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DENTAL TREATMENT IN A PATIENT WITH PIERRE ROBIN SYNDROME UNDER GENERAL ANESTHESIA : A CASE REPORT (피에르 로빈 증후군 환아의 전신마취 하 치아우식 치료 증례 보고)

  • Ryu, Jiyeon;Shin, Teo Jeon;Hyun, Hong-Keun;Kim, Young Jae;Kim, Jung-Wook;Jang, Ki-Taeg;Kim, Chong-Chul;Lee, Sang-Hoon
    • The Journal of Korea Assosiation for Disability and Oral Health
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    • v.12 no.2
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    • pp.87-91
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    • 2016
  • Pierre Robin syndrome (PRS) is characterized by the triad of congenital mandibular hypoplasia, glossoptosis and cleft palate. Infant PRS patients are frequently suffering from upper airway obstruction, gastroesophageal reflux and growth retardation caused by above mentioned problems. We report a dental caries treatment of 3-year old girl with Pierre Robin syndrome with multiple caries. The cause of multiple caries was mainly presumed as patient's eating habit caused by her general condition. She had some feeding problems and had history of gastric tube. She was still using milk bottle and took more than an hour to finish a meal. The treatment was performed under general anesthesia considering patient's condition; mild autism, poor cooperation and respiratory problem due to micrognathia. Severely affected upper incisors were treated with pulp treatment and restored with zirconia crown for esthetic purpose. Lower incisors were treated with pulp treatment and restored with composite resin. Upper right first primary molar was restored with stainless steel crown and other primary molars were treated with composite resin. There were no postoperative complications. According to her parents, the patient's compliance to oral hygiene management was greatly improved after the treatment since she was very pleased with the esthetic result and highly motivated by her looks. The treatment without sedation or general anesthesia would be possible once the airway is improved as the mandible grows.

Osteological Development of the Larvae and Juvenile in Coreoperca herzi (Perciformes: Centropomidae) (꺽지 (Coreoperca herzi) 자치어의 골격발달)

  • Han, Kyeong Ho;Park, Jun Taek;Jin, Dong Soo;Yoo, Dong Jae;Park, Jae Min
    • Korean Journal of Ichthyology
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    • v.29 no.1
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    • pp.32-40
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    • 2017
  • Samples were obtained from broodstok in May, 2010, while naturally fertilized embryos were maintained, and the process of skeletal development was observed from larvae and juvenile. Prelarvae immediately after hatching showed an average total length of $6.85{\pm}0.63mm$ (n =5), Premaxillary and dentary were ossified, parasphenoid was ossified in the cranium, and centrum and caudal bone did not ossify. Prelarvae showed ossification with maxillary, articular, and epihyal, and branchiostegal rays of hyoid arch were ossified at 2 to 3 days after hatching with an average total length of $7.25{\pm}0.28mm$ (n=5). The vertebrae began to ossify in the direction of the tail, and neural spine began to ossify above the ossified vertebra. Postlarvae showed ossification of lateral ethmoid, alisphenoid, parietal, and caudal skeleton in the cranium when the average total length was $9.00{\pm}1.53mm$ (n=5) in 6 days after hatching. At 40 days after hatching, postlarvae ossified maxillary in the cranium, and ossified endopterygoid and ectopterygoid, etc. in the palate, when the average length of $23.3{\pm}0.28mm$ (n=5). At 120 days after hatching, with the average length was $37.5{\pm}2.83mm$ (n=5), caudal skeleton had one additional epural bone ossification, resulting in ossification of a total of 3 epural bone to complete ossification of all spicules.

Nerve Injuries after the Operations of Orbital Blow-out Fracture (안와골절 수술 후 발생한 신경손상)

  • Choi, Jae Il;Lee, Seong Pyo;Ji, So Young;Yang, Wan Suk
    • Archives of Craniofacial Surgery
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    • v.11 no.1
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    • pp.28-32
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    • 2010
  • Purpose: In accordance with the increasing number of accidents caused by various reasons and recently developed fine diagnostic skills, the incidence of orbital blow-out fracture cases is increasing. As it causes complications, such as diplopia and enophthalmos, surgical reduction is commonly required. This article reports a retrospective series of 5 blow-out fracture cases that had unusual nerve injuries after reduction operations. We represents the clinical experiences about treatment process and follow-up. Methods: From January 2000 to August 2009, we treated total 705 blow-out fracture patients. Among them, there were 5 patients (0.71%) who suffered from postoperative neurologic complications. In all patients, the surgery was performed with open reduction with insertion of $Medpor^{(R)}$. Clinical symptoms and signs were a little different from each other. Results: In case 1, the diagnosis was oculomotor nerve palsy. The diagnosis of the case 2 was superior orbital fissure syndrome, case 3 was abducens nerve palsy, and case 4 was idiopathic supraorbital nerve injury. The last case 5 was diagnosed as optic neuropathy. Most of the causes were extended fracture, especially accompanied with medial and inferomedial orbital blow-out fracture. Extensive dissection and eyeball swelling, and over-retraction by assistants were also one of the causes. Immediately, we performed reexploration procedure to remove hematomas, decompress and check the incarceration. After that, we checked VEP (visual evoked potential), visual field test, electromyogram. With ophthalmologic test and followup CT, we can rule out the orbital apex syndrome. We gave $Salon^{(R)}$ (methylprednisolone, Hanlim pharmaceuticals) 500 mg twice a day for 3 days and let them bed rest. After that, we were tapering the high dose steroid with $Methylon^{(R)}$ (methylprednisolon 4 mg, Kunwha pharmaceuticals) 20 mg three times a day. Usually, it takes 1.2 months to recover from the nerve injury. Conclusion: According to the extent of nerve injury after the surgery of orbital blow-out fracture, the clinical symptoms were different. The most important point is to decide quickly whether the optic nerve injury occurred or not. Therefore, it is necess is to diagnose the nerve injury immediately, perform reexploration for decompression and use corticosteroid adequately. In other words, the early diagnosis and treatment is most important.

A Case Report of Chondroid Syringoma of Philtrum (인중에 발생한 연골모양 땀샘종의 치험례)

  • Cha, Jeong Ho;Kim, Jin Woo;Shin, Han Kyung;Jung, Jae Hak;Kim, Young Hwan;Sun, Hook
    • Archives of Craniofacial Surgery
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    • v.11 no.2
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    • pp.107-110
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    • 2010
  • Purpose: Chondroid syringoma is a rare mixed tumor of the skin that was first described by Hirsch and Helwig (1961). Characteristically, it is composed of the proliferation of epithelial cells in a myxoid and chondroid matrix. Most lesions occur on the head and neck region, and their size may range from 0.5~3 cm. Since a chondroid syringoma presents similar characteristics to other masses on the head and neck region, it is significantly important to distinguish with other masses by a surgical biopsy. Methods: A 51-year old woman presented with a painless nodular mass ($0.5{\times}0.5{\times}0.5cm$) on the philtrum, which appeared during the previous year. The mass was treated with a laser without a surgical biopsy. However, the size of the mass showed no changes. Surgical excision under local anesthesia was performed and sent for histopathology. Results: Gross examination showed a mass surrounded by a well developed capsule within the dermal layer. After complete excision without injury to the orbicularis oris muscle, the wound was covered with a local flap. The histology examination revealed numerous cuboid epithelial cells with tuboalveolar structures and keratinous cysts within a chondroid stroma. No recurrence or metastasis was observed at the follow-up visits. Conclusion: Chondroid syringoma is a rare mass on the face. An accurate diagnosis is essential for optimal treatment. This paper reports a case of a chondroid syringoma on the philtrum with a brief review of the relevant literature.

RIGID FIXATION AND SPACE MAINTENANCE BY TITANIUM MESH FOR RECONSTRUCTION OF THE PREMAXILLA (상악골 전방 결손부 재건 시 견고 고정과 공간 유지로 사용된 타이타니움 메쉬의 임상 예)

  • Lee, Eun-Young;Kim, Kyoung-Won;Choi, Hee-Won;Koh, Myoung-Won
    • Maxillofacial Plastic and Reconstructive Surgery
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    • v.27 no.1
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    • pp.85-92
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    • 2005
  • Reconstruction of defect in the anterior part of the maxilla to enable implant placement or prothesis is a complicated treatment due to the anatomical position and lack of soft tissues. Two cases are presented in which autogenous iliac PMCB(particulate marrow and cancellous bone) with titanium mesh were used for premaxilla reconstruction and alveolar bone repair of the anterior maxillas prior to denture and implants fixation respectively. Cancellous bone from the anterior iliac crest was compressed and placed against a titanium mesh fixed to the bone of palate in a patient with severe defect of the anterior maxilla. There were no problem in the healing, and the anterior maxillas of two patients had increased height and width during the initial healing and remodeling. The clinical reports describe the use of titanium mesh for reconstruction of premaxilla. Autogenous bone grafts were harvested from the iliac crest and were loaded on a titanium mesh that were left in the patient's maxilla for 6 months before they were removed respectively. The radiographic analysis demonstrated that a 10mm vertical ridge augmentation had been achieved. In guided bone regeneration, the quantity of bone regenerated under the barrier has been demonstrated to be directly related to the amount of the space under the membrane. This space can diminish as a result of membrane collapse. To avoid this problem which involved the use of a titanium mesh barrier to protect the regenerating tissues and to achieve a rigid fixation of the bone segments, were used in association with autologous bone in 2 cases. The aim of this study was to evaluate the capability of a configured titanium mesh to serve as a mechanical and biologic device for restoring a vertically defected premaxilla.

Changes of Pharyngeal Airway Space after Mandibular Setback Surgery in Computed Tomography Images (전산화단층촬영상에서 하악후퇴수술 후 인두기도 공간의 변화)

  • Kim, Bang-Sin;Jung, Seung-Gon;Han, Man-Seung;Jeoung, Youn-Wook;Kook, Min-Suk;Park, Hong-Ju;Oh, Hee-Kyun;Ryu, Sun-Youl
    • Maxillofacial Plastic and Reconstructive Surgery
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    • v.33 no.1
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    • pp.36-43
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    • 2011
  • Purpose: This study evaluated the pharyngeal airway space changes in CT images in patients receiving bilateral sagittal split osteotomy (BSSRO) for the surgical correction of mandibular prognathism. Methods: A total of 22 patients with mandibular prognathism were treated using BSSRO. Computed tomography was performed 1 month (T0) before surgery and, 1 month after surgery (T1). The anteroposterior length (AP), lateral width (LAT) and cross-sectional area (AREA) at the level of soft palate (C2) and base of the tongue (C3) were measured using CT images. Results: The mean amount of mandibular setback was 7.41 mm (${\pm}$3.46 mm). All the AP, LAT and AREA at the C2 and C3 level were decreased significantly 1 month after surgery (P<0.001). As the amount of mandibular setback was increased, the AP, LAT and AREA levels at the level of C2 and C3 had decreased. In addition, the reduction of the AREA at the C3 level was associated with the amount of mandibular setback (P<0.05). Conclusion: A significant decrease in pharyngeal airway space was observed 1 month after the operation. The cross-sectional area at the level of base of tongue was decreased with increasing amount of mandibular setback.

Repair of Unilateral Cleft Lip and Nose: Mulliken's Modification of Rotation Advancement (편측 구순열비의 교정술: Rotation Advancement 원칙에 근거한 Mulliken의 방법)

  • Jung, Young-Soo;Lee, Gyu-Tae;Jung, Hwi-Dong;Mulliken, John B.
    • Maxillofacial Plastic and Reconstructive Surgery
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    • v.34 no.2
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    • pp.133-139
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    • 2012
  • This is a review regarding Mulliken's Modification using the Millard rotation-advancement principle for the repair of unilateral complete cleft lip and nasal deformity. All patients underwent prior labionasal adhesion and dentofacial orthopedics with a pin-retained (Latham) appliance used for infants with a cleft of the lip and palate. Technical variations concerning the operation are described. A high rotation and releasing incision in the columella lengthens the medial labial element and produces a symmetric prolabium with minimal transgression of the upper philtral column through the advancement flap. The orbicularis oris muscle is everted, from caudad to cephalad, to form the philtral ridge. A minor variation of unilimb Z-plasty is used to level the cleft side of Cupid's bow handle, and cutaneous closure proceeds superiorly from this junction. The dislocated alar cartilage is visualized though a nostril rim incision and suspended to the ipsilateral upper lateral cartilage. Symmetry of the alar base is addressed in three dimensions, including maneuvers to position the deviated anterior-caudal septum, configure the sill, and efface the lateral vestibular web. The authors believe the technical refinements described herein contribute favorably to the outcome of repair regarding unilateral cleft lip and nasal distortion.

ANALYSIS OF SPEECH PATHOLOGIC EVALUATION FOR CHILDREN WITH ANKYLOGLOSSIA (설유착증 환아의 언어병리학적 평가)

  • Lee, Ju-Kyung;Kim, Young-Bin;Leem, Dae-Ho;Baek, Jin-A;Shin, Hyo-Keun;Ok, Seung-O
    • Maxillofacial Plastic and Reconstructive Surgery
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    • v.30 no.5
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    • pp.447-456
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    • 2008
  • There is close relationship between intraoral structural anomaly and speech- functional problem. Patient with cleft palate patients & ankyloglossia is a typical example, patients with structural anomaly is repaired toward normal structure by operation. Ankyloglossia may cause functional limitation even after adequate surgical treatment speech disorders being one of them. Interindividually, they vary a lot, showing typical articulation specifics. The objective of this study was to evaluate and compare speech for children with ankyloglossia and general public, to determine whether ankyloglossia is associated with articulation problem. We wanted to present criteria for indication of frenectomy. The group of subject is composed of 10 childrens with ankyloglossia and articulation problem, visited the Oral and Maxillofacial surgical unit, dental hospital, Chonbuk university. The average age is 5 Y 7M, M : F ratio is 8 : 2 at the time of speech test. Control group is composed of 10 members without oral structural anomaly. The average age is 5 Y 10M, M : F ratio is 3 : 7 at the time of speech test. Outcomes were measured the PPVT(Peabody Picture Vocabulary Test), PCAT(Picture Consonant Articulation Test), Nasometer II test result obtained each group, statistically measured by Mann-whitney's U Test. There was no difference for 'chronological age-age equivalent' between two group. There was significant difference for 'consonant accuracy' between two group, showed more lower scores in subject group. There was more 'consonant error' in subject group, mostly showed/1/,/s/. A major modality of 'consonant error' was mostly distortion and replacement. There was no significant difference between two group for nasality.

Clinical Cases Analysis of Forearm Free Fasciocutaneous Flaps on Oral Cavity Defect Area (구강 결손부에 적용된 요골 유리전완 피부피판 적용례 분석)

  • Kim, Uk-Kyu;Lee, Kwang-Ho;Song, Won-Wook;Hwang, Dae-Seok;Kim, Yong-Deok;Shin, Sang-Hun;Kim, Jong-Ryoul;Chung, In-Kyo
    • Maxillofacial Plastic and Reconstructive Surgery
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    • v.32 no.4
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    • pp.324-331
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    • 2010
  • The radial forearm free flap (RFFF) has become a workhorse flap as a means of reconstructing surgical defects in the head and neck region. We have transferred 12 RFFFs with fasciocutaneous type on oral cavity defects in 12 patients after cancer resection and submucous fibrotic lesion ablation from 2005 to 2007 at Department of oral and maxillofacial surgery, Pusan National University Hospital. We reviewed retrospectively patients' charts and followed up the patients. Clinical analysis on the cases with RFFFs focusing on flap morbidity, indications and available vessels was done. The results of study are follows: 1. RFFF could be applied for all kind of defects after resection of tongue, floor of mouth, buccal mucosa, denuded bone of palate, maxilla, and mandible. 2. All free flaps could be used for primary reconstruction. The survival rate of 12 RFFFs was 92%. Partial marginal loss of the flaps was shown as 3 cases among 12 cases. Large size-vessels like superior thyroid artery, facial artery, internal jugular vein were favorable for microvascular anastomosis. 3. Parenteral nutrition instead of nasal L-tube also can be favorable for postoperative a week for better healing of the flap if the patients couldn't be tolerable with nasal tubing. 4. Donor sites with thigh skin graft were repaired with wrist band for 2 weeks. The complications included scarring, abnormal sensation on hand, and reduced grip strength in few patients, but those didn't induce major side effects. 5. Most RFFFs were well healed even if mortality rate of cancer patients was shown as 50% (5/10 persons). The mortality of patients was not correlated with morbidity of the flaps. We could identify the usefulness of RFFF for restoration of oral function, esthetics if the flap design, tissue transfer indications, and well controlled operation are proceeded.

Clinical Outcomes of Oral Squamous Cell Carcinoma Patients Treated in National Cancer Center for Last 10 years (최근 10년간 국립암센터에서 치료받은 구강 편평상피세포암종 환자의 치료성적 연구)

  • Jo, Sae-Hyung;Kim, Tae-Woon;Choung, Han-Wool;Park, Sung-Won;Park, Joo-Yong;Choi, Sung-Weon
    • Maxillofacial Plastic and Reconstructive Surgery
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    • v.32 no.6
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    • pp.544-550
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    • 2010
  • Purpose: The result of all malignant neoplasms including oral cancer is decided by long-term prognosis. However, until now, there are only a few reports about long-term prognosis of cancer secluded in the oral cavity. So, we investigated all patients that visited our clinic for oral squamous cell carcinoma (SCCa) for the last 10 years. From this survey, we hope to find important factors that influence prognosis of the disease. Patients and Methods: A retrospective study was performed for patients that visited the oral oncology clinic for oral cancers from Jan. 2001 to Feb. 2010. We selected the patients that were diagnosed with SCCa and received curative treatment. In these patients, we investigated basic epidemiology, smoking history, body mass index, recurrence rate, treatment methods, pathologic data and 5-yr survival rate. Results: There was a total of 185 patients (115 males, 70 females and mean age: 57.3 years) that visited the oral oncology clinic for oral SCCa. Areas of primary lesion were tongue (105 cases, 57%), lower gum (19 cases, 10%), floor of mouth (16 caess, 8%), retromolar trigone (12 cases, 6.5%), and buccal cheek (11 cases, 6%). Other involved areas were upper gum, palate, lip, and salivary glands-of 1 case each. The overall 5-year survival rate was 63.7%. The factors that influenced prognosis of the disease were stage of the disease, status of differentiation, recurrence, metastasis of cervical lymph node and age. Conclusion: The factors that influence prognosis of disease are stage of the disease, status of differentiation, recurrence, metastasis of cervical lymph node and age. To point out a current trend, the mean age of patients that developed oral cancer was lower than that of before. Secondly, the prevalence of oral cancer in non-smoker are on the rise. Thus, further studies on etiology and epidemiology should be done.