CHANGES OF THE HYOID BONE POSITION AND THE UPPER AIRWAY DIMENSION AFTER ORTHOGNATHIC SURGERY IN SKELETAL CLASS III PATIENTS

After orthognathic surgery in skeletal class III patients, the hyoid bone position and the upper airway dimension could be changed due to mandibular setback. There has been many studies about airway dimension of the patients with skeletal class II malocclusion or obstructive sleep apnea. but not with skeletal class III. The purpose of this study was to examine the change of position of the hyoid bone and the consequent change of airway space as the result of retrusion of mandible after orthognathic surgery in skeletal Cl III malocclusion patients. It is also to apply this results in predicting, diagnosing and treating the subsequent obstructive sleep apnea. Forty patients who were diagnosed as skeletal Cl III maloccusion, received orthoganthic surgery of both jaws including mandibular setback, and were followed up post-operatively for more than 6 months were selected. There were 10 male patients 30 female patients. The preoperative and postoperative lateral cephalograms were traced and the distances and angles were measured. The nasopharyngeal space increased postoperatively while the oropharyngeal space decreased. Except for the change of oroparyngeal space, the changes in male patients were greater than female patients. The hyoid bone moved in the posterior-inferior direction, and the change was greater in males than in females. If the postoperative mandibular setback is great, then a significant decrease of airway space and posterior and inferior movement of the hyoid bone were observed. This can result in symptoms related to obstructive sleep apnea. This result should be considered in the diagnosis and treatment planning of orthognathic surgery patients.ope

Iatrogenic epidermoid cyst in the parotid gland: A case report

Epidermoid cysts presents as a nodular and fluctuant subcutaneous lesion beneath the skin and are most common in acne-prone areas of the head, neck and back. This cyst often arises after localized inflammation of the hair follicle and occasionally after the implantation of epithelium following trauma and surgery including a biopsy procedure. It is often associated with Gardner syndrome, particularly before puberty. The lesion is normally treated by a surgical excision or enucleation, and recurrence is uncommon. A 27 year old woman complained of a swelling of the left parotid gland when she visited our clinic. A cystic lesion was found in the left parotid gland from the high signal intensity on the MR images. Ultrasonography showed that the cystic lesion was heterogeneous echogenic. Six months earlier, botulinum toxin was injected in her left masseter muscles six months earlier and progressive swelling of the left parotid area was noticed four months after treatment. The lesion was surgically removed. It was encapsulated by a thin wall and filled mainly with keratin. The final diagnosis was an epidermoid cyope

Open Reduction of Mandibular Condyle Fracture Via Preauricular Approach

Purpose: Anatomical reduction of the fractured condylar process is an important prerequisite for re-establishing function. The authors reported about effectiveness of transoral approach for mandibular subcondyle fracture using trochar device in cases that the fracture line is below the reference line, the perpendicular line of the longitudinal axis of condylar process passing the lowest point of sigmoid notch. As a serial study, we report the open reduction via preauricular approach for mandibular condyle fracture, in cases that the fracture line is above the reference line. Patients and Methods: Sixteen condylar fractures of 15 adult patients were divided two groups and treated by open reduction via preauricular approach (8 cases) or by closed reduction (8 cases). The degree of maximal mouth opening, occlusion, anatomical reduction, condylar resorption and complications were assessed and evaluated for the two groups. Results: The open reduction of condyle via preauricular approach leads to good results without permanent complications. Anatomical reduction of open reduction group and maximal mouth opening range of the closed reduction group is significantly better than the other group. No significant differences were found in the condylar resorption and the occlusion. Conclusion: The preauricular approach was useful to reduce and fix the condylar fragment, in cases that the fracture line is above the reference line.ope

Analysis of treatment patterns of temporomandibular disorders

Introduction: This study examined the treatment patterns of temporomandibular disorders (TMD) including conservative and surgical procedures. Materials and Methods: Patients with TMD who visited Gangnam Severance Hospital from June 2007 to May 2008 were enrolled in this study. All patients were examined from the orthopantomogram, temporomandibular joint (TMJ) tomography, and a clinical examination. The patients who required a further evaluation were examined by magnetic resonance imaging and/or computed tomography. The treatment patterns were divided into counseling, medication, splint therapy, botulinum toxin injection (BTI) and surgical treatment. Results: Among the 2,464 patients, the average age was 31.8 years (ranging from 6 to 93); 764 (31.0%) were male and 1,700 (69.0%) were female. 2,355 (95.6%) patients were treated with conservative therapy; 1,460 (62.0%) patients were treated with medication, 931 (39.5%) patients were treated with splint, and 46 (2.0%) were treated with BTI. There were 109 (4.4%) patients treated surgically. Eight (0.3%) patients were treated with total temporomandibular joint replacement surgery. Conclusion: Almost all patients with TMD were treated using conservative methods. Those patients who received surgical treatment because of an ineffective response to conservative treatment had definite problems with the internal derangement and/or osteoarthritis or had severe clinical symptomsope

EXPRESSION OF ESTROGEN RECEPTORS IN RETRODISCAL TISSUE OF THE TEMPOROMANDIBULAR JOINT DISORDER PATIENTS

Those composing temporomandibular joint (TMJ) complex such as the temporal bone, the disc and the mandibular condyle perform their own functions with organic relation. The retrodiscal tissue is the main area of pain induction and contributes to compositional change of synovial fluid. If displacement of the disc lasts long time, not only adaptive changes, but also destructive or degenerative changes may happen. It was reported that these changes and symptoms appear mostly to female rather than male and especially, in the case of patients suffering from TMJ disorder, a large quantity of female sex hormone is found in the joint synovium. And that may play a role in bone resorption and inflammation. Also, the frequency and the intensity of pain perception for female is reported to be much more than for male. In this study, we investigated the expression extents of estrogen receptors (ER) and progesteron receptors (PR) in retrodiscal tissue with immunohistochemistry among the patients received TMJ surgery and compared with MRI findings and surgical findings. We report the relations between the expression of ER in retrodiscal tissue and the pathological change in TMJ, such as inflammation, internal derangement and osteoarthritisope

VILLONODULAR SYNOVITIS OF THE TEMPOROMANDIBULAR JOINT : A CASE REPORT

Villonodular synovitis, also called pigmented villonodular synovitis, is the benign lesion with the characteristic of locally aggressive proliferation of mononuclear histiocyte and giant cell. Typically it involves single joint, especially about 80% of disease occurs in the knee joint. Villonodular synovitis of the temporomandibular joint is very rare disease. Differential diagnosis includes synovial chondromatosis and tumors of the temporomandibular joint. Optimal treatment consists of complete excision of the mass and removal of the synovium including adjacent affected bony structures. This is a case report of villonodular synovitis developed in the temporomandibular jointope

Drawing the Emotion of Loss and Absence

학위논문 (석사)-- 서울대학교 대학원 미술대학 서양화과, 2017. 8. 임자혁.우리는 일반적으로 어떤 감정을 느꼈을 때 그 감정을 대표하는 단어를 떠올림으로써, 즉 감정에 이름을 붙임으로써 그것을 파악하려 한다. 그러나 감정이 복잡 미묘한 일종의 양상인데 반해 이름이란 결국 하나의 개념을 지시하는 기호일 뿐이므로, 결코 감정을 온전히 담아내지 못한다. 나는 감정의 풍부한 모호성을 단순화, 일반화하지 않으면서 있는 그대로 드러낼 수 있는 방식이 그림이라 믿는다. 이는 그림이 의도의 구현일 뿐만 아니라 그린 이의 신체적, 심리적, 무의식적 정황까지도 드러내는 총체적인 장(場)이라는 인식에 근거한다. 그리하여 나는 그림을 통해 감정을 다룬다. 나에게 감정을 그린다는 것은 그리기라는 구체화의 과정을 통해 막연히 느끼던 감정의 실체를 시각적으로 파악해가는 일이며, 내가 느낀 것들을 이해함으로써 나에 대해 알아가는 과정이다. 나아가 그것은 개인적 감정과 그에 관한 성찰을 타인에게 유의미한 시각적 결과물로 만들어가는 과정이기도 하다. 감정은 자신을 둘러싼 환경에 대한 주체의 내적반응이므로 나는 나를 둘러싼 환경, 즉 일상 속에서 마주치는 것들 중 내 감수성을 자극하는 대상들을 작품의 소재로 삼는다. 그렇게 그린 일련의 그림들을 돌아보며 나는 작품의 소재를 두 가지로 분류해볼 수 있었다. 하나는 타인의 무표정한 얼굴이다. 나는 무표정을 이름 없는 미세한 표정들의 집합으로 본다. 그것들은 너무도 미세하여 그로부터 읽어낸 감정의 기척이 그의 것인지, 혹은 내 마음으로부터 비롯된 것인지 가늠하기 어렵다. 즉 무표정한 얼굴은 불확실한 얼굴이다. 나는 거울 속의 나를 그리듯 그들의 얼굴을 그림으로써 나의 감정을 표현하기도 하며, 화면을 창문처럼 바라보고 그 너머에 있는 그들을 그림으로써 일종의 거리감을 드러내기도 한다. 다른 하나는 부재의 풍경이다. 빈 공간이나 무언가의 빈 껍질과 같은 소재들은 그 자신의 의미 있는 부분을 결여함으로써 그것에 대한 기억의 매개체가 된다. 나는 그것들을 상실의 경험과 관련하여 다루는데, 상실한 대상을 직접적으로 그리기보다는 비유적 소재들을 통해 그것에 관해 이야기하려 한다. 이는 상실한 대상을 타자(他者)로서 바라보고, 그의 알 수 없는 부분을 임의로 해석하거나 상징화하지 않으려는 나의 태도를 반영한다. 이러한 소재들은 흐린 그림으로 구현된다. 나는 대상이 지닌 다양한 시각적 대비를 소거하거나 완화하는 과정을 통해 흐린 그림을 만들어낸다. 제한된 색과 명도의 대비 안에서 대상을 드러내거나 형상의 윤곽을 모호하게 함으로써 시각적 명료성을 떨어뜨리는 것, 혹은 종이의 흰 바탕이나 판면의 요철 위로 엷게 그려냄으로써 대상의 특성을 희석 또는 여과(濾過)하는 것은 직접적으로 흐림을 그려내는 방식이라 할 수 있다. 반면 판화의 유령상(幽靈像, ghost image)을 활용하거나 그림을 다른 재료와 크기로 다시 한 번 옮겨 그리는 표현의 번역과 같은 시도는, 이미 그려진 것의 명료성을 간접적 표현의 과정을 통해 약화(弱化)함으로써 특유의 흐릿함에 이르는 방식이라 할 수 있다. 결과적으로 그림은 현실과 닮아있으면서도 어딘가 다른 세계를 보여주며, 그 다름의 양상에 따라 다양한 시간적, 공간적 거리감을 자아낸다. 이는 세상으로부터 내가 느낀 특정한 심리적 거리가 시각적으로 구체화된 것이라 할 수 있다. 이러한 거리감은 또한 그와 관련된 여러 감정을 파생시킨다. 그것은 주의 깊게 들여다보지 않으면 알아챌 수 없는 일련의 미묘한 감정으로, 미세한 변화 속에서 드러나는 섬세한 이미지를 통해 구현된다.Ⅰ. 서론 1 Ⅱ. 감정과 그림 3 1. 감정의 모호성 4 2. 그림의 총체성 7 3. 감정을 그리는 것 10 Ⅲ. 존재와 부재 17 1. 타인의 얼굴 18 2. 부재의 풍경 25 Ⅳ. 흐린 그림 36 1. 색의 소거 37 2. 희미한 형상 40 3. 유령상 50 4. 다시 그리기 59 Ⅴ. 결론 62 그림 목록 65 참고 문헌 67 Abstract 69Maste

(The) patterns of the temporomandibular joint internal derangement according to the shapes of the mandibular condyle and ramu

치의학과/석사[한글] 파노라마 방사선 사진은 비교적 적은 비용으로 전체 하악골 형태 및 양측 측두하악관절의 구조적 변화에 대한 좌우 비교가 가능하고, 치과 전 분야에 걸쳐 널리 사용되므로 쉽게 접할 수 있다. 그러나 임상적으로 파노라마 방사선 사진상에서 관찰된 비대칭과 측두하악장애의 연관성 또는 하악골 변화에 따른 작은 하악과두와 하악지 쪽의 측두하악장애 가능성 등에 대한 분명한 평가 기준은 부족하였다.이에 본원 턱관절 클리닉에 내원한 환자들을 대상으로, 측두하악관절과 저작근의 영향을 많이 받는 하악과두와 하악지 부위에 대해 과두의 길이 및 과두경부의 두께, 그리고 하악지의 길이 세 부분에서 파노라마 방사선 사진상의 비대칭 여부를 판정하고 그 양상에 따라 하악골의 형태를 다음과 같이, 모두 대칭 범주인 경우(제 1군), 과두길이만 짧은 경우(제 2군), 과두경부두께만 얇은 경우(제 3군), 하악지길이만 짧은 경우(제 4군), 과두길이와 과두경부두께가 함께 작은 경우(제 5군), 과두길이와 하악지길이가 함께 작은 경우(제 6군), 세 부위가 모두 작은 경우(제 7군)의 일곱 군으로 분류하였다. 그리고 분류된 각 군별로 자기공명영상에서 측두하악관절원판의 변위 상태를 조사하여 하악과두와 하악지의 여러 형태들과 악관절내장증의 상관관계에 대한 다음과 같은 결과 및 결론을 얻었다.파노라마 방사선 사진상에서 하악과두와 하악지 부위의 비대칭이 관찰된 경우, 과두경부의 두께나 하악지의 길이에서 보이는 비대칭보다는 과두의 길이에서 차이나는 비대칭의 경우에 더 작은 쪽의 비복원성 관절원판 변위가 높은 비율로 관찰되었다.또한, 과두길이가 짧은 상태에서는 과두경부두께가 얇거나 하악지길이가 짧은 형태가 함께 동반되어 좌우측 비대칭 정도가 더 커질수록 동측에서 비복원성 관절원판 변위의 빈도가 더욱 높아지는 양상이 관찰되었으며, 이는 차례대로 과두길이만 짧은 경우(제 2군), 과두길이와 과두경부두께가 함께 작은 경우(제 5군), 과두길이와 하악지길이가 함께 작은 경우(제 6군), 그리고 과두길이, 과두경부두께, 하악지길이가 모두 작은 경우(제 7군)의 순서였다. 특히, 세 측정값이 모두 작은 제 7군의 경우는 이환측의 비복원성 관절원판 변위가 93.3%로 매우 높게 나타났다.하악지와 하악과두의 형태는 측두하악장애와 밀접하게 연관되어 있으며, 이를 유형별로 분류하여 각각의 특징과 의미를 고려해보고 임상에서 활용한다면, 파노라마 방사선 사진을 통하여 측두하악장애 환자의 초기 진단 및 치료 계획 수립 등에 많은 도움을 얻을 수 있으리라고 사료된다. [영문] There have been many reports about the close correlation with the temporomandibular disorder(TMD) and the mandibular asymmetry caused by the deformation of the mandible. Some studies have shown that the more frequent TMD is associated with the deformed small mandible and the more aggravated one is connected with the more deformed asymmetry.The panoramic radiography is a device widely used in the dental fields and it has advantage in addition to the low cost that the whole mandible and the both temporomandibular joint(TMJ)s are seen on single film, so we can compare the structural changes of the both sides. However even if some morphologic changes and asymmetry could be found on panoramic radiography, there has been no clear standard for evaluation of TMD in relation to the shapes of the mandible or the extent of the asymmetry except the vague recognition about those relationship and the problem possibility in small side.So this study divided the asymmetric mandibular shapes on the panoramic radiography into 7 groups in TMD patients: the symmetric cases(Group 1), the asymmetric condylar length cases(Group 2), the asymmetric condylar neck width cases(Group 3), the asymmetric ramal length cases(Group 4), the asymmetric condylar length and condylar neck width cases(Group 5), the asymmetric condylar length and ramal length cases(Group 6), and the all asymmetric cases(Group 7). And then the correlation between the mandibular shapes and the TMJ internal derangement was evaluated by investigating the disc positions in both TMJs of each group on the magnetic resonance imaging.The short side with the asymmetric condylar length cases showed the high incidence of the anterior disc displacement without reduction(ADsR). On the other hand, no statistical significance was found in the asymmetric cases of the condylar neck width or the ramal length. And the more the additional asymmetry with the condylar neck width and the ramal length besides the condylar length asymmetry increased the extent of the total asymmetry, the higher the ADsR incidence became. It was arranged group 2, group 5, group 6, and group 7 in the incidence order. Especially, Group 7 showed the highest incidence of ADsR in the short side(93.3%).The shapes of the mandibular condyle and mandibular ramus showed the close correlation to TMD and the panoramic radiography could be very helpful in the practical uses such as the early diagnosis and the decision for treatment plans of TMD patients by considering the each groups.restrictio

Method for aerobic exercise simulation to burn fat

본 발명은 지방 연소 촉진을 위한 유산소 운동 유지 방법에 대한 것으로서, 더 상세하게는 유산소 운동과 무산소 운동을 구분 짓고 있는 지점이 바로 무산소성 역치 지점이 되며, 무산소성 역치 이하의 운동 강도로 지속적으로 운동할 때 효율적으로 지방을 연소하게 되므로 무산소성 역치 지점에서 심박수를 산출하는 방법에 관한 것이다. 또한, 본 발명은 심박수를 실시간 측정하여 측정된 심박수가 설정된 심박수를 넘을 경우, 알림음을 내거나 알림 메시지를 보여줌으로써 유산소 운동을 유지하게 하는 방법에 관한 것이다. 본 발명에 따르면, 사용자의 무산소성 역치를 산출하여 이 무산소성 역치 지점에서의 심박수를 산출함으로써 무산소성 역치 이하의 운동 강도로 지속적으로 운동할 때 효율적으로 지방 연소를 수행하는 것이 가능하다

부틸산 및 부탄올 생산 최적화를 위한 대장균의 정량적 재설계 연구

DoctorGlobal demand for the development of environmentally favorable microbial processes that producing petroleum-derived chemicals and fuels, is increasing dramatically owing to environmental concerns and uncertainty of oil supply. Certainly, advances in synthetic biology and metabolic engineering has been fueled these strides to design optimal microbial cell factories, capable of converting biomass into various bio-chemicals with maximal yield and productivity. These cellular phenotypes are particularly important for the high-volume (and low-value) bulk chemicals and biofuels such as n-butanol, butyrate. n-Butanol obviously have spotlighted as an advanced ‘drop-in’ alternative for gasoline owing to its close physicochemical properties, such as high energy density, low corrosiveness, and low vapor pressure, compared to gasoline than ethanol. Moreover, n-butanol has versatility not only as an advanced biofuels but also as a feedstock and solvent for various industrial applications, requiring large global demand. Butyric acid, a short-chain fatty acid, and its derivatives are also utilized as feedstock for various industrial products, including plastics, fibers, food additives, and pharmaceuticals. Furthermore, direct hydrogenation of butyric acid by copper-based catalysts can produce n-butanol, a chemical in the world spotlight as mentioned above. Here, I proposed novel synthetic biology-driven engineering approaches to design optimal cell factory for butyric acid and n-butanol in Escherichia coli. First issue to be solved is balancing the intracellular redox state that plays a governing factor for the continuation of both catabolic and anabolic pathways. Beyond stoichiometric-dependent redox rebalancing, the effect of optimizing catalytic amounts of reducing powers depending on cellular demands, which termed carbon flux-associated redox rebalancing, was investigated to improve yield and productivity of bio-chemical synthesis. Secondly, the optimization of metabolic pathways between glycolysis and the engineered product-forming pathway was evaluated using proposed a metabolic valve of glycolytic flux to further increase yield and/or productivity of desired products. Followings are summarized contents by chapters. In chapter 1, the recent advances for the production of advanced biofuels in tractable microorganisms, mostly in E. coli, are outlined following specific engineering approaches: i) Engineering of heterologous product-forming pathways ii) Engineering of endogenous pathways iii) Cofactor engineering iv) Protein engineering v) Tolerance engineering vi) Diversification of carbon sources. Furthermore, traditional approaches for the redox rebalancing are categorized in detailed. In chapter 2, the native redox cofactor regeneration system in E. coli was engineered to construct base strain for the production of butyric acid as model system. By implementing a nonnative butyrate synthetic pathway, rendering butyrate as the only final electron acceptor, the engineered strain (JHL26) produced 4.35 g/L of butyrate from glucose in 24 hours batch fermentation, which corresponds to 83.4% of theoretical maximum yield. Moreover, selective fermentation of butyric acid over acetic acid enabled (Butyrate/Acetate ~ 41 in the engineered JHL26 strain, but 5~7 in the native butyrate host, Clostridia). To the best of my knowledge, the data represented the highest yield and selectivity for butyric acid fermentation. Moving forward, the advanced concept of redox rebalancing, i.e., carbon flux-associated redox rebalancing was demonstrated using n-butanol as model compound. The intracellular redox state was modulated by anaerobically activating the pyruvate dehydrogenase (PDH) complex and was further balanced by fine-tuning expression levels of yeast NAD+-dependent formate dehydrogenase (Fdh1) through UTR engineering. In a batch fermentation, optimized strain (JHL85) showed the highest productivity of n-butanol in E. coli (0.26 g/L/h) at the 69% of theoretical maximum yield. Furthermore, 4.44g/L of n-butanol was produced from galactose for the first time and also demonstrated that different amounts of reducing equivalents were required to efficiently produce the desired products, depending on the carbon flux of substrates. Finally, the production of n-butanol from galactose further enhanced through the implementation of galactose utilization module. The resulting strain (GAL_061) dramatically increased productivity of n-butanol from galactose, about 2.5-fold increase, due to 66.4% improvement in specific galactose uptake rate. By optimizing intracellular redox state depending on the enhanced carbon flux enabled 22% further increase in productivity (0.13 g/L/h). To the best of my knowledge, the data represented the highest productivity of n-butanol from galactose. In chapter 3, glucose-specific transporter (encoded by ptsG) is proposed as a metabolic valve to control overall glycolytic flux. The specific glucose uptake rate ranged from -28% to +21% compared to wild type E. coli W3110 through UTR engineering of ptsG. The n-butanol system further optimized using the metabolic valve, the yield controlled from 65% to 93% of theoretical maximum. In another case, the productivity of butyric acid 7% increased than the parental strain while the yield was maintained around 83% of theoretical maximum. To the best of my knowledge, the data represented in this study showed the highest yield and productivity of n-butanol and butyric acid