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The treatment of obstructive sleep apnea patient using extended uvulopalatal flap: a case report.

Ji Youn KIM ; Soung Min KIM ; Hoon MYOUNG ; Soon Jung HWANG ; Byoung Moo SEO ; Jong Ho LEE ; Pill Hoon CHOUNG ; Myung Jin KIM ; Jin Young CHOI

Journal of the Korean Association of Oral and Maxillofacial Surgeons.2011;37(1):81-85. doi:10.5125/jkaoms.2011.37.1.81

The uvulopalatal flap (UPF) technique is a modification of uvulopalatopharyngoplasty (UPPP) for the surgical treatment of obstructive sleep apnea. In the UPF technique, an uvulopalatal flap is fabricated and sutured to the residual mucosa of the soft palate to expand the antero-posterior dimensions of the oropharyngeal inlet. In the extended uvulopalatal flap (EUPF) technique, an incision at the tonsillar fossa is added to the classical UPF technique followed by the removal of mucosa and submucosal adipose tissue for additional expansion of the lateral dimension. The EUPF technique is more conservative and reversible than UPPP. Therefore, complications, such as velopharyngeal insufficiency, dysphagia, dryness, nasopharyngeal stenosis and postoperative pain, are reduced. In the following case report, the patient was diagnosed with obstructive sleep apnea and treated with the EUPF technique. The patient's total respiratory disturbance events per hour (RDI) was decreased to 15.4, the O2 saturation during the sleep was increased, and the excessive daytime sleepiness had disappeared after the surgery without complications. The authors report this case with a review of the relevant literature.
Adipose Tissue ; Bays ; Constriction, Pathologic ; Deglutition Disorders ; Humans ; Mucous Membrane ; Pain, Postoperative ; Palate, Soft ; Sleep Apnea, Obstructive ; Surgical Flaps ; Treatment Outcome ; Uvula ; Velopharyngeal Insufficiency

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Calcifying epithelial odontogenic tumor (CEOT) in palate: report of a case.

Joong Min KIM ; Hyon Seok JANG ; Jae Suk RIM ; Sang Ho JUN ; Jung Kyun PARK ; Hyun Joong JU ; Eui Seok LEE

Journal of the Korean Association of Oral and Maxillofacial Surgeons.2011;37(1):77-80. doi:10.5125/jkaoms.2011.37.1.77

A calcifying epithelial odontogenic tumor (CEOT) was first described as a separate entity in 1955 by Pindborg, and has since been referred to as Pindborg tumor. CEOT is characterized by the presence of squamous-cell proliferation, calcification and amyloid deposits, and accounts for only 1% of all odontogenic tumors. CEOT is a benign, though occasional locally invasive, slow-growing neoplasm. It is located either intraosseously or extraosseously, and is usually associated with an unerupted permanent tooth. A 24 year-old female visited our clinic, presenting with a palatal swelling and intra-oral ulcer. After an incisional biopsy, the lesion was confirmed to be odontogenic tumor. A tumor resection and reconstruction surgery with tongue flap were performed.
Biopsy ; Female ; Humans ; Jaw Neoplasms ; Odontogenic Tumors ; Palate ; Plaque, Amyloid ; Skin Neoplasms ; Tongue ; Ulcer

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Polymorphous low-grade adenocarcinoma on hard palate: case report.

Young Min SHIN ; So Young CHOI ; Jin Wook KIM ; Ki Jung BYEON ; Chin Soo KIM

Journal of the Korean Association of Oral and Maxillofacial Surgeons.2011;37(1):72-76. doi:10.5125/jkaoms.2011.37.1.72

Polymorphous low-grade adenocarcinomas (PLGA) are distinctive salivary gland neoplasms with a propensity to arise from the minor salivary glands. The most frequent location of PLGA is the palate, even though other locations have been described. Previously used terms for PLGA include lobular carcinoma and terminal duct carcinoma. Although the frequency of the tumor is unknown, the recognition of PLGA as an individual tumor has increased with the establishment of specific histopathological criteria characterizing the PLGA. The first choice of treatment is a wide surgical excision including the subjacent bone if necessary. The prognosis is generally good and the recurrence rate ranges from 17% and 22%. Distant metastases is unusual (9%) but occur mainly in the regional lymph nodes. This is a case report of a 67 year old female patient with PLGA who was treated with a wide excision by layers (2 stage) of the lesion including the surrounding bone. We present this case with a review of the relevant literature.
Adenocarcinoma ; Carcinoma, Lobular ; Female ; Humans ; Lactic Acid ; Neoplasm Metastasis ; Palate ; Polyglycolic Acid ; Prognosis ; Recurrence ; Salivary Gland Neoplasms ; Salivary Glands, Minor

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Low-grade myxofibrosarcoma in the mandible: a case report.

Ji Hoon PARK ; So Young CHOI ; Tae Geon KWON ; Chin Soo KIM

Journal of the Korean Association of Oral and Maxillofacial Surgeons.2011;37(1):67-71. doi:10.5125/jkaoms.2011.37.1.67

Myxofibrosarcoma, also known as a myxoid variant of a malignant fibrous histiocytoma (MFH), is one of the most common sarcomas in the extremities of elderly people. The lesion is characterized by a high frequency of local recurrence but is uncommon in the head and neck regions. Low-grade myxofibrosarcoma, which is commonly misinterpreted as being benign, has a tendency for histological and biological progression in local recurrences, highlighting the importance of an accurate diagnosis and wide surgical excision of the primary lesion. We report a rare case of low-grade myxofibrosarcoma of the mandible located in the left mandibular body and angle area. The tumor was first diagnosed as a myxofibroma and was resected initially. After the final biopsy the patient underwent combined chemo-radiotherapy. The progress of the patent was uneventful until the one year follow up.
Aged ; Biopsy ; Extremities ; Fibroma ; Follow-Up Studies ; Head ; Histiocytoma, Malignant Fibrous ; Humans ; Mandible ; Neck ; Recurrence ; Sarcoma

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The result of endoscope-assisted open reduction and internal fixation (EAORIF) of lateral overridden subcondyle fracture.

Eun Joo CHOI ; In Ho CHA ; Woong NAM

Journal of the Korean Association of Oral and Maxillofacial Surgeons.2011;37(1):62-66. doi:10.5125/jkaoms.2011.37.1.62

INTRODUCTION: Endoscope-assisted open reduction and internal fixation (EAORIF) reduces the amount of facial scaring, but limitations, such as the possibility to convert to the open technique and the large learning curve, remain. MATERIALS AND METHODS: The medical records of 19 patients diagnosed as lateral overridden subcondyle fractures and treated with endoscope-assisted open reduction and internal fixation at Yonsei University Health System from December 2006 to August 2010 were reviewed. RESULTS: 11 patients underwent temporary discomfort or pain such as limitation of mouth opening, temporomandibular joint discomfort, lip paresthesia or facial weakness, but the symptoms disappeared within 3 months. There was no severe long-term complication except 2 patients with re-fractures of operated subcondyles. CONCLUSION: Subcondyle fracture with lateral overridden proximal segment is a better indication of endoscope-assisted open reduction and internal fixation than a condylar head/neck fracture, or medial overridden subcondyle fracture: allowing an anatomic reduction.
Humans ; Learning Curve ; Lip ; Medical Records ; Mouth ; Paresthesia ; Temporomandibular Joint

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Clinical study of diagnosis and treatment of bisphosphonate-related osteonecrosis of the jaws.

Kyung Wook KIM ; Beom Jin KIM ; Chung Hyun LEE

Journal of the Korean Association of Oral and Maxillofacial Surgeons.2011;37(1):54-61. doi:10.5125/jkaoms.2011.37.1.54

INTRODUCTION: Bisphosphonates is used widely for the treatment of the Paget's disease, multiple myeloma, bone metastases of malignant tumors with the prevention of pain and their pathological fracture. However, it was recently suggested that bisphosphonates related osteonecrosis of the jaw (BRONJ) is a side effect of bisphosphonate use. MATERIALS AND METHODS: Twenty-four individuals, who were referred to the Department of Oral and Maxillofacial surgery, Dankook University Dental Hospital, were selected from those who had exposed bone associated with bisphosphonates from January, 2005 to December, 2009 according to the criteria of American Association of Oral and Maxillofacial Surgeons (AAOMS) for BRONJ. The patients group consisted of 7 males and 17 females between the age of 46 to 78 years (average 61.8 years). Each patient had panoramic imaging, computed tomography (CT), whole body bone scanning performed for a diagnosis and biopsy sampling from the necrotizing tissue. C-terminal cross-linking telopeptide of type I collagen (CTX) level of patients who had undergone surgical intervention was measured 7 days before surgery. RESULTS: The main cause of bone exposure was post-extraction (15), chronic periodontitis (4), persistent irritation of the denture (3). Twenty people had undergone BRONJ treatment for two to eight months except for 4 people who had to maintain the bisphosphonates treatment to prevent a metastasis and bone trabecular pain with medical treatment. When the bisphosphonate treatment was suspended at least for 3 months and followed up according to the AAOMS protocols, the exposed necrotizing bones were found to be covered by soft tissue. CONCLUSION: Prevention therapy, interruption of bisphophonates for at least 3 months and cooperation with the physician for conservative treatment are the essential for treating BRONJ patient with high risk factors. The CTX level of BRONJ patients should be checked before undergoing surgical intervention. Surgical treatments should be delayed in the case of a CTX level <150 pg/mL.
Biopsy ; Bisphosphonate-Associated Osteonecrosis of the Jaw ; Chronic Periodontitis ; Collagen Type I ; Dentures ; Diphosphonates ; Female ; Fractures, Spontaneous ; Humans ; Jaw ; Jaw Diseases ; Male ; Multiple Myeloma ; Neoplasm Metastasis ; Osteonecrosis ; Risk Factors ; Surgery, Oral

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Comparative study of removal torque of 3 different hydroxyapatite coated implants in the femur of rabbits.

Sang Soo KIM ; Ju Hyung LEE ; Seok Hyun YU ; Hyung Ju LEE ; Jee Won MOON ; In Sook PARK ; Dong Seok SOHN

Journal of the Korean Association of Oral and Maxillofacial Surgeons.2011;37(1):49-53. doi:10.5125/jkaoms.2011.37.1.49

INTRODUCTION: This study compared the strength of osseointegration as determined by the resistance to reverse torque rotation of three different hydroxyapatite coated implants in the rabbit femur model. MATERIALS AND METHODS: Three hydroxyapatite coated implants (HAPTITE), Tapered Screw-Vent (TSV) and BioTite-H - were used. A total of 40 implants were placed in the femur of 20 adult male rabbits. The animals were divided into two groups. In group A (n=10); one HAPTITE was placed into each right femur and one TSV was placed into each left femur. In group B (n=10); one HAPTITE was placed into each right femur and one BioTite-H was placed into each left femur. Five rabbits of each group were sacrificed at 4 and 8 weeks. The implants were removed by reverse torque rotation using a digital torque-measuring device. A total of 40 implants in 20 rabbits were used for the removal torque measurements. RESULTS: In the Group A, 4 weeks after implant placement, the mean removal torque for the HAPTITE and TSV was 70.7+/-31.6 N cm and 28.9+/-15.1 N cm, respectively. Eight weeks after implant placement, the mean removal torque for the HAPTITE and TSV was 87.9+/-26.2 N cm and 54.9+/-22.4 N cm, respectively. In the Group B, 4 weeks after implant placement, the mean removal torque for the HAPTITE and BioTite-H was 58.0+/-29.6 N cm and 37.7+/-14.1 N cm, respectively. Eight weeks after implant placement, the mean removal torque for the HAPTITE and BioTite-H was 91.4+/-47.1 N cm and 30.8+/-9.8 N cm. HAPTITE showed a higher removal torque than the other implants. CONCLUSION: These results suggest that HAPTITE increases the strength of osseointegration significantly as determined by the resistance to reverse torque rotation.
Adult ; Animals ; Dental Implants ; Durapatite ; Femur ; Humans ; Male ; Osseointegration ; Rabbits ; Torque

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An anatomical study on the mandibular medial surface by CBCT analysis for safer implant placement.

Jung Kyo LEE ; Yeo Gab KIM

Journal of the Korean Association of Oral and Maxillofacial Surgeons.2011;37(1):43-48. doi:10.5125/jkaoms.2011.37.1.43

INTRODUCTION: This study examined the anatomical morphology of the medial surface of the posterior mandible using 3-dimensional cone-beam computed tomography (CT) images to reduce the number of complications related to dental implant placement. MATERIALS AND METHODS: Fifty patients were enrolled in this study with an average age (+/-standard deviation) of 44.28 (+/-13.05). On the coronal views cone-beam CT of the first molars, the distance between the top of the canal and alveolar crest vertical distance (VD), the distance between the upper-most point of the canal and the point perpendicular to the lingual cortical margin of the mandible lingual distance (LD), the location of the starting point of VD for reducing from the vertical reference line (VD point), and the inclination of the mandibular medial surface (lingual inclination) were measured, and a statistical evaluation was performed using SPSS for Windows version 15.0. RESULTS: The mean VD0 was 16.91+/-2.47 mm and VDx decreased with increasing x value. The mean LD was 5.27+/-1.36 mm. The VD began to decrease at the mean location of 6.12+/-0.96 mm from the vertical reference line. The mean lingual inclination was 1.52+/-0.72degrees. CONCLUSION: These results will assist in the accurate placement of dental implants and the reduction of complications, particularly in the case of preoperative implant planning using only 2-dimensional imaging methods. (ex. panoramic radiography)
Cone-Beam Computed Tomography ; Dental Implants ; Humans ; Mandible ; Molar

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Morphological analysis of maxillary sinus septum using computed tomography.

Jong Beom CHAE ; Sang Han LEE ; Chin Soo KIM ; Jong Bae KIM ; Tae Geon KWON

Journal of the Korean Association of Oral and Maxillofacial Surgeons.2011;37(1):36-42. doi:10.5125/jkaoms.2011.37.1.36

INTRODUCTION: The current study examined the morphological characteristics of maxillary sinus septum by computed tomography (CT). MATERIALS AND METHODS: Two hundred and four patients (408 maxillary sinuses) who visited dental clinic were evaluated. CT were examined. The height of the septum measured from the sinus floor to the apex of the septum more than 3 mm was defined as "sinus septum". RESULTS: The prevalence of sinus septa was 21.3% (87/408), and 31.4% (64/204) of patients had more than 1 sinus septum. Females showed higher and thinner sinus septa than males. The anatomic location of the septa were distributed in the 2nd molar region (43.7%), 1st molar region (31.0%), 2nd premolar region (21.8%) and 1st premolar region (3.5%). In 57 patients with chronic disease, there was no significant difference between sinus disease and the presence of sinus septa. The loss of remaining teeth and teeth adjacent to the sinus septum area was not related to the presence of sinus septa. Older subjects showed a reduced height and length of the septum, and a thicker septum. CONCLUSION: These results show that the maxillary sinus septum undergoes atrophy with age.
Atrophy ; Bicuspid ; Chronic Disease ; Dental Clinics ; Female ; Floors and Floorcoverings ; Humans ; Male ; Maxillary Sinus ; Molar ; Prevalence ; Tooth

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Bone response around immediately placed titanium implant in the extraction socket of diabetic and insulin-treated rat maxilla.

Dae Won KIM ; Hyun A HEO ; Sang Gyu LIM ; Won LEE ; Young Sil KIM ; Sung Woon PYO

Journal of the Korean Association of Oral and Maxillofacial Surgeons.2011;37(1):30-35. doi:10.5125/jkaoms.2011.37.1.30

INTRODUCTION: Dental implants are used routinely with high success rates in generally healthy individuals. By contrast, their use in patients with diabetes mellitus is controversial because altered bone healing around implants has been reported. This study examined the bone healing response around titanium implants placed immediately in rats with controlled and uncontrolled diabetes. MATERIALS AND METHODS: Twenty rats were divided into the control, insulin-treated and diabetic groups. The rats received streptozotocin (60 mg/kg) to induce diabetes; animals in the insulin-treated group also received three units of subcutaneous slow-release insulin. A titanium implant (1.2x3 mm) was placed in the extraction socket of the maxillary first molar and bone block was harvested at 1, 2 and 4 weeks. RESULTS: Bone formation around the implants was consistently (from 1 to 4 week post-implantation) slower for the diabetic group than the control and insulin-treated group. Bone morphogenesis in the diabetic rats was characterized by fragmented bone tissues and extensive soft tissue intervention. CONCLUSION: The immediate placement of titanium implants in the maxilla of diabetic rats led to an unwanted bone healing response. These results suggest that immediate implant insertion in patients with poorly controlled diabetes might be contraindicated.
Animals ; Bone and Bones ; Bone Remodeling ; Dental Implants ; Diabetes Mellitus ; Humans ; Insulin ; Maxilla ; Molar ; Morphogenesis ; Osseointegration ; Osteogenesis ; Rats ; Streptozocin ; Titanium

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