상악결손부의 2차적 재건에 있어 유리 혈관화 피판의 적용

권대근(Tae-Geon KWON),김진수(Chin-Soo KIM) 대한치과의사협회 2011 대한치과의사협회지 Vol.49 No.9

Microvascular reconstruction of maxillary composite defect after oncologic resection has improved both esthetic and functionai aspect of quality of life of the cancer patients. However, a lot of patients had prior surgery with radiation and/or chemotherapy as a part of comprehensive cancer treatment. Sometimes it is nearly impossible to find out adequate recipient vessel for maxillary reconstruction with microvascular anastomosis. Therefore long pedicle of the flao is needed to use distant neck vessels located far from the reconstruction site such as ipsilateral transverse cervical artery or a branch of contralateral external carotid artery. For this reason, although we know the treatment of the choice is osteocutaneous flap, it is difficult to use this flap when we need long pedicle with complex three dimensional osseous defect. Vascular option for these vessel-depleted neck patients can be managed by a soft tissue reconstruction with long vascular pedicle and additional free non-vascularized flap that is rigidly fixed to remaining skeletal structures. For this reason, maxillofacial reconstruction by vascularized soft tissue flap with or without the secondary restoration of maxillary bone with non-vascularized iliac bone can be regarded as one of options for reconstruction of profound maxillofacial composite defect resulted from previous oncological resection with chemoradiotherapy.

폐쇄성 수면 무호흡증에 대한 포괄적 치료

권대근(Tae-Geon Kwon),조용원(Yong-Won Cho),안병훈(Byung-Hoon Ahn),황상희(Sang-Hee Hwang),남기영(Ki-Young Nam) 대한구강악안면외과학회 2004 대한구강악안면외과학회지 Vol.30 No.2

The etiology of the obstructive sleep apnea includes the various factors such as anatomical abnormality in upper airway, craniofacial structure, obesity and personal habit. To establish reasonable treatment plan, multi-department approach is should be emphasized because the treatment modality is depend on the result of analysis for degree & site of obstruction and various behavioral factors. In Sleep Clinic in Keimyung University Medical Center, the standard of care for sleep apnea patient was established according to the Standard of practice committee of Americal Sleep Disorders Association. After one year experience of comprehensive approach for sleep apnea we could achieve following recommendation for the treatment. 1) The multi-department examination and diagnosis could prevent unnessesary treatment because the treatment plan could be established under comprehensive discussion. 2) Determination of the site of obstruction is important for treatment planning. However, no single determinant could be found. We expect multi-department approach can reduce the mistake in detection of obstruction. 3) Further evaluation of treatmet outcome should be succeeded to establish Korean standard of care for sleep apnea treatment.

측완피판(Lateral upper arm free flap)을 이용한 구강내 결손부의 재건

권대근(Tae Geon Kwon),이상한(Sang Han Lee),R Schmelzeisen,N-C.Gellrich 대한구강악안면외과학회 1999 대한구강악안면외과학회지 Vol.25 No.3

1997년 4월부터 1998년 8월까지 독일 Freiburg 대학에서 행하여진 20증례의 측완피판(Lateral upper arm free flap)을 대상으로 수술증 임상적 소견과 피판생존률, 술후 합병증등의 술후 경과를 관찰하여 다음과 같은 결과를 얻었다. 1. 한 증례의 피판의 완전괴사와 한 증례의 부분괴사를 제외하고 측완피판은 구강내 결손부 재건에 수혜부와 양호한 적합을 이루었으며 저작, 연하등의 기능적 재건에 적합한 정도의 두께와 크기를 제공하였다. 2. 공여부의 감각이상을 보인 증례가 전체의 40%를 차지하였으나 이로인한 불편감을 호소하는 환자는 없었으며 Radial n. 의 손상이나 심한 반흔을 보이지 않았다. 3. 측완피판은 과거 구강악안면부위 결손부의 수복에 주로 이용된 전완피판의 새로운 대안이 될 수 있으나 혈관경의 직경이 작아 수술에 다소의 숙련도를 요하는 것으로 사료된다. Thin and pliable fasciocutaneous free flap is recommended to reconstruct the intraoral defects of intraoral mobile structures to maintain function at optimum. Recently, radial forearm free flap is one of the popular flaps for intraoral reconstruction for these reasons. However, donor site morbidity such as necessary skin grafting and esthetic compromise was the problems of this flap. In this point of view, lateral upper arm free flap(LUFF) has many advantages include relatively simple vascular anatomy and very low doner site morbidity. The purpose of this study is to investigate the 20 consecutive LUFF and evaluate the surgical procedure and postoperative results. The lateral arm flap provided a good functional and esthetic result except for one case of complete flap necrosis because of vascular insufficiency of the supplying vessel of the neck. Although post-operative lower arm partial sensory deficit is a possible disadvantage of this flap, it is a highly reliable method for oral reconstruction with minimal complication.

비스포스포네이트 관련 골괴사의 병태생리학적 기전에 대한 검토

권대근(Tae-Geon Kwon) 대한치과의사협회 2014 대한치과의사협회지 Vol.52 No.4

Bisphosphonate(BP) significantly influence the bone remodeling process. Increasing number of patients with osteoporosis and metastatic bone disease need high dose or long term bisphosphonate therapy. Major adverse effect is jaw bone necrosis and now the bisphosphonate-related necrosis of the jaw(BRONJ) is the major concern of dental practitioner. This study intended to perform the review of the current understandings concerning the pathophysiology of BRONJ. Even though pathophysiological mechanism of BRONJ is not clearly elucidated but now suggested as largely two different concepts; so-called “inside-out” or “outside-in” theory. Inside-out theory emphasize the osteonecrosis of the jaw is the initial major event and subsequent infection and inflammation is the second event that accompanies bone exposure and death of overlying mucosa. However, in “outside-in” theory, infection or inflammation initiated by traumatized oral epithelium is the major event of BRONJ. Both theory would be partially explain BRONJ. Recent research reveals the immune modulating effect and influence of microcrack accumulation by BP. These findings and those of others might explain the missing part of outside-in theory.

구강암의 연구동향 및 임상적 의의

권대근(Tae-Geon Kwon),김진수(Chin-Soo Kim) 대한치과의사협회 2010 대한치과의사협회지 Vol.48 No.8

Recent advancement in molocular biology enhanced further understanding of the carcinogenesis of oral cancer and its relation with various genetic backgrounds. Familial risk factors includes similar habits of the family and polymorphic variations of the genes. Recently, human papilloma virus has been suggested to be linked with oral cancer progression. Enhancement of understanding of the damage or alteration in molecular pathway in various cellular response of oral cancer progression would lead the targeted therapy or precise early diagnosis of the oral cancer.

임플란트 식립후 하악 신경손상에 대한 후향적 연구

권대근(Tae-Geon Kwon),김신유(Shin-Yu Kim),김종배(Jong-Bae Kim) 대한구강악안면외과학회 2004 대한구강악안면외과학회지 Vol.30 No.4

The purpose of this study was to evaluate neurosensory disturbance associated with implant surgery performed by implant practitioner(n=47) composed of trained oral surgeon, periodontist, prosthodontist. The incidence, type and duration of sensory disorder were investigated. Anatomical factor of the patient and experience of operator were also evaluated. The result revealed high incidence of inferior alveolar nerve damage (45%) regardless of experience of implant practitioner. The sensory disturbance sustained within 6 months for 61% of cases, which revealed almost normal recovery of nerve function. Initial neurologic sign after nerve damage was not coincide with their consequence of recovery. Half of the practitioners tried surgical intervention to the implants such as removing the fixture, partial unscrewing or re-implant shorter fixture, of which trial regarded as effective measure for 53% of cases. The result indicates that the objective method of sensory nerve evaluation should be introduced to the implant practitioners and the importance of informed consent for possibility of nerve damage in mandibular implant fixation.

구순구개열환자에 대한 악교정수술후 안정성에 대한 연구

권대근(Tae Geon Kwon),森悅秀(Yoshihide Mori),南克浩(Katsuhiro Minami),김종배(Jong Bae Kim) 대한구강악안면외과학회 2000 대한구강악안면외과학회지 Vol.26 No.4

To evaluate the stability after orthognathic surgery in cleft lip and palate patients using rigid fixation, 20 patients underwent primary repair in childhood and later developed a jaw deformity and malocclusion that required orthognathic surgery were reviewed. Two groups, one of 10 patients performed Le Fort I osteotomy with sagittal split ramus osteotomy and one of 10 patients with sagittal split ramus osteotomy of the mandible, were evaluated. Each group had unilateral cleft only and all alveolar cleft sites had been grafted with autogeneous bone before the orthognathic surgery. The amount of surgical movement and relapse were compared in both horizontal and vertical dimensions. Two-jaw surgery group was more stable than mandibular surgery only group in mandibular position (p< 0.05). Statistically significant relapse was observed in mandibular skeletal point in mandibular surgery group (p<0.05). There was no statistically significant relapse in the skeletal point of two-jaw surgery group. However, the correlation between the horizontal surgical movement and relapse was detected (r = 0.88). This correlation indicates the need of overcorrection. The presence of scar tissues and relatively deficient maxillary bone could be attributed to this close relation between the surgical change and relapse.

폐쇄성 수면 무호흡증에 있어 두부 규격 방사선 계측학적 기여 인자

권대근(Tae-Geon Kwon),조용원(Yong-Won Cho),안병훈(Byung-Hoon Ahn),서영성(Young-Sung Suh) 대한구강악안면외과학회 2003 대한구강악안면외과학회지 Vol.29 No.5

Purpose : This study was intended to perform cephalometric comparison between the patients with and without obstructive sleep apnea (OSA). The factors influencing the OSA in the lateral cephalogram was also investigated. Patient and Method : Twenty four patients who visited Sleep Disorder Clinic in Dongsan Medical Center, Keimyung University and evaluated with polysomnograph(PSG) and cephalogram were included in the study. The patients had apnea-hypopnea episode(AHI) over 10 times per hour was diagnosed as OSA after overnight PSG. To evaluate hard and soft tissue profile, cephalometric radiogram were taken at maximal intercuspation(P1) and mandibular protruding position(P2). The diffefence between the OSA and normal group were evaluated statistically and the stepwise regression analysis was applied to analyse the cephalometric influencing factors to OSA. Result : The OSA Group(n=14) had significantly higher Body Mass Index(BMI) than control group(n=10). Lower facial height(ANSGn) was longer in OSA group. However statistically significant difference was not detected in other anteroposterior craniofacial measurements. The soft palate lenth (PNS-P), hyoid position (MP-Hyoid) had positive correlation between AHI (r=0.496, r=0.413, respectively, p<0.05). However, the measurements of oropharyngeal airway was not different between the two groups. The hypothesis, the antero-posteriorly narrow oropharyngeal airway might aggravate the airway resistance and can give rise to higher AHI, was not accepted in the study. This can be attributed by inclusion of the patients performed uvulopalatopharyngoplasty because of the tonsilar or soft palate hypertrophy in the present study. The results of regression analysis revealed that PNS-P, upper airway width(Nph1), upper facial heght(N-ANS), and lower facial height(ANS-Gn) could influence the degree of AHI (F value < 0.0001, R2 = 0.829). Conclusion : We suggest lateral cephalogram may utilized as a useful method to evaluate OSA. The patient with long soft palate, narrow upper airway width, long upper & lower facial height can be expected to have high risk of OSA. However, it should be emphasized the comphrehensive intraoral inspection including soft palate and tonsilar hypertrophy because lateral cepahlogram cannot visualize oropharyngeal status completely

턱교정 수술에서 3차원 입체 모델과 치아 석고모형의 결합을 이용한 하악 근원심 골편간 간섭의 예측

권대근(Kwon Tae-Geon),이상한(Lee Sang-Han),김종배(Kim Jong-Bae),남기영(Nam Ki-Young) 대한구강악안면외과학회 2003 대한구강악안면외과학회지 Vol.29 No.3

Three-dimensional solid model has not been widely used in surgical prediction of orthognathic surgery because frequent artifacts from occlusal restorations or prosthesis limited the usefulness of simulated surgery involving occlusion. We prepared three-dimensional(3D) solid model from CT data and integrated the 3D solid model with dental cast using a face-bow transfer technique combined with skeletal reference measurement and confirmation with cephalometric radiographs. With this simple and easy method, it was possible to predict bony interference between the proximal and distal segment of the mandible so that we can prevent condylar displacement after sagittal split ramus osteotomy of the mandible with prominent asymmetry. The method error was within 2mm and it seemed to be useful in preoperative planning for maxillofacial surgery with maxillo-mandibular occlusal change.

탈단백 소뼈 기질과 다양한 종류의 흡수성 막을 이용한 상악동 거상술 후의 조직-형태학적 분석

장태화(Tae-Hwa Jang),장윤제(Yoon-Je Jang),권대근(Tae-Geon Kwon),이상한(Sang-Han Lee) 대한구강악안면외과학회 2007 대한구강악안면외과학회지 Vol.33 No.6

Purpose: The aim of the present study was to evaluate the effect of Bio-Oss on bone formation in terms of healing period and type of membrane so that determine the most suitable condition for implant fixation in grafted maxilla. Material & Method: Forty-five biopsy specimens from graft site were evaluated. Sinus lift was performed in the patients with reduced alveolar bone height(less than 5mm). The specimen was taken at the time of implant fixation, which was performed at least 5 months after the sinus lift procedure. All specimens were stained with H&E and Trichrome staining and evaluated histomorphometrically. Result: The results showed that Bio-Oss particle was in direct contact with newly formed bone in all cases. In the present study, the amount of newly formed bone and the residual bone substitute material were not statistically different according to various membrane and different healing period. There was no difference between the histological feature of the specimen of 5 and 31 months. No statistical significance was detected between male and female. Conclusion: The result implies that Bio-Oss does not seem to be resorbed over time regardless of the type of the membranes. The further investigation is needed to clarify this issue with the extended period of follow-up.