선천성 기형환자에서의 악교정수술 적용과 수술 증례 분석

Distraction osteogenesis and orthognathic surgery are the widely used surgical methods for treating hemifacial microsomia and cleft lip and palate, the representative forms of congenital deformity. Distraction osteogenesis is an outstanding treatment of choice when more traction is needed than what can be achieved by general orthognathic surgery. However, the stability of distraction osteogenesis has not yet been established, and in most of the cases, additional orthognathic surgery is mandatory. Moreover, the difficulty in precise control of the traction directions is another disadvantage of distraction osteogenesis. Therefore, it would be desirable not to conduct distraction osteogenesis when the patient is suitable for an orthognathic surgery. Also, distraction osteogenesis should be recognized as an accessorial method of treatment, and be used restrictively.ope

Expression patterns of tenascin-N in the developing mandible

Previous studies have demonstrated that tenascin-N belongs to the family of tenascins, which are found in the extracellular matrix of various embryonic tissues, wounds, and tumors. Tenascin is expressed in the embryonic epithelium, including the neural epithelium from which neural crest cells emerge. However, the expression pattern and role of tenascin-N in the craniofacial region remains unknown. In this study, expression patterns of tenascin-N were confirmed in the mouse craniofacial region from embryonic day 12.5 (E12.5) to postnatal 11. In the diastema region, tenascin-N was strongly expressed in the mesenchyme from E12.5 to E14.5. Tenascin-N expression was also detected in the developing tooth germ. From the bell stage to the premature stage, tenascin- N was expressed in the odontoblasts and ameloblasts of the molar tooth germ, and the ameloblasts of the incisor tooth germ. These findings indicate that the spatial and temporal expression of tenascin-N might have a role in proper mouse craniofacial development, especially tooth developmentope

Alveolar cleft graft

Bone grafting the alveolar cleft allows for stability and continuity of the dental arch, provides bone for eruption of permanent teeth or placement of dental implants, and gives support to the lateral ala of the nose. Closure of residual oronasal fistula can occur simultaneously. Repair of alveolar clefts can occur at a variety of stages defined as primary, early secondary, secondary, and late. Most centers perform this surgery as secondary bone grafting. Autogenous bone provides osteogenesis, osteoinduction and conduction and is recommended for grafting to the cleft alveolus and several donor sites are available. The surgeon should select the best flap design considering the amount of mucosa available, blood supply and tension-free closure, and the extent of the oronasal communication. The authors provide a comprehensive understanding of alveolar clefts and their repair by reviewing the historical perspective, objectives for treatment, timing, source of graft, presurgical orthodontics, surgical techniques, postoperative care, and complicationsope

Onset of analgesia and analgesic efficacy of tramadol/acetaminophen and codeine/acetaminophen/ibuprofen in acute postoperative pain : a single-center, single-dose, randomized, active-controlled, paral

Dept. of Dentistry/박사[한글] 연구배경: tramadol과 acetaminophen 복합제제는 다양한 통증 임상 시험에서 좋은 효과를 보여왔지만 급성 통증 상태에서 이 복합제제와 강력한 진통제라고 알려진 다른 진통제의 효과 발현 시점과 진통효과를 비교하는 것이 필요하다고 생각되었다. 연구목적: 본 연구의 목적은 구강 수술후 급성 동통의 치료에서 75 ㎎ tramadol/650 ㎎ acetaminophen (Tr/Ac) 복합제제와 20 ㎎ codeine/500 ㎎ acetaminophen/400 ㎎ ibuprofen (Co/Ac Ib) 복합제제의 효과발현 시점과 다른 진통효과를 비교하고자 하였다. 연구방법: 이 연구는 무작위, 1회 투여, 평행그룹 디자인으로, 단일 센터에서 실시한 비교 임상시험이었으며, 골삭제를 필요로 하는 하나 이상의 하악 매복 제3대구치 외과적 발거 수술을 시행 받는 건강한 환자들을 대상으로 하였다. 구강 수술 후 피험자가 중등도 또는 심도의 통증을 호소하였을 때(통증 평가를 위한 10단계 순위에서 5점 이상), 각 피험자는 무작위 배정 방법에 따라 두 군 중의 한 군에 할당되었다. 시험 약 투여 후 6시간 동안 지각할 수 있는 통증 완화시점과 의미있는 통증완화시점은 2개의 stopwatch방법을 이용하여 측정하였고, 그 외 통증 강도, 통증 완화 정도, 전반적 평가, 이상 반응 등을 기록하였다. 연구결과: 128명의 한국인 환자가 이 시험에 등록되어 같은 수(64명씩)로 두 군에 무작위로 할당되었는데, 성별, 나이, 체중, 신장 같은 인구통계학적 기초 자료뿐만 아니라 두 군의 수술 특징도 서로 유사하였다. 지각할 수 있는 통증 완화시점의 중간값(median)은 Tr/Ac 군과 Co/Ac/Ib 군이 각각 21.0 분과 24.4분이었고, 의미있는 통증완화시점의 중간값(median)은 56.4분과 57.3분이었으며, 이들은 통계적으로 유사하였다. 전체 통증 완화정도(TOTPAR)와 최초 통증에 대한 통증 강도 차이의 합(SPID) 같은 다른 효과 변수들은 처음 2번의 시간 구간 동안(0-2시간과 2-4시간)에선 두 군간의 차이가 유의하지 않았지만 마지막 시간 구간인 4-6시간에선 통계적으로 유의 있는 차이가 발견되었다(P < 0.05). 시간별 통증강도차이(PID)도0.5에서 4시간까지 두 약제는 비슷한 효과를 보였으나, 5시간과 6시간째 측정치에서 Co/Ac/Ib 군이 더 좋았다. 환자의 전반적인 평가에서 "좋음" 이상으로 평가한 것도 Co/Ac/Ib 군이 Tr/Ac 군보다 유의있게 많았다. Tr/Ac의 안정성은 Co/Ac/Ib과 통게적으로 유사하였다. 결론: 이번 구강 수술 후 급성 통증의 치료에서 Tr/Ac 의 통증완화시점이 Co/Ac/Ib 의 통증완화시점과 차이가 없었으며 다른 진통 효과 변수들도 약물 투여 후 조기에는 유사하였다. 따라서 Tr/Ac은 수술 후 급성 통증의 빠르고 효과적인 치료를 위해 추천할 만 하다고 사료되었다. [영문]Background: The combination of tramadol and acetaminophen has demonstrated good efficacy in various clinical pain models. However, there is a need for comparisons of the onset of analgesia and other measures of analgesic efficacy with this combination and other strong combination analgesics for the management of acute pain. Objective: The goal of this study was to compare the time to onset of analgesia and other measures of analgesic efficacy with tramadol/acetaminophen 75/650 mg (Tr/Ac) and codeine/acetaminophen/ibuprofen 20/500/400 mg (Co/Ac/Ib) in the management of acute pain after oral surgery. Methods: This was a single-center, single-dose, randomized, active-controlled, parallel-group study in healthy subjects who had undergone surgical extraction of ≥1 impacted third molar requiring bone removal. When patients reported at least moderate pain after dental surgery (score ≥5 on a 10-point scale), they were randomized to 1 of 2 treatment groups. The time to onset of analgesia was measured using a 2-stopwatch technique. The times to the onset of perceptible and meaningful pain relief, pain intensity, pain relief, patient''s overall assessment, and adverse events were recorded for 6 hours after dosing. Results: One hundred twenty-eight subjects participated in the study, 64 in each treatment group. The 2 groups were similar in terms of baseline pain severity and demographic characteristics (mean age, 23.7 and 23.4 years in the Tr/Ac and Co/Ac/Ib groups, respectively; mean body weight, 58.5 and 60.3 kg). The median times to the onset of perceptible pain relief were a respective 21.0 and 24.4 minutes, and the median times to the onset of meaningful pain relief were 56.4 and 57.3 minutes. Mean total pain relief and the sum of pain intensity difference were also similar in the early period after dosing (0-4 hours). However, between 4 and 6 hours, Co/Ac/Ib was associated with significant differences in both variables compared with Tr/Ac (P < 0.05). Although similar through the 4-hour assessment, mean pain intensity difference was significantly greater with Co/Ac/Ib at 5 and 6 hours. The proportion of the patients assessing their assigned treatment as good or better was significantly greater with Co/Ac/Ib compared with Tr/Ac (P < 0.05). The safety profile of Tr/Ac was comparable to that of Co/Ac/Ib. Conclusions: In this small and selected group of subjects, the onset of analgesia and analgesic efficacy of Tr/Ac was comparable to that of Co/Ac/Ib. Tr/Ac provided rapid and effective analgesia for acute postoperative dental pain in this population.ope

The Report on the Medical Voluntary Activities for Cleft Lip and Palate in Vietnam by the Korean Association of Maxillofacial Plastic and Reconstructive Surgeons

ope

Craniofacial Centre of Children's Hospital Boston and Sequential Management for Cleft Lip and Palate

Craniofacial Centre at Children's Hospital Boston is a worldwide leader in the care of children and adolescents with craniofacial anomalies especially with cleft lip and/or cleft palate, which provides a team approach to the evaluation, diagnosis and treatment of children and adults with congenital (present at birth) or acquired facial deformities. This is staffed by an experienced team of clinicians, such as in oral and maxillofacial surgery, plastic surgery, neurosurgery, dentistry, audiology, speech and language pathology, genetics, psychiatry, otolaryngology, and social work, all with specialized training in the care of children with craniofacial anomalies. Here, there is a short introduction of history, attending surgeons, works, and sequential treatment for cleft lip/palate patients about this institutionope

Repair of Unilateral Incomplete Lesser Form Cleft Lip

Cleft lip arises from congenital underdevelopment with various degrees and patterns. Mulliken named a unilateral incomplete cleft lip with no severe cleft as a lesser-form cleft lip and categorized it into three subgroups. Anatomically categorized subgroups are minor-form, microform, and mini-microform cleft by the extent of vermilion-cutaneous dysjuntion. The vermillion cutaneous notch is more than 3 mm from the regular Cupid`s bow peak for minor-form, less than 3 mm for microform, and almost no gap with discontinuity on the vermillion cutaneous border for mini-microform. The treatments are rotational advancement flap for minor-form, double unillimb Z-plasty for microform, and vertical lenticular excision for mini-microform, respectively. This article aims to present the literature review about the incomplete lesser form cleft lip classified by Mulliken and to report our experiences.ope

Repair of bilateral cleft lip and nose by the Mulliken method: a case report.

The simultaneous surgical correction of bilateral cleft lip and nasal deformity has become a more common surgical technique that has greatly changed conventional strategies for secondary nasal correction. Mulliken has been known as one of the earliest proponents for the synchronous repair of bilateral cleft lip and nasal deformity, and he emphasized the responsibility of the treating surgeon to evaluate nasolabial growth by comparing anthropometric measurements with age-matched normal patients. Good outcomes from this surgical method have been reported in clinical cases worldwide. Herein, we describe the management of two cases of bilateral cleft repair, following the principles and methods established by Mulliken. We also provide a relevant review of the literature.ope

Facial asymmetry with mandibular prognathism - A new trial of classification and interpretation -

Object : Patients with facial asymmetry accompanying mandibular prognathism have various causes and clinical features. So, it is difficult to find a satisfactory treatment method functionally and esthetically. Every traditional classification and interpretation to find etiopathogenesis and/or to establish ideal surgical modality has many limitations because it can't be applied simply to various conditions of patients with facial asymmetry accompanying mandibular prognathism. Therefore, we employ a new classification to interpret more details of the morphologic change of mandible and the spatial change of mandible and maxilla. Materials and Methods : Using panoramic X-ray films, PA cephalograms and submentovertex films of 126 patients diagnosed with facial asymmetry accompanying mandibular prognathism as resources, the following results were gathered after analyzing each characteristics through distributing the patterns according to the morphological mandibular asymmetry and mandibular and maxillary spatial asymmetry. Results : Almost frequency of morphological mandibular asymmetry was shown. In case of condyle-ramus elongation and body elongation group, it's frequency was the highest. Higher frequency of compensating vertical growth was shown on the side of over growing maxilla in case of vertical length difference between left and right condyle-ramus. On the other hand, higher frequency of no compensating vertical growth difference between left and right side was shown in case of no vertical length difference in condyleramus. Spatial mandibular asymmetry generally occurred when there was no morphological mandibular asymmetry. Correlation between condyle length difference and condyle-ramus length difference between left and right side was very high, but correlation between condyle length difference and body length difference, and correlation between condyle length difference and body vertical length difference was low. Conclusion : In case of patients with facial asymmetry accompanying mandibular prognathism, it is suggested that various pattern of facial asymmetry is occurred by the independent growth of each unit rather than dependent growth of other unit by major growth unit abnormality. Due to the untypical pattern and the various asymmetry occurring according to the changes of each mandibular growth unit, it is considered that an appropriate surgical method should be searched based on the accurate recognition of the each pattern for patients with facial asymmetry accompanying mandibular prognathism.ope

Changes of transverse mandibular width after intraoral vertical ramus osteotomy

Purpose: In order to clarify the correlation of mandibular setback using bilateral intraoral vertical ramus osteotomy (BIVRO) and post-surgical transverse mandibular width (TMW), this study examined the pre- and postsurgical changes in hard and soft tissues of TMW and the relationship of TMW and the amount of mandibular setback. Patients and Methods: One-hundred seven patients who had undergone BIVRO were evaluated radiographically and clinically. A comparison study of the changes in hard and soft tissue after surgery in all 107 patients was performed with preoperative, 1 month, 3 month, 6 month and 1 year postoperative posteroanterio cephalograms and clinical photographs by tracing. And this changes were evaluated in parts to amounts of mandibular setback. Results: Statistically significant increases of TMW in hard and soft tissue from preoperative to postoperative 1 month were seen. TMW in hard tissue from 1 month to 1 year postopertive were gradually decreased. TMW in soft tissue was not changed uniformly but almost equal to pre-operative width. And there was no significant correlation between TMW and amount of mandibular setback. Conclusions: The results show that mandibular setback using BIVRO did not significantly influence increasing of TMW in soft tissue.ope