 임상적 연구

유준영(Jun Young You),김용관(Yong Kwan Kim),신동용(Dong Yong Shin),이창선(Chang Sun Lee),양병은(Byung Eun Yang),송상훈(Sang Hun Song) 대한악안면성형재건외과학회 1998 Maxillofacial Plastic Reconstructive Surgery Vol.20 No.4

Moderns have desire likely to be further good-looking concomitant with a qualitative advancement of the life. With one of this phenomenon, an orthognathic surgery performing at the dept. of oral and maxillofacial surgery have been becoming a more extensively. It's possible to occur many complications during the operations and especially, an excessive bleeding of those may be fatal and so a transfusion is performing for the prevention &management of that. But, because of the rate of increase of an blood-born infection like AIDS via transfusion, nowadays an autologous blood transfusion is interesting to us. We made a comparative study of an amount of blood loss &transfusion using hemoglobin value after classifying the orthognathic surgeries from Feb. `97 to Mar. `98 in single-jaw and doublejaw surgery. And we intended to set a standard against of a routine preoperative cross-matching deciding the amount of predictive homologous blood transfusion according to operative method. Simultaneously, we studied the realization &effectiveness of autologous blood transfusion with some cases, so would like to present. Results: 1. Single-jaw operation can be performed without blood transfusion or with homologous blood transfusion through only blood typing & screening. 2. We commonly transfuse two units of blood with double-jaw operation and an autologous blood transfusion has much more advantage than an homologous blood transfusion. 3. We can reduce charge associated with blood transfusion through precisely preoperative evaluation of patients and proper type of blood transfusion.

상악골 수평골절단술 후 비외형 변화에 관한 임상적 연구

유준영(Jun Young You),배준수(Jun Soo Bae),류정호(Jong Ho Lyoo),김용관(Yong Kwan Kim) 대한구강악안면외과학회 1999 대한구강악안면외과학회지 Vol.25 No.4

The facial esthetics are much affected by nasal changes due to especially its central position in relation to facial outline and so appropriately evaluated should be the functional and esthetic aspects of the nose associated with the facial appearance. Generally, a maxillary surgical movement is known to induce the changes of nasolabial morphology secondary to the skeletal repositioning accompanied by muscular retraction. These changes can be desirable or undesirable to individuals according to the direction and amount of maxillary repositioning. We investigated the surgical changes of bony maxilla and its effects to nasal morphology through the analysis of the lateral cephalogram in the Le Fort Ⅰ osteotomy. Subjects were 10 patients(male 2, female 8, mean age 22.3 years) and cephalograms were obtained 2 weeks before surgery(T1) and 6 months after surgery(T2). The surgical maxillary movement was identified through the horizontal and vertical repositioning of point A. Soft-tissue analysis of the nasal profile was performed employing two angles: nasal tip projection(NTP), columellar angle(CA). Also, alar base width(ABW) was assessed directly on the patients with a slide gauge. The results were as follows; 1. Both anterior and superior movement above 2㎜ of maxilla rotated up nasal tip above 1㎜. Either anterior or superior movement above 2㎜ of maxilla made prediction of the amount & direction of NTP changes difficult. Especially, a correlation between horizontal movement of maxilla and NTP rotated-up was P<0.01. 2. Both much highly anterior and superior movement of maxilla is accompanied by more CA increase than either highly. Especially, the correlation between horizontal movement of maxilla and CA change was P<0.05. 3. Anterior and/or superior movement of maxilla was accompanied by the unpredictable ABW widening. 4. The amount of changes of NTP, CA, and ABW is not in direct proportion to amout of anterior and/or superior movement of maxilla. 5. Nasal morphologic changes following Le Fort Ⅰ osteotomy are affacted by not merely bony repositioning but other multiple factors.

Intra-oral vertico sagittal ramus osteotomy for treatment in habitual luxation

유준영(Jun Young You),이국엽(Kook Yeop Lee),윤현중(Hyun Hoong Yoon),고광희(Kwang Hee Ko),강명수(Myung Soo Kang) 대한구강악안면외과학회 1995 대한구강악안면외과학회지 Vol.21 No.4

악관절질환중 가장 오래전부터 인지되어왔고 치료되어졌던 악관절질환이며 그래서 그에 대한 치료방법도 많이 이루어져왔다. 습관성 악관절탈구의 원인은 악관절의 인대가 느슨해져서 악관절의 전방운동시 그의 제어가 불가능해져서 이루어진다. 이 악관절탈구의 치료방법은 느슨해진 인대에 Scleosing solution의 주입으로부터 악관절의 고정술, condylotomy까지 다양한 방법의 술식이 사용되어져왔다. 각각 술식의 장단점이 노출된 바 일종의 condylotomy로써 IVSRO를 이용하여 치료해본 결과 별다른 문제없이 치유되어 보고하는 바이다. Acute, recurrrent, and long-standing forward dislocation of the mandible are not common conditions compared with other conditions. Chronic recurrent dislocations of the mandible can be a significant problem. The understanding of the etiologic factors involved and the interrelations of the joint laxity to internal derangements of the disc are significant when considering the multiple factors of the TMJ disorders in general. A lot of literature shows that the treatment of painful condylar hypermobility, subluxation, and dislocation is approached in a rational conservative way utilizing surgical methods when nonsurgical treatment is not effective. In recurrent dislocation of the temporomandibular joint, many ways of treatment were reported such as eminectomy, eminence augmentation, and condylotomy. The final choice of the correct method(s) of tretment depends on a correct diagnosis and an understanding of the etiologic factors. Intra-oral vertical osteotomy is one of the widely used methods in correction of temporomandibular joint recurrent dislocation. But sagging of the TMJ after IVRO results in a bony step between the proximal segment and distal segment, and lateral rotation of the tempormandibular joint in a natural joint position. In this point of view, IVSRO has advantages. And healing is medular-to-medular minimum cortex-to-medular comparison with cortex-to-cortex healing in IVRO. The author thinks that IVSRO in correction of emporomandibular joint recurrent dislocation. The author performed the IVSRO(Choung s Osteotomy) in a habitual TMJ dislocation patient and it lead to good, and favorable post-pperative results in both function and esthetics.

악교정 수술 후 치수 생활력에 관한 임상적 연구

배준수(Jun Soo Bae),류정호(Jong Ho Lyoo),유준영(Jun Young You),김용관(Yong Kwan Kim),신동용(Dong Yong Shin),이창선(Chang Sun Lee) 대한악안면성형재건외과학회 1998 Maxillofacial Plastic Reconstructive Surgery Vol.20 No.4

After orthognathic surgery, postoperative complications are studied by many clinician. The complications include sensory disturbance, jaw fracture, excessive bleeding, condylar positional changes and loss of pulp vitality. Few surgical procedures are as satisfying for the surgeon and patient as a well-done orthognathic surgery. On the other hand, the patient is more satisfied with the result than who are treated with only orthodontic treatment especially in severe deformity case. There are problems that patient overcome but it is not serious complications. One of these, the problem about loss of pulp vitality can't influence function but give a lot of discomfort to the patient. From September 1997 to January 1998, 7 patients who are treated for dentofacial deformity via Le Fort I osteotomy or anterior segmental osteotomy were examined pulp sensitivity using digital pulp tester. This preliminary study have a focus on the investigation of recovery of pulp vitality. The electric pulpal test were used at preoperative, postoperative, at intervals. And we report some results acquired from this study. Following result are obtained 1. In anterior segmental ostetomy case (1 case), total 12 teeth were examined. Postoperative 8 weeks, 1 tooth are positive reaction 2. In Le Fort I osteotomy case (6 case), total 71 teeth were examined. Postoperative 8 weeks, 5 teeth are positive reaction.

악교정 수술 후 치수 생활력에 관한 임상적 연구

양병은,송상훈,유준영,김용관,신동용,이창선,Yang, Byung-Eun,Song, Sang-Hun,You, Jun-Young,Kim, Yong-Kwan,Shin, Dong-Yong,Lee, Chang-Sun 대한악안면성형재건외과학회 1998 Maxillofacial Plastic Reconstructive Surgery Vol.20 No.4

After orthognathic surgery, postoperative complications are studied by many clinician. The complications include sensory disturbance, jaw fracture, excessive bleeding, condylar positional changes and loss of pulp vitality. Few surgical procedures are as satisfying for the surgeon and patient as a well-done orthognathic surgery. On the other hand, the patient is more satisfied with the result than who are treated with only orthodontic treatment especially in severe deformity case. There are problems that patient overcome but it is not serious complications. One of these, the problem about loss of pulp vitality can't influence function but give a lot of discomfort to the patient. From September 1997 to January 1998, 7 patients who are treated for dentofacial deformity via Le Fort I osteotomy or anterior segmental osteotomy were examined pulp sensitivity using digital pulp tester. This preliminary study have a focus on the investigation of recovery of pulp vitality. The electric pulpal test were used at preoperative, postoperative, at intervals. And we report some results acquired from this study. Follwing result are obtained 1. In anterior segmental ostetomy case (1 case), total 12 teeth were examined. Postoperative 8 weeks, 1 tooth are positive reaction 2. In Le Fort I osteotomy case (6 case), total 71 teeth were examined. Postoperative 8 weeks, 5 teeth are positive reaction

악교정 수술시 출혈량과 수혈에 관한 임상적 연구

배준수,류정호,유준영,김용관,신동용,이창선,Bae, Jun-Soo,Lyoo, Jong-Ho,You, Jun-Young,Kim, Yong-Kwan,Shin, Dong-Yong,Lee, Chang-Sun 대한악안면성형재건외과학회 1998 Maxillofacial Plastic Reconstructive Surgery Vol.20 No.4

Moderns have desire likely to be further good-looking concomitant with a qualitative advancement of the life. With one of this phenomenon, an orthognathic surgery performing at the dept. of oral and maxillofacial surgery have been becoming a more extensively. It's possible to occur many complications during the operations and especially, an excessive bleeding of those may be fatal and so a transfusion is performing for the prevention &management of that. But, because of the rate of increase of an blood-born infection like AIDS via transfusion, nowadays an autologous blood transfusion is interesting to us. We made a comparative study of an amount of blood loss &transfusion using hemoglobin value after classifying the orthognathic surgeries from Feb. '97 to Mar. '98 in single-jaw and doublejaw surgery. And we intended to set a standard against of a routine preoperative cross-matching deciding the amount of predictive homologous blood transfusion according to operative method. Simultaneously, we studied the realization &effectiveness of autologous blood transfusion with some cases, so would like to present. Results: 1. Single-jaw operation can be performed without blood transfusion or with homologous blood transfusion through only blood typing & screening. 2. We commonly transfuse two units of blood with double-jaw operation and an autologous blood transfusion has much more advantage than an homologous blood transfusion. 3. We can reduce charge associated with blood transfusion through precisely preoperative evaluation of patients and proper type of blood transfusion.

악교정 수술시 보스민 거즈에 의해 나타난 폐부종 증례보고

김재경,김용관,유준영,주진철,이창선,Kim, Jae-Gyung,Kim, Yong-Kwan,You, Jun-Young,Joo, Jin-Churl,Lee, Chang-Sun 대한악안면성형재건외과학회 1998 Maxillofacial Plastic Reconstructive Surgery Vol.20 No.2

구강악안면영역은 그 해부학적 구조상 혈관 분포가 풍부하고 따라서 구강내로 접근하는 수술시 신체 다른 부위와 달리 출혈 소견을 많이 보이며 수술중 과다출혈의 방지와 지혈의 목적으로 epinephirne soaked gauze즉 bosrnine gauze의 사용이 널리 이루어지고 있고 또한 사용이 불가피하다고 할 수 있다. 그러나 이 부분은 혈관 분포가 풍부하므로 epinephrine의 systemic uptake의 가능성 또한 존재한다 할 수 있겠다. 고농도의 epinephrine은 이론상 혈관수축을 일으켜 순간적인 systemic volume overload의 상태를 야기시켜 폐부종 및 pulmonary effusion을 일으킬 수 있으나 아직까지 보고된 바 없었다. 악안면부위는 혈관공급이 많아 수술중 지혈이 용이하지 못해 bleeding control을 위해 또 습관적으로 bosmine 거즈의 packing이 행해지고 있지만 수술자에 의한 정확한 농도로 희석된 bosmine 거즈 사용이 필수적이다. 본원에서 양악 악교정 수술시 소독간호사에 의해 잘못 희석된 고농도의 bosmine 거즈를 상악후방에 packing하여 발생된 전신적 합병증으로써 폐부종이 발생한 바 bosmine 거즈의 사용시 사용부위에 따라 농도의 확인과 술자의 주의를 요한다고 생각된다. There are many vessels in oral and maxillofacial region. Therefore blood oozing is a frequent findings in this area when operation takes place. Beacuse of this, most oral and maxillofacial surgeons as well as operators of this region usually use bosmine soaked gauze for oozing control during operation. Theoretically overdose of systemic epiniephrine(bosmine) may lead to pulmonary edema due to secondary systemic volume overload. For this reason, oral and maxillofacial surgeons should give more attention to the use of bosmine soaked gauze. In spite of this possibility, epinephrine induced pulmonary edema using bosmine soaked gauze has not been reported. We experienced one case of pulmonary edema which was induced by epinephrine overdose by bosmine soaked gauze that has not been diluted by mistake in preparing bosmine soaked gauze. The authuors report a case with review of literature.