The management of mandibular arteriovenous malformation using the surgical therary with preoperative embolization

장도근(Do Geun Jang),최강영(Kang Young Choi),김진수(Chin Soo Kim) 대한구강악안면외과학회 1995 대한구강악안면외과학회지 Vol.21 No.4

구강악안면영역의 혈관질환은 매우 위험한 질환으로 술자에게 주의를 요한다. 여기에는 혈관종과 혈관기형이 있으며 정확한 기왕력과 적절한 임상검사로 감별진단이 가능하지만 진단적인 혈관조영술이 요구되기도 한다. 치료에는 경화술, 냉동술, 방사선치료, 결찰술, 혈관색전술, 레이저치료 및 외과적 접근법이 있다. 특히 동정맥기형에서의 외과적 접근법에는 많은 논란이 있는데, 병소의 경계를 포함한 완전한 제거가 요구된다는 의견과 단순한 소파술만으로 치료가 가능하다는 상반된 경우가 있다. 본 증례는 Gelfoam을 이용하여 술전 혈관색전술 시행한 후 건전한 협측 피질골을 거상, 내부 종물의 소파술을 시행한 후 거상한 피질골을 재위치시킴으로서 악골의 외형을 잘 보존한 경우로 술후 기능적 및 심미적으로 양호한 결과를 얻었기에 보고합니다. Vascular lesions of the oral and maxillofacial region are as challenging to clinicians as they are devastating to patients. Two basic entities of hemangioma and vascular malformations exist as vascular lesions. The differential diagnosis bfetween these two lesions can be done through the history and the phyisical findings. Some lesions may be difficult to evaluate; therefore, a diagnostic angiography may be employed. Management of maxillofacial vascular malformations consists of sclerotherapy, cryotherapy, radiotherapy, intralesional ligation, embolotherapy, laser therapy, and surgical treatment. The surgical management of vascular malformations, particularly the arteriovenous malformation, remains as controversial an issue as any in contemporary oral and maxillofacial surgery. On one hand, there is a surgically aggressive school of thought that advocates major segmental or en bloc resecton of the arteriovenous malformation. The opposite point of view is clearly reflected by the numerous case reports that appear in the literature of arteriovenous malformations managed by simple curettage. We experienced a large mandibular arteriovenous malformation with an intact buccal cortex that was treated with curettage with the lateral decortication and reposition of the decorticated buccal bone plate after preoperative embolization using Gelfoam and without arbitrary sacrifice of the uninvolved cortical margin that could provide stability of the mandibular arch. The postoperative result was good aesthetically and functionally.

유두상 혈관내막 증식증의 임상적 보고

이정우,정호윤,이석종,김귀락,최강영,양정덕,조병채,Lee, Jeong-Woo,Chung, Ho-Yun,Lee, Seok-Jong,Kim, Gui-Rak,Choi, Kang-Young,Yang, Jung-Dug,Cho, Byung-Chae 대한성형외과학회 2010 Archives of Plastic Surgery Vol.37 No.3

Purpose: Intravascular papillary endothelial hyperplasia (IPEH), also known as Masson's pseudoangiosarcoma, is a rare disease which is now considered as a reactive process of the endothelium rather than a benign neoplasm. It can occur in any blood vessels in the body but more common in the head and neck region as a solitary, often tender, bluish or reddish nodule. IPEH is characterized by the development of endothelial-lined papillary projections in a vascular lumen, usually associated with thrombotic material, the endothelial cells in the papillary structures showing only slight atypia and occasional mitotic Figures, the absence of tissue necrosis. Methods: 8 patients with IPEH were enrolled in the study from 2002 to 2007. All 8 lesions were surgically excised for histopathologic diagnosis. Results: 4 patients were female. The duration of the lesions ranged from 3 months to 15 years. The tumors were first noted between the ages of 20 and 72 years. 4 patients had lesions on the head; 2 on the toe; 1 on the back; and 1 on the finger, respectively. All lesions were solitary, ranged in size from 2 mm to 27 mm. There were no recurrences. Conclusion: The clinical appearance of IPEH is not specific, presented as a primary neoplasm, and the diagnosis can be established by microscopic examination. Complete surgical excision is the best choice of therapy for patients with IPEH, and is both diagnostic and curative. Awareness of this lesion will prevent incorrect diagnosis and overly aggressive treatment.

과다 유두(Supernumerary Nipple) 2례

이정우,양정덕,이정훈,최강영,김귀락,정호윤,조병채,Lee, Jeong-Woo,Yang, Jung-Dug,Lee, Jung-Hun,Choi, Kang-Young,Kim, Gui-Rak,Chung, Ho-Yun,Cho, Byung-Chae 대한성형외과학회 2010 Archives of Plastic Surgery Vol.37 No.5

Purpose: Supernumerary nipple or polythelia is one of the developmental anomalies occurring at the embryonic stage and this anomaly usually arises from the milk line. While this atypical feature is determined during early developmental stage, it may not come out obviously or become troublesome until puberty or lactation. Moreover, sometimes it is confused with a pigmented nevus. Methods: Case 1, a 18-year-old woman with intramammary supernumerary breast consisted of another nipple with middle sized areola on the right lower breast was admitted for a $2.8{\times}3.1\;cm$-sized mass on the right breast which was starting appeared 1 year earlier. The preliminary cytological examination of the material obtained by needle aspiration biopsy from the mass was revealed by fibroadenoma with no malignant change. The patient had the surgical excision of the mass and accessory breast. Case 2, a 16 year-old woman admitted for intra-areolar polythelia of the left breast, even she doesn't have any family history of polythelia. Since she wanted surgical correction of her atypical nipple for aesthetic and psychological reasons, we reconstructed the areola using transposition flaps in an S-plasty design. Results: Case 1, the excised supernumerary nipple showed following histological features. In the superficial layer, an acanthotic and hyperpigmented epithelium with elongated rete ridges was found. In the dermis, there were follicles with hairs surrounded by hypertrophic sebaceous glands. In the deepest portion, abundant secretory glomerules and excretory ducts of apocrine gland type were observed. Case 2, follow-up visits 3 months after the procedure showed a satisfactory result with good shape and projection of the nipple. Conclusion: We report two cases of aberrant mammary tissue who underwent surgical correction, including complete breast (with nipple, areola, and glandular tissue) and intra-areolar polythelia according to the Kajava's classification, and the results were satisfactory.

진행성 유방암에 있어 유방절제술 후 발생한 광범위 피부결손 부위의 가슴배피판을 이용한 흉벽재건술

김학태,양정덕,정호윤,조병채,김귀락,최강영,이정훈,박호용,Kim, Hak-Tae,Yang, Jung-Dug,Chung, Ho-Yun,Cho, Byung-Chae,Kim, Gui-Rak,Choi, Kang-Young,Lee, Jung-Hun,Park, Ho-Yong 대한성형외과학회 2010 Archives of Plastic Surgery Vol.37 No.6

Purpose: Radical surgical extirpation in advanced breast cancer patients produces extensive loss of skin with large defects requiring plastic surgical procedures for the closure. Many reconstructive methods exist, the choice of which depends upon the characteristic of the wound, extent of resection and patient comorbidities. For adequate coverage of the large skin defects following resection of advanced breast cancer, current authors have performed a thoracoabdominal flap. Methods: From August 2008 to June 2009, 4 cases of thoraco-abdominal flap were performed for chest wall reconstruction after mastectomy of advanced breast cancer. Flap dissection was entirely performed in a subfascial plane and the flap involving the external oblique abdominal muscle. The flap was rotated clockwise in left chest wall defects and counterclockwise in right chest defects and the donor site was closed directly. Results: Their mean age, 55.7 years and the average follow-up interval was 9 months. Patients' oncologic status ranged from stage IIIc to stage IV, it was classified according to the TNM staging system. Flap dimensions ranged between $15{\times}15$ and $25{\times}25\;cm$. One flap sustained a partial loss at the distal margin and revision with pectoralis major musculocutaneous island flap. Conclusion: Large chest wall reconstructions are usually required after radical excision of advanced cancer stages patients with poor general conditions. Thoracoabdominal flap is a simple, quick single-stage procedure, and offer to patient fast recovery, low complication rate, enabling further concomitant adjuvant therapy.

지난 8년간의 구강악안면외과 입원환자에 대한 임상통계학적 분석

이상한(Sang Han Lee),김진수(Chin Soo Kim),장현중(Hyun Jung Jang),홍창수(Chang soo Honag),최강영(Kang Young Choi) 대한구강악안면외과학회 1995 대한구강악안면외과학회지 Vol.21 No.2

This study was done to analyze annual changes in hospital admission rates, coming rate at emergency room and demographic profiles of hospital care in Oral and Maxillofacial Surgery (OMS) and Kyungpook National University Hospital (KNUH) at the Taegu City and Kyungpook Province region 1986-1933. The result were as follows : 1. In annual changes of inpatient, increasing rate of inpatients from 1986 to 1933 were 12.9% (OMS), 10.8% (KNUH), male to female ratio was about 1.9 : 1(OMS), 1.2 : 1(KNUH). 2. There was more deviation of the month at early stage (1986-1989) and less deviation at the stage (1990-1993). 3. Most of inpatients at surgical parts (62.9% OMS, 76.1% KNUH) underwent operation under G.A.(95.8% OMS, 65.8% KNUH) 4. For the consultation, 108.3 cases were referred from OMS, and 287.4 cases were referred to OMS. 5. In annual changes of each department, total number of inpatient-days and discharged patient by 1993 were over the average values of each other at NEU, OB & GY, ENT, OMS. 6. In annual changes of patients at emergency room, increasing rate of coming patients were 12.5% (OMS), 5.6% (KNUH). Also average coming patients per day was incresed from 0.4 to 0.9 7. By assoryment of patients, component ratio of T.A. was largely decresed from 10.4% (1986-1989) to 5.3% (1990-1991) 8. There was ore patients in September (OMS, August-October at T.A.), and less in February (OMS, T.A). 9. Most of coming patients came from Taegu(53.2%) and Kyungpook province(43.7%)

전산화단층촬영법을 이용한 하악 전돌증 환자의 하악지 시상 골절단술후 하악과두 위치변화 분석

이상한,최강영 大韓顎顔面成形再建外科學會 1996 Maxillofacial Plastic Reconstructive Surgery Vol.18 No.4

This study was intended to perform the influence of condyle positional change after surgical correction of skeletal Class Ⅲ malocclusion after BSSRO in 20 patients(males 9, females 11) using computed tomogram that were taken in centric occlusion before, immediate, and long term after surgery and lateral cephalogram that were taken in centric occlusion before, 7 days within the period intermaxillary fixation, 24hour after removing intermaxillary fixation and long term after surgery. 1. Mean intercondylar distance was 84.45 ±4.01㎜ and horizontal long axis of condylar angle was 11.89 ±5.19°on right, 11.65 ±2.09°on left side and condylar lateral poles were located about 12㎜ and medial poles about 7㎜ from reference line(AA') on the axial tomograph. Mean intercondylar distance was 84.43 ±3.96㎜ and vertical axis angle of condylar angle was 78.82 ±3.43°on right, 78.09 ±6.12°on left. 2. No statistical significance was found on the condylar change(T2C-T1C) but it had definitive increasing tendency. There was significant decreasing of the distance between both condylar pole and the AA'(p<0.05) during the long term(TLC-T2C). 3. On the lateral cephalogram, no statistical significance was found between immediate after surgery and 24 hours after the removing of intermaxillary fixation but only the lower incisor tip moved forward about 0.33㎜(p<0.05). Considering individual relapse rate, mean relapse rate was 1.2% on L1, 5.0% on B, 20.% on Pog, 9.1% on Gn, 10.3% on Me(p<0.05). 4. There was statistical significance on the influence of the mandibular set-back to the total mandibular relapse(p<0.05). 5. There was no statistical significance on the influence of the mandibular set-back(T2-T1) to the condylar change(T2C-T1C), the condylar change(T2C-T1C, TLC-T2C) to the mandibular total relapse, the pre-operative condylar position to the condylar change(T2C-T1C, TLC-T2C), the pre-operative mandibular posture to the condylar change(T2C-T1C, TLC-T2C)(p>0.05). 6. The result of multiple regression analysis on the influence of the pre-operative condylar position to the total mandibular relapse revealed that the more increasing ofintercondylar distance and condylar vertical axis angle and decreasing of condyalr head long axis angle, the more increasing of mandibular horizontal relapse(L1,B,Pog,Gn,Me) on the right side condyle. The same result was founded in the case of horizontal relapse(L1,Me) on the left side condyle.(p<0.05). 7. The result of multiple regression analysis on the influence of the pre-operative condylar position to the pre-operative mandibular posture revealed that the more increasing of intercondylar distance and condylar vertical axis angle and decreasing of condylar head long axis angle, the more increasing of mandibular vertical length on the right side condyle. and increasing of vertical lengh & prognathism on the left side condyle(p<0.05). 8. The result of simple regression analysis on the influence of the pre-operative mandibular posture to the mandibular total relapse revealed that the more increasing of prognathism, the more ncreasing of mandibular total relapse in B and the more increasing of over-jet the more increasing of mandibular total relapse(p<0.05). Consequently, surgical mandibular repositioning was not significantly influenced to the change of condylar position with condylar reposition method.

전산화단층촬영법을 이용한 하악 전돌증 환자의 하악지 시상 골절단술후 하악과두 위치변화 분석

최강영 慶北大學校 齒科大學 1996 慶北齒大論文集 Vol.13 No.-

본교실에서 하악지 시상 골절단순을 시행한 하악전돌증 환자 20명(남자 9명, 여자 11명)을 대상으로 술전, 술직후 장기관찰기간동안의 전산화단층촬영법을 이용한 하악과두의 위치변화와 술전, 술직후, 악간고정제거 24시간후 및 장기관찰기간동안의 측모두부방사선사진에서의 재발과의 상관관계를 연구한 결과 다음과 같은 결과를 얻었다. 1. 두부 축방향 전산화단층에서의 과두간거리(MM')는 84.45±4.01mm 였으며, 장축각은 우측 11.89+5.1 9˚ 좌측 11.65±2.09˚로 좌우 비슷하였으며, 기준선(AA')에서 과두의 외측점은 12mm,내측점은 7mm 정도 전방에 위치하였다. 관상면 전산화단층사진에서의 과두간 거리(mm')는 84.43±3.96mm였으며, 사축각은 우측 78.12±3.43˚ 좌측 78.09±6.12˚ 로 좌우 비슷하였다. 2. 술전후 과두위치 변화 (T2C-T1C)는 통계적인 유의성은 없었으나(p>0.05), 다소 증가하는 경향을 보였으며, 장기관찰에 따른 회귀성향(TLC-T2C)에서는 LMD,LLD(p<0.05),RLD, RMD(p<0.01), mm'(P<0.001)는 모두 감소하였다. 3. 측면두부방사선사진상에서 술직후와 악간고정제거 24시간후(T3-T2)에서 하악의 초기재발은 통계적인 의의가 없었으며(p>0.05)하악전치의 경우만 평균 0.33mm 전방이동 하였다(p<0.05). NN'L1, NN'Pog, NN'Gn, NN'Me, over-jet에서 통계적인 유의성이 있었으며(p<0.05), NN'L1 1.2%, NN'B 5.0%, NN'Pog 2.0%, NN'Gn 9.1%, NN'Me 10.3%의 총재발량을 보였다, 4. 하악골의 술전, 술후 변화량(T2-T1)이 총재발량에 미치는 영향에 대한 희귀분석에서 후퇴량이 많을수록 하악골의 총재발량이 많은 것으로 나타났다(P<0.05). 5. 하악골 변화량(T2-T1)과 하악과두 변화량 (T2C-T1C, TLC-T2C), 하악과두 변화량 (T2C-T1C, TLC-T2C)과 총재발량(TL-T2), 술전 하악과두 형태(T1C)와 하악과두 변화량(T2C-T1C, TLC-T2C), 그리고 술전 하악골 외형(T1)과 하악과두 변화량 (T2C-T1C,TLC-T2C)에 대하여 단순 및 복잡회귀분석에서 통계적인 유의성은 없었다(p>0.05). 6. 술전 하악과두 형태(T1C)가 총재발량(TL-T2)에 미치는 영향에 대한 복잡회귀분석결과 우측과두에서는 과두간 거리가 멀고 장축각이 적고 사축각이 클수록 하악골의 수평적인 재발(NN'L1, NN'B, NN'Pog, NN'Gn, NN'Me)이 많은 것으로 나타났으며 (p<0.05), 좌측과두에서는 NN'L1, NN'Me에서 같은 결과를 보였다. 7. 술전 하악과두 형태 (T1C)가 술전 하악골외형(T1)에 미치는 영향에 대한 복잡회귀 분석결과 우측과두에서는 과두간 거리가 멀고 장측각이 적고 사축각이 클수록 하악골의 수직고경이 큰 것으로 나타났고(p<0.05), 좌측과두에서는 과두간 거리가 멀고 장축각이 적고 사축각이 클수록 수직고경이 크며, 전돌된 양상으로 나타났다(p<0.05). 8. 술전 하악롤 외형(T1)이 총재발량(TL-T2)에 미치는 영향에 대하여 단순희귀분석을 시행한 결과 NN'L1 NN'B, NN'Gn, NN'Me, over-jet 등의 계측점에서 하악골이 전돌된 양상을 보일수록 NN'B에서의 총재발량은 많은 것으로 나타났다(p<0.05). 또 수평피개량(over-jet)이 클수록 NN'B, NN'Pog, NN'Gn, NN'Me에서의 총재발량이 많은 것으로 나타났다(p<0.05).따라서 과두보존술을 이용하여 과두를 안정화시키고 난후 악골 형태를 재구성하였을 때 이로 인하여 생기는 하악과두 이동은 미미하여 술후 재발에 크게 영향을 미칠 정도는 아니라고 사료된다. This study was intended to perform the influence of condyle positional change after surgical correction of skeletal Class Ⅲ malocclusion after BSSRO in 20 patients(males 9, female 11) using computed tomogram that were taken in centric occlusion before, immediate, and long term after surgery and lateral cephalogram that were taken in centric occlusion before, 7 days within the period intermaxillary fixation, 24hours after removing intermaxillary fixation and long term after surgery. 1. Mean intercondylar distance was 84.45±4.01nm and horizontal long axis of condylar angle was 11.89±5.19˚ on right, 11.65±2.09˚ on left side and condylar lateral poles were located about 12mm and medial poles about 7mm from reference line(AA') on the axial tomograph. Mean intercondylar distance was 84.43±3.96mm and vertical axis angle of condylar angle was 78.72±3.43˚ on right, 78.09±6.12˚ on left. 2. No statistical significance was found on the condylar change(T2C-T1C) but it had definitive increasing tendency. There was significant decreasing of the distance between both condylar pole and the AA(p<0.05) during the long term(TLC-T2C). 3. On the lateral cephalogram, no statistical significance was found between immediate after surgery and 24 hours after the removing of intermaxillary fixation but only the lower incisor tip moved forward about 0.33mm(p<0.05). 4. There was statistical significance on the influence of the mandibular set-back to the total mandibular relapse(p<0.05) 5. There was no statistical significance on the influence of the mandibular set-back(T2-T1) to the condylar change(T2C-T1C), the condylar change(T2C-T1C, TLC-T2C) to the mandibular total relapse, the pre-operaive condylar position to the condylar change(T2C-T1C, TLC-T2C), the pre-operative mandibular posture to the condylar change(T2C-T1C,TLC-T2C)(P>0.05). 6. The result of multiple regression analysis on the influence of the pre-operative condylar position to the total mandibular relapse revealed that the more increasing of intercondylar distance and condylar vertical axis angle and decreasing of condyalr head long axis angle, the more increasing of mandibular horizontal relapse(L1,B,Pog,Gn,Me) on the right side condyle. The same result was founded in the case of horizontal relapse(L1,Me) on the left side condyle(P<0.05). 7. The result of multiple regression analysis on the influence of the pre-operative condylar position to the pre-operative mandibular posture revealed that the more increasing of intercondylar distance and condylar vertical axis angle and decreasing of condylar head long axis angle, the more increasing of mandibulaar vertical length on the right side condyle. and increasing of vertical lengh & prognathism on the left side condyle(p<0.05). 8. The result of simple regression analysis on the influence of the pre-operative mandibular posture to the mandibular total relapse revealed that the more increasing of prognathism, the more increasing of mandibular total relapse on B and the more increasing of over-jet the more increasing of mandibular total relapse(p<0.05). Consequently, surgical mandibular repositioning was not significantly influenced to the change of condylar position with condylar reposition method.