TMJ internal derangement has been treated by the conservative methods and the surgical methods according to the clinical state. There are several surgical methods for treatment of TMJ internal derangement, such as disk repositioning and repair, diskectomy with and without grafts, articular surface contouring, high condylectomy, condylotomy, and arthroscopic surgery etc. Especially, it has been reported that the condylotomy produced the increase of the joint space, the pain relief, the elimination of the joint dysfunction due to the antero-inferiorly movement of the condyle, and the condylar morphologic change resulted from the progressive remodeling in TMJ without the surgical intervention within the TMJ. We have performed EVRO(extraoral vertical ramus osteotomy) to the 5 patients diagnosed as ADDWR(Anterior disk displacement with reduction) from June 1997 to December 1997 in the Chin-Hae military hospital. We diagnosed them with MRI and clinical examination. And we compared the preoperative symptoms with postoperative 2 months symptoms. They were compared by Helkimo index, mandibular mobility index, and pain scale. Anamnestic Index(Ai) was changed from 2.0 preoperatively to 1.2 postoperatively, clinical dysfunction score from 11.8 to 2.8, and Clinical Dysfunction Index(Di) from 2.8 to 1.2. The pain scale of the affected side was changed from 4.4 to 2.6 and that of the non-affeted side from 2.2 to 2.6. The maximal mouth opening was changed from 35.2mm to 40.9mm, right lateral excursion from 7.8mm to 8.0mm, left from 8.8mm to 7.0mm, and protrusion from 6.2mm to 6.2mm. In these results, we could not expect any excellent improvement of the clinical symptoms during the immediate postoperative periods. But we could observe the disappearance of the joint noise and the improvement of the clinical dysfunction score. On the basis of the results of the previous investigations about condylotomy effect which presented the condyle position were changed antero-inferiorly in the articular fossa during the immediate postoperative period, the displaced condyles may prevent wide mouth opening. Therefore it is elucidated that the improvement of the maximal mouth opening and other functions were restricted during the immediate postoperative periods. After long term follow-up period, the symptomatic and functional improvement will be expected by the passive repositioning of the proximal segment. We report the preliminary results with the related references.
Arthroscopy ; Diskectomy ; Follow-Up Studies ; Hospitals, Military ; Humans ; Joints ; Magnetic Resonance Imaging ; Mouth ; Noise ; Postoperative Period ; Temporomandibular Joint* ; Transplants

Percutaneous catheter drainage (PCD) of pancreatic pseudocyst has been reported to have good therapeutic results, low complications, and short hospital course. To find the clinical and radiological findings which can predict the treatment period for PCD, we retrospectively correlated the clinical data (presence of invection, initial and 1 week follow-up serum and aspirate amylase level, daily drainage amount) and radiological findings (evidence of fistula, PCD route, inital size of pseudocyst) with the treatment period in each case. The age ranged from 20 to 64 years(mean:39.8 years) and male to female ratio was nine to one. When the cavity was obliterated after PCD and did not recur after tube removal without a surgical treatment, we regarded the patient to be cured. Mean treatment period was 20.2 days and nine patients(90%) were cured. We think that the factors shortening treatment period are the presence of superimposed infection and the abrupt decrease of the amount of daily drainage for the first week. But the presence of fistula to the pancreatic duct may prolong the treatment period. In conclusion, PCD is safe and effective in the treatment of pancreatic pseudocyst, and the clinical ad radiological findings are expected to be able to predict the treatment period of PCD.
Amylases ; Catheters* ; Drainage* ; Female ; Fistula ; Follow-Up Studies ; Humans ; Male ; Pancreatic Ducts ; Pancreatic Pseudocyst* ; Retrospective Studies

The minor fissure is an important anatomical landmark in the localization of the pulmonary diseases. For the evaluation of the normal feature of the minor fissure, we analyzed the high-resolution computed tomography (CT) scans in 51 normal patients. The purposes of this study are to evaluate the normal appearance of the minor fissure on high-resolution CT scans and to compare it with that on the coventional CT and chest radiographs. We analysed the morphologic feature of the minor fissure on the high-resolution CT scans in 51 normal patients, and compared it with that on the conventional CT scans. On the high-resolution CT scans, we particularly paid attention to the completeness and types according to Berkmen classification. And finally, we compared the types determined by the high-resolution CT scans with those by the plain radiographs. In most patients (n=47), the minor fissure was seen as a hyperattenuating line or hand on the high-resolution CT scans. In contrast, it was mostly seen as a lucent zone on the conventional CT scans (n=44). Of 47 patients having a hyperattenuating line or band on the high resolution CT scans, the minor fissure was considered to be complete in 17 patients (36%), and incomplete in 30 patients (64%), who had defect at medial portion of the minor fissure. The most common type of the minor fissure seen on the high-resolution CT scans was type I variety (n=23), followed by type IIa (n=10) and type II (n=8). We could not determine the type in six patients. The type determined by the high resolution CT scans was highly well correlated with that determined by the plain radiographs (p<0.05). In conclusion, the minor fissure was seen on CT studies as variable appearances and high-resolution CT scans were superior to the conventional CT scans in the evaluation of the minor fissure. The type of the minor fissure determined by the high-resolution CT scans were well correlated with those seen on the radiographs.
Classification ; Hand ; Humans ; Lung Diseases ; Radiography, Thoracic ; Tomography, X-Ray Computed

The minor fissure is an important anatomical landmark in the localization of the pulmonary diseases. For the evaluation of the normal feature of the minor fissure, we analyzed the high-resolution computed tomography (CT) scans in 51 normal patients. The purposes of this study are to evaluate the normal appearance of the minor fissure on high-resolution CT scans and to compare it with that on the coventional CT and chest radiographs. We analysed the morphologic feature of the minor fissure on the high-resolution CT scans in 51 normal patients, and compared it with that on the conventional CT scans. On the high-resolution CT scans, we particularly paid attention to the completeness and types according to Berkmen classification. And finally, we compared the types determined by the high-resolution CT scans with those by the plain radiographs. In most patients (n=47), the minor fissure was seen as a hyperattenuating line or hand on the high-resolution CT scans. In contrast, it was mostly seen as a lucent zone on the conventional CT scans (n=44). Of 47 patients having a hyperattenuating line or band on the high resolution CT scans, the minor fissure was considered to be complete in 17 patients (36%), and incomplete in 30 patients (64%), who had defect at medial portion of the minor fissure. The most common type of the minor fissure seen on the high-resolution CT scans was type I variety (n=23), followed by type IIa (n=10) and type II (n=8). We could not determine the type in six patients. The type determined by the high resolution CT scans was highly well correlated with that determined by the plain radiographs (p<0.05). In conclusion, the minor fissure was seen on CT studies as variable appearances and high-resolution CT scans were superior to the conventional CT scans in the evaluation of the minor fissure. The type of the minor fissure determined by the high-resolution CT scans were well correlated with those seen on the radiographs.
Classification ; Hand ; Humans ; Lung Diseases ; Radiography, Thoracic ; Tomography, X-Ray Computed

Deglutition ; Dislocations ; Ligaments ; Mastication ; Recurrence ; Temporomandibular Joint ; Transplants ; Zygoma

STUDY DESIGN: Two case reports. OBJECTIVES: We present two cases of quadriplegia after posterior decompression with fusion caused by a suspicious reperfusion injury of spinal cord without remarkable surgical insult. SUMMARY OF LITERATURE REVIEW: Posterior decompression and posterolateral fusion have been reported as effective procedures in patients with multilevel myelopathy. However, postoperative spinal cord injury without remarkable intraoperative technical damage has been reported in a few articles. Reperfusion mechanism was suggested as one of the leading causes and reported in some animal models. MATERIALS AND METHODS: There was one case of ossification of the posterior longitudinal ligament and one developmental multilevel stenosis that underwent laminectomy with lateral mass instrumentation. After surgery, the patients presented with quadriplegia; MRI demonstrated swelling of the spinal cord and intramedullary lesion in two cases. RESULTS: After surgery, the patients presented with quadriplegia; MRI demonstrated swelling of the spinal cord and intramedullary lesion in two cases. CONCLUSION: Although patients with such a medical condition are rare, it is difficult to predict postoperative swelling of the spinal cord before surgery. The surgeon should thus be aware of such rare disease conditions involving the spinal cord before the surgical procedure.
Constriction, Pathologic ; Decompression* ; Humans ; Laminectomy ; Longitudinal Ligaments ; Magnetic Resonance Imaging ; Models, Animal ; Quadriplegia ; Rare Diseases ; Reperfusion ; Reperfusion Injury* ; Spinal Cord Diseases ; Spinal Cord Injuries ; Spinal Cord*

No abstract available.
Amniotic Fluid* ; Female ; Pregnancy*

Substernal extension of a goiter into the thoracic inlet endows a generally benign neck mass with morbid potential. The reported incidence varies between 1% and 15% of all thyroidectomies performed. Whether all patients with a substernal goiter should undergo an operation or whether the operation should be performed selectively remains controversial. From May 1989 to March 1996, 10 patients underwent thyroidectomies for substernal goiters, and those cases of resected substernal goiters have been reviewed to access the symptoms and signs that brought patients to surgery: the size and the position of goiter, the preoperative work-up, the risk associated with the operation, and the histopathologic state of the goiter. There were 3 male and 7 female patients, and their ages ranged from 40 to 68 years. The chief complaints were cervical mass (4), dyspnea (2), facial edema (1) and chest pain (1). No symtomatic cases (2) were also found. The average mass size was 8.4 cm (5-14 cm) and the average weight was 109 gm (41-350 gm). Although chest film was the most used, computed tomography was by far the most useful study. Thyroid scans often failed to show the substernal goiter. Fine-needle aspiration was not helpful because of inaccessibility. In the majority of the patients (7 cases), the substernal goiters were removed by a cervical incision. Three cases of goiters located deep to the carina level required a combined cervical and sternotomy approach or thoracotomy. In the cervical incision group, the complications were transient hypocalcemia (1) and unilateral recurrent laryngeal nerve injury (1). In the combined cervical and sternotomy approach or thoracotomy, unilateral recurrent laryngeal nerve injury (1) and bilateral recurrent laryngeal nerve injury (1) and mediastinitis (1) were the complications. An occult papillary carcinoma, which was not identified preoperatively, was found in one case. Removal was almost always accomplished via cervical incision and with low morbidity and no deaths. Also, the substernal goiters revealed unusual symptoms and signs, such as dyspnea, facial edema and chest pain, compared to usual thyoid goiters and were relatively bigger in size. In conclusion, most substernal goiter above the carinal level could be removed by cervical incision with a low rate of complication. The threat of compression, the substantial chance of malignancy, and the safety of resection mean that the presence of a substernal goiter is an indication for surgery.
Bays ; Biopsy, Fine-Needle ; Carcinoma, Papillary ; Chest Pain ; Dyspnea ; Edema ; Female ; Goiter ; Goiter, Substernal* ; Humans ; Hypocalcemia ; Incidence ; Male ; Mediastinitis ; Neck ; Recurrent Laryngeal Nerve Injuries ; Sternotomy ; Thoracotomy ; Thorax ; Thyroid Gland ; Thyroidectomy

STUDY DESIGN: To analyze the relationship between the adjacent superior segment disease and facet joint violations after lumbar fusion. OBJECTIVES: We retrospectively analyzed the relationship between the adjacent superior segment disease and facet joint violations after lumbar fusion. SUMMARY OF LITERATURE REVIEW: Among numerous literatures regarding adjacent superior segment disease, there is no analysis concerning the relationship between adjacent superior segment disease and facet joint violations after lumbar fusion. MATERIALS AND METHODS: We reviewed 2056 patients who underwent lumbar fusion, between March 2004 and April 2009. Analysis was performed for 79 (3.8%) of the 2056 patients with adjacent superior segment disease and needed a second operation. A facet joint was considered as 3 types of violations with computed tomography scans if any of the following situations were encountered: pedicle screw clearly within the facet joint; pedicle screw head clearly within the facet joint; and pedicle screw and/or screw head within 1mm from or abutting the facet joint, without clear joint involvement. RESULTS: The incidence of the violations was 45% (36/79) of all patients and 28% (44/158) of all screws. The incidence of L4-5 facet joint violations was 35% (28/79) of patients with adjacent superior segment disease, statistically. CONCLUSIONS: Facet joint violations were observed in patients with the adjacent superior segment disease after posterolateral lumbar fusion. Because L3-4 facet joint violations increased when L4-5 fusion was done, more care should be taken to avoid facet joint violations when the surgeon is considered for insertion of the pedicle screws at L4-5.
Head ; Humans ; Incidence ; Joints ; Retrospective Studies ; Zygapophyseal Joint

Maxillary defect may be induced by trauma, inflammation, cyst, tumor and surgical procedure. In case of limited wall defect, free bone graft has been preferred. But it has some problems such as postoperative bone resorption and soft tissue inclusion to recipient site. And we can not use free bone in the case who has inflammation in the donor site. So we used the micro-titanium mesh as reconstructive material for the maxillary wall defect. We had operated 8 patients who were diagnosed as maxillary partial defects from June 1997 to September 1998 in the Chin-Hae military hospital. They were 1 case of antral wall defect, 1 case of palatal wall defect, 5 cases of infra-orbital wall defects and 1 case of oro-antral fistula case. As a result, the micro-titanium mesh has shown the morphological stability and biocompatibility and it could be used in case who has infection. And mesh structure could prevent soft tissue ingrowth to bony defect area. Thus it can be used to the case of maxillary partial defect successfully.
Bone Resorption ; Fistula ; Hospitals, Military ; Humans ; Inflammation ; Tissue Donors ; Transplants