KAMPRS 2018_내지_10차-초록만.indd

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1 Poster Session Part Ⅰ [Trauma & Orthognathic surgery / Orthognathic surgery] PⅠ-01 전신질환자의구강연조직손상대처법 : 증례보고유한창 1*, 윤필영 1, 김영균 1,2 1 분당서울대학교병원, 치과, 구강악안면외과 2 서울대학교치의학대학원치의학과, 치의학연구소 Oral Presentation Preventing oral soft tissue damage in patients with systemic diseases : case report Han-Chang YU 1*, Pil-Young Yun 1, Young-Kyun Kim 1,2 1 Department of Dentistry, Seoul National University Bundang Hospital, Seongnam, Korea 2 Department of Dentistry & Dental Research Institute, School of Dentistry, Seoul National University, Seoul, Korea PⅠ-02 PⅠ-03 PⅠ-04 후하악접근법을이용한양측하악과두경부및정중부주위골절치료의증례보고신영민 1* 계명대학교동산의료원, 계명대학교의과대학치과학교실 ( 구강악안면외과 ) Open reduction & Internal fixation of Bilateral Condylar neck and Parasymphyseal Fractures via Retromandibular Approach; Case Report Youngmin Shin 1* Keimyung University School of Medicine, Department of Dentistry & Oral surgery 1 하악골골절의관혈적정복술후발생한부정교합에대한치료 : 증례보고이혜정 *, 김수관, 문성용, 오지수, 유재식, 최해인, 신나라 조선대학교치의학전문대학원구강악안면외과학교실 제57차대한악안면성형재건외과학회종합학술대회및정기총회 The treatment of malocclusion after open reduction of mandibular fracture : a case report Hye-jung Lee *, Su-Gwan Kim, Seong-Yong Mon, Ji-Su Oh, Jae-Seek You, Hae In Choi, Na-Ra Shin Department of Oral and Maxillofacial Surgery, School of Dentistry, Chosun University 심한전안면골절로인한상하악골의불완전한정복과악교정수술을통한교합재건 : 증례보고오광진 *, 류동목, 지유진, 이덕원, 김세원, 양선인, 정상필, 강미주, 이재덕 강동경희대학교치과병원구강악안면외과학교실 Incomplete reduction of maxilla-mandibular bone due to severe panfacial fracture and occlusal reconstruction via orthognathic surgery : a case report Gwangjin Oh *, Dong-mok Ryu, You-jin Jee, Deok won Lee, Se-won Kim, Sunin Yang, Sang-pil Jung, Miju Kang, Jaedeok Lee Dept. of Oral and Maxillofacial surgery, Kyung-Hee University Dental Hospital at Gangdong PⅠ-05 편측하악각골절에서흡수성 polymer, 티타늄과 Mg-Ca-Zn 합금을이용한고정을하였을때, 유한요소분석통한흡수성 polymer 의안정성비교박병호 1*, 김원현 2, 이종호 3, 이지호 1 1 서울아산병원구강악안면외과학교실 2 서울대학교치과병원중개임상시험지원센터 3 서울대학교치의학대학원구강악안면외과학교실 Stability of absorbable polymer fixation compared with titanium and Mg-Ca-Zn alloy for

2 KS (25-A) 안면골골절수술과관련된감각이상에대한연구송재민 1, 이재열 *, 황대석, 김용덕, 신상훈, 김욱규 부산대학교치의학전문대학원구강악안면외과학교실목적 : 안면골절환자에서 hypoesthesia의발생률을조사하고, 외상후감각이상과관련된일반적특성및골절관련특성을포함한위험인자사이의관계를확인하고자하였다. 대상및방법 : 안면골절수술을받은총 437명의환자를대상으로하였다. 임상신경감각검사는여러시점 ( 외상후 1 주, 1개월, 수술후 6개월 ) 에실시되었다. 검사결과는환자의일반적특성과골절부위특성과관련하여비교하였다. 결과 : 감각이상의유병율은하악 (19.1%), 상악 (18.3%), 안와골절 (8.5%) 순이었다. 수술후 6 개월까지대부분환자의감각은 97.3 % 까지회복되었다. 감각이상의위험인자는직접적인신경손상 (p=.002), 골절과신경공 (p=.002) 사이의거리 ( 10mm), 골변위양 (p =.035), 나이 (p = 0.004) 등이었다. 골절부위간에도유의한차이가있었다는것을확인할수있었다. 결론 : 외상후감각이상은수술후일시적으로증가하였으나대부분의환자는수술후 6개월까지회복되었다. 수술후감각저하는골절부위와유형과관련이있었다. 환자가회복하지못한경우는직접적인신경손상이동반된경우였다. Risk Factors for hypoesthesia of Operative Facial bone Fractures Jae-Min Song 1 Jae-Yeol Lee * Dae-Seok Hwang, Yong-Deok Kim, Sang-Hun Shin, Uk-Kyu Kim Department of Oral and Maxillofacial Surgery, School of Dentistry, Pusan National University Purpose: The aim of this study was to investigate the incidence of hypoesthesia in patients with facial bone fractures, and to identify the relationships between posttraumatic hypoesthesia and risk factors, including general and fracture-related characteristics. Materials and methods: A total of 437 patients who underwent surgery for facial bone fractures were included. Clinical neurosensory testing was performed at different time points (post-trauma and 1 week, 1 month, and 6 months after surgery). The results of these assessments were compared between characteristics and fracture sites. Results: The hypoesthesia incidences were highest in the mandible (19.1%), maxilla (18.3%), and orbit (8.5%). Sensation was recovered by 97.3% of all patients by 6 months after surgery. Risk factors for hypoesthesia were direct nerve injury (p =.002), distance ( 10 mm) between the fracture and nerve foramen (p =.002), the amount of bony displacement (p =.035), and age (p =.004). There were significant differences among the fracture sites. Conclusion: Post-traumatic hypoesthesia increased temporarily after surgery but most patients recovered by 6 months postoperatively. Recovery from postoperative hypoesthesia was related to the fracture site and pattern. Cases in which the patient did not recover involved direct nerve injury. 2 대한악안면성형재건외과학회

3 O1 (25-A) 하악골과두경부골절의관혈적내고정술에사용된생체흡수성판과금속판의비교연구 임세정 1*, 전도현 1, 이수호 2, 서정민 2, 손장호 1, 조영철 1, 성일용 1 1 울산대학교의과대학울산대학교병원 구강악안면외과학교실 2 울산대학교의과대학울산대학교병원 통합치의학과 목적 : 내시경을이용한하악골과두경부골절의정복및고정술에사용된생체흡수성판과금속판의효용성에대해비교해보고자한다. 방법 : 2013년 1월부터 2016년 12월까지하악골과두경부골절로진단되어내시경을이용한골절의정복및고정술을시행받은환자들을조사대상으로하였다. 조사대상환자들은생체흡수성판또는금속판으로치료를받았다. 수술전골절상태와수술후골합성기간동안의안정성그리고합병증여부를변수로평가하였다. 그외에임상적특징 ( 연령, 성별, 골절부위와추적관찰기간 ) 그리고수술중, 후의자료 ( 수술시간, 악간고정술시행기간 ) 를변수로포함하였다. 결과 : 총 28명의환자에서생체흡수성판으로치료를받은환자들은 13명, 금속판으로치료받은환자는 15명이었다. 고정물제거를위한 2차수술은평가에서제외하였다. 각변수들의평가결과두집단간에유의미한차이가없었다. 결론 : 하악골과두경부골절의치료에서생체흡수성판은임상적으로만족할만한견고성과안정성을가지고있는것으로보인다. 또한고정물제거를위한 2차수술이필요하지않아고정에있어선택가능한유용한재료로생각된다. Surgical treatment of mandibular subcondylar fracture : a comparative study of bioabsorbable and titanium plates Se-Jeong Lim 1 *, Do-Hyun Jeon 1, Su-Ho Lee 2, Jung-Min Seo 2, Jang-Ho Son 1, Yeong-Cheol Cho 1, Iel-Yong Sung 1 1 Department of Oral and Maxillofacial Surgery, Ulsan University Hospital, University of Ulsan College of Medicine 2 Department of Advanced General Dentistry, Ulsan University Hospital, University of Ulsan College of Medicine Purpose: To compare the effectiveness of bioabsorbable systems with titanium systems for the management of facial fractures, especially in endoscope- assisted open reduction and internal fixation(eaorif) of mandibular subcondylar fractures. Materials and methods: This study included patients who underwent EAORIF for mandibular subcondylar fractures at the Department of Oral and Maxillofacial Surgery, Ulsan University Hospital between January 2013 and December The patients were treated with bioabsorbable system or titanium miniplates systems. The variables included preoperative fracture conditions and postoperative stability during osteosynthesis. Also complications evaluation during the follow-up period was performed. Other variables included clinical characteristics(age, sex, fracture site and total followup duration) and intra- and postoperative data(surgical duration, duration of intermaxillary fixation/elastic band guidance). Result: Of the 28 patients were included, 13 underwent EAORIF using bioabsorbable systems and 15 underwent EAORIF using titanium systems. Second surgery for plate removal was excluded. None of the assessed variables showed significant differences between the two groups. Conclusion: No relevant clinical complications were found during patients assessments. We conclude that EAORIF using biodegradable plates is a stable and reliable method for the management of mandibular subcondylar fractures. And also it eliminates the secondary surgery for plate removal. 제 57 차종합학술대회및정기총회 3

4 O2 (25-A) 인상재없는악교정수술 : Digilog approach(14 증례 ) 안태웅 *1, 윤선웅 1, 유길화 1, 설가영 1, 박철민 1, 오민석 1, 강나라 1 백민정 2, 하태영 2, 정길용 2 선치과병원구강악안면외과 1 선치과병원교정과 2 Introduction 악교정수술분야에서디지털요소가도입되어기존의아날로그방식이서서히대체되고있다. 다양한환자친화적수술장비와도구들이 3D프린팅기술을통해제작되고디자인되고있으며향상된결과를가져오고있다. 악교정수술에서 3D프린트의임상적적용은수술용 wafer, 골절단가이드, spacer, 고정용 plate, screw, 3D printed 모델등다양하다. 또한스캐닝기술은기존의인상재를통해제작되는석고모델을 3D 모델로바꾸어놓았다. 3D 프린터로모델을출력하면기존의방식을간략화해서오차와시간을줄일수있고, 왜곡없이모델을복제할수있다. 디지털스캐너에는 Contact, Non-contact active, Non-contact passive, Hand-held laser scanners, Structured light, Modulated light종류가, 3D 프린터는 Binder jetting, Material jetting, Material extrusion, Direct energy deposition, Powder bed fusion, Photo polymerization, Sheet lamination 등의종류가, 프로그램에는 SLA, DLP, FFF, Polyjet 등의방식이존재하고, 적절한조합으로사용하게된다. 본원에서는기존의인상재를통한인상채득후 face bow 와기공과정을통해수술용 wafer를만드는방식대신디지털요소를도입하여, intraoral scanning으로구강내인상을채득하여 3D 프린터로모델을제작하였고, 모델을 face bow mounting 한뒤에는기존의기공과정을통해wafer를만드는과정을채택하고있다. 본연구에서는이러한디지털-아날로그혼합방식을통해기존방식과의장단점을비교해보고, 향후악교정수술분야에서디지털요소의도입가능성을모색해보고자한다. Material & Methods 본원에서악교정수술이결정된 14명의환자에대해수술 1 달전혈액검사및각종검사를시행하고, 2주전 face bow 및 3D intraoral scanning 하고, 3D printing으로 model을 제작해서 face bow mounting 후기공과정을통해 wafer를제작하였다. 스캐너는 3Shape 사의 Trios를사용하였고, 3D 프린터는 3D Bio를, 모델의재료는 Nextdent를, 프로그램은 DLP(digital light processing) 방식인 3Shape 사의 Dental design을사용하였다. Results 인상재를사용하지않음으로써인상채득시의환자의불편감이최소화되고, 인상체와모델을시각화된영상으로얻을수있어서분석과상담에도움이되며, 추후연구자료분석가능하다. 모든과정을디지털화하는것은시간과비용의한계에봉착하는반면, intraoral scanning과 model 제작만디지털화하고그후의 wafer 제작은기존의방식을사용함으로써편의성을증대하였고, 비용증가를최소화하였다. 그결과 14 증례의모든환자들에서임상적으로용인가능한수준의수술용 wafer로수술하였고, 추적관찰기간동안개선된안모와안정된교합을통한높은만족도를얻을수있었다. Conclusion 악교정분야에서디지털요소의도입으로인상재를통해인상채득하여모델을제작하는것에대한부정확성과환자의불편감을최소화하고, 시간과비용을줄이려는노력이계속되고있다. 3D프린터는 3D digital intraoral images를통해더정확하고환자특이적인모델을만들수있는가능성을열었다. 그결과많은수의문헌에서 3D 프린팅기술이임상가들의수술시간단축, 수술안정성증가, 수술후결과예측성증가에기여함을밝혔다. Marvil et al.1은 3D printed 모델을이용함으로써악교정수술의정확도를높일수있으며, 과두의잘못된위치와 sagging을방지할수있다고하였다. 하지만모든과정을디지털화하기에는아직까지시간과비용등의한계가존재하는실정이다. 본원에서는 wafer를제작하는과정에있어서기존의아날로그방식에구강내를정확하게스캔할수있는3d intraoral scanning으로구강내 image를채득한뒤, 3D 프린터로모델을제작하고, 그후의 wafer를제작하는것은기존의방식을따르는디지털요소를혼합한방식을채택함으로써모든과정을디지털화하는방식에비해환자의편의와정확성을높이고있다. 1) Mavili ME et al. Use of three-dimensional medical modeling methods for precise planning of orthognathic surgery. J Craniofac Surg 2007;18: 대한악안면성형재건외과학회

5 The Alginate-free Approach(Digilog) in Orthognathic Surgery: Case Report(14cases) Tae-Woong Ahn *1, Sun-Ung Yoon 1, Kil-Hwa Yoo 1, Ka-Young Seol 1, Chul-Min Park 1, Min-Seok Oh 1, Na-Ra Kang 1 Min-Jung Paek 2, Tae-Young Ha 2, Kil-Yong Jung 2 Se-Jeong Lim 1*, Do-Hyun Jeon 1, Su-Ho Lee 2, Jung-Min Seo 2, Jang- Ho Son 1, Yeong-Cheol Cho 1, Iel-Yong Sung 1 1 Dept. of Oral and Maxillofacial surgery, Sun Dental Hospital 2 Dept. of Orthodontics, Sun Dental Hospital Introduction In orthognathic surgery, digital technology was introduced and conventional analogue system is being substituted. A variety of patient-specific surgical guides and devices have been designed and manufactured using 3D printing technology, which rapidly gained widespread popularity to improve the outcomes. The clinical applications of 3D printers in orthognathic surgery include the production of occlusal splints, osteotomy/cutting guides, repositioning guides, spacers, fixation plates/implants and 3D printed models. Also scanning technology changed conventional analogue plaster model to 3D model. For digital scanners, there are Contact, Non-contact passive, Hand-held laser scanners, Structured light, Modulated light methods, and for 3D printers, there are Binder jetting, Material jetting, Material extrusion, Direct energy deposition, Powder bed fusion, Photo polymerization, Sheet lamination and so on. For programs, there are SLA, DLP, FFF, Polyjet and so on. And adequate methods are combined. In our clinic, 3D intraoral scanning images are taken by 3D intraoral scanner and models are printed by 3D printer. And then, models are mounted by face bow and through conventional laboratory work up, surgical wafers are made. In this study, we report digital method combined with analogue method so called digilog method. Material&Methods For 14 patients planned for orthognathic surgery, laboratory test was done 1 month before and 3D intraoral scanning images were taken 2 weeks before and models were printed by 3D printer and then mounted with face bow and through conventional laboratory work up, surgical wafers are made. Scanner was used Trios(3 shape) and 3D printer was used 3D Bio and material of model was Nextdent and program was Dental design(3 Shape), DLP(digital light processing) method. Results As for not using impression materials, unconvenience of patients was minimized and visualized images were gained so, analysis and consultation were easy to do. All digitalized technique needs much time and cost, but digilog technique maximizes convenience and minimizes cost increasing. As a result, all cases of 14 patients got successful orthognathic operations through surgical wafers falls within clinically accepted and during follow-up period, all patients had esthetic improvement and stable dental occlusion with a high satisfaction rate. Conclusion In orthognathic surgery, many attempts have been done to minimize time and cost by adopt digital technique. 3D printers opened up new possibilities to fabricate more precise patient-specific models based on patient s 3D digital intraoral scanned images. Subsequently, numerous studies have demonstrated that 3D printing technologies help the clinician to shorten operative time, increase surgical safety, and improve the predictability of surgical outcomes. Mavili et al.1 demonstrated an increase of accuracy in orthognathic surgery and prevention of condylar mis-positioning and sag by using 3D printed models. But there are limitations of cost and time for all digitalized techniques so far. In our clinic, 3D intraoral scanning images are taken by 3D intraoral scanner and models are printed by 3D printer. And then, models are mounted by face bow and through conventional laboratory work up, surgical wafers are made. Through this digilog technique, accuracy and conveniences were elevated compared with all digital technique. 1)Mavili ME et al. Use of three-dimensional medical modeling methods for precise planning of orthognathic surgery. J Craniofac Surg 2007;18:740-7 제 57 차종합학술대회및정기총회 5

6 O3 (3-A) 하악우각부및하악과두부골절발병률에미치는하악제 3 대구치의영향에관한연구 조현미 *, 이백수, 권용대, 최병준, 오주영, 이정우, 정준호, 황보연경희대학교치의학전문대학원구강악안면외과학교실 서론 : 많은선행적연구에서하악 3대구치가존재하는경우, 외력에의해발생되는하악우각부골절이더욱취약함을입증해왔다. 이와유사한사례로, 본연구자료는제 3대구치가없는경우하악과두골절의위험성은증가시키며또한우각부골절의위험도는낮출수있음을제시하고있다. 본연구에서는제 3대구치가하악우각부및과두부골절의유병률에미치는영향에대해특징지어보고자한다. 방법 : 본연구는2006 년 2월부터 2017년 11월까지경희대학교치과병원구강악안면외과에내원한총 714명의하악골골절환자들에대한후향적평가를시행했다. 모든환자들의임상기록지와파노라마방사선사진, 그리고 Pell and Greogry 분류를통한하악 3대구치의평가자료를수집하였다. 결과 : 본연구는이전의결과들과유사함을나타냈다. 제3 대구치가존재하는경우하악우각부골절이현저하게높은반면, 과두부골절발생률은제3대구치가결손되거나, 완전맹출된제3대구치가없는경우에높게나타났다. 또한하악골골절시동시이환되는부위로하악정중부와우각부가장높은발생률을나타냈다. 고찰및결론 : 하악제 3대구치가존재유무및맹출상태모두하악우각부및과두부골절위험도에영향을미친다. Effect of Lower Third Molars on the Incidence of Mandibular Angle and Condylar Fractures Hyun Mi Jo*, Baek Soo Lee, Yong Dae Kwon, Byung Joon Choi, Joo Young Ohe, Jung Woo Lee, Jun Ho Jung, Bo Yeon Hwang Dept. of Oral & Maxillofacial surgery, Kyung Hee University School of Dentistry Purpose: Numerous previous studies already have proven that mandibles with a third molar are significantly more susceptible to angle fracture by external force. Similarly, other data suggest that the absence of a third molar increases the risk of condylar fracture, while concurrently decreasing the risk of angular fracture. We attempt to characterize the effect of a third molar on the incidence of mandibular angle and condylar fractures. Methods: This retrospective study reviews data from 714 patients, all of whom were seen in our clinics between February 2006 and November All data were collected from clinical examination notes and panoramic radiographs, with third-molar state evaluated by the Pell and Gregory classification system. Results: Our results mirror those of previous studies. The incidence of mandibular angle fracture was significantly greater on sides with a third molar, whereas the condylar fracture rate significantly increased in mandibles lacking a third molar or without a fully erupted third molar. The rate of symphysis and mandibular angle fracture was also high in cases of multiple comorbid fractures. Conclusions: Both the presence and the state of the lower third molar affect the risk of future mandibular angle and condylar fracture. 6 대한악안면성형재건외과학회

7 O4 (25-A) 3 년간안면외상및악교정수술환자의소형금속판의제거 김희진 *, 김수관, 문성용, 오지수, 유재식, 최해인, 신나라조선대학교치의학전문대학원구강악안면외과학교실 서론 : 본연구의목적은 3년간외상과악교정수술로구강악안면영역에소형금속판을삽입하고제거한환자들을분석하여소형금속판제거의원인과그위험요소를파악하기위함이다. 방법 : 2015년 1월부터 2017년 12월까지 3년간조선대학교치과병원에서소형금속판삽입을동반한골절의정복술및악교정수술을시행한환자와소형금속판제거술을시행한환자를조사하였다. 조사는조선대학교치과병원데이터베이스검색으로이루어졌다. 소형금속판을삽입한환자는 359 명이었고, 제거한환자는그중 119명이었다. 환자들의나이, 흡연유무, 소형금속판삽입의이유, 소형금속판의삽입개수, 소형금속판의삽입부위, 소형금속판삽입과제거사이의기간, 소형금속판의제거이유를조사하였다. 결과 : 3년간소형금속판을삽입한환자의수는 359명이었으며, 소형금속판을제거한환자의수는 119(33.1%) 명이었다. 삽입된소형금속판의개수는 790개이며, 제거된소형금속판은 266(33.7%) 개였다. 이중외상그룹의환자는 206명중 62(30.1%) 명이소형금속판을제거하였고제거된소형금속판은 396개중 124(31.3%) 개였다. 악교정수술그룹에서는 153명중 57(37.3%) 명이소형금속판을제거하였고제거된소형금속판은 394개중 142(36.0%) 개였다. 결론 : 앞선문헌들과비슷하게감염이가장소형금속판제거의큰원인이다. Removal of miniplates following facial trauma and orthognathic surgery : a 3-year sudy Hee-jin Kim *, Su-Gwan Kim, Seong-Yong Mon, Ji-Su Oh, Jae-Seek You, Hae In Choi, Na-Ra Shin Department of Oral and Maxillofacial Surgery, School of Dentistry, Chosun University Introduction: The purpose of this study is to analyze patients who inserted and removed miniplates into the face area for three years through trauma and orthognathic surgery to identify the causes and risks of removing miniplates Method and materials: Three years from January 2015 to December 2017 were investigated for patients who performed reduction surgery of fractures and orthognathic surgery accompanied by the insertion of a miniplate at a Chosun University dental hospital. The survey was conducted with a database of dental clinics at Chosun University dental hospital. There were 359 patients with miniplates, and 119 of them had been removed. We examined the age of patients, their smoking status, the reason for insertion of the miniplate, the number of the miniplate, the insertion points of miniplates, the duration between insertion and removal of the miniplate, and the reasons for removal. Results: For three years, the number of patients with miniplates was 359, while the number of patients who removed the miniplate was 119 (33.1%). The number of miniplate inserted was 790 and 266 (33.7%) were removed. 62 (30.1%) of the 206 patients in the trauma group removed the miniplates, while 124 (31.3%) of the 396 were removed. Among 153 people, 57 (37.3%) of them removed, and 142 (36.0%) of 394 were removed, In the orthognasthic group. Conclusion: Similar to the preceding literature, infections was the most among the reasons for removing miniplates. 제 57 차종합학술대회및정기총회 7

8 O5 (25-A) 상악골재위치장치의정확도평가강민혜 *, 조진용, 김진우, 류재영, 김성범 가천대길병원구강악안면외과서론 : 본연구의목적은악교정수술에서상악골재위치장치를이용한경우와통상적인방법의중간장치를이용한경우에술후상악골위치의정확도를평가하는것이다. 방법 : 악교정수술을받은 20명의환자 ( 그룹1: 12명, 중간장치, 그룹2: 8명, 상악골재위치장치 ) 를대상으로 3개의기준점 ( 상악중절치치간유두, 상악좌측제1대구치 MB교두, 상악우측제1대구치 MB교두 ) 에대해 3차원좌표 (x, y, z) 를측정하여두그룹사이의차이를평가하였다. 결과 : 2mm 오차가발생하는비율을비교하였을때, 두그룹간에유의한차이가없었다. x, y, z좌표의오차를비교하였을때, 그룹2에서상악골이계획보다하방에위치하는경향을보였으며 (p<0.05), 그룹2에서전후방오차가더적은것으로나타났다 (p<0.05). 또한, 두그룹간에 pitch, yaw, roll 각도오차에서는유의한차이가없었다. 결론 : 상악골재위치장치를사용한경우와통상적인방법의중간장치를사용한경우를비교했을때비슷한술후오차를보인다. 따라서상악골재위치장치는과두가불안정한환자에서중간장치를대체하여유용하게사용할수있을것으로보인다. Accuracy evaluation of maxillary repositioning device Min-Hye Kang *, Jin-yong Cho, Jin Woo Kim, Jaeyoung Ryu, Sungbeom Kim Dept. of Oral & Maxillofacial Surgery, Gachon University Gil Medical Center, South Korea Introduction: The aim of the present study was to evaluate the accuracy of the maxillary position in orthognathic surgery performed using maxillary repositioning device and intermediate wafer. Material and methods: 20 patients who underwent orthognathic surgery (Group1: 12 patients, intermediate wafer, Group2: 8 patients, maxillary repositioning device) were assessed for the error between group 1 and 2 by measuring the three-dimensional coordinates(x, y, z) at three reference points(upper incisor embrasure, #16 MB cusp, #26 MB cusp). Results: There was no significant difference between the two groups with the error of 2mm. Comparing the errors of the x, y, and z coordinates, the maxilla was positioned below the planned location in group 2 and antero-posterior error was less. There was no significant difference in pitch, yaw, and roll angle errors between the two groups. Conclusion: Similar errors are observed in the case of using the maxillary repositioning device and the conventional device. Therefore, in patients with unstable condyle, maxillary repositioning device is expected to be useful as a substitute for an intermediate wafer. 8 대한악안면성형재건외과학회

9 KS (25-B) 악교정수술 ; 만족 이란무엇인가이주민 * 줌구강악안면외과의원 Orthognathic Surgery; What is SATISFACTION? Ju Min, Lee * JUM Oral and Maxillofacial Surgery Clinic 최근십수년사이, 악교정수술중혈압의세밀한조절, 술기의발전등으로출혈, 부종등이최소화되어입원및회복기간도대폭단축되었다. 또한술자에따른술기의차이도거의없고, 숙련된구강악안면외과의사가수술을시행할경우, 악교정수술에소요되는시간도일정한편이다. 최근에는각종 3D 스캐너, 3D CT 등의 digital tool 을이용하여 3차원적인진단, 분석이가능할뿐아니라, 수술후변화까지도미리예측할수있게되었다. 다만, 모든악교정수술을하는외과의사가자신이원하는결과는낼수있다는전제하에, 술자에따라, 혹은술자와환자간에수술전후환자의안모평가, 이상적인안모에관한개념은다소차이가있을수있는데, 이번발표에서는개원가에서악교정수술이후환자가표현하는만족과불만족의경계에서술자가느끼는고민에관해허심탄회하게얘기해보려고한다. 제 57 차종합학술대회및정기총회 9

10 O6 (25-B) 안면비대칭환자의하악지수직골절단술 (VRO) 을동반한악교정수술후하악과두의골침착양상및영양인자분석 김보라 *, 용해성, 정철희, 장효원, 허종기연세대학교치과대학구강악안면외과학교실 ( 강남세브란스병원 ) 안면비대칭은선천적혹은후천적으로발생하며안면비대칭환자에서는중안면부의비대칭, 교합면의수직적위치차이, 하악지, 하악체의길이차이, 하악지축뿐아니라하악과두및과두경부의크기차이등이나타나게된다. 악교정수술은수술적으로상하악골을이상적인위치로이동시킴에따라골격적인개선을통해기능및안모개선을도모한다. 하악지수직골절단술은수술후골편의고정을시행하지않기때문에하악과두가생리적위치로이동하거나때로는후상방으로골침착이유발된다는보고가존재한다. 본연구에서는안면비대칭해소를위해하악지수직골절단술을시행한환자의수술전후 cbct 영상을비교하였으며, 하악과두에서일어나는골침착양상과영향을미치는인자에대해분석하였다. Evaluation of the condylar bone apposition and affecting factors after mandibular vertical ramus osteotomy in facial asymmetry patient Bola KIM *, Hae-Seong YONG, Cheol-Hee JEONG, Hyo- Won JANG, Jong-Ki HUH Depart Department of Oral and Maxillofacial Surgery, Gangnam Severance Hospital, Yonsei University colleges of Dentistry, Seoul, South Korea Facial asymmetry is caused by congenital or acquired causes and the symptom includes the middle facial asymmetry, difference of the occlusal plane of both sides, the length of the mandibular body, the tilted ramal axis and the difference of the width and length of condyle. These can be improved by moving the bimaxillary bone to an ideal position through orthognathic surgery. Since the proximal segment of the bone is not fixed in mandibular vertical ramus osteotomy(vro), the mandibular condyle moves to the physiological position. It is also reported that bony apposition of condyle can occur after VRO The purpose of this study is to evaluate pre- and postoperative condylar bony apposition and affecting factors in patients with facial asymmetry. 10 대한악안면성형재건외과학회

11 O7 (25-B) CAD/CAM surgical guide 와 customize titanium plate 를사용한시상분할절골술시근심골편이동의정확성 이승현 a, 우재만 b, 최진영 a a 서울대학교구강악안면외과학교실 b 제주대학교병원치과 시상분할절골술 (SSRO) 이처음소개된이후로, 악교정수술에있어서가장많이사용되는기법중에하나로자리잡게되었다. SSRO의안정성을높이기위한여러가지요소가있는데, 원심골편의이동량, 골절선의디자인, 고정의방법과재료, 원심골편의이동방향, 견고한교정치료, 근심골편의하악과두이동등이있다. SSRO의특성상, 시상면상의간섭은원심골편의복잡한이동에따라발생하고특히그양이많을때증가한다. 이러한경우에, 정확한시상면상간섭의제거와근심골편에발생하는하악과두회전력이최소한이되는것이중요하다. Computer-aided design(cad) 는지난몇년동안가상수술을시행하는신경외과영역에서특히발전해왔다. 3차원영상과가상수술은 SSRO시골절선사이간섭과근심골편의이동을예상할수있게하였다. 여러가지요소들을예측할수있기때문에 3D 플랫폼은 SSRO를수행하는집도의에게많은이점이있다. Computer-aided manufacturing(cam) 은 surgical guides를제작하여가상수술과실제수술공간을연결한다. 환자맞춤형 plate또한수술을더쉽게하는데기여한다. 수술방에서손으로구부려적합하던기존방식의고정 plate는수술오차를생산하는한요인이였다. Surgical cutting and drill guide와환자맞춤형 plate의결합은 SSRO 원심골편의정확한재위치를가능하게한다. 이조사의목적은 CAD/CAM을이용하여술전에제작한 surgical guide와환자맞춤형 plate가술후 SSRO 근심골편의안정성에기여하는지를알아보는데있다. The postoperative accuracy of proximal segment in sagittal split ramus osteotomy using CAD/CAM fabricated surgical guides and customize titanium plates Seung-Hyun Rhee a, Jae-Man Woo b, Jin-Young Choi a a Department of Oral and Maxillofacial Surgery, Seoul National University, Dental Hospital, Seoul, Korea b Department of Dentistry, Jeju National University Hospital, Jeju, Korea Since sagittal split ramus osteotomy(ssro) was introduced(1), this technique has become one of the most widely used techniques of mandibular orthognathic surgery. To optimize the stability of SSRO, there are some factors as followed: amount of distal segment setback, design of osteotomy line, type of fixation, material of fixation plate, direction of distal segment movement, solid occlusion and condylar displacement(2-8). In nature of SSRO, sagittal interference may happen due to complex movements of distal segment, particularly in large amount of mandibular setback. In such cases, accurate elimination of sagittal interference and minimal rotational force in proximal segments and condyles is essential(8, 9). Computer-aided design(cad) has been developed in the past decades for performing the virtual surgery especially in neurosurgical procedures(10). With 3- dimensional image and virtual surgery make it possible to predict the interference between osteotomy line and movements of proximal segments(11, 12). Because many different factors can be expected, the 3D platform provides many benefits to the surgeon for operating SSRO. Computer-aided manufacturing(cam) fabricated surgical guides connects the virtual surgery with operation room(12). The individualized plates make easier to be used in operating room also. In former method of orthognathic surgery, adjusting the plate manually for fix the segments during operation is one of the main factor of occuring errors. Accompanying surgical cutting and drill guides with customized fixation plates allow precise reposition of distal segment of SSRO(13, 14). The purpose of this study is to analyze the postoperative stability using CAD/CAM fabricated surgical guides and customized titanium plates in proximal segment of SSRO. 제 57 차종합학술대회및정기총회 11

12 O8 (25-B) 관절와깊이와하악과두크기에따른하악골의시상분할하악지골절단술후하악과두변위비교 유강희 *1, 양훈주 2, 권익재 1, 황순정 1,2 1서울대학교치의학대학원구강악안면외과 2서울대학교치과병원턱교정수술센터 서론 : 하악골의시상분할하악지골절단술 (SSRO) 은악교정술식에있어서가장널리이용되는방법중하나이다. SSRO 의중요한합병증으로는하악과두의위치변화가있다. 이는수술후환자의예후를결정하는중요한요소로작용하기때문에술자는수술전후하악과두의위치변화를면밀히관찰해야한다. 하악과두변위의정도에영향을미치는요소를미리파악할수있다면환자의예후평가및술후관리에도움이될것이다. 본연구에서는관절와의깊이와하악과두크기에따른 SSRO 후하악과두변위의정도를비교해보고자하였다. 환자및방법 : 서울대학교치과병원구강악안면외과에서한명의숙련된술자에게 SSRO를시행받은환자 50명을대상으로수술직전 CT, 수술직후 CT, 수술 6개월후 CT를분석하였다. 시뮬레이션프로그램 (OnDemand3D, Cybermed, Seoul, Korea) 을이용하여과두와관절와의폭과깊이, 하악과두의크기, 수술전후과두의중심점이동량및장축각도변화량를측정하였다. 결과 : 과두의중심점이동량및장축각도변화량은모두관절와의깊이가깊을수록적었고, 관절와에들어간하악과두의볼륨이관절와의볼륨에비해 70% 이하인경우에관절변위가많았다. 과두와관절와의폭차이정도는과두의변위와양의상관관계를보였다. 또한 6개월후과두의변위정도는수술직후에비하여줄어드는경향이나타났다. 고찰및결론 : 상기분석을통하여관절와의깊이가깊을수록, 그리고과두의관절와내유격의정도가적을수록 SSRO 후과두의변위량이적다는것을알수있었다. 수술전과두와관절와를측정해봄으로써환자의예후에대하여보다더예측성있게대응할수있을것이다. 또한수술후과두의변위를회복시켜나갈수있기때문에술후환자관리가중요하다하겠다. Comparison of condylar displacement after SSRO depending on the depth of glenoid fossa and condylar volume in relation to glenoid fossa volume Kang Hee YU *1, Hoon Joo YANG 2, Ik Jae KWON 1, Soon Jung HWANG 1,2 1 Department of Oral and Maxillofacial Surgery, School of Dentistry, Seoul National University 2 Orthognathic Surgery Center, Seoul National University Dental Hospital Introduction: Sagittal split ramus osteotomy(ssro) is one of the most popular method for orthognathic surgery. Surgeons should observe the condylar displacement, important complication of SSRO, thoroughly before and after surgery because it is the main factor of prognosis. Grasping the factors of condylar displacement before the surgery can be helpful for assessment of prognosis and postoperative management. In this study, we compare condylar displacement after SSRO depending on the depth of glenoid fossa and condylar volume in relation to glenoid fossa volume. Patients and Methods: We analyzed 50 patients preoperative CT, postoperative CT, and 6 months after operative CT who were undergone SSRO by one skillful surgeon in our clinic. We measured width and depth of condyle and glenoid fossa, volume of condyle, displacement of condylar center and axis before and after surgery by using simulation program(ondemand3d, Cybermed, Seoul, Korea). Result: Displacement of condylar center and axis is smaller when glenoid fossa is deeper, and greater when volume of condyle in glenoid fossa is lesser than 70% volume of glenoid fossa. Difference between width of condyle and glenoid fossa showed positive correlation with condylar displacement. Also, we can find tendency of decrease of condylar displacement 6 months after surgery compared with right after surgery. Discussion and Conclusion: By this study, we can find that condylar displacement after SSRO is lesser when glenoid fossa is deeper and gap between condyle and glenoid fossa is smaller. We can cope more predictably about patient s prognosis by measuring condyle and glenoid fossa before surgery. As well, postoperative management is important because condylar displacement can be recovered after surgery. 12 대한악안면성형재건외과학회

13 O9 (3-B) 3 차원시뮬레이션시스템을이용한악교정수술에서수술정확도에대한연구 : 원심골편과근심골편의관계및교합평면분석 오현준 *1, 이용찬 2, 손홍범 3, 서병무 1 1 서울대학교치과병원구강악안면외과 2 베스티안서울병원구강악안면외과 3 이튼치과병원교정과 서론 : 3차원시뮬레이션시스템을이용하여 5년간시행한악교정수술에서, 수술계획과수술결과를비교하여수술정확도를정량적으로분석하였다. 본연구에서는특히, 원심골편과근심골편의관계및교합평면에대해상세히분석하고자한다. 방법 : 본연구에서는 3차원시뮬레이션시스템을사용하여수술계획을수립한후, 3차원프린팅을이용하여, 상하악 RP (Rapid Prototyping) 모델과중간웨이퍼 (intermediate wafer) 및최종웨이퍼 (final wafer) 를제작하였다. 골절단을위한수술용가이드 (surgical guide) 및수술이동량을반영한금속판 (pre-bent plates) 을미리구부려수술시사용하였다. 동일한술자가 2014년부터 2018년까지 5년간악교정수술을시행한증례를분석하였으며, 수술전후의 3차원영상을중첩하여원심골편및근심골편, 그리고교합평면의 3차원좌표를비교하였다. 증례는남성 27명, 여성 28명의총 55명으로구성되며, 평균나이는 21세 6개월이었다. 결과 : 좌측원심골편의평균오차는 2.17mm이고, 표준편차는 1.06mm였다. 우측원심골편의평균오차는 2.25mm 이고, 표준편차는 1.14mm였다. 좌측근심골편의평균오차는 2.66mm이고, 표준편차는 1.72mm였다. 우측근심골편의평균오차는 2.35mm이고, 표준편차는 1.22mm였다. 교합평면에대해서는, 시상평면에서평균오차는 1.36 이고, 표준편차는 0.93 였다. 관상평면에서평균오차는 0.54 이고, 표준편차는 0.41 였다. 축상평면에서평균오차는 0.67 이고, 표준편차는 0.49 였다. 고찰및결론 : 3차원시뮬레이션및 3차원프린팅을이용하여예측가능하고, 정확하며, 효율적인악교정수술을시행할수있었다. 원심골편과근심골편의관계및교합평면에대한분석은수술계획과기법에임상적인의미를더할수있을것으로생각된다. Study on Accuracy of Orthognathic Surgery using 3-dimensional Simulation System : Analysis of Distal & Proximal Segments, and Occlusal plane Hyun Jun Oh *1, Yong-Chan Lee 2, Hong-Bum Sohn 3, Byoung- Moo Seo 1 1 Department of Oral and Maxillofacial Surgery, Seoul National University Dental Hospital 2 Department of Oral and Maxillofacial Surgery, Seoul Bestian Hospital 3 Department of Orthodontics, Eton Dental Hospital Introduction: The purpose of this study was to quantitatively analyze the accuracy of orthognathic surgery using 3-dimensional computerized simulation system. Surgical plans were compared with surgery results for 5 years. Specifically, the relationship between distal segment and proximal segment, and occlusal plane were analyzed. Method and materials: The system in this study, characterized computerized surgical planning with 3-dimensional simulation. Moreover, RP (Rapid Prototyping) models, intermediate wafer, and final wafer were fabricated using 3-dimensional printing. Surgical guide for osteotomy and pre-bent plates based on amount of surgical movement were fabricated with the RP models and used during operation. From 2014 to 2018, 5-year cases of orthognathic surgery done by one operator, were analyzed. Pre-operative and postoperative 3D images were superimposed. 3-dimensional coordinates of landmarks of distal segment, proximal segment and occlusal plane were compared. The study included 55 patients (27 males, 28 females) whose average age was 21 years and 6 months old. Results: The mean error of left distal segments was 2.17mm, and the SD (standard deviation) was 1.06mm. The mean error of right distal segments was 2.25mm, and the SD was 1.14mm. The mean error of left proximal segments was 2.66mm, and the SD was 1.72mm. The mean error of right proximal segments was 2.35mm, and the SD was 1.22mm. Regarding occlusal plane, the mean error on the sagittal plane was 1.36, and the SD was The mean error on the coronal plane was 0.54, and the SD was The mean error on the coronal plane was 0.67, and the SD was Conclusion: Predictable, accurate, and efficient orthognathic surgery was possible using 3-dimensional simulation and 3-dimensional printing. The analysis of the relationship between distal segment and proximal segment, and occlusal plane were expected to clinically improve surgical planning and method. 제 57 차종합학술대회및정기총회 13

14 O10 (25-B) 양악수술이임플란트골유착에미치는영향에대한다기관코호트성향분석연구 김진우 1,7, 이호 2,7, 임호경 3,7, 김주원 4,7, 변수환 5,7, 최영준 6, 이의룡 *6,7 1 구강악안면외과, 이화여대목동병원, 2 구강악안면외과, 보라매병원, 3 구강악안면외과, 고려대구로병원, 4 구강악안면외과, 평촌성심병원, 5 구강악안면외과, 동탄성심병원, 6 구강악안면외과, 중앙대학교병원, 7 강남구강악안면외과연구회 이연구는치과임플란트골유착에대한 RAP의영향을조사하고자하였다. Orthognathic 수술은 RAP의개입으로설정되었고두그룹에대한다중센터코호트연구가수행되다. Group O는악교정수술후 chlth 4개월후임플란트를식립하고1 년이상기능적부하를단일임플란트식립환자를포함하는반면대조군 ( 그룹 C) 은구강악안면영역에어떠한수술도받지않고임플란트식립수술을받은환자를대상으로하였다. 변연골수준의변화를포함한임플란트의임상적및방사선학적평가를 6 개월및 12 개월추적조사후분석하였다. 성향점수매칭을시행한두군의이변량분석을시행하였다. 성향점수매칭이후에 10 개의모든변수는합당한표준화된차이점수 (<20 %) 를가졌으며, 이는매칭절차로인하여두그룹이효율적으로균형을이뤘음을나타낸다. 경향점수조정후, 한계골손실은 6 개월째대조군 (1.66 ± 1.05 mm vs 0.59 ± 0.64 mm, p <0.001) 과 12 개월 (2.30 ± 1.27 mm vs 0.82 ± 0.78 mm, p<0.001) 에서유의하게높았다. C 군과비교했을때, O 군의피험자는임플란트주위염발생률이더높았다 (11.8 % vs 1.5 %, p = 0.033). 악교정수술환자에서임플란트를한경우분제가발생하는경우가많았다. 악교정수술을받은환자에서임플란트치료를수행하는경우임프란트주위의연조직및경조직의안정성에대한고려가필요하며유지관리에더큰주의를기울여야한다. Orthognathic Surgery Deteriorates the Osseointegration of Dental Implants : A Propensity-matched Multi-center Cohort Study Jin-Woo Kim 1,7, Ho Lee 2,7, Ho-Kyung Lim 3,7, Ju-Won Kim 4,7, Soo-Hwan Byun 5,7, Young-Jun Choi 6,Ui-Lyong Lee *6,7 1 Department of Oral and Maxillofacial Surgery, Ewha Womans University Medical Center, Seoul, Korea 2 Department of Oral and Maxillofacial Surgery, Section of Dentistry, Seoul Metropolitan Government - Seoul National University Boramae Medical Center, Seoul, Korea 3 Department of Oral and Maxillofacial Surgery, Korea University Medical Center, Guro Hospital, Seoul, Korea 4 Department of Oral and Maxillofacial Surgery, Pyeong-chon Sacred Heart Hospital, Hallym University Medical Center, Kyonggi-do, Korea 5 Department of Oral and Maxillofacial Surgery, Dongtan Sacred Heart Hospital, Hallym University Medical Center, Kyonggi-do, Korea 6 Department of Oral and Maxillofacial Surgery, Chung-Ang University Hospital, Seoul, Korea 7 Research Society of Gangnam Oral and Maxillofacial Surgeons, Seoul, Korea This study aimed to investigate the possible influence of the RAP on dental implant osseointegration. Orthognathic surgery was set as an intervention for RAP, and a multicenter cohort study of two groups was undertaken. Group O included patients with single implant placement at least 4 months after orthognathic surgery and functional loading for more than 1 year, while controls (Group C) were without any major surgery. Clinical and radiographic assessments of implants, including changes in marginal bone levels, were analysed at baseline, 6- and 12-months follow-up. Bivariate analysis of two groups with propensity score matching was performed. After propensity score matching, all 10 confounding variables had acceptable standardized difference scores (<20%), indicating that the matching procedure had efficiently balanced the two groups. Following the propensity score adjustment, the marginal bone loss was significantly higher in Group O than the control at 6 months (1.66 ± 1.05 mm versus 0.59 ± 0.64 mm, p<0.001) and 12 months (2.30 ± 1.27 mm versus 0.82 ± 0.78 mm, p<0.001). Compared to Group C, subjects in Group O had a higher incidence of peri-implant mucositis and implantitis (11.8 versus 1.5%, p=0.033). Impaired osseointegration of dental implants was associated with orthognathic surgery. Special considerations for peri-implant soft and hard tissue stability should be addressed to obtain ideal treatment results and prognosis for patients who have had prior orthognathic surgery. 14 대한악안면성형재건외과학회

15 KS (25-C) Computer assisted simulation surgery and surgical guides for oral and maxillofacial reconstructive surgery Jung-Woo Lee * Department of Oral and Maxillofacial Surgery, School of Dentistry, KyungHee University, 26, Kyungheedae-ro, Dongdaemun-gu, Seoul Korea Functional and esthetic maxillofacial reconstruction is challenging. This is very difficult to effectively reconstruct the defect due to the complicated anatomy of the oral maxillofacial region. To overcome this problem, there have been many trials, for example, 3D virtual simulation and surgical guides using computer. This method represents a three - dimensional model based on computer tomographic (CT) data and simulates the 3D image on a computer before performing the actual operation. To transfer the simulation, surgical guides are fabricated using a 3D printer. However, commercial medical simulation software is expensive and the learning curve of this engineering is inevitable for its intended use. For this reason, most of the simulation is processed by the company. Therefore, communication between the engineer of the company and the surgeon is essential and even small differences in communication can have adverse effects on the outcome of the surgery. In some cases, the duration of the surgical simulation and guide fabrication may take long time. For this reason, we propose a method of direct surgical simulation and designing guides by the operator and actual operation. This method takes a long time until the operator gets used to the software, and the time for the surgical simulation is also high. However, there are the many advantages. Acknowledgment: This work was supported by the National Research Foundation of Korea Grant funded by the Korean Government (NRF-2017R1D1A1B ) 제 57 차종합학술대회및정기총회 15

16 O11 (25-C) Retrospective study about Temporomandibular joint dislocation after fibula reconstruction surgery. Bakri, Mohammed Mousa *1,2, Jong-Ho Lee 1 1 Department of Oral and Maxillofacial Surgery, School of Dentistry, Seoul National University, Korea. 2 Department of Oral and Maxillofacial Surgery, School of Dentistry, Jazan University, Saudi Arabia. Introduction: Some reconstruction surgeons think that success of anastomosis and resection of the diseased tissue is everything in reconstruction. This is not true. Yes, helping the patient to restore and get back his life is a big achievement. However, following the patient up to see the prognosis after the surgery is important too. In the article we collected fibula free flap patents since 2013 the we examine the panoramic images before and after the surgery. We find out that the nonignorable number of patients have developed TMJ dislocation after Fibula reconstruction. Here we will show a simple method that could be used to check the condylar position post operatively, and some conditions that my lead to postoperative TMJ dislocation according our prospective study. 16 대한악안면성형재건외과학회

17 O12 (25-C) 구강암환자에서염증반응생체표지자의예후인자로서의가치 이상훈 *, 권순모, 남웅연세대학교치과대학구강악안면외과학교실 목적 : 다양한부위의암에서, 전신적염증반응이환자의생존과질병진행에중요한요소중하나라고제시된바있다. 염증반응과관련된임상척도는진단과예후를위한생체표지자로사용될가능성이있다. 여러변수들중에서, 이연구는전체생존과구강편평상피세포암의특정한생존과관련된것으로증명된림프구, 호중구, 단핵구및혈소판사이의비율에초점을맞추었다. 방법 : 이연구는 2005년 11월부터 2017년 7월까지원발암의절제술을받는모든구강편평상피세포암환자의중심, 후향적, 종단면코호트연구였다. 18세이상성인환자가포함되었고, 전이성질환, second primary tumor, 수술중사망, 이전의방사선치료또는 / 및화학요법병력또는이전두경부암병력의환자는제외되었다. 전체생존및무재발생존에대한호중구-림프구, 림프구-단핵구, 혈소판-림프구비율의임계치를구하기위하여수신자조작특성곡선 (ROC curve) 이이용되었다. 전체생존및무재발생존의생존곡선은 Kaplan-Meier 방법과로그순위테스트를사용하여추정되었다. 전체생존는수술날짜부터사망원인까지계산되었고, 무재발생존은수술일로부터재발일또는사망일까지계산되었다. Cox 비례위험모델을사용하여생존을위한독립적위험요소를식별하기위해단변량및다변량분석을수행했다. 그룹간차이는연속변수에대한 ANOVA ( 단방향분산분석 ) 또는 student t-검정을사용하여평가되었다. Prognostic value of preoperative inflammatory response biomarkers in oral squamous cell carcinoma Sanghoon Lee *, Sun-Mo Kwon, Woong Nam Department of Oral and Maxillofacial Surgery, Yonsei University College of Dentistry, Seodaemoon-gu, Seoul, Republic of Korea Introduction: In various cancer, it has been suggested that systemic inflammatory responses are one of significant factor for patient survival and disease progression. Clinical parameters regarding inflammatory responses have the potential to be used as biomarkers for diagnosis and prognosis. Among the several parameters, this study focused on the ratios between lymphocyte, neutrophil, monocyte and platelet which were demonstrated to be associated with overall survival and disease specific survival of oral squamous cell carcinoma (OSCC). Material and methods This was a single-centre, retrospective, longitudinal cohort study of all OSCC patients undergoing primary tumor resection between November 2005 and July Adult patients defined as 18 years of age or older were included. Patients with metastatic disease, secondary primary cancer, perioperative mortality, a history of previous radiotherapy or/ and chemotherapy, or a history of previous head and neck cancer were excluded. A receiver operating characteristic (ROC) curve analysis was done in order to obtain neutrophil-lymphocyte, lymphocytemonocyte, platelet-lymphcyte ratio cut-off value for overall survival (OS), disease-specific survival (DSS), and diseasefree survival (DFS). The survival curves for OS, DSS, and DFS were estimated using the Kaplan Meier method and logrank test. OS was calculated from the date of surgery to death from any cause. DSS was derived from the date of surgery to death due to OSCC. DFS was calculated from the date of surgery to the date of recurrence, or death from any cause. If the patient survived without an event, survival was censored at the latest date of follow-up when no event was confirmed. Univariate and multivariate analyses were done to identify independent risk factors for survival using Cox proportional hazards models. Differences between groups were assessed using the Student t-test, or one-way analysis of variance for continuous variables. 제 57 차종합학술대회및정기총회 17

18 O13 (25-C) Nerve Sliding Technique 을활용한하치조신경문합술시행후감각회복평가 강상규 1*, 정한울 1, 이종호 1 1 서울대학교치과병원구강악안면외과 서론 : 구강악안면영역의외상, 치과치료, 또는수술과정에서발생할수있는하치조신경의손상은중대한삶의질저하를초래하며, 신경조직의절단에대한확신이있는경우또는 3 개월이상의보존적인치료에도개선이없을경우수술적치료를고려할수있다. 수술적치료시행시손상부위또는신경종의크기가클경우신경이식을필요로하기도하는데, 이경우공여부의결손및문합부위의증가등의단점이있다. 이러한단점을극복하기위하여시행하는 Nerve Sliding Techinique 은이공전방의절치신경을절단하고이공을후방으로이동시켜신경이식없이결손부를문합할수있도록한다. 본연구를통해 2009 년부터본원에서시행된 Nerve Sliding Technique 의치료경과를고찰해보고자한다. 방법 : 2009 년 2 월부터 2018 년 8 월까지 nerve sliding technique 을활용하여하치조신경문합술을시행한 17 명의환자 ( 남 5, 여 12) 를대상으로하였다. 이중술전및술후감각신경검사결과가현재시점에서모두이루어져치료의경과를평가할수있는 14 명의환자 ( 남 4, 여 10) 를대상으로접촉인지검사, 방향식별검사, 두점식별검사, 압통검사, 온도자극검사의 5 가지검사항목으로구성된감각신경검사를시행하여그결과를분석하였다. 결과 : 14 명의환자중한명을제외한 13 명의환자의수상기전은타의료기관에서의임플란트식립이었다. 수술일기준환자의평균연령은 55.4 세였으며, 명확한수상일이확인된환자 10 명은수상일로부터평균 일시점에 Nerve Sliding Technique 을활용한하치조신경문합술을시행받았다. 가장최근감각신경검사는수술일로부터평균 16.4 개월시점에이루어졌으며, 이기간동안술전감각신경검사대비접촉인지검사, 방향식별검사, 두점식별검사, 압통검사는각각평균 0.94, 5%, 4.1mm, 94.9g 의개선을보였다. 항목별로는접촉인지검사및방향식별검사의경우 7 명의환자에게서, 두점식별검사의경우 5 명의환자에게서, 압통검사는 11 명의환자에게서개선이확인되었다. 온도자극검사의경우술전검사에서이상반응이확인되었던 10 명의환자중 8 명의환자에게서술후정상반응이확인되었다. 14 명의환자모두적어도한가지이상의검사항목에서개선을경험하였다. 고찰및결론 : Nerve Sliding Technique 은추가적인신경이식없이도하치조신경의결손을장력없이문합할수있도록해주며, 2009 년부터본원에서수술을시행받은환자들에게서도증상호전을확인할수있어, 하치조신경결손부문합시활발히활용될수있다. Sensory Outcome of Inferior Alveolar Nerve Microsurgery Using Nerve Sliding Technique Sang-Kyu Kang 1*, Han-Wool Choung 1, Jong-Ho Lee 1 1 Department of Oral and Maxillofacial Surgery, Seoul National University Introduction: Inferior alveolar nerve damage caused by trauma, dental treatment, or surgery in the oral and maxillofacial region significantly worsens the quality of patient s life and often leads to legal disputes. Surgical treatment methods are considered if there is a sign of neurotmesis, or if conservative treatment is ineffective for more than three months. Nerve graft is considered in case of large defect or neuroma. Disadvantages of nerve graft are donor site morbidity and increased length of nerve anastomosis. To overcome such disadvantages, the nerve sliding technique relocates the mental foremen posteriorly after sacrificing the incisive branch of inferior alveolar nerve. Clinical prognosis of patients who received the nerve sliding technique since 2009 was reviewed in this study. Methods: 17 patients who received IAN anastomosis by nerve sliding technique were reviewed. Among these patients, 14 patients who had both preoperative and postoperative sensory test results available were included for this study. Contact threshold, direction, two point discrimination, pin prick, and thermal test results were compared. Results: IAN was injured during implant placement at local clinics in 13 of 14 patients. The mean age of the patients was 55.4 years old. In ten patients whose exact date of injury was known, nerve anastomosis using the nerve sliding technique was performed days since the injury in average. The latest sensory test were conducted 16.4 months in average since the surgery. Within this period, the mean improvement in contact threshold, direction, two point discrimination, and pin prick test were 0.94, 5%, 4.1mm, 94.9, respectively. In contact threshold and direction tests, 7 patients showed improvement. 5 and 11 patients showed improvement in two point discrimination and pin prick tests, respectively. For thermal tests, 8 out of 10 patients who showed abnormal sensation preoperatively exhibited normal sensation postoperatively. All patients experienced improvements at least in one of the 5 sensory tests. Conclusion: The nerve sliding technique allows anastomosis of inferior alveolar nerve under minimal tension without additional nerve graft. Sensory improvements were found among patients who received anastomosis of inferior alveolar nerve with the nerve sliding technique since 2009 at SNUDH 18 대한악안면성형재건외과학회

19 O14 (25-C) 피부침습을동반하여하악에발생한편평세포암종의 DCIA flap 을이용한복합재건 김효준 *, 김수관, 문성용, 오지수, 유재식, 정희석조선대학교치과대학구강악안면외과학교실 복합장골유리피판 (DCIA flap) 은깊은 circumemblex 장골동맥 (DCIA) 피판은 1975 년 O`Brien에의해소개된이후구강악안면영역에서재건을위해주로사용되는유리피판이다. 골근육피부피판, 근육피부피판, 골근육피판및혈행성골피판등다양한디자인이가능하다. 장골의모양은하악의윤곽과비슷한장점을가지고있다. 비골피판과비교하였을때비골피판의절단폭이 15~20mm에불과하지만, 장골피판의골량은훨씬많아서정상하악과유사한형태의재건을가능하게한다. 이논문에서는피부침범을동반한우측하악골체부의편평상피세포암종으로진단된환자에대하여하악골절제술및피부절제술을시행한뒤좌측장골능과내복사근을포함한유리피판을이용한복합재건을실시한증례를보고하고, 복합장골유리피판을이용한복합재건술에대하여논하여보고자한다. Composite recosntrcution with DCIA flap for mandibular squamous cell carcinoma with skin invasion Hyo-Joon Kim *, Su-Gwan Kim, Seong-Yong Moon, Ji-Su Oh, Jae-Seek You, Jung Hee-Suk Dept of Oral and maxillofacial Surgery, School of Dentistry, Chosun University A deep circumflex iliac artery (DCIA) flap is usually used for reconstruction in oral and maxillo-facial surgery department since introduced by O`Brien in Various flap designs are possible for osteomusculocutaneous, musculocutaneous, musculosseous and vascularized bone types. Iliac crest shape is similar to contour of mandible. Moreover, though a fibular flap has only 15~20 mm of cutting plane width, a DCIA flap contains much more bone amount, making this a similar reconstruction compare with normal mandible. In this paper, we report a case of right mandibular squamous cell carcinoma with skin invasion. The patient underwent Composite reconstruction with iliac crestal and internal oblique muscle flap after wide resection and segmental mandibulectomy. We present an experience of DCIA flap for reconstruction with a literature review. 제 57 차종합학술대회및정기총회 19

20 O15 (25-C) 미세수술재건 : 110 증례성공률및합병증분석홍준희 *, 안강민 울산대학교의과대학구강악안면외과서울아산병원서론 : 구강악안면영역에서미세재건수술은유경피판을대체하고있으며미세재건외과의사는해부학적지식과다양한환자의경험을요한다. 재건외과의사는경부의혈관을확보하는동시에혈관문합술에능숙하여야하며암의제거전과같이안모를회복하여사회적, 심미적, 기능적으로재건하여야한다. 본연구의목적은미세재건 110 증례분석을통하여재건피판의종류, 성공률, 합병증및치료결과에관하여보고하고자하였다. 재료및방법 : 본연구는 2006년 1월부터 2018년 8월까지서울아산병원에서시행된연속적인유리피판 110 증례를분석하여피판의종류, 성공률, 합병증발생및합병증치료에대한내용을발표하고자하였다. 결과 : 사용된피판은총 4가지였으며전완요피판이 60 증례, 비골피판이 32증례, 광배근피판이 17증례전거근-늑골피판이 1증례였다. 광배근피판중 2증례에서피판의괴사가있었으며비골피판의 2증례가괴사되어총 96.3% 의피판생존율을보였다. 전완요피판으로재건한증례에서수술후출혈로재수술을시행하였으며재수술시전완요피판은제거하고광배근피판으로재건하였다. 전완요피판의 2증례에서수술후피판의부피가줄지않아서일부절제하는수술을하였다. 결론 : 악안면재건에유리피판은성공적으로사용되어질수있으며환자의삶의질을높이는데가장유용한수술법이다. 유리피판의성공률은 96.3% 였으며전완요피판은 100% 생존율을보였다. 수술시공여부혈관의혈류를잘파악하여수술후합병증을방지하여야한다. Microvascular reconstruction: analysis of success rate and complications in 110 cases Jun-Hee Hong *, Kang-Min Ahn Department of oral and maxillofacial surgery, College of medicine, University of Ulsan Introduction: Microsurgical reconstruction of the oral and maxillofacial area is a challenging procedure which replaces pedicled flaps. Reconstructive surgeon should know the exact anatomy of the donor site and can dissect neck vessels and restore the removed structure with available flaps functionally as well as esthetically and socially. The purpose of this study was to report survival rate of consecutive 110 cases with complication and treatment results after microsurgical reconstruction. Materials and methods: This study included the patients who underwent microsurgical reconstruction with free flap from January 2006 to August 2018 in the department of oral and maxillofacial surgery of Asan medical center by one experienced surgeon. A total of 110 cases were reviewed retrospectively. Survival rate of the flap, a type of flap, complications and treatment results were described. Results: A total of four flaps were used such as radial forearm (n=60), fibular (n=32), latissimus dorsi(n=17) and serratus anterior muscle with rib bone free flap(n=1). Total necrosis of the flap was found in 4 cases (two latissimus dorsi flap and two fibular flap). The total survival rate of the free flap was 96.3%. One patient with radial forearm free flap reconstruction showed postoperative bleeding. Patient needed emergency operation and latissimus dorsi free flap was used to revise the flap. Two patients with radial forearm free flap reconstruction required flap reduction. Conclusion: Microsurgical reconstruction is the most versatile methods to restore large defect in the head and neck and it could improve the life quality of the patients. The success rate was reliable with 96.3%. Radial forearm free flap showed 100% survival. To verify donor site vessels before operation is important to obtain successful microanastomosis. Complications should be prevented with careful monitoring after operation. 20 대한악안면성형재건외과학회

21 KS (26-A) Past and Present of Dental Implant Jae-Seek You Dept. of Oral and Maxillofacial surgery, school of Dentistry, chosun university Implants are of great interest in majority of dental fields not just in oral & maxillofacial surgery field. Implants have been developed remarkably until the present date and many companies as well as dentists are still conducting researches for further developments. However, in the case of oral &maxillofacial surgeons, there are many operations which require general anesthesia as well as outpatient operations, thus it is true that the scope of surgery to be responsible is so broad that the surgeons can not spend sufficient amount of time in the study of implant. Implantology should be treated with interest from the perspective of current residents in oral and maxillofacial surgery and it is also very important for the local specialists who majored in oral and maxillofacial surgery. In the past, implants have been actively studied regarding the surface treatment of implants. Nowadays, there have been many developments during 30 years of time ever since implant was commercialized in Korea, reaching the advent of digital guided implant surgery today. Today, I would like to explore the current status of implant technology and related developments. It would be grateful if this presentation be able to provide general interest about implantology to the audiences who are mostly current residents. 제 57 차종합학술대회및정기총회 21

22 O16 (26-A) 상악동거상량에따른 3차원상악동부피평가김효준 *, 김수관, 문성용, 오지수, 유재식, 최해인, 신나라 조선대학교치과대학구강악안면외과학교실서론 : 본연구에서는상악동거상술시에고려해야하는후상치조동맥의위치, 상악동측벽의두께그리고상악동거상량에따른상악동의부피를평가하고자한다. 재료및방법 : 상악동거상술을받기위해내원한환자들중 CT를촬영하고 CT 소견에서염증이나증식의증거가없는 46 명의환자를대상으로하였다. CT 스캔데이터를 3D 모델로재형성후. 상악동저에서부터후상치조동맥까지의거리, 상악동외벽두께, 상악동저의높이를측정하였다. 상악동의형태에따라좁은형 (N) 과넓은형 (B) 으로구분한뒤상악동의부피측정및거상술시필요한이식재의부피측정을위해상악동바닥에서 3mm, 5mm, 7mm, 10mm의높이에따라 3차원모델을재구성한후부피를통계적으로평가하고분석하였다. 결과 : 상악동저에서후상치조동맥외측가지의수직거리의평균은 5.56 mm에서 mm까지 mm이었다. 상악동외측벽두께의평균은 0.40mm에서 2.04mm 범위의 0.90mm였다. 상악동저에서 3 mm, 5mm, 7mm, 10mm 높이의부피측정결과 B형과 N형의부피차이는통계학적으로유의미하였다. 결론 : 후상치조동맥의평균적인위치와외측벽두께, 평균적인상악동거상량에따른부피는상악동거상술시에임상의에게도움을줄수있다. Assessment of 3D volume of the maxillary sinus according to the amount of maxillary sinus elevation Hyo-Joon Kim *, Su-Gwan Kim, Seong-Yong Moon, Ji-Su Oh, Jae-Seek You, Hae-In Choi, Na-Ra Shin Dept of Oral and maxillofacial Surgery, School of Dentistry, Chosun University Purpose: The purpose of this study is to evaluate the position of the posterior superior alveolar artery, the thickness of the maxillary sinus wall, and the volume of the maxillary sinus according to the amount of maxillary sinus elevation. Materials and Methods: Forty - six patients who had undergone CT scans and who had no evidence of inflammation or proliferation on CT findings were included in this study. After reshaping the CT scan data into a 3D model. The distance from the maxillary sinus to the posterior superior alveolar artery, the thickness of the maxillary sinus wall, and the height of the maxillary sinus floor were measured. In order to measure the volume of the maxillary sinus and the volume of the implant needed for the elevation of the maxillary sinus, it was divided into narrow type (N) and wide type (B) according to the morphology of the maxillary sinus. After restructuring the model, the volume was statistically evaluated and analyzed. Result: In the maxillary sinus, the mean vertical distance of posterior superior alveolar artery was mm from 5.56 mm to mm. The mean thickness of the lateral wall of the maxillary sinus was 0.90 mm in the range of 0.40 mm to 2.04 mm. As a result of volume measurements of 3 mm, 5 mm, 7 mm, and 10 mm in the maxillary sinus floor, The difference in volume between type B and type N was statistically significant. Conclusion: The mean position of posterior superior alveolar artery, lateral wall thickness, and volume according to the mean maxillary sinus elevation volume can help the clinician in the maxillary sinus elevation. 22 대한악안면성형재건외과학회

23 O17 (26-A) 임플란트제거원인에대한분석 : 128 명의환자에대한후향적연구 이유정 *, 장성백, 이성탁, 최소영, 김진욱, 권대근경북대학교치의학전문대학원구강악안면외과학교실 목적 : 본연구의목적은임플란트식립후제거한환자들의증례를통해임플란트제거원인을분석하기위함이다. 방법 : 2015 년 6 월부터 2018 년 8 월까지경북대학교치과병원구강악안면외과외래에임플란트제거를위해내원한 128 명의환자들을대상으로의무기록지및방사선사진을이용하여후향적연구를진행하였다. 각환자의초진기록을바탕으로임플란트제거원인을임플란트주위염, 골수염, 감각이상, 상악동문제, 임플란트파절로분류하였으며임플란트제거후일주일뒤내원하였을때환자의주관적평가와조직치유정도에대한의사의객관적평가에따라호전정도를동일, 호전, 악화로분류하였다. 결과 : 전체 128 명의환자중여성은 71 명, 남성은 57 명이었으며평균연령은 64.8 세였다. 2 명의환자가임플란트제거일주일뒤완쾌되었다고진술하였고 75 명의환자가증상이호전된것을확인할수있었다. 임플란트제거이후에도증상이동일한환자는 12 명이었으며증상이악화되거나다른증상이발현된환자는 8 명이었다. 그외 31 명은증상변화여부를확인할수없었다. 56 명의환자가임플란트주위염, 34 명의환자가임플란트파절, 17 명의환자가감각이상, 9 명의환자가골수염, 7 명의환자가상악동문제, 4 명의환자가하치조신경손상, 1 명의환자가교정치료목적으로임플란트를제거하였다. 본연구에서계측된임플란트개수는 183 개였으며방사선사진기준으로임플란트종류를분류하였을때 Internal type 126 개, External type 30 개, 그외명확히구분되지않는것 27 개를제거하였다. 임플란트제거부위에따라서는하악전치부에서 12 개, 하악구치부에서 69 개, 상악전치부에서 22 개, 상악구치부에서 80 개를제거하였다. 또한노출된 thread 개수가 5 개이상인것을기준으로분류하였을때, 하악전치부에서 9 개, 하악구치부에서 39 개, 상악전치부에서 13 개, 상악구치부에서 42 개를제거하였다. 결론 : 임플란트제거의주요원인은임플란트주위염이었으나감각이상발생으로인해임플란트를제거한환자또한 13% 의비율을차지한다. 대개임플란트주위염이나임플란트파절로인해임플란트제거술을시행한경우술식이후 65% 의환자에서증상이호전되었으나감각이상으로인해임플란트를제거한경우 35% 의환자는증상이완화되었으나 41% 는주관적으로증상이호전되지않거나악화됨을호소하였다. 즉감각이상또는특발성원인으로인해임플란트를제거하는환자의경우임플란트를제거하더라도증상이호전되지않을가능성이높으며이에대한추가적인연구가필요할것으로사료된다. Analysis of the Cause of Dental Implant Removal: A Retrospective Study of 128 Patients You-Jung Lee *, Seong-Baek Jang, Seong-Tak Lee, So-Young Choi, Jin-Wook Kim, Tae-Geon Kwon Dept. of Oral & Maxillofacial surgery, School of Dentistry, Kyungpook National University Purpose: Dental implant is widely used to replace teeth loss. However, it is not always successful. The purpose of this study is to analyze the cause of implant removal in patients who complained of pain or discomfort at the implant site. Methods and Materials: A 3-year retrospective study was done on 128 patients admitted to remove dental implants to the Department of Oral and Maxillofacial Surgery, Kyungpook National University Dental Hospital, using medical records and radiographs. The causes of implant removal were classified based on the initial recordings and underlying diseases of each patient. The degree of improvement was classified according to subjective evaluation of the patient and healing state of the tissue, one week after implant removal. Results: One hundred and twenty-eight patients included 71 females and 57 males, and mean age was 64.8 years. Two patients reported complete recovery after one week of implant removal, and 75 patients showed improvement in symptoms. Twelve patients had the same symptoms even after removal of the implants. Eight patients had worse symptoms or other symptoms, and 31 patients could not confirm the improvement of the symptoms. There were 56 patients with peri-implantitis, 34 patients with implant fracture, 17 patients with paresthesia, 9 patients with osteomyelitis, 7 patients with maxillary sinusitis/perforation, 4 patients with IAN damage and 1 patient for orthodontic treatment. The number of implants countered in this study was 183. When we classified the types of implants based on the radiographs, internal types were 126, external types were 30 and other undifferentiated ones were 27. Depending on the implant removal sites, 12 implants were removed from the Mn. ant. Area, 69 implants from the Mn. post. Area, 22 implants from the Mx. Ant. Area and 80 implants from Mx. Post. Area. Also, when the number of implants with 5 or more exposed threads was classified according to the region, 9 implants were removed from the Mn. ant. Area, 39 from the Mn. post. Area, 13 from the Mx. Ant. Area and 42 from the Mx. Post. Area. Conclusion: The main cause of implant removal was periimplantitis, but 13% of the total patients removed implants due to paresthesia. Generally, patients who had undergone implant removal due to peri-implantitis or implant fracture showed improvement of symptoms in 65% of patients. However, of the patients who had removed the implants due to paresthesia, 35% of the patients alleviated their symptoms after the operation, but 41% complained that their subjective symptoms did not improve or even worsened. In the case of the patients who removed the implants due to idiopathic causes, implant removal is unlikely to improve their symptoms and further studies are needed. 제 57 차종합학술대회및정기총회 23

24 O18 (26-A) 상악동거상술과동시에식립한임플란트의생존률및성공율 : 434 개임플란트분석 정용재 *, 안강민울산대학교의과대학구강악안면외과서울아산병원 서론 : 임플란트의디자인과표면처리의발달도인하여심하게흡수된상악구치부에서도초기고정을얻는것이가능한경우상악동거상술과임플란트동시식립이믿을만한결과를보이는것으로보고된다. 본연구의목적은상악동거상술과동시임플란트식립을한경우생존및성공률을조사하고실패인자를분석하기위함이었다. 재료및방법 : 2006년 1월에서 2017년까지 12월까지상악동거상술과동시에식립된 434개임플란트를대상으로하였다. 골이식재료는이종골혹은합성골로만이식하였으며 10-12mm 길이의거친표면을가진임플란트만을사용하였다. 2차수술을 3~6개월지난뒤하였다. 임플란트는 2개의그룹으로나누어 4mm 이하의잔존골을가진것을그룹 1로 5mm이상은그룹2로분리하여잔존골이임플란트의성공에미치는영향을조사하였다. Chi-square test와 Cox proportional hazard regression를이용하여잔존골, 성별, 나이, 위치, 초기고정, 흡연및음주가임플란트의성공에미치는영향을조사하였다. 결과 : 평균추적기간은 81.5개월이었으며 434개임플란트중 287개는 group I 이었고 148개임플란트는 group II 였다. 4개의임프란트가 2차수술시제거되었으며 4개의임플란트가보철물장착후탈락되었다. 최종생존율은 98.2% 였으며성공율도같은수치로관찰되었다. 잔존골비교군간에는성공률의차이가없었으나흡연군은비흡연군에비하여유의한성공률의차이가있었다. `결론 : 남은잔존골의높이와관계없이상악동거상술과동시에시행한임플란트의성공률은예측가능하였으며적절한디자인의임플란트와외과적인술식을이용하면심하게흡수된상악구치부에서도성공적인결과를가져올수있다. Survival and success of dental implants with sinus lifting and simultaneous installation: Results of 434 implants Yong-Jae Choung *, Kang-Min Ahn Department of oral and maxillofacial surgery, College of medicine, University of Ulsan Introduction: If less than 4mm residual bone was left in posterior maxilla, two stage operations have been recommended. However, implant design and surface treatment has been improved, so it is possible to gain initial stability even in severely resorbed maxilla. The purpose of this prospective study was to evaluate the survival and success rate of the implants simultaneously placed into grafted sinus using xenogenic bone graft material and to analyze the risk factors for implant failure. Material and methods: A total of 434 implant were installed simultaneously with sinus lifting by one experienced surgeon from 2006 to Rough surfaced implants of 10~12mm length and xenogenic bone were used. The second surgery was performed 3~6 months after first operation. Implants were divided into 2 groups according to residual alveolar bone (Group 1 :1 to 4mm and Group 2 : 5 to 8mm). Statistical differences of success rate between groups were analyzed with chi-square test. Cox proportional hazard regression was employed to identify risk factors such as residual alveolar bone, initial stability, bone quality, sex, age, site of implants, smoking and alcohol drinking habits related to implant failure. Results: The mean follow-up was 81.5 months. Of the 434 implants, 287 implants (66.1%) were Group 1 and 148 implants (33.9.0%) were Group 2. Four implants were removed at the time of second surgery and four implants were removed right after definite prosthesis. The cumulative survival and success rate was 98.2% There was no statistically significant difference in success rate between the two groups (p=0.577). However, significant differences were found in smoker (p<0.001) groups. Conclusions: Sinus lifting with simultaneous implant placement could be used to treat atrophic maxilla in patients with minimal residual bone heights when initial stability can be obtained by using appropriately designed implants and careful surgical techniques. 24 대한악안면성형재건외과학회

25 O19 (26-A) 상악동거상술후 3 차원분석을통한골부피와골질변화량분석 권진주 1*, 최나래 1, 백영재 1, 송재민 1, 황대석 1, 김용덕 1, 신상훈 1, 김욱규 1, 황재준 2, 이재열 1 1 부산대학교치의학전문대학원구강악안면외과학교실 2 부산대학교치의학전문대학원영상치의학교실 서론 : 상악구치부는상악동의함기화및치아상실에따른빠른치조골흡수로인하여임플란트식립을위한충분한골높이를갖지못한경우가많으며, 골질에있어서도하악구치부및상악전치부에비하여피질골이얇고망상골이많아임플란트식립을위한충분한골질을제공하지못하는경우가다수존재한다. 이를극복하기위하여다양한접근법과여러이식재를통한상악동거상술이시행되어지고있다. 본연구에서는상악동거상술이시행된환자들의 CBCT data 및 3D 분석소프트웨어를통하여이식재의부피및골질의변화를분석해보고자한다. 방법 : 2014년부터 2016년사이양산부산대학교치과병원에서수면마취하에상악동거상술이시행된환자중상악동거상술전 CT(T1), 술후 CT(T2) 그리고임플란트식립전경과관찰용 CT(T3) 가존재하는 29명환자의총 39개상악동을대상으로조사되었다. MATLAB 2018a (MathWorks, Natick, MA) 으로작성된프로그램으로환자들의 T1, T2, T3 CT를정합한후이식재의부피와평균픽셀값을측정하고, 구조분석을통해골질을분석해비교하였다. 결론 : 다수의이전논문에서삼차원분석을통한상악동거상술후골부피의변화에대하여고찰이있어왔다. CBCT의신뢰도와 3차원분석소프트웨어의발전에도불구하고상악동내부의구조적특성에따른신뢰할만한부피측정과표준화된골질평가가이루어지지못하고있다. 이번분석과향후추가적검증을통하여 3D 분석소프트웨어를통한골부피측정뿐만아니라표준화된골질의평가가가능할것이다. Analysis of Bone Volume and Bone Density Change by 3D Analysis after Maxillary Sinus Lift Jin-Ju Kwon 1*, Na-rae Choi 1, Young-jae Baek 1, Jae-Min Song 1, Dae-Seok Hwang 1, Yong-Deok Kim 1, Sang-Hun Shin 1, Uk-Kyu Kim 1, Jae-joon Hwang 2, Jae-yul Lee 1 1 Dept. of Oral and maxillofacial surgery, School of Dentistry, Pusan National University 2 Dept. of Oral and maxillofacial radiology, School of Dentistry, Pusan National University Introduction: The maxillary posterior area often does not have enough bone height for implant placement because of pneumatization of maxillary sinus and the rapid alveolar bone absorption after tooth loss. Furthermore, there are many cases in which the cortical bone is thin, and the cancellous bone is largely composed when it is compared with the mandibular posterior area and the maxillary anterior area, which does not provide sufficient bone quality for implant placement. To overcome this, various approaches and maxillary sinus lift through various graft materials have been used. The purpose of this study was to analyze the changes of bone volume and bone quality of bone graft material by 3D analysis software and CBCT data of patients who underwent a maxillary sinus lift. Method and materials: In twenty-nine patients, maxillary sinus lift surgery under monitored anesthesia care at Pusan National University Dental Hospital were performed from 2014 to Cone beam computer tomographies ware taken before surgery (T1), day after surgery (T2) and follow-up CT (T3). And thirty-nine sinuses were studied with image processing 3D reconstruction software. The program, written in MATLAB 2018a (MathWorks, Natick, MA), was used to match T1, T2, and T3. The volume and average pixel values of bone graft material were measured and analyzed. Conclusion: Many previous studies have examined the change of bone volume after a maxillary sinus lift with three dimensional analysis program. Despite the reliability of CBCT and the development of 3D analysis software, reliable volume measurement and standardized bone quality evaluation cannot be achieved. Through this analysis and further verifications, it will be possible to evaluate not only bone volume but also standardized bone quality through 3D analysis software. 제 57 차종합학술대회및정기총회 25

26 O20 (26-A) 약물과연관된임플란트주위염 : 항흡수약물투여후이미유착된임플란트실패를설명하기위한새로운용어에대한제안 김준영 *, 박진후, 정영수연세대학교치과대학구강악안면외과학교실 본연구의목적은성공적으로골유착을얻어기능하던임플란트를가지고있던환자에서비스포스포네이트를포함한항흡수약물의투여가임플란트주위염및임플란트탈락에영향을주는지와그특성을분석하기위한후향적연구이다. 2009년부터 2018년까지본원에서임플란트를제거했던 733 명의환자중성공적인임플란트골유착을얻은환자에서임플란트기능후골다공증또는악성질환으로인하여비스포스포네이트및항흡수약물을투여받았던환자에서임플란트제거를했던환자는 65명이었으며이환자들을대상으로차트와방사선사진및임상적검사를후향적으로분석하였다. 각종가변척도에대해유의수준 p=0.05 에대해통계적으로분석하였다. 본연구를통해성공적인임플란트를가지고있더라도비스포스포네이트를포함한항흡수약물투약시약물과연관된임플란트주위염을가속화시킬수있고후기임플란트실패로진행할수있음을확인하였다. 즉방사선치료전치과치료와같은개념으로약물치료전기존의임플란트주위염의조절과같은예방적처치가필요할것으로필요하다. Medication related peri-implantitis : Proposal for a new terminology to explain late failure of osseointegrated implant after anti-resorptive medication Jun-Young Kim *, Jin Hoo Park, Young-Soo Jung Department of Oral & Maxillofacial Surgery, Yonsei University College of Dentistry, Seoul, Korea The purpose of this study is to investigate whether the administration of antispasmodic drugs including bisphosphonate affects the peri-implantitis and late implant failure in patients who had successful osseointegrated implants. Among 733 patients who had removed dental implants from 2009 to 2018, the number of patients who had successfully osseointegration and those who received bisphosphonates and anti-resorptive drugs due to osteoporosis or malignant disease after implantation is 65. Medical charts were reviewed and adiographs and clinical examinations were retrospectively analyzed for these patients. The variable scales were statistically analyzed (significance level p = 0.05.) This study confirmed that even with successful implants, medication-related peri-implantitis can be accelerated and the late implant failure can proceed with antiresorptivec medication including bisphosphonate or denosumab. In other words, preoperative treatment such as the control of inflammation and peri-implantitis before antiresorptive treatment as the concept of pre-radiotherapy dental care for cancer patients. 26 대한악안면성형재건외과학회

27 KS (26-B) 턱관절장애의영상및감별진단김수호 고려대학교부속구로병원구강악안면외과턱관절은신체관절중가장복잡한운동을하는관절로, 턱관절장애는저작근과턱관절부위에염증성, 외상성, 의원성, 유전적, 전신적요인등다양한인자들로인해생리적내성을넘어광범위한임상적문제들이나타나는포괄적인질환을뜻한다. 턱관절장애의진단기준은대부분 Bell과 Okeson이제시한분류기준을기초로, 임상적검진과더블어다양한영상, 비영상장비들이진단에이용되어왔다. 턱관절장애는흔히자기제한적이라고알려져있지만, 환자들의병력청취를해보면다양한질병진행양상을나타낸다. 턱관절장애에는여러외과적, 비외과적치료방법이있지만, 오랜기간동안여러치료를받았음에도증상이쉽게조절되지않고만성구강안면동통의지속과삶의질저하도종종보게된다. 그렇기때문에증상초기에적절한진단이무엇보다중요하다. 본발표에서는턱관절장애진단에사용되는영상기법들의효용성및다양한임상증례들의감별진단에대해고찰해보려한다. Imaging and Differential Diagnosis of Temporomandibular Joint Disorder Soo-Ho Kim Department of Oral and Maxillofacial Surgery, Guro Hospital, Korea University The temporomandibular joint(tmj) shows the most complicated movement of the body joints, and temporomandibular joint disorder(tmd) is a comprehensive term which refers to broad clinical problems of the masticatory muscles and TMJ when various factors such as inflammatory, traumatic, iatrogenic, genetic, and systemic factors exceed the physiologic tolerance. The diagnostic criteria of TMD is mostly based on Bell s and Okeson s criteria, and various imaging and non-imaging techniques have been used so far. TMD is usually known as a self-limiting disease, however, patients show diverse courses of disease progression in history taking. There are many surgical and non-surgical treatment options treating TMD, but sometimes symptoms are difficult to manage despite of various treatment for long time, leading to chronic orofacial pain and detriment of quality of lives. Therefore, exact diagnosis in early stage of disease is a top priority. This presentation will discuss about the efficacy of imaging techniques used in TMD diagnosis and differential diagnosis of various clinical cases. 제 57 차종합학술대회및정기총회 27

28 O21 (26-B) 측두하악관절염진단시골극과 SPECT-CT 영상장효원 *, 유영훈, 김재영, 허종기 연세대학교치과대학구강악안면외과학교실 ( 강남세브란스병원 ) 연세대학교의과대학핵의학교실 ( 강남세브란스병원 ) 측두하악장애는근골격계질환으로서턱관절, 저작근, 그리고이와관련된두경부구조물의기능이상및통증을포괄하는용어이다. 이러한기능이상, 혹은통증의원인을감별하고그에따른치료계획을수립하는것은임상가들에게있어매우어려운점중하나이며, 많은임상적경험을요구한다. Dimitroulis 등에의하면, 측두하악장애를유발하는원인이관절내부에국한될경우수술적치료의예후가우수하다고보고하였다. 최근측두하악관절에대한영상학적진단방법의진보와더불어, 단일광자단층촬영술 (Single photon emission computed tomography : SPECT-CT) 은관절내부에서기인하는기능적이상, 통증에대한진단및치료에매우유용한단서를제공한다. 이에저자들은 SPECT-CT를활용하여환자의측두하악장애원인을감별하고, 원인부위에대한최소침습적치료를통해최선의치료효과를얻은증례를경험하였기에이들증례를검토하고발표하고자한다. Bony spur of mandibular condyle and SPECT-CT imaging for diagnosis of temporomandibular joint osteoarthritis Hyo-Won JANG 1*, Young Hoon RYU2, Jae-Young KIM 1, Jong-Ki HUH 1 1 Department of Oral and Maxillofacial Surgery, Gangnam Severance Hospital, Yonsei University College of Dentistry, Seoul, Korea 2 Department of Nuclear medicine, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea Temporomandibular disorder is a musculoskeletal disorder that includes dysfunction and pain of the jaw joint, masticatory muscle, and related head and neck structures. It is one of the difficulties for clinicians to identify the cause of these abnormalities, or to identify the cause of the pain and to plan the treatment accordingly, and requires a lot of clinical experiences. According to Dimitroulis et al., the prognosis of surgical treatment is excellent when the cause of temporomandibular disorder is localized within the joint. In addition to advances in imaging modalities for temporomandibular joints, singlephoton emission computed tomography (SPECT-CT) is a useful clue for diagnosis and treatment of functional anomalies and pain in the joints to provide. In this study, we used SPECT-CT to identify the etiology of temporomandibular disorder and to report the best results of minimally invasive treatment. 28 대한악안면성형재건외과학회

29 O22 (26-B) 측두하악관절질환환자에서초음파진단기를이용한관절낭거리의측정 장동규, 김헌영, 성태환, 박정현, 김진우, 김선종이화여자대학교의료원목동병원구강악안면외과 많은연구에서관절공간은측두하악관절질환에있어중요한구조물임을보고하였다. 측두하악관절의영상평가는주로 MRI와 CT를이용하였다. MRI는 TMJ의병태생리와형태를관찰하기에가장선호되나, 아직비용이많이들고촬영하는데오랜시간이걸린다. CT는방사선노출이있고주로경조직을관찰하는데제한된다. CT와 MRI는반복적으로촬영하기에어려움이있다. 최근초음파는새롭게제시되고있는치의학에서의진단도구로, 특히턱관절부위의진단에서관심을받고있다. 초음파는저렴하고, 비침습적이며, 실시간영상으로환자에게설명하고교육하기에알맞다. 더군다나인체조직에무해하기때문에주별또는월별로촬영할수있다. 관절공간은임상증상과연관이되어있고, 초음파를이용해서는관절공간의크기측정이어려우나외측관절낭공간의거리측정이가능하다. 이에우리는통증점수, 관절잡음, 개구량등의임상증상과관찰한관절낭거리간의연관성을조사하였다. 통증평가를위해이화여자대학교목동병원에턱관절질환치료를위해 2017년 5월부터 2018년 8월에내원한환자의의무기록을조사하였고, 해당환자들의관절낭공간은초음파기구를이용하여수직적또는수평적위치에서조사되었다. 본연구의목적은측두하악관절질환의증상과초음파를이용하여측정한관절낭거리간의관계를평가하는것이다. Measurement of capsular width using ultrasound in temporomandibular joint disorders patients Dongkyu Jang *, Heonyoung Kim, Taewhan Sung, Junghyun Park, Jinwoo Kim, SunJong Kim Department of Oral and Maxillofacial Surgery, Ewha Womans University Mokdong Hospital Many studies reviewed that joint space is an important structure to temporomandibular joint(tmj) disorder. Imaging evaluation of TMJ was used MRI and CT mainly. MRI is the most preferred technique to look into TMJ pathophysiology and morphology, but it is still expensive and take a long time. CT is limited to survey hard tissue and it uses radiation. CT and MRI are hard to take repeatedly. Nowadays ultrasound is suggested to new clinical diagnostic tool in dentisty, especially in diagnosis of TMJ area. Ultrasound is inexpensive, noninvasive, harmful and realtime image and it is good to explain and educate patients. Moreover, it is not harmful to human tissue and it is able to take weekly or monthly. Joint space is related to clinical symptom. Joint space is difficult to measure size of space but external capsular width is measurable using ultrasound. Thus we inquire into relationship of that parameter and clinical symptom such as pain score, joint sound, mouth opening. Medical records of patients who came to Ewha womans university Mokdong hospital for treatment of temporomandibular disorder from 2017 May to 2018 August were reviewed for pain evaulation. Capsular width is invested with ultrasound horizontally and vertically. The aim of this study is to evaluate that relationship between symptom of temporomandibular joint disorder and measured capsular width using ultrasound. 제 57 차종합학술대회및정기총회 29

30 O23 (26-B) 양측성측두하악관절강직환자에 3D 가상수술과 CAD/CAM 기술을이용한기성 TMJ 보철물의적용 이승현 *a, 백승학 b, 백범주 a, 양병은 c, 김종철 d, 정춘기 e, 최진영 a a 서울대학교구강악안면외과학교실 b 서울대학교교정과학교실 c 한림대학교의과대학구강악안면외과 d 미르치과병원 a 메가젠임플란트, FACEGIDE 목적 : 양측성턱관절강직환자에 3D virtual surgery를이용하여수술계획을수립하고, CAD/CAM 으로제조한 surgical guide로 stock TMJ prosthesis를적용한증례를고찰해보고자한다. 증례 : 여러번의 TMJ 수술을시행했던 66세환자였고, 강직으로인해개구와저작에심각한장애가있었다. 방법 : 3D virtual surgery를소프트웨어 (FACEGIDE, MegaGen implant, Daegu, South Korea) 를통해시행하였다. 광대상에위치한병소의상부경계와하악과두상에위치한병소의하부경계를설정하였고, 기성 TMJ 보철물 (Biomet, Jackson-ville, FL, USA) 의위치가결정된이후에, CAD/CAM 기술을이용하여가상수술을실제수술로연결시켜주는 surgical guide를제작하였다. 전신마취하에병소의골절제선과 TMJ 보철물 (Biomet) 은수술전계획과동일하게이행되었다. 환자는수술후 2개월째경과관찰중이며, 특이적인합병증없이3mm 가량의개구량회복을보인다. 결론 : 재발성의양측성턱관절강직을보이는환자에게있어서, 3D virtual surgery 를이용한수술계획과 CAD/CAM 을이용한 surgical guide의제작이기성 TMJ 보철물을좀더효과적으로환자에게적용하는치료방법이된다. Total Joint Reconstruction Surgery for a Patient with Recurrent Ankylosis in Bilateral Temporomandibular Joints using Threedimensional Virtual Surgical Planning, CAD/ CAM-fabricated Surgical Guides, and Stock Prostheses Seung-Hyun Rhee *a, Seung-Hak Baek b, Bum-Joo Baek a Byoung-Eun Yang c, Jong-Cheol Kim d, Chun-Gi Jeong e Jin-Young Choi f a Department of Oral and Maxillofacial Surgery, Seoul National University, Dental Hospital, Seoul, South Korea b Department of Orthodontics, School of Dentistry, Dental Research Institute, Seoul National University, Seoul, South Korea c Department of Oral and Maxillofacial Surgery, College of Medicine, Hallym University, Anyang, South Korea d Mir Dental Hospital, Daegu, South Korea e FACEGIDE, Division of Digital Business, Megagen Implant, Daegu, South Korea f Department of Oral and Maxillofacial Surgery, School of Dentistry, Dental Research Institute, Seoul National University, Seoul, South Korea OBJECTIVE: To discuss the total joint reconstruction surgery for a patient with recurrent ankylosis in bilateral temporomandibular joints (TMJs) using three-dimensional (3D) virtual surgical planning, computer-aided manufacturing (CAD/CAM)-fabricated surgical guides, and stock TMJ prostheses. CASE: A 66 years-old female patient, who had a history of multiple TMJ surgeries, complained of severe difficulty in eating and trismus. Methods: The 3D virtual surgery was performed with a virtual surgery software (FACEGIDE, MegaGen implant, Daegu, South Korea). After confirmation of the location of the upper margin for resection of the root of the zygoma and the lower margin for resection of the ankylosed condyle, and the position of the fossa and condyle components of stock TMJ prosthesis (Biomet, Jackson-ville, FL, USA), the surgical guides were fabricated with CAD/CAM technology. Under general anesthesia, osteotomy and placement of the stock TMJ prosthesis (Biomet) were carried out according to the surgical planning. At 2 month post-operative follow-up, the patient was able to open her mouth up to 30 mm without complication. CONCLUSION: For a patient who has recurrent ankylosis in bilateral TMJs, total joint reconstruction surgery using 3D virtual surgical planning, CAD/CAM-fabricated surgical guides, and stock TMJ prostheses may be an effective surgical option. 30 대한악안면성형재건외과학회

31 O24 (26-B) 턱관절질환과류마티스인자와의상관관계분석안재명 *, 홍종락, 팽준영 성균관대학교의과대학삼성서울병원구강악안면외과개요 : 턱관절질환 (TMD) 이류마티스질환 (RA) 환자와연관이있을수있다는것은지금까지의문헌고찰을통해알수있다. RA 환자에서보고된 TMD의빈도는 2 % 에서 88 % 까지다양하다. 관절의민감한것과강성이가장흔한증상이며, 증상이심한경우, 통증, 강직, 주름살및전치부개방교합을동반한관절표면의마모가있다. 본연구의목적은류마티스관절염환자에서류마티스인자에따른턱관절장애의유병률과유형을영상자료와함께평가하는것이다. 방법 : 2011년 1월부터 2018년9월까지턱관절장애를주소로내원한환자 1821명 ( 남647명, 여1174명 ) 중에서 complete blood cell count(cbc), Chemistry, C-polysaccharide reactive protein(crp), Erythrocyte Sedimentation Rate(ESR), Rheumatoid(RA) factor, Anti-Cyclic Citrullinated Peptide Antibody검사를시행한환자에대하여그검사결과를조사하였다. 또한증상에따라 MRI나 CT 를촬영한환자에대하여하악과두와관절원판과의관계와하악과두의흡수또는마모에대하여조사하고 RA factor와의상관관계를알아볼것이다. 결론 : 류마티스관절염환자에서적혈구침강속도, 류마티스인자및자기공명영상소견이중요한것으로나타났다. 류마티스관절염환자에서 TMJ 병력의평가를위해병력, ESR 및류마티스인자검사, 방사선소견을함께평가해야한다. Analysis of Correlation between Temporomandibular Joint Disease and Rheumatoid Factor Jaemyung Ahn *, Jongrak Hong, Jun-Young Paeng Dept. of Oral and maxillofacial surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine Introduction: It is well known that TMJ can be involved in patients with rheumatic disease. Reported frequencies of TMD vary between 2% and 88% in RA patients. Joint tenderness and stiffness are the most frequent symptoms. In severe disease, there is the destruction of the joint surface, with pain, stiffness, crepitation and anterior open bite. The purpose of this study was to evaluate the prevalence and type of temporomandibular joint disorder according to rheumatoid factor in rheumatoid arthritis patients with image data. Methods: The complete blood cell count (CBC), chemistry, and C-polysaccharide reactive protein (CRP) of 1821 patients (647 males and 1174 females) who visited our clinic between January 2011 and September 2018 The results were evaluated for patients who underwent an erythrocyte sedimentation rate (ESR), a rheumatoid factor (RA) factor, or an anticyclic citrullinated peptide antibiotic test. In addition, we will investigate the relationship between the mandibular condyle and the disc of the mandible and the absorptive or abrasive wear of the mandibular condyle and the correlation with the RA factor for patients who underwent MRI or CT according to the symptoms. Conclusion: TMJ is one of the frequently involved joints in RA, and MRI is the best imaging modality. The MRI findings, ESR and RF values of the patients are valuable parameters for TMJ involvement. History, physical examination, laboratory and radiological findings should be evaluated together for evaluation of TMJ involvement in RA patients. 제 57 차종합학술대회및정기총회 31

32 KS (26-C) 구강편평세포암종의기초연구최소영 경북대학교치과대학구강악안면외과학교실구강암의대부분은편평상피세포암종으로인접조직으로의침범및전이빈도가높으며, 여러진단기법의발달과다양한치료방법에도불구하고 5년생존율이현재까지도낮다. 초기진단방법이나조직병리학적인연구, 임상적특징이나예후에관한연구들은구강악안면외과의사나구강악안면병리의사에의해많이이루어지고있다. 하지만다른암종들과비교했을때기초분야에서의구강편평상피세포암종의연구에대한관심은적은편이며, 임상과연계된기초연구도다른암종에비해적은편이다. 구강편평상피세포암종에대한기초연구에있어서환자를직접치료하고있는구강악안면외과의의적극적인아이디어가필요하며, 또한임상가가기초적연구에많은관심을가졌을때더욱활발한연구가이루어질수있을것이다. 본강의에서는임상가로서관심을가질수있는구강편평상피세포암종의기초연구방법에대해논의하고자한다. Basic Research of Oral Squamous Cell Carcinoma So-Young Choi Department of Oral & Maxillofacial Surgery, School of Dentistry, Kyungpook National University Most of the oral cancer is squamous cell carcinoma, and the invasion and metastasis to adjacent tissues are high. Despite the development of multiple diagnostic techniques and various treatment methods, the 5 - year survival rate is still low. Research on early diagnosis methods, histopathological studies, clinical features and prognosis have been performed by oral and maxillofacial surgeons and oral and maxillofacial pathologists. However, there is less interest in the study of oral squamous cell carcinoma in the basic field when compared with other cancers, and the basic research linked to clinical studies is also less than other cancers. In the basic study on oral squamous cell carcinoma, it is necessary to have active ideas of oral and maxillofacial surgeons who directly treat patients and more active research can be conducted if the clinician has a lot of interest in basic research. In this lecture, we will discuss basic research methods of oral squamous cell carcinoma which can have interest as a clinician. 32 대한악안면성형재건외과학회

33 O25 (26-C) Comparison of tantalium-coated with non tantalium coated facial implants Experimental study. Bakri, Mohammed Mousa *1,2, Sung Ho Lee 1, Jong-Ho Lee 1 Department of Oral and Maxillofacial Surgery, School of Dentistry, Seoul National University, Korea. Department of Oral and Maxillofacial Surgery, School of Dentistry, Jazan University, Saudi Arabia. Introduction: Facial implants, therapeutic augmentations, are substances use to restore facial volume and contour. And the most widely used alloplastic materials in oral and maxillofacial filed are Silicon (the trade name for the dimethyl siloxane polymer) and EPTFE (the trade name of expanded polytetrafluoroethylene: EPTFE). Through application of various coatings and technical fabrication processes, the properties of facial implants have been optimized. biocompatibility of various metallic coats has been investigated in several studies. This study was conducted to evaluate the efficiency of coating facial implants material (Silicon and Gore-Tex) with Tantalium in improving their biocompatibility. Material and methods: Five adult male rats weighing g were used in each group. The animals received 10*10 mm size implant that put on the rat caldaria. Implants collected in three different intervals: 2 weeks, 4weeks, and 12 weeks. Histomorphometrically analysis was done on the implants to examine the biocompatibility of the implant after coating. Conclusions: Gore-Tex coated implants shows god result and the attachment of the implants to underling bone get better. On the other hand, silicone implant did not show and significant difference. 제 57 차종합학술대회및정기총회 33

34 O26 (26-C) Foxp3 + 조절 T 임파구가구강악안면면역항상성을조절하는기전에관한연구 박주영 1,2, 박정현 2 1 서울대학교치과병원구강악안면외과, 서울, 대한민국 2 Experimental Immunology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA 서론 : 구강점막은구강악안면영역으로침투하는대부분의병원균과외부인자가처음으로만나게되는장벽조직으로서면역반응이시작되는곳이기도하다. 외부환경에항시노출되어있음에도불구하고구강점막의면역항상성은잘유지되고있는데, 이는심한면역반응을억제하는인자가작동하고있음을의미한다. 이러한억제인자중에하나로 Foxp3 + CD4 + 조절 T 임파구 (Foxp3 + regulatory T cells; Treg cells) 가잘알려져있으나, 구강점막에존재하는 Treg cells 에대해서는많이알려진바가없다. 본연구에서는구강점막의 Foxp3 + Treg cells의존재와역할및구강악안면영역의면역반응을조절하는기전에대해알아보고자한다. 방법 : 구강점막의임파구분석을위해생쥐모델을이용하였다. 생쥐의구강점막으로부터면역세포를분리하는방법은본저자들에의해개발된 staggered enzyme digestion방법을사용하였으며, 세포표면및전사인자마커를이용한유세포분석법을사용하여 Foxp3 + CD4 + Treg cells을식별하였다. Foxp3 + Treg cell의결손을유도하였을때구강점막에일어나는변화를관찰하기위하여 Foxp3 유전자변이생쥐모델 (Scurfy) 과 Foxp3 유전자결손유도생쥐모델 (Foxp3- DTR) 을이용하였다. 결과 : 구강점막에서놀라울정도로높은비율의 Foxp3 + Treg cell이발견되었다. Treg cell들은구강점막의 CD4 + T 임파구의약 20-25% 를차지하고있었으며, 이는다른점막조직인폐, 소장점막과비교했을때도가장높은비율이었다. 구강점막 Foxp3 + Treg cells은임파절이나비장에존재하는 Treg cells와형질에서많은차이를보였는데, 특히 Treg cell의면역억제능력을결정하는 CTLA-4 의발현이유의하게높았다. 구강점막에서 Foxp3 + Treg cells 이어떤역할을하는지알아보기위해 Foxp3 발현이선천적으로결손되었거나결손이유도된생쥐모델의구강점막을분석한결과, 구강점막에서면역반응이활성화된 T 임파구의숫자가현저하게증가된것을관찰할수있었다. 또한활성화된 T 임파구는염증성 cytokine 특히 Interferon-ggamma를강하게발현하여, Foxp3 + Treg cell이결손되면구강점막에극심한면역반응이유도됨을알수있었다. 결론 : 이번연구을통해구강점막에존재하는 Foxp3 + Treg cells의존재와특성에대한새로운정보를얻을수있었다. Treg cells는구강점막의면역항상성유지에필수적인역할을하고있으며, 구강악안면면역조절의 key player 로서향후질환연구의중요한단초가될것으로생각된다. The oral mucosa favorably recruits Foxp3 + regulatory T cells regulating immune reaction in the oral mucosa Joo-Young Park 1,2*, and Jung-Hyun Park 2 1 Department of Oral and Maxillofacial Surgery, Seoul National University Dental Hospital, Seoul, South Korea 2 Experimental Immunology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA Introduction: The oral mucosa is a critical barrier tissue that protects the head and neck against invading pathogens and foreign antigens. Notably, inflammation in the oral cavity is rarely observed, indicating that overt immune activation is actively suppressed in this site. One of the most potent immune suppressing cells is the Foxp3 + CD4 + T cells also known as regulatory T (Treg) cells. Whether the Foxp3 + Treg cells are present and control immunity of the oral mucosa has not been clear. Method: Oral mucosal tissues were harvested from experimental mice and digested with enzymes based on the staggered enzyme method recently reported by us. After isolation of the immune cells, Treg cells were identified and visualized by flow cytometry and immunohistochemistry using surface markers and transcription factors. To identify the roles of Treg cells in the oral mucosa, Foxp3 gene mutation mice were used. Result: We show that the oral mucosa is highly enriched for Foxp3 + Treg cells, in fact, at the highest frequency among CD4 + T cells compared to other mucosal barrier tissues. Oral mucosal Treg cells are phenotypically distinct from Treg cells of lymph node or spleen, as they expressed exceptionally large amounts of CTLA-4, which presumably equips them with superior suppressor function to maintain immune quiescence in the oral mucosa. In agreement, the failure to generate Treg cells in newborn mice or the acute removal of Treg cells in adult mice had catastrophic effects, resulting in dramatic infiltration of highly activated effector T cells that were associated with autoimmunity and tissue destruction of the oral mucosa. Conclusion: These results report a previously unappreciated role of Foxp3 + Treg cells in protection of the oral mucosa that is further accompanied with tissue-specific changes in their phenotype and activation status. 34 대한악안면성형재건외과학회

35 O27 (26-C) Animal models for the study of platelet-rich fibrin (PRF) and concentrated growth factor (CGF) for the clinical application KYUHOON LEE *, HYEJEONG LEE, HEEJIN KIM, DAUM KIM, SEUNGHWAN KIM, JIHOON PARK, SEUNGWOO PAEK, HOJIN YOON, HYOJIN CHA, JAESEEK YOU, SUGWAN KIM Directed by JAESIK YOO Maxillofacial Surgery Department Purpose: In order to botain abundant and high quality bone, much research has been conducted to find the materials which accelerate new bone formation and these substances are present in blood within platelets. Platelet-derived substances such as platelet-rich fibrin (PRF) and concentrated growth factor (CGF) are the most commonly used. The aim of the animal experimental study is to evaluate the efficiency of the platelet derived material on bone formation in vivo Results: Alkaline phosphatease activity, calcification and mineralization increased more gradually in PRF(new) group than PRF(old) and CGF groups. In addition, mrna levels of type I collagen, BMP-2 and osteocalcin genes were higher in the PRF (new) and CGF groups than in the controls and PRF (old) groups. Similarly, in the animal experiment, the amount of new bone formation was larger in the PRF (new) and CGF groups. Conclusion: We conclude that PRF(old), PRF(new) and CGF can promote bone regeneration as a growth factor without complications and those all experiment groups. Additionally, the use of PRF(old), PRF(new), and CGF facilitates new bone formation effectively when used with guided bone regeneration (GBR). However, in comparison of the osteogenic effects among the experimental groups based on these results, we consider that the osteogenic effects of PRF(new) and CGF are greater than those of PRF(old). 제 57 차종합학술대회및정기총회 35

36 O28 (26-C) 하이드로젤이혼합된이상인산칼슘골이식재의생체적합성및골재생평가 문성호 1, 김한종 1, 임헌준 1, 김봉철 1, 이준 1,2 1 원광대학교대전치과병원구강악안면외과 2 원광골재생연구소 목표 : 외상, 종양의제거, 발육부전등으로인한악골결손부의재건시다양한골이식술이사용된다. 최근들어조직공학의발전으로인하여기존골이식재의단점을보완한합성골의사용이각광받고있으며, 이들의골재생능을향상시킬수있는첨가물에대한연구들이많이이루어지고있다. 본연구에서는하이드로젤 ( 젤라틴 ) 을기존의이상인산칼슘골이식재와혼합하여골이식재의물성, 생체적합성및골결손부에서의골재생을평가하고자하였다. 재료및방법 : 농도를달리한 (0.1, 0.3 및 0.6 %) 과산화수소와젤라틴을기존의이상인산칼슘골이식재에첨가하여골이식재의물성과골육종세포 (MG-63 cell) 의세포증식및골분화유도에미치는영향을평가하였다. 그후가장적합하다고판단된과산화수소의농도와젤라틴을첨가한골이식재를가토의악골결손부에이식하여 8 주후얻은조직시편을면역조직염색을통해신생골의형성을평가하였다. 결과 : 하이드로젤 ( 젤라틴 ) 을첨가한골이식재에서기존의이상인산칼슘골이식재와비교하였을때다공성및압축강도가증가하였다 (P < 0.05). 특히과산화수소의농도가 0.1 % 일때가장높은다공성을보였으며, 과산화수소의농도가 0.6 % 일때가장높은압축강도를보였다 (P < 0.05). 골육종세포의증식과분화도또한기존의골이식재와비교하였을때하이드로젤을첨가한골이식재에서더높은결과값을측정하였으며과산화수소의농도가 0.1 % 일때가장높은증가율을보였다 (P < 0.05). 가토의악골골결손부에서기존의골이식재와비교하여골결손부의경계및중앙부에서더많은신생골의분포를보였다. 결론 : 0.1 % 과산화수소농도의하이드로젤이첨가된이상인산칼슘골이식재는기존의골이식재보다높은다공성과압축강도를가지며골결손부에이식되었을때기존의골이식재보다높은골형성능을보인다. Biocompatibility and Bone Regeneration of Hydrogel / Biphasic Calcium Phosphate Bone Graft Materials Seong Ho Mun *1, Hanjong Kim 1, Hun Jun Lim 1, Bong Chul Kim 1, Jun Lee 1,2 1 Dept. of Oral and maxillofacial surgery, Daejeon Dental Hospital, College of Dentistry, Wonkwang University 2 Wonkwang Bone Regeneration Research institute, Wonkwang University Objective: A variety of bone grafts are used for the reconstruction of the defects of the jaw due to trauma, tumor removal and developmental failure. Recently, the use of synthetic bone has attracted attention due to the development of tissue engineering and many studies have been carried out to improve biocompatibility and bone regeneration ability of synthetic bone graft materials. In this study, we evaluate the mechanical properties, biocompatibility and bone regeneration of Hydrogel / BCP bone graft materials. Methods and materials: The scaffold made of BCP with Hydrogel (gelatin) and Hydrogen peroxide with different concentrations (0.1, 0.3 and 0.6 %) were evaluated its mechanical properties and the effect of MG-63 cell on cell proliferation and differentiation. After that, effect of bone regeneration in vivo were evaluated using a rabbit calvarial defect model with 8 weeks tissue specimens through immunohistochemistry staining. Results: The scaffold with 0.1 % H2O2 and hydrogel (gelatin) showed higher porosity and compressive strength as compared with the conventional BCP scaffolds (P < 0.05). The highest porosity was obtained at 0.1 % H2O2 concentration and the highest compressive strength at 0.6 % H2O2 concentration (P < 0.05). The proliferation and differentiation of MG-63 cells were also higher than those of conventional BCP scaffold. The highest value was obtained at the 0.1 % of H2O2 concentration. In rabbit calvarial defect model, there were more new bone distributions at the border and center of the bone defects compared to the conventional BCP scaffold. Conclusion: Hydrogel / BCP scaffold with 0.1 % H2O2 concentration have higher porosity and compressive strength than conventional BCP scaffold. They show higher bone regeneration compared as conventional BCP scaffold on the bone defect of rabbit calvaria. This work was supported by the National Research Foundation of Korea(NRF) grant funded by the Korea government(msit)(nrf-2018r1a2b ) 36 대한악안면성형재건외과학회

37 O29 (26-C) 실크로부터느리게방출되는세리신단백질조각의 TNF-α 유도와골형성조절 조유영 1, 권해용 1, 김대원 2, 백경화 3, 강예진 4*, 김민근 4, 김성곤 4, 채원식 5, 최재용 6, Horatiu Rotaru 7 1 잠사양봉소재과, 국립농업과학원, 완주 2 강릉원주대학교치과대학생화학교실 3 강릉원주대학교치과대학약리학교실 4 강릉원주대학교치과대학구강악안면외과 5 한국기초과학지원연구원, 대구 6 경북대학교의과대학생화학교실 7 두개악안면외과, Iuliu Hatieganu University of Medicine and Pharmacy, Rumania 누에고치의각층에들어있는세리신의양은서로다르고이에따라각층에서방출되는세리신의양도달라진다. 누에고치에서방출된단백질의농도는최외층과최내층에서중간층보다높게관찰되었다. 쥣과의대식세포에서발현된 TNF-α 의양은적용된세리신의농도에따라다르며골모세포유사세포들에서골생성에관련된유전자의발현은적용된 TNF-α 농도에따라다르다. 동물실험에서누에고치의중간층을사용했을때최외층과최내층보다더많은골형성을나타냈다. 중간층에 TNF-α단백질을포함시켰을때포함시키지않았을때보다골형성이억제되었다. 따라서누에고치로부터얻은차폐막은세리신조각을분비하는캐리어로생각될수있으며세리신분비량은 TNF-α유도와골재생에영향을준다. Slow and fragmented release of sericin from silk mat induces tumour necrosis factor α and indirectly regulates bone formation You-Young Jo 1, Hae-Yong Kweon 1, Dae-Won Kim 2, Kyung- Hwa Baek 3, Yei-Jin Kang 4*, Min-Keun Kim 4, Seong-Gon Kim 4, Weon-Sik Chae 5, Je-Yong Choi 6, Horatiu Rotaru 7 1 Sericultural and Apicultural Division, National Institute of Argricultural Science, Wanju 2 Department of Oral Biochemistry, College of dentistry, Gangneung- Wonju National University 3 Department of Oral Pharmacology, College of dentistry, Gangneung-Wonju National University 4 Department of Oral and Maxillofacial Surgery, College of dentistry, Gangneung-Wonju National University 5 Analysis Research Division, Daegu Center, Korea Basic Science Institute 6 School of Biochemistry and Cell Biology, Kyungpook National University 7 Department of Cranio-Maxillofacial Surgery, Iuliu Hatieganu University of Medicine and Pharmacy, Rumania The content of sericin is different to the silk mat layer. Accordingly, the level of sericin release from each layer is also different. The concentration of protein released from silk mats was higher in the outermost and the innermost layers than in the middle layers. The level of TNF-α in murine macrophages was dependent on the applied concentration of sericin, and the expression of genes associated with osteogenesis in osteoblast-like cells was dependent on the applied concentration of TNF-α. In animal experiments, silk mats from the middle layers led to higher regenerated bone volume than silk mats from the innermost layer or the outermost layer. If TNF-α protein was incorporated into the silk mats from the middle layer, bone regeneration was suppressed compared with unloaded silk mats from the middle layers. Accordingly, silk mats from the silk cocoon can be considered to be a fragmented sericin-secreting carrier, and the level of sericin secretion is associated with TNF-α induction and bone regeneration. 제 57 차종합학술대회및정기총회 37

38 KS (27-A) 이뽑다가생긴일김봉철 * 원광대학교발치로시작해서발치로끝날제일상을나누고자합니다. What happens in the extraction? Bong Chul KIM * Hospital, Wonkwang University College of Dentistry I d like to share my daily life beginning with the extraction and ending with the extraction. 38 대한악안면성형재건외과학회

39 O30 (27-A) 가상현실을이용한치과임상술기교육김효준 *, 문성용, 정희석 조선대학교치과대학구강악안면외과, 조선대학교대학원본연구에서는실제적인환자의모델을바탕으로가상현실기반의치과임상술기를실습할수있는 VR 시뮬레이터를제작하여이를이용하여국소마취및치아프렙실습에활용할수있게하고자한다. 실습환자의안면해부학적모델은실제환자의 CT 데이터를바탕으로안면부위골에대한삼차원모델을먼저완성한후각각의근육과혈관, 신경을표현하고안면부에대한삼차원스캔그리고치아의 3차원스캔후모델링을통해각각의해부학적구조물을표현하였다. Unity3D와햅틱장비를활용해현실감있는치아프렙을구현하였다. 가상현실기반의시뮬레이션은치과대학생들과수련의들의교육도구로서임상술기를습득하고평가하는데사용할수있으며, 다양한실습과정을반복적으로시행할수있으며, 컴퓨터기반의평가를통해객관적평가가가능하다. 통상적으로치과임상술기교육방법이많지않은현실에서 HMD 와햅틱장비를이용한시뮬레이터실습은몰입감과현실감을동반한실습장비로서치과임상술기교육에질을높일수있을것으로사료된다 Virtual Reality for Clinical technique education in Dentistry Kim Hyo Joon *, Moon Seong Yong, Jung Hee Suk Department of Oral and Maxillofacial Surgery, College of Dentistry, Chosun University The purpose of this study is to develop a virtual reality (VR) simulator that can be practiced on a virtual reality based on actual patient model and to utilize it for local anesthesia and tooth preparation practice. The facial anatomical model of the practitioner is based on the CT data of the actual patient. After completing the 3D model of the facial bone, the 3D model of the facial muscle, vessels and nerve are represented, respectively. Unity3D and haptic equipment were used to implement realistic tooth preparation. Simulation based on virtual reality can be used to acquire and evaluate clinical skills as an educational tool for dental college students and practitioners, and it is possible to repeatedly practice various training courses, and it is possible to perform objective evaluation through computer based evaluation. In the reality that there are not so many dental clinic training methods in general, it is thought that the practice of simulator using HMD and haptic device can enhance the quality of dental clinical education as an exercise equipment with immersive and realistic feeling 제 57 차종합학술대회및정기총회 39

40 O31 (27-A) 의원성으로발생한이물질제거 : 11 증례분석이동훈 *, 안강민 울산대학교의과대학구강악안면외과서울아산병원서론 : 치과치료도중에발생하는기구의파절이나치과재료가상악동내로들어가는경우즉시제거하는것이원칙이다. 하지만조직내에깊숙한위치에서파절된경우국소마취로제거가어려운경우가있다. 본연구에서는기구파절과치과재료의이동으로발생한 11증례를분석보고하고자하였다. 재료및방법 : 본연구는 2006년 2월부터 2018년8월까지서울아산병원구강악안면외과에서한명의외과의사에게시행된연속적인이물질제거증례를분석하여원인, 수술합병증및재발방지에대한내용을조사하였다. 결과 : 의원성으로발생한이물질제거로 11명의연속적인환자가내원하였으며고주파침과치과마취용바늘의파절환자가 4명, 발치용치과기자파절이 2명, GP cone 함입, 미니스크류파절, 근관치료용파일파절, Bur 파절이각각 1 례있었으며봉합사침이봉합도중에조직내에묻혀온경우가각 1례있었다. 고주파침과마취용바늘의파절은전신마취하에제거하였으며나머지이물질은국소마취하에제거하였다. 치과용발치기자파절된 1명의환자는불편감을호소하지않았고파절된조각이하치조신경과가까이있어서제거하지않고관찰하였다. 수술후에특이한합병증은없었다. 결론 : 치과용마취바늘은가늘고하악골의내면에골과큰압력으로접촉하는경우파절의위험성이있기때문에전달마취시주의하여야하며, 치아발치시기구파절이될정도로강한힘을주면기구파절과동시에시야에보이지않는곳으로기구일부가이동될수있으므로주의하여야한다. 기타근관치료에사용되는기구의파절이흔하므로기구가낡은경우즉시교체하여야한다. Removal of foreign body from iatrogenic origin: analysis of 11 cases Dong-Hun Lee *, Kang-Min Ahn Department of oral and maxillofacial surgery, College of medicine, University of Ulsan Introduction: Dental instrument fracture or displacement of dental material into the maxillary sinus is a rare condition which should be corrected right after the event. However, it is difficult to remove under local anesthesia if the fractured instrument were positioned in deep muscle area. The purpose of this study was to report 11 consecutive patients who required surgical removal of foreign bodies due to fracture or malpractice. Materials and methods: This study included the patients who referred for removal of foreign body from February 2006 to August 2018 in the department of oral and maxillofacial surgery of Asan medical center by one experienced surgeon. Etiology of fracture, type of foreign body, postoperative complications and prevention rule were reviewed. Results: Eleven patients were referred from local dental clinic to remove foreign body. Fracture of dental needle for local anesthesia and high-frequency wave needle for debulking masseteric muscle were the most common situation (n=4). Fracture of dental elevator, miniscrew, endodontic file, surgical bur, gutta percha in maxillary sinus was the other etiologies. Fractured needles were removed under general anesthesia. The other dental instruments were removed under local anesthesia. One patient who had a fractured dental elevator showed proximity to inferior alveolar nerve did not want to undergo surgery, so periodic radiographic examination was performed. There was no postoperative complication reported after removal of the foreign body. Conclusion: Because dental needle for local anesthesia is quite long and thin, improper position or strong contact with inner cortical bone of the mandible may cause fracture or division from plastic connector. During dental extraction, too strong force to make dental instrument fracture should be avoided. Endodontic instruments such as endodontic file, rotary instrument should be replaced if it has been used over its limit. 40 대한악안면성형재건외과학회

41 O32 (27-A) 하악매복제 3 대구치발치후콜라겐스폰지의삽입이치유에미치는영향 : 무작위대조군실험 성태환 *, 김헌영, 장동규, 박정현, 김진우, 김선종이화여자대학교의과대학부속목동병원 이연구의목적은하악제 3 대구치의수술적발치후치유에흡수성콜라겐스폰지삽입의효과를알아보기위함이다. 동일한 Pell-Gregory와 Winter 분류에기초한양측하악제 3대구치를발치한 36명의환자를대상으로하였다. 이연구는무작위대조군실험으로진행되었으며한쪽은콜라겐스폰지의삽입을시행하였고반대측은시행하지않았다. 수술후임상적합병증, 치주조직치유, 방사선학적평가등을수술전및수술후 1, 2, 14주에시행하였다. 5명의환자가경과관찰중내원하지않아소실되어총 31명을대상으로연구를진행하였다. 평균 VAS 점수는수술후 1주경 1.26으로콜라겐스폰지삽입군에서유의하게낮았다. 평균치주낭깊이는수술후 1주경콜라겐스폰지삽입군에서 7.55 mm로유의하게낮았다. 방사선학적평가는유의한차이를보이지않았다. 즉, 하악매복제3대구치발치후콜라겐스폰지의삽입은초기임상적합병증을줄이며연조직과치주조직의치유를돕는역할을한다. Randomized controlled trial on the effectiveness of absorbable collagen sponge after extraction of impacted mandibular third molar: Split-mouth design Tae-Whan Seong *, Heon-Yeong Kim, Dong-Kyu Jang, Jung-Hyun Park, Jin-Woo Kim, Sun-Jong Kim Ewha Womans University Medical Center The purpose of this study was to compare the effectiveness of absorbable collagen sponge insertion in tooth extraction sites on socket healing of the impacted mandibular third molar. Thirty-six patients with bilateral mandibular impacted third molars based on same Pell-Gregory and Winter classification were included in this study. This study was a randomized clinical trial utilizing a split-mouth design wherein one side was assigned as collagen sponge insertion while the other side was control. Post-operative clinical complications, periodontal integrities and radiographic outcomes were assessed preoperatively 1, 2 and 14-weeks. Five patients were excluded during the follow-up period due to loss of follow-up period, the study was conducted on 31 patients. The mean VAS score of collagen sponge insertion side at 1week post-operatively was 1.42 ± 1.26, which was significantly lower than control side (P<0.05). The mean probing depth of collagen sponge insertion side at 1week post-operatively was 7.55 ± 3.17 mm, which was significantly lower (P<0.05). Other various measurements including radiographic outcomes showed no significant time-group effects. Placement of collagen sponge in osseous defects from surgical removal of mandibular impacted third molar reduces early stage post-operative complications and enhances initial healing of soft tissues and periodontal defects. 제 57 차종합학술대회및정기총회 41

42 O33 (27-A) 내시경을이용한악하선도관내타석제거술에대한증례보고 이동건 *, 김창우, 강몽헌, 송인석, 전상호고려대학교안암병원구강악안면외과학교실 서론 : 타석증은주타액선및도관에석회물질이생겨침의통로가막히면서생기는질환으로, 침샘의부종및통증을유발할수있다. 해부학적및생리학적요인으로주타액선중악하선에가장호발하며, 자연탈락되지않을시, 수술을통해제거해왔다. 현재타액선내시경술의발전에따라비침습적접근을통한타석제거술이등장하였으며, 이를이용한증례를보고하고자한다. 재료및방법 : 고려대학교안암병원에내원하여타액선내시경술을통한타석제거술을시행한환자들에대하여연구를진행하였다. 한명의술자가수술을시행하였으며, 시술전후임상적증상에대한평가를시행하였다. 결과 : 시술후타석으로인한임상증상은모두소실되었으며, 기존침습적방법에비해시술후부종, 동통및환자의불편감이적은것을확인할수있었다. 결론 : 본연구의결과타액선내시경을이용함으로써, 기존침습적방법에비해시술후환자들의불편감을줄일수있으며, 타석증외에구강건조증등에도내시경을응용한더넓은임상적용의가능성이있음을알수있었다. Sialolithotomy of submandibular duct using sialoendoscopy: case report Dong-Keon Lee *, Chang-Woo Kim, Mong-Heun Kang, In- Seok Song, Sang-Ho Jun, Dept. of Oral and Maxillofacial Surgery, Korea University Anam Hospital Introduction: Sialolithiasis(also termed salivary calculi, or salivary stones), is a condition where a calcified mass or sialolith forms within a salivary gland or duct, which can cause salivary edema and pain. Due to anatomical and physiological factors, it is most common in the submandibular glands, and has been surgically removed when it is not naturally removed. We present a case of salpingectomy using a noninvasive approach according to the development of sialoendoscopy. Materials and Methods: We studied the patients who underwent sialolithotomy with sialoendoscopy at Korea University Anam Hospital. One surgeon performed the operation and evaluated the clinical symptoms before and after the operation. Results: After the procedure, all the clinical symptoms due to the salivary stones were disappeared, and it was confirmed that there was less postoperative edema, pain, and discomfort than the conventional invasive method. Conclusions: The results of this study suggest that the use of sialoendoscopy can reduce the discomfort of the patients after the operation compared with the conventional invasive method. And it was also found that there is a possibility of broader clinical application of endoscopy for xerostomia. 42 대한악안면성형재건외과학회

43 O34 (27-A) 낭종감압술과하치조신경관의재생김진우 *, 조진용, 류재영, 김성범 가천대길병원구강악안면외과연구목적 : 하악골에발생한낭종이하치조신경관을침범한경우감압술이후에신경관이재생되는것을관찰할수있다. 본연구의목적은감압술을통한하치조신경관의재생률과속도에대해알아보기위함이다. 연구방법 : 2012년부터 2017년까지하악골에발생한낭종을가진환자중에서명확한하치조신경관의침범이관찰되는 12명의환자를대상으로하였다. 초진과감압술이후의 CT 를통해낭종의부피를측정하고크기의변화를계산하였다. Lingula가시작되는부위부터 mental foramen까지를하치조신경관으로설정하고길이를측정하였다. 이때낭종에의해신경관일부가침범된부위는길이측정에서제외하였다. 초진과감압술이후의신경관길이변화를계산하였다. 결과 : 모든환자에서감압술이후낭종의부피는감소하였고신경관의길이는증가하였다. 초기낭종의부피는평균 10.98cc 였으며평균감압기간은 8개월이었다. 감압술이후낭종의부피는 3.05cc 였으며 (p<0.05) 평균적으로 72.19% 의부피감소가관찰되었고 1개월당평균 0.99cc의감소를보이는것으로계산되었다. 초기신경관의길이는평균 52.47mm 였으며감압술이후에는 80.29mm로 67.54% 의길이증가율을보였다. (p<0.05) 12명의환자중 6명에서신경관이완벽하게낭종성병소에서분리되는것을관찰할수있었다. 낭종의부피가감소하는것과신경관의길이가증가하는것사이에유의한상관관계를찾을수없었다. 결론 : 하치조신경관을침범한낭종성병소에서감압술을통해낭종의부피를감소시키며병소와하치조신경의접촉면적을줄일수있어술후하치조신경관손상예방에도움이될것으로사료된다. Decompression of cyst and recovery of inferior alveolar canal Kim Jin Woo *, Cho Jin-yong, Ryu Jae Young, Kim SungBeom Department of Oral & Maxillofacial surgery, Gachon University Gil Medical Center Purpose: A cystic lesion which was developed in the mandible can invade the inferior alveolar canal. After decompression treatment, the inferior alveolar canal can be regenerated. The purpose of this study is to investigate the regeneration rate and speed of inferior alveolar canal through decompression treatment. Material and method: From 2012 to 2017, 12 patients with cystic lesion in the mandible which shows explicit destruction of inferior alveolar canal were included. The volume of the cyst was measured and the change in volume was calculated by comparing initial and postoperative CT. The area from the beginning of lingua to the mental foramen was set as inferior alveolar canal and the length was measured. The portion of the inferior alveolar canal affected by the cyst was excluded from the length measurement. The changes in inferior alveolar canal length before and after decompression was calculated. Result: After decompression, the volume of the cyst decreased and the length of the inferior alveolar canal increased in all patients. The mean volume of the initial cyst was 10.98cc and the mean decompression period was 8 months. After decompression, the mean volume of the cyst was 3.05cc (p<0.05), and the mean volume reduction rate was 72.19%, which was calculated 0.99 cc as average reduction per month. The length of the inferior alveolar canal at initial CT was mm in average and mm after decompression which showed 67.54% increase in length (p<0.05). In 6 of 12 patients, the inferior alveolar canal was completely isolated from the cystic lesion. There was no significant correlation between decreased volume of the cyst and increased length of the inferior alveolar canal. Conclusion: Decompression of the cystic lesion involving the inferior alveolar canal cannot only reduce the volume of the cyst but also reduce the contact area between the lesion and inferior alveolar nerve. This result means that decompression treatment can reduce the possibility of damage to the inferior alveolar nerve during enucleation surgery. 제 57 차종합학술대회및정기총회 43

44 KS (27-B) 구순열에서의이차교정술정승곤 전남대학교치의학전문대학원, 구강악안면외과학교실, 전남대학교치의학연구소대부분의구순구개열환자에서한번의수술만으로안면기형을충분히교정하기는어렵다. 구순열환자에서는일차수술로인한반흔, 지지구조물의이상, 주변연조직의발육저하로인해이차변형이생긴다고볼수있다. 이차변형의정도는구순구개열의종류와정도, 일차수술의시기, 수술방법, 술자의술기와경험, 반흔의범위와형태, 그리고성장양상에의해영향받는다. 이차변형은만족스럽지못한반흔, 조직의결핍, 입술의수직적부조화, 입술의수평적결손, 구륜근의변형, 인중의변형, 홍순의변형등의형태로나타난다. 이차변형의형태와정도에따라 Z-성형술, W-성형술, V-Y 전진술, 전체적재수술, 아베피판술등을이용하여이차변형을교정할수있다. 구순열의이차변형과그교정을위한수술기법에대하여고찰하고자한다. Secondary correction in cleft lip Seunggon Jung Department of Oral and Maxillofacial Surgery, School of Dentistry, Dental Science Research Institute, Chonnam National University For most of cleft lip and palate patients, a single operation would not suffice for total correction of the deformity. It is assumed that secondary deformities resulted from scar of primary surgery, problem of supporting structure, and developmental deterioration of adjacent soft tissue. Severity of secondary deformities is influenced by types and severity of primary cleft, timing of primary surgery, dexterity and experience of operator, extent and shape of scar, and growth pattern. Secondary deformities appear in forms of undesirable scar, deficiency of tissue, vertical disharmony of lip, horizontal deficiency of lip, deformation of orbicularis oris, deformation of philtrum, and deformation of vermilion. Those can be corrected by means of Z-plasty, W-plasty, V-Y advancement, reoperation, Abbe flap, according to the shape and severity. In this presentation, secondary deformities and its correction procedures will be reviewed and discussed. 44 대한악안면성형재건외과학회

45 O35 (27-B) 치근하방골절단술과교정을통한유착된치아의수직재배열 박병호 *, 안강민울산대학교의과대학구강악안면외과서울아산병원 서론 : 유소년때발생한전치부의심한외상은치아의유착을유발하게되며기존의치과교정치료에반응하지않는경우가많다. 유착된치아를제자리에위치시키려면외과적술식을동반해야하는데이때는치아단독혹은 2~3개만을포함하는치근하방골절단술이필요하다. 본연구에서는심한치아유착으로발생한개교합을치근하방골절단술과르포씨골절단술그리고교정치료를동반한치료를받은 3명의환자에관하여리뷰하고자하였다. 재료및방법 : 본연구는서울아산병원구강악안면외과에내원한상악전치유착환자 3명을대상으로하였다. 상악전치 1개의유착을가진환자 1명과상악전치 2개의유착을보인 2명의환자총 3명을대상으로외과적및교정치료의결과및합병증분석그리고치아의상태및예후에관하여임상적및방사선학적분석을하였다. 수술은한개의치아혹은 2개의치아를치근하방골절단술을시행하였으며발생한골이개부위는하악지를이용한골이식을하였으며미니플레이트로고정하였다. 결과 : 단일치아골절단술과 2치아골절단술을이용하여수직고경을증가시키는데성공하였다. 유착된치아는수술전에도내흡수가있었으며이는수술하고난뒤에내흡수가더증가하는양상을보였다. 1명의개교합을보이는환자는수술후르포씨 1형골절단으로교합을정상으로가져오는데성공하였다. 내흡수가보이는치아는추후임플란트치료를요하였다. 결론 : 외상으로인한유착된치아는치조인대의손상으로교정력에반응하지않으며이는수술을통한교정을요한다. 치아의생활력이없는경우가많아서치아의내흡수혹은외흡수가발생할가능성이많기때문에수술전에환자에게고지하여야하며추후임플란트치료계획을염두해두어야한다. 골절단은임플란트시술시심미적인치료를가능하게한다. Vertical tooth alignment with subapical osteotomy and orthodontic treatment in ankylosed tooth Byungho Park *, Kang-Min Ahn Department of oral and maxillofacial surgery, College of medicine, University of Ulsan Introduction: Severe dental trauma in the adolescence might cause ankylosed tooth which is refractory to conventional orthodontic treatment. Surgical intervention is often required to correct vertical discrepancy. Subapical osteotomy involving one tooth or two teeth is the operation of the choice for vertical augmentation. In this study, three patients who underwent subapical osteotomy with orthodontic treatment to correct vertical discrepancy due to tooth ankyloses were reviewed to evaluated the pros and cons of single tooth or two teeth osteotomy. Materials and methods: This study included three patients who referred to correct vertical height in the department of oral and maxillofacial surgery of Asan medical center by one experienced surgeon. All three patients reported trauma history during adolescence period. One patient showed single tooth(#21) ankyloses and two patients reported two teeth ankyloses. Subapical osteotomy was performed in all patients. Interdental osteotomy was performed in one patient. Bone graft from ramus and miniplate fixation were performed to secure vertical movement. Long-term prognosis and clinical and radiographic analysis was performed. Results: Single or two teeth osteotomy was successfully performed. Vertical movement was maintained throughout the follow-up period. Ankylosed teeth showed internal resorption before operation, however, it was aggravated after osteotomy in two patients. One patient who reported anterior open bite required Le Fort I osteotomy to normalize his occlusion. Teeth with internal resorption is expected to be replaced with dental implant. Conclusion: Direct trauma of periodontal ligament could induce tooth ankyloses which is not respond to conventional orthodontic treatment. Non vital tooth after subapical osteotomy could aggravate internal resorption due to temporary loss of blood supply, however, vertical positioning of ankylosed tooth makes it possible to restore esthetic dental implant prosthesis. Before subapical osteotomy, surgeon should instruct patient about internal resorption of the ankylosed tooth and possible dental implant therapy. 제 57 차종합학술대회및정기총회 45

46 O36 (27-B) 구순열코변형에대한외과적교정술이장하, 김민근, 김성곤, 권광준, 박영욱 강릉원주대학교치과대학구강악안면외과학교실서론 : 일차구개에구개열이있는환자에서코의기형이선천적으로존재하는데, 이는수술의효과와성장변화에의해발달한다. 이와같이순열수술후에발생하는코모양의심미적변형을이차코변형이라고한다. 본연구에서우리는코성형술을시술받은구순구개열환자들을후향적으로분석하여, 구순열코변형환자의치료계획의수립과수술방법의선택에있어서지침으로삼고자하였다. 연구방법 : 이차코변형으로진단된 46 명의환자들이포함되었다. 의무기록지와수술동안의임상사진들을후향적으로분석하였다. 연구결과 : 37 명의환자가편측성코변형이었고, 9 명의환자가양측성코변형이었다. 48 증례의코성형술이시행되었고, 1명의환자에서 3 차례의코성형술이시행되었다. 비강내절개를통한제한된코성형술이 10세이하의환자들에서주로시행되었다. 10세이상의환자들에서는개방성코성형술이다양한이식술과함께시행되었다. 성공적인코성형술을위한요인들로는골격성기저부의저형성, 이전에시행되었던수술에의한흉터나의원성결손등이있다. 결론 : 구순열코변형을최소화하기위해, 편측성구순구개열에서는콧구멍의대칭성이, 양측성구순구개열에서는비주의연장이일차순열수술동안달성되어야한다. 그리고코에대한건전한골격기저부가성공적인코성형술에있어서의전제조건이다. Surgical correction on cleft patients with secondary nasal deformity Jang-Ha Lee *, Min-Keun Kim, Seong-Gon Kim, Kwang-Jun Kwon, Young-Wook Park Department of Oral and Maxillofacial Surgery, College of Dentistry, Gangneung-Wonju National University Introduction: The nasal deformity exists congenitally in patients with cleft in primary palate, which evolves by the effect of surgeries and growth changes. The aesthetic deformation of the nose that occurs after permutation is called the ssecondary nasal deformity. In this study, we retrospectively analyzed the cleft lip and palate patients with rhinoplasty, and aimed to guide the selection of the treatment plan and the choice of surgical method for patients with cleft nasal deformity. Patients and Methods: The subjects included 46 patients who were diagnosed as secondary cleft nasal deformity. Medical records and peri-operative clinical photographs were analyzed retrospectively. Results: 37 patients were the unilateral cleft nasal deformity and 9 patients were the bilateral cleft nasal deformity. 48 cleft rhinoplasties were performed, and 3 rhinoplasties were performed in one patient. Limited rhinoplasty via intranasal incision was performed under 10 years of patient s age. For above 10 years of age, open rhinoplasty was performed with various graft procedures. Limiting factors for successful cleft rhinoplasty were underdeveloped skeletal base, scar burden, or iatrogenic deformity during antecedent surgeries. Conclusion: To minimize cleft nasal deformities, symmetry of the nostril for unilateral cleft and columellar lengthening for bilateral cleft should be achieved during primary cheiloplasty. And sound skeletal base of the nose is a prerequisite for successful cleft rhinoplasty. 46 대한악안면성형재건외과학회

47 O37 (27-B) 악안면기형에따른경추형태의비교하태욱 *1, 김진규 1, 김학진 1, 이상휘 1 1 연세대학교치과대학병원구강악안면외과악안면기형은반안면왜소증과같은선천성기형증, 성장이상과같은발육성, 그리고악관절외상등의외상성원인에의해발생할수있다. 안면골격형태가신체타부위, 특히척추및골반등과관련성을가지는가에관해서는많은논란이있었다. 그럼에도현재까지이들사이의관련성이나상호작용가능성은명확하게밝혀지지않았다. 이와관련한기존연구들에서는얼굴비대칭이몸통의기울기, 골반의기울기및골반의회전과연관가능성이있다고하였으나논란이많았다. 그러나얼굴비대칭환자들이 menton 변위를보상하려는방향으로머리를기울여서경사진 head position을가지는경향이있다는보고는일관된결과였다. 또한골격성 3급부정교합환자들의측모상 Cervical lordosis angle (CVT/EVT angle) 의유의미한감소, 즉 cervical spine의 flexion이있다고보고되었다. 이렇게경사진머리위치를유지하기위해서는단순히근육의도움만으로는머리경사를유지하기어려울것이며, 경추를포함한골성변화도일어날수있을것으로추정할수있다. 더구나이제까지의연구대부분은 2차원적인방사선사진분석이어서한계가뚜렷하였다. 이에본연구에서는얼굴비대칭환자및골격성 3급부정교합환자들의경추를 3차원분석하고얼굴구조와경추형태사이의관련성을평가하여여기에보고하고자한다. Morphological Comparison of Cervical Spine by Dentofacial Deformity Tae-Wook Ha *1, Jin-kyu Kim 1, Hak-Jin Kim 1, Sang-Hwy Lee 1 1 Department of Oral and Maxillofacial Surgery, Dental Hospital, Yonsei University, Seoul, Korea The dentofacial deformity can be developed by the congenital disease, such as hemifacial macrosomia, the developmental deformity, such as growth abnormality, or the acquired deformity, such as temporomandibular disease or trauma. And it has been debated for long time about the interrelationship between the facial skeletal structure and other body area, including the vertebrae or pelvis. But their relationship or interactivity is not clear yet. It was reported that the facial asymmetry may be correlated with the body canting, pelvic asymmetry or even rotation, though not conclusive to all the clinicians. But the findings of tilted head position in relation to the menton deviation were consistent for facial asymmetry. It is also reported that there is a significant decrease in the Cervical lordosis angle (CVT / EVT angle) on the skeletal Class III malocclusion patients, that is, flexion of the cervical spine. Based on these reports, it can be deduced that there can be some adaptive morphological changes of skeleton, especially the cervical spine, since it would not be sufficient to keep the head tilting only by the muscular power. In addition, the traditional researches were limited in three dimensional changes because they were based on 2-dimentional analysis. Thus we wanted to study about the relationship between the facial structure and the morphology of cervical spine, and to we report them here. 제 57 차종합학술대회및정기총회 47

48 O38 (27-B) 사두증의비대칭교정을위한 3 차원적전두 - 안와전진술 정한울, 박상윤, 김영우 *, 이주영, 하성호, 왕규창, 정필훈서울대학교치과병원구강악안면외과 3D Surgery of Fronto-orbital Advancement with correction of plagiocephaly asymmetry Han-Wool Choung, Sang Yoon Park, Yeong Woo Kim *, Ju-Young Lee, SungHo Ha, Gyu-Chang Wang, Pil-Hoon Choung Oral and Maxillofacial Surgery, Seoul National University Dental Hospital 48 대한악안면성형재건외과학회

49 KS (27-C) 치과치료에서감염성심내막염의위험성박성민 * 단국치대병원구강악안면외과감염성심내막염은심장의내피표면, 특히판막에서발생하는치명적인감염으로심각한이환율과사망률을보일수있습니다. 감염성심내막염의임상특징은비특이적이며, 고열이나체중감소, 혼수, 호흡곤란, 심잡음및피부발현을포함합니다. 구강내공생세균이중요한병인으로작용할수있습니다. 감염성심내막염은일반적인치과치료뿐만아니라비외과적인치과치료로인해서도발생할수있습니다. 구강악안면외과의사는감염성심내막염에대한근거중심의지식에능통해야하고발병원인및예방법에대해숙지하여야할것입니다. Dental Procedures and the Risk of Infective Endocarditis Sung Min Park * Clinical fellow in Department of Oral and Maxillofacial Surgery, College of Dentistry, Dankook University, Se-Jong, Korea. Infective endocarditis(ie) is a serious infection occurring on the endothelial surfaces of the heart, especially at the valves which is associated with significant morbidity and mortality. Clinical features of IE are non-specific and include high fever loss of weight, lethargy, shortness of breath, heart murmurs and possibly skin manifestations. Oral commensal bacteria are the important etiologic agents in this disease. Common dental procedures, even non-surgical dental procedures, can often cause bacteremia of oral commensals. Oral and maxillofacial surgeon need to know the evidence, pathogenesis, and prevention of infective endocarditis. 제 57 차종합학술대회및정기총회 49

50 O39 (27-C) 골아세포의골형성능에미치는 bisphosphonate 의효과와이에적용된 rh-bmp2 의효과 장승일 *, 김주연, 안재명, 홍종락, 팽준영성균관대학교의과대학삼성서울병원구강악안면외과 서론 : Bisphosphonate는흡수성골질환을가진환자에게서널리사용되며, 흔히고령의환자에게서사용되는약물이다. 이약물로인한주요한부작용중하나는턱뼈의괴사증이다. Bisphosphonate-Related Osteonecrosis of the Jaw(BRONJ) 라고불리며, 이러한증상이나타나는원인으로주로 osteoclast 의작용억제와연관이있는것으로알려져있으나뚜렷한발생원인은알려져있지않다. 본연구에서 3종류의 bisphosphonate를 Osteoblast cell에적용하여세포의성장과분화에어떤영향을미치는지알아보았다. 방법 : 건강한 20세남성에게서악교정수술중에하악에서 bone marrow를포함해블럭골을채취하고, 여기서 human alveolar bone cell을획득하여배양하였다. Bisphosphonate(zoledronate, aldronate, pamidronate) 를사용하여 proliferation에미치는영향을 CCK ASSAY를이용하여측정하였다. 골생성능에대한영향을알아보기위하여 alkalinphosphatase(alp) 를 3일차에염색하고활성도를측정하였다. 결과 : 3가지 biosphosphonate는각각골아세포의 proliferation을억제하는정도가달랐으며, Zoledronate 가가장많이억제하는것으로나타났다. Zoledronate를제외한두가지 BPN는 1uM에서음성대조군보다골아세포의증식을증가시켰다. 3일차의 ALP측정에서 rhbmp- 2(CGBio) 를 BPN과같이사용한군에서 zoledronate를사용한군을제외하고대조군보다 ALP가증가하는것으로나타났다. 결론 : Bisphosphonate는저농도에서골아세포의증식을증가시키고고농도에서억제하는것으로나타났으며, 이는약제마다차이가있었다. rhbmp-2와 bisphosphonate와같이사용할경우대조군보다 ALP의활성을증가시켰다 The Effect of Bisphosphonate and rh-bmp2 on the osteogenic differentiation of osteoblast Seug-Il Jang *, Juyeon Kim, Jaemyung Ahn, Jongrak Hong, Jun-Young Paeng Department of Oral and Maxillofacial Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, 06351, Republic of Korea Introduction: Bisphosphonate is a drug widely used in patients with absorbent bone disease and is often used in elder patients. One of the main side effects of this drug is the sclerosis and necrosis of the jaw bone. Bisphosphonate- Related Osteonecrosis of the Jaw (BRONJ), which is known to be associated with suppression of the action of osteoclast. In this study, we applied three types of bisphosphonates to Osteoblast cells to find out how they affect cell growth and differentiation. Method: In a healthy 20-year-old male, block bones including bone marrow were harvested from the mandible during the 2-Jaw surgery, and the human alveolar bone cell was acquired and cultivated. The effects of Bisphosphonates(zoledronate, alendronate, and pamidronate) on the proliferation of the osteoblast were measured using CCK ASSAY. To investigate the effects of the osteogenic differentiation, alkaline phosphatase (ALP) was dyed on the third day of incubation and the activity was measured. Results: Each of the three biosphosphonates had different degrees of inhibition to the proliferation of osteoblasts, and zoledronate was the most inhibited. Two bisphosphonates, excluding zoledronate, increased the proliferation of osteoblasts more than the negative control group at 1 um. In the third day ALP measurement, it was found that the values of the ALP staining in the using rhbmp-2 (CGBio) with bisphosphonates, excluding zoledronate, was higher than that of the control group. Conclusion: Bisphosphonates was found to increase the proliferation of osteoblast at low concentrations and suppress at high concentrations, which differed from the types of bisphosphonates. When used with rhbmp-2 and bisphosphonates, we noticed that the activity of the ALP is more increased than the control group. 50 대한악안면성형재건외과학회

51 O40 (27-C) Medication-Related Osteonecrosis of the Jaw(MRONJ) 환자에식립된임플란트예후에관한연구 정연우 *, 김경민, 심유송, 한정준, 정승곤, 국민석, 박홍주, 오희균, 전남대학교치의학전문대학원구강악안면외과학교실 목적 : 본연구는임플란트가식립된 MRONJ 환자들을후향적으로조사하여 MRONJ 환자에서식립된임플란트가병소이환에연관된요인과예후를알아보고자시행하였다. 연구대상및방법 : 전남대학교치과병원구강악안면외과에서 MRONJ 로진단되고수술을진행한 176 명의환자중에서치과용임플란트고정체가식립되어있는 30 명의환자를선택하여 MRONJ 수술시에고정체를제거하지않은 17 명을 1 군으로, 고정체를제거한 13 명을 2 군으로나눠조사하였다. 조사항목으로는나이와성별, 약물복용원인 ( 질환 ), 복용약물종류와복용방법, 약물복용기간, 임플란트고정체식립시기와임상증상발현까지의간격, MRONJ 임상증상발현후수술까지의기간, 재발여부, 임플란트식립부위분포, 임플란트실패율등을조사하여다음과같은결과를얻었다. 결과 : 1. 2 군의여성비율 (92.3%) 이 1 군 (76.5%) 에비해약간높고, 2 군의평균연령 (72.6 세, range : 63 세 -85 세 ) 이 1 군 (65.3 세, range: 45 세 -83 세 ) 에비해약간많았으나두군사이에성별과나이에따른유의한차이가없었다. 2. 악성종양 ( 유방암, 다발성골수종 ) 으로인해처방받은환자의비율이 1 군 (11.8%) 에비해 2 군 (23.1%) 에서약간높았으나유의한차이가없었다. 3. 두군사이에약물의종류와투여방법, 임플란트고정체식립전까지의약물복용기간, 임플란트식립후약물복용기간, MRONJ 수술전휴약기간은유의한차이가없었다 4. 임플란트고정체식립후 MRONJ 증상발현까지의평균기간은 1 군 (3 년 11 개월, range: 4 개월 ~11 년 ) 에비해 2 군 (5 년 6 개월, range: 1 개월 ~ 20 년 ) 에서약간높았으나유의한차이가없었다. 5. MRONJ 증상발현부터수술까지의평균기간은 2 군 (5.7 개월, range: 8 일 ~ 3 년 2 개월 ) 에비해 1 군 (6.0 개월, range: 1 개월 ~2 년 ) 에서약간높았으나유의한차이가없었다. 6. 술후 MRONJ 의재발은 1 군 (1 명, 5.9%) 에비해 2 군 (3 명, 23.1%) 에서약간높았으나두군사이에유의한차이가없었다 군에서 37 개의임플란트가식립되어있었고, 2 군에서는 43 개의임플란트중에서 24 개의임플란트를 MRONJ 수술시제거하여임플란트실패율은 30% 였으며, 부위별임플란트실패율은상악소구치부 (50%), 하악대구치부 (37%), 하악소구치부 (36%), 상악대구치부 (22%) 순이었다. 결론 : 이상의결과에서상하악구치부에식립된임플란트는 MRONJ 병소이환가능성이높으므로임플란트시술전과후에 MRONJ 발생을예방하기위한조치와계속적인추적관찰이필요함을시사한다. A study on Prognosis of Dental Implant in Medication-Related Osteonecrosis of the Jaw (MRONJ) Patients YeonWoo Jeong *, Kyungmin Kim, You Song Sim, Jeong Joon Han, Seunggon Jung, Min-Suk Kook, Hong-Ju Park, Hee-Kyun Oh Department of Oral and Maxillofacial Surgery, School of Dentistry, Chonnam National University Objective: This study was to investigate the factors and prognosis associated with installation of implant fixture in MRONJ patients. Method: Out of 176 patients who were diagnosed as MRONJ and underwent surgery in Oral Maxillofacial Surgery, Chonnam National University Dental Hospital, 30 patients who had dental implant fixture were included in this study. Patients were divided into two groups; Group 1(n=17 patients) were not removed during MRONJ surgery, Group 2(n= 13 patients) were removed dental implant fixture during MRONJ surgery. Investigating items were age and sex, predisposing diseases for medication, type of medication & method of taking medication, duration of medication & drug holiday, interval from implant installation to onset of MRONJ symptoms, interval from onset of MRONJ symptoms to surgery, recurrence, distribution of implants site, and implant failure rate. Results: 1. Although the proportion of women in group 2 (92.3%) was slightly higher than that in group 1 (76.5%) and the mean age of group 2 (72.6 years, range: 63 to 85 years) was slightly higher than that in group 1 (65.3 years, range: 45 to 83years), there was no significant difference between the two groups according to gender and age. 2. The proportion of patients prescribed for malignant tumor(breast cancer, multiple myeloma) was slightly higher in group 2 (23.1%) than in group 1 (11.8%), but there was no significant difference between the two groups. 3. There was no significant difference between the two groups in the type of drug & method of taking medication, duration of medication before and after implant installation and duration of drug holiday before operation. 4. The mean interval from implant installation to onset of MRONJ symptoms was slightly higher in group 2 (5 years 6 months, range; 1 month to 20 years) than in group 1 (3 years 11 months, range; 4 months to 11 years), but there was no significant difference. 5. The mean interval from onset of MRONJ symptoms to surgery was slightly higher in group 2 (5 years 6 months, range; 1 month to 20 years) than in group 1 (3 years 11 months, range; 4 months to 11 years), but there was no significant difference. 6. Postoperative MRONJ recurrence was slightly higher in group 2 (3 cases, 23.1%) than in group 1 (1 case, 5.9%), but there was no significant difference between the two groups. 7. In group 1, 37 implants were installed. In group 2, 24 out of 43 implants were removed during MRONJ operation, and implant failure rate was 30%. The implant failure rate in each region was divided into Maxillary premolars (50%), Mandibular molars (37%), Mandibular premolars (36%), Maxillary molars (22%). Conclusion: These results suggest that implants installed in Maxillary and Mandibular molars are more likely to develop MRONJ. So when before and after installation of dental implant, it needs precaution to prevent MRONJ and follow-up is necessary. 제 57 차종합학술대회및정기총회 51

52 O41 (27-C) 치아기원으로추정되는비중격농양이상민 *1,2, 임대호 1,2, 고승오 1,2, 백진아 1,2 1 전북대학교치과대학구강악안면외과학교실 2 전북대학교임상의생명연구소목적 : 치성기원으로인한비중격농양은1920년 McKenzie D. 가상악우측측절치의치조농양에서기원한비중격농양에대해처음보고한이후, 현재까지 6개의영어논문이발표되어있다. 가장흔한원인은사고또는수술로인한코의외상으로부터발생한비중격혈종이다. 비중격농양의드문원인으로써의치성감염및처치에대하여알리고자한다. 방법 : 13년전진단받은당뇨병이외에별다른의학적특이사항이없는 64세의여자환자가 4일전 #21일발치이후코안의부종을주소로전북대학교구강악안면외과에내원하였다. 임상검사상, 비중격주변으로발적된부종을보였으며이로인한비강호흡불편감을호소하였다. 발치된 #21 주변으로는농배출이소견은보이지않았다. 결과 : 비중격주위부종을보이는곳에서갈색의맑은액체를흡인하였으며, 항생요법및입원치료시행하였으며, 구강내에서농배출확인되어구강내소염술, 비강내흡인술및소파술시행하였다. 조영증강 CT 결과비중격농양으로진단되었으며균배양결과 Klebsiella pneumoniae가검출되었다. 결론 : 비중격농양이적절히치료되지않는다면, 코의기형뿐만아니라, 해면동혈전증, 뇌막염, 뇌농양, 안구주위농양등으로이어질수있다. 따라서비중격농양의조기진단과처치가심각한합병증을예방하는데중요하다. Nasal septal abscess presumed to be of dental origin Sang Min Lee *1,2, Dae Ho Leem 1,2, Seung-O Ko 1,2, Jin-A Baek 1,2 1 Department of Oral and Maxillofacial Surgery, School of Dentistry, Chonbuk National University, Jeonju, Korea 2 Research Institute of Clinical Medicine-Biomedical Research Institute, Chonbuk National University Hospital, Jeonju, Korea Purpose: Nasal septal abscess (NSA) from dental origin have been first reported by McKenzie D. due to alveolar abscess of right maxillary lateral incisor in Since then, 6 articles have been published in English literature. Mostly, NSA is derived from nasal septal hematoma as a result of accidental or surgical trauma of nose. The purpose of this study is to increase awareness about dental infection as a rare cause of NSA. Methods: A 64-year-old female patient visited Chonbuk National University Hospital with a chief complaint of nasal swelling. It was started 4 days ago, when the left upper central incisor was extracted. She had no underlying disease but diabetes mellitus for 13 years. On the physical examination, there was reddish bulging around nasal septum and she was suffered from nasal congestion. There was no pus discharge around the extracted tooth. Results: On needle inspiration around nasal septal area, relatively transparent brownish fluid was observed. Under admission, triple anti therapy, daily aspiration and curettage on septal area, and further intra oral I&D was performed. On enhanced CT, it was diagnosed as a NSA. Klebsiella pneumoniae was detected by pus culture. Conclusion: If NSA is not diagnosed and treated properly, it can be led to cavernous sinus thrombosis, meningitis, brain abscess, periorbital cellulitis/abscess as well as nasal deformity. Hence, early management is important for preventing serious complications. 52 대한악안면성형재건외과학회

53 O42 (27-C) 크론병환자에서구강내궤양성병소및악골골수염의진단과치료 최용석 *, 박주영서울대학교치과병원구강악안면외과 서론 : 최근인구노령화와더불어자가면역질환의발병이증가하는추세이며국내전체자가면역질환의연간발병률은 5% 로보고되고있다. 발병률이증가함에도불구하고자가면역질환의원인규명및치료방법개발은진행형이며, 특히구강점막을포함한머리목부위에발생하는임상증상에대한진단과치료법은거의알려진바가없는실정이다. 구강악안면외과에내원한자가면역질환환자들의임상증상을해결하기위하여개개자가면역질환에대한이해뿐아니라진단및치료에대한새로운최적치료계획의정립이필요하다. 본연구에서는위장관에발생하는중증자가면역질환인크론병환자에서발생한구강점막궤양및악골골수염의진단방법에대하여고찰하고최적이치료방법을물색하고자한다. 증례보고 : 크론병으로진단받은 55세남환이구강내통증과음식저작시불편감을주소로구강악안면외과에내원하였으며 25kg 이상의급작스런체중감소와복통을동반하여내과병동에서입원치료중이었다. 전신상태가호전되지않았음에도구강악안면외과에내원한이유는구강내에서발견된우측상악구치부의궤양성병소가저작시통증을유발하여음식섭취에어려움이있었으며체중증가를방해하는원인중에하나로생각되어즉각적인처치를필요로하였다. 궤양성병소는약 3cm정도의크기로내부에상악구개부치조골이노출된상태였으며 CT 상골수염의패턴을보였다. 궤양부위점막의조직학적분석결과많은양의면역세포의침윤이발견되었으며이는구강점막발생한일차적인자가면역반응으로해석되었다. 이에국소적으로궤양성병소에 steroid 제재의주사를시행하였으며노출된치조골을최소한절제하여염증반응과저작시통증을감소시키려하였다. 치료 1달후궤양성병소의크기가감소하였으며환자의저작시통증이경감된것을관찰할수있었다. 결론 : 자가면역질환환자의머리목부위의임상증상은정확하게진단되어야하는데, 특히일차적자가면역반응인지, 아니면환자의질병및치료과정에서발생한이차적합병증인지를판단해야한다. 이와더불어환자의전신적인건강상태, 복용중인면역억제제등의약제및구강악안면외과를내원하게된주소를꼼꼼히파악하면최선의치료계획을세울수있다. Diagnosis and treatment for oral mucosal ulceration and jaw osteomyelitis in Crohn s disease patient Yong Suk Choi * and Joo-Young Park Department of Oral and Maxillofacial Surgery, Seoul National University Dental Hospital Introduction: Autoimmune diseases were considered to be rare but recent epidemiological studies have shown that overall incidence increased in the last decades. More than 80 autoimmune diseases were identified and the most common ones such as type I diabetes and rheumatoid arthritis yearly develop up to 5% of total Korean population. Despite increasing incidence however, causes and treatment of autoimmune diseases are still under investigation. Moreover, clinical manifestations in the head and neck are often challenging to oral and maxillofacial surgeons, especially when necessity of surgical intervention has to be determined. In this study, we would like to investigate how to diagnose oral manifestations of Crohn s disease, which is one of the severe autoimmune diseases developed in the gastrointestinal tract. Based on the correct diagnosis, the best treatment options will be discussed. Case Report: A 55-year old male patient visited the oral and maxillofacial surgery clinic and complained intraoral pain and difficulty in eating. The patient was diagnosed as Crohn s disease with severe abdominal pain a year ago and had taken massive amount of medications such as high dose of steroid and various formulas of immune suppressant. Intraorally, the patient had large ulceration at the right upper posterior gingiva with underlying alveolar bone exposed. Two old extraction sockets with delayed healing were found at the lower dental arch and alveolar bone was also exposed. Oral ulcerations need be treated urgently as keeping good nutrition is an important factor for patient s weight gain in Crohn s disease. To identify the cause of patient s oral manifestations, clinical and radiographical examinations were carried out and accompanied with histological examinations. CT scan showed osteomyelitis of both maxilla and mandible having atypical bone marrow pattern. Histologically, the ulcerative gingival lesions showed immune cell accumulation at basal membrane of gingival epithelium, suggesting overt inflammatory reactions resulting from autoimmune disease. To reduce the pain and inflammatory reactions in gingiva, long-acting steroid is locally injected and the exposed alveolar bone was trimmed. After 1 month of treatment, size of ulceration is dramatically reduced and the patient s pain was controlled. Conclusion: Oral manifestations in autoimmune disease patients should be diagnosed with multiple considerations, such as patient s general health, current medications and chief complaints. Successful treatment can be made when the origin of oral manifestations is accurately identified, either intraorally primary or secondary sequelae of the disease. 제 57 차종합학술대회및정기총회 53

54 O43 (27-C) MRONJ 의수술적치료 : 일차적치유혹은이차적치유? 정상환 *, 장성백, 이성탁, 김진욱, 권대근, 최소영경북대학교치과병원구강악안면외과학교실 목적 : 본연구에서는 MRONJ 환자의수술적치료에대한임상적데이터분석을통하여, 일차봉합과이차적창상치유를유도한경우에대한예후를평가하고보다효율적인치료방법에관하여논의하고자한다. 방법 : 2009년 1월부터, 2018년 1월까지조직검사결과 MRONJ로진단된환자중, 수술적치료를시행한환자 465 명을대상으로임상데이터를활용하여후향적연구를시행하였다. 치유양상은양호, 일부골의노출및염증상태의지속, 완전한골노출이나농이배출되는경우등 3가지로분류했다. 재수술의경우는포함하지않았다. 결과 : 치유양상에대하여수술의종류보다는오히려수술부위의일차봉합여부 (P<0.005) 와, 골다공증약물의투약경로 (P<0.0001) 가가장큰영향을미쳤다. 일차봉합의여부는 Bisphosphonate의정맥주사병력이있는 73명의환자의경우더영향력있었으며 (P=0.002), 소파술보다는부골적출술을시행한경우에더의미있는차이를보였다.(P=0.034) 또한, Stage ll에서명확한차이를보였으며 (P<0.002), Stage lll에서는일차봉합의여부가치유양상에별다른영향을미치지않았다. 결론 : MRONJ의수술적치료에있어서치유양상에대해일차봉합의경우가창상을개방시켜이차적치유를유도하는경우에비해창상치유측면에서보다좋은결과를나타냈다. 특히, Bisphosphonate제제의정맥투여, 부골적출술, Stage ll의경우에그차이가명백히드러나는데, 이는, 골다공증약물의정맥투여병력이있는 Stage ll 정도의환자에게서이환부위에부골이형성되어있다면부골적출술을시행한후, 일차적봉합을하는방법을선택하는것이좋은선택지가될수있다는근거가된다. Stage lll 의경우에는이미누공이형성되었거나기저골의침범이있는경우로, 이미좋지않은예후를예상할수있다. Surgical treatment of MRONJ: Close or open? Sang-Hwan Jung *, Sung-Beak Jang, Seong-Tak Lee, Jin- Wook Kim, Tae-Geon Kwon, So-Young Choi Dept. of Oral and Maxillofacial surgery, School of Dentistry, Kyungpook National University, Daegu, Republic of Korea PURPOSE: To evaluate the prognosis of patients with primary suture and secondary wound healing, and to discuss more effective treatment methods, in this study, by clinical data analysis of surgical treatment of MRONJ patients. METHODS: From January 2009 to January 2018, we retrospectively reviewed the clinical data of 465 patients who underwent surgery for MRONJ. Re-operation was excluded. The healing pattern was classified as three occations: good/ pin point bone exposures, persistent inflammation/ complete bone exposure, pus discharging. We did not include cases of reoperation. RESULTS: Regarding the healing aspect, the primary closure (P <0.005) and the route of administration (P <0.0001) were the most influential factors rather than the type of surgery. The primary suture was more effective when intravenous injection of bisphosphonate history was present (P = 0.002) and more significant when sequestrectomy cases compared with curettage (P = 0.034). There was significant difference between close and open in stage ll patients.(p <0.002) In the case of Stage III, there was no significant difference in the healing pattern. Conclusions: In the surgical treatment of MRONJ, the primary suture was better than the wound healing method by opening the wound and inducing secondary healing. The difference is clearly evident in the case of a staging ll patient with a history of intravenous osteoporosis drug, It is a good basis for selecting a method of primary suturing on patients like these with sequestrectomy. In the case of Stage III, already a fistula or involvement of the basal bone may already be predictive of a poor prognosis. 54 대한악안면성형재건외과학회

55 Poster Presentation 제 57 차대한악안면성형재건외과학회종합학술대회및정기총회

56 PⅠ-01 전신질환자의구강연조직손상대처법 : 증례보고유한창 1*, 윤필영 1, 김영균 1,2 1 분당서울대학교병원, 치과, 구강악안면외과 2 서울대학교치의학대학원치의학과, 치의학연구소서론 : 파킨슨병, 루게릭병등의전신질환은근육의문제를일으켜자유로운개, 폐구를어렵게한다. 이로인하여혀, 협점막등과같은구강내연조직의지속적손상이일어날수있으며, 이러한경우일반적으로잔존치를발거하게된다. 그러나잔존치가너무많거나, 임플란트인경우발거가어렵고매우침습적일수있다. 연조직손상을방지하기위한방법으로 soft splint를고려할수있다. 다만폐구상태를지속시키거나, 과도한구역반사를유발할경우일반적인인상채득이어려운경우가있다. 증례보고 : 파킨슨질환을보유한 74세남자환자가폐구상태가지속됨으로인해하악잔존치및임플란트가상악무치악부위잇몸을자극하며심한통증과염증을유발한다는증상을주소로내원하였다. 자발적개구가불가능한상태여서전신마취후인상을채득하여하악에 soft splint 장착하였다. 72세여자환자가근위축성측삭경화증으로인해비의도적구강활동이발생하여어금니로혀를계속깨물게되어상처가낫지않고침을삼킬때마다이가혀를자극해통증이심하다는증상을주소로내원하였다. 통상적인방법으로인상채득을시도하였으나호흡곤란을보여실패하였다. 이후구강내스캐너를이용하여구강모형을채득한후 soft splint 를제작하여장착하였다. 고찰및결론 : soft splint는구강내연조직손상을방지할수있는좋은치료법이다. 일반적인인상채득이어려운전신질환자에서구강내스캐너사용또는전신마취후인상채득을고려할수있다. Preventing oral soft tissue damage in patients with systemic diseases : case report Han-Chang YU 1*, Pil-Young Yun 1, Young-Kyun Kim 1,2 1 Department of Dentistry, Seoul National University Bundang Hospital, Seongnam, Korea 2 Department of Dentistry & Dental Research Institute, School of Dentistry, Seoul National University, Seoul, Korea Introduction: Parkinson s disease, Lou Gehrig s disease and other systemic diseases cause muscle problems, making it difficult to perform mouth opening and closing This may result in continuous damage to the soft tissue of the mouth, such as tongue and buccal mucosa. In this case, the residual teeth are generally extracted. However, if the numbers of remaining teeth is too large, or if implants remain, it may be difficult to remove, and a soft splint may be made to resolve soft tissue damage. And it may be difficult to obtain a normal impression due to systemic disease that causes continuous closure of the mouth or excessive gag reflex Case report: Case 1) A 74-year-old man with Parkinson s disease was admitted to the hospital because of persistent closure of the mandibular permanent teeth and implants to stimulate the gums of the maxillary edentulous area, causing severe pain and inflammation. After general anesthesia, dental impression was made to make a soft splint. Both the patient and the caregiver were satisfied with the symptoms disappearing. Case 2) A 72-year-old woman had unintentional oral activity due to systemic disease. She continued to chew her tongue with her molars. Whenever she swallowed her saliva, molars stimulate her tongue, causing pain, the wound doesn t heal. We tried to make an impression on the outpatient but she failed to show breathing difficulties. After the oral scanner was used, a soft splint was prepared and delivered. Symptoms were lost and both patients and caregivers were satisfied. Conclusions: In patients with systemic diseases, it is possible to consider the use of an intraoral scanner or an impression after general anesthesia. However, in patients who can t open the mouth after general anesthesia with muscle relaxant, the botulinum toxin injection, hyaluronic acid injection in the TMJ, and mandibular manipulation can be used to facilitate the mouth opening more easily. 56 대한악안면성형재건외과학회

57 PⅠ-02 후하악접근법을이용한양측하악과두경부및정중부주위골절치료의증례보고 신영민 1* 계명대학교동산의료원, 계명대학교의과대학치과학교실 ( 구강악안면외과 ) 목적 : 양측과두경부골절의치료방법은아직도명확하게정해져있지않다. 어떤연구에서는보존적처치를권유하고있기도하다. 이증례에서는금속판의파절에도불구하고성공적으로치유된양측하악과두경부및정중부주위골절의증례를발표하고자한다. 방법 : 56세의남자환자가넘어져서수상후본원으로안면부종과성대손상을주소로의뢰되어왔다. 이비인후과에의뢰하여성대손상을치료한다음, 골절의정복을계획하였다. CT상에서양측과두경부의골절과정중부주위골절을진단하였으며, 임상검사상 1.5 손가락너비정도의개구량과개구시의편향을관찰할수있었다. 후하악접근법을이용하여치료를시행하였으며, 2mm 두께의금속판을이용하였다. 결과 : 골절정복시행후골절은잘정복되었다. 9개월후경과관찰후에도교합과개구량은잘유지되었다. 안면신경의손상도관찰되지않았다. 결론 : 과두경부골절의치료에는여러가지방법이있으나각각의장단점이있다. 이증례에서는양쪽을다정복술을시행하였으며, 금속판파절이라는합병증에도불구하고특별한문제없이치유되었기에발표하는바이다. Open reduction & Internal fixation of Bilateral Condylar neck and Parasymphyseal Fractures via Retromandibular Approach; Case Report Youngmin Shin 1* Keimyung University School of Medicine, Department of Dentistry & Oral surgery 1 Purpose: The treatment of bilateral condylar neck fractures remains controversial. Some studies recommend conservative managements. The author introduce a successful case of bilateral condylar neck and parasymphyseal fractures even if the fracture of plate with the treatment of ORIF. Methods: A fifty-six-year-old male patient was transferred to our hospital for severe facial swelling and vocal cord hematoma after slip down on stairs. We planned on ORIF after otolaryngology department management for vocal cord hematoma. Computed tomography (CT) revealed fractures of mandible, parasymphysis and both condylar necks. On physical examination, 1.5 finger wide and deviated mouth opening were observed. Retromandibular and intraoral approach were adapted for both condylar neck and parasymphyseal fracture, respectively. We used two 2.0 mm mini-plates to fix each fracture. Results: After ORIF, the displacement condyle neck was corrected successfully. Nine months after ORIF, occlusion, mouth opening, and lower face height (LFH) were successfully restored. Also, there were no symptoms of facial nerve palsy. Conclusion: There were three treatment options for bilateral condylar fracture; first, conservative; second, one side ORIF; third, both side ORIF. Conservative management can make LFH problem. One side ORIF can cause lack of stability. Both side ORIF can result the problem of mouth opening. In our case, both side ORIF makes satisfactory results with normal occlusion, enough mouth opening, and well preserved LFH with no complications. 제 57 차종합학술대회및정기총회 57

58 PⅠ-03 하악골골절의관혈적정복술후발생한부정교합에대한치료 : 증례보고 이혜정 *, 김수관, 문성용, 오지수, 유재식, 최해인, 신나라조선대학교치의학전문대학원구강악안면외과학교실 하악골골절은대부분관혈적정복술을시행하여만족스러운결과를얻을수있다. 하악골골절치료의목표는정확한정복과고정을통해치유를도모하고교합을회복, 발생할수있는합병증을최소화하는데있다. 그러나부적절한치료는부정교합, 감염, 부정유합, 유합지연, 안면비대칭, 그리고감각저하와같은많은합병증을발생시킨다. 본증례에서는술후합병증을호소하는 31세남환에대한성공적인재수술에대해보고하고자한다. 교통사고후좌측하악결합부와우측하악골상행지의골절을주소로성형외과에서관혈적정복술을시행하였으며술후부정교합및부정유합이발생한환자이다. 첫수술 4개월후, #33 발치와함께재골절및하악골상행지시상분할골절단술을시행하였으며술전제작한스플린트로적절한교합을형성하여소형금속판을이용, 고정하였다. 정확한술전검사와외상전교합의확인및적절한수술과정, 그리고적절한술후관리는악골골절에서술후합병증을방지하는데필수적이다. The treatment of malocclusion after open reduction of mandibular fracture : a case report Hye-jung Lee *, Su-Gwan Kim, Seong-Yong Mon, Ji-Su Oh, Jae-Seek You, Hae In Choi, Na-Ra Shin Department of Oral and Maxillofacial Surgery, School of Dentistry, Chosun University Most mandibular fractures can be managed by open reduction with satisfactory outcome. The goals of treatment for mandibular fracture are to ensure healing through accurate reduction and fixation, to recover the occlusion, and to minimize disability and complications. However, unsuccessful treatment can result in many complications such as malocclusion, infection, malunion, nonunion, facial asymmetry and hypoesthesia. This case report represent successful revision surgery of a 31-year-old man complaining of postoperative complication. The patient with Left mandibular parasymphysis and Right ramus fracture after a traffic accident who suffered from postoperative complications: malocclusion and malunion after having open reduction in Department of plastic surgery. The Sagittal split ramus osteotomy on right side of mandible and re-fracture were performed with extraction of #33 in Department of Oral and Maxillofacial surgery 4 month after first operation. And fixation was done with miniplate using surgical occlusal splint to ensure proper occlusion. A precise pre-operative examination, verifying a pre-traumatic occlusion and appropriate surgical procedure followed by proper post-operative management are necessary to prevent post-surgical complications of jaw fracture fixation. 58 대한악안면성형재건외과학회

59 PⅠ-04 심한전안면골절로인한상하악골의불완전한정복과악교정수술을통한교합재건 : 증례보고 오광진 *, 류동목, 지유진, 이덕원, 김세원, 양선인, 정상필, 강미주, 이재덕강동경희대학교치과병원구강악안면외과학교실 목적 : 본연구의목적은심한전안면골절로인한상하악골의불완전정복에대하여악교정수술을통하여재건한사례의치료경과를보고하기위함이다. 연구대상및방법 : 낙하산훈련도중수상하여전안면골절로진단되어본원에서관혈적정복술및내고정술시행하였으나불완전정복되어악교정수술을후술후교정중인환자를대상으로하였으며, 임상및방사선학적검사를통해진단및평가, 경과관찰하였다. 결과및결론 : 본 36세남환은낙하산훈련중사고로본원에서전안면골절로진단받았다. 임상및방사선학적검사결과하악정중부, 좌측관절돌기, 양측관골궁, 양측상악동전벽, 전두동벽, 상안와벽, 비골골절을포함한전안면골의분쇄, 함몰골절로확인되었다. 전신마취하관상접근및구강내접근을통하여수상부위에대하여관혈적정복술및내고정술을시행하였다. 술후전치부개교합이관찰되었다. 이에재수술시행하였으나전치부개교합의증상은지속되었다. 이는상악골의정복시에기존보다상악골전체가후방으로이동되어고정된것과수상으로인한관절돌기의불안정으로인한것으로의심되었다. 이에교합재건을위하여교정치료와악교정수술계획을세웠다. 술전교정을시행하였으며, 마지막수술 18개월후에 RP 모델을통한예측을통해악교정수술을시행하였다. 악교정수술후에전치부개교합의증상은해소되었으며현재술후교정을시행하며경과관찰중이다. 따라서, 이번증례를통하여심한전안면골절로인한상하악골의불완전한정복시에악교정수술로치료할수있음을보고하는바이다. Incomplete reduction of maxilla-mandibular bone due to severe panfacial fracture and occlusal reconstruction via orthognathic surgery : a case report Gwangjin Oh *, Dong-mok Ryu, You-jin Jee, Deok won Lee, Se-won Kim, Sunin Yang, Sang-pil Jung, Miju Kang, Jaedeok Lee Dept. of Oral and Maxillofacial surgery, Kyung-Hee University Dental Hospital at Gangdong Purpose: The aim of this study is to evaluate the result of orthognathic surgery in case of incomplete reduction of maxilla-mandibular bone due to severe panfacial fracture. Material and Method : A patient who diagnosed as panfacial fracture due to parachute training accident was treated by open reduction and internal fixation. Because of incomplete reduction by severe panfacial fracture the patient underwent orthognathic surgery. And we have followed up him through a clinical, radiographic analysis. This thirty six years old male was diagnosed as panfacial fracture due to parachute training accident. According to clinical and radiologic analysis, comminuted, depressed fracture of anterior facial bone including mandibular symphysis, Lt. condylar process, both zygomatic arch, both anterior wall of maxillary sinus, frontal sinus wall, superior orbital wall, nasal bone fracture was examined. We carried out open reduction & internal fixation through coronal approach & intraoral approach under general anesthesia. Right after the operation, anterior open bite was observed. Thus, surgery was performed again, but symptom of anterior open bite continued. We suspected that it was caused by position of maxilla moved backwards and instability of condylar process. So, orthodontic treatment and orthognathic surgery were planned for occlusal reconstruction. Pre-OP orthodontic treatment was performed. After the last 18 months of surgery, orthognathic surgery was performed through prediction using RP skull model. Right after the operation, symptom of anterior open bite was resolved and the patient is being followed up. Therefore, We report that in case of incomplete reduction of maxilla-mandibular bone due to severe panfacial fracture, it can be treated by orthognathic surgery. 제 57 차종합학술대회및정기총회 59

60 PⅠ-05 편측하악각골절에서흡수성 polymer, 티타늄과 Mg-Ca-Zn 합금을이용한고정을하였을때, 유한요소분석통한흡수성 polymer 의안정성비교 박병호 1*, 김원현 2, 이종호 3, 이지호 1 1 서울아산병원구강악안면외과학교실 2 서울대학교치과병원중개임상시험지원센터 3 서울대학교치의학대학원구강악안면외과학교실 흡수성 polymer는악안면외과수술에서고정재료로적용이제안되고있다. 하악골의편측하악각골절의고정을위한유한요소모델을구성하였다. 하악각은 Champy s technique으로하나의미니플레이트로설정을하였다. 하악각골절의 platescrew 고정에서흡수성 polymer, 티타늄및 Mg-Ca-Zn 합금은 132N의교합하중을갖는가상모델을사용하여평가되었다. 이세가지재료의변형률은 N의저작력에따라관찰되었다. 이연구의목적은유한요소분석을사용하여 3차원모델에서세가지다른재료에대한하중을계산하고, 흡수성 polymer 가하악각골절에서적용을위해충분히안정한지를알아내기위한것이다. Stability of absorbable polymer fixation compared with titanium and Mg-Ca-Zn alloy for unilateral angle fracture of the mandible using finite element analysis model Byungho Park 1*, Won Hyeon Kim 2, Jong Ho LEE 3, Jee-Ho Lee 1 1 Dept. of Oral and Maxillofacial Surgery, Asan Medical Center, college of medicine, Ulsan University, Seoul, Korea 2 Clinical Translational Research Center for Dental Science, Seoul National University Dental Hospital, Seoul, Korea 3 Dept. of Oral and Maxillofacial Surgery, School of Dentistry, Seoul National University Absorbable polymer has been suggested for the application of fixation materials during maxillofacial surgery. The finite element model for the fixation of unilateral angle fracture of the mandible was constructed. The mandibular angle were just treated with one miniplate following Champy s technique. In the plate-screw fixation of the angle fracture, the stress distributions of absorbable polymer, titanium and Mg-Ca-Zn alloy were evaluated using the virtual model with occlusal loading of 132N. The deformations of the three different materials were observed according to masticatory force ranging from 132 to 1,000N. The purpose of this study was to compute the load on different plate-screw materials in a 3-dimensional model using finite element analysis, and to find out whether absorbable polymer has sufficiently stable for application at the mandibular angle. 60 대한악안면성형재건외과학회

61 PⅠ-06 외이도골절을동반한하악과두의외상성후방탈구 민송희 *, 조동현, 이정근 *, 송승일아주대학교치과병원구강악안면외과 하악과두골절은일반적으로외상후발생하며, 일반적으로 condyle neck 골절또는악관절의탈구로나타난다. 다른연구에따르면, 과두골절은모든하악골절의 25~35 % 를차지한다. 하악과두의 intracapsular, extracapsular 골절은에너지를분산시켜뇌와두개골에대한수상을방지한다고생각되어왔으며, 이는하악과두의골절및탈구경향을나타낸다. 악관절탈구는관절내에서의기능적위치와 articular eminence의후방경사를벗어난위치에서관절의비제한적변위를수반한다. TMJ의전형적인탈구는하악과두가관절의 articular eminence를넘어전방으로벗어날때발생한다. 많은논문에서하악과두의 middle cranial fossa 내측으로의외상성상방전위를기술하고있으나, TMJ의후방전위는거의기술되어있지않다. 이논문에서는안면외상후하악과두골절및외이도골절을수반한하악과두의후방탈구사례를보고하며이에대한임상증상, 진단및치료에대해논의하는바이다. Traumatic posterior dislocation of mandibular condyle with external auditory canal fracture Song Hee Min *, Dong Hyun Cho, Jeong Keun Lee *, Seung Il Song Department of Oral and Maxillofacial Surgery, AJOU University Dental Hospital Mandibular condylar fractures commonly occur after trauma, generally presenting as fracture of the condylar neck or dislocation of the temporomandibular joint. According to other study, condylar fractures account for 25% to 35% of all mandibular fractures. Both intracapsular and extracapsular fractures of the condyle have been thought to dissipate energy and thus prevent penetrating injuries to the brain and skull. And this cause the mandibular condyle fracture and displacement. By definition Temporomandibular joint (TMJ) dislocation involves a non self limiting displacement of the condyle, outside of its functional position within the glenoid fossa and the posterior slope of articular eminence. Typical dislocation of the TMJ occurs when the mandibular condyle is displaced anteriorly beyond the articular eminence. Many articles describe traumatic superior dislocation into the middle cranial fossa, but posterior dislocation of the TMJ is rarely described. In this article, we report a case with posterior dislocation of the mandibular condyle with condyle fracture and external auditory canal fracture after facial trauma, and the clinical symptoms, diagnosis and management are discussed. 제 57 차종합학술대회및정기총회 61

62 PⅠ-07 비골골절에대한최근 9년간후향적연구강병훈 *, 최송제, 고성혁, 정지훈, 안준형, 한정준, 정승곤, 박홍주, 오희균, 국민석 전남대학교치의학전문대학원, 구강악안면외과학교실, 전남대학교치의학연구소서론 : 비골은안면골에서가장돌출되어있는구조로서흔하게발생하는안면부골절중하나이다, 비골골절시나타날수있는증상으로는안모추형, 출혈, 그에따른호흡곤란등이있다. 환자및연구방법 : 본연구는 2009년부터 2017년까지본원에내원한 180명의비골골절환자들의임상검사, 환자기록, 방사선사진들을평가하여, 비골골절의발생률, 골절유형, 치료, 동반골절, 그리고합병증등을연구하였다. 결과및요약 : 1. 환자는유아에서부터노인에이르기까지다양했으며남성이여성보다월등히많았다. 2. 비골골절의원인으로는교통사고가가장많았고, 폭행이두번째로많았다. 3. 비골골절의양상은변위없는편측비골골절, 변위없는양측비골골절, 변위를동반한골절, 폐쇄성분쇄골절, 개방성분쇄골절, 여러합병증을동반한골절이있었다. 4. 동반골절로 Le Fort I, II, III 골절, 비안와사골골절, 관골-상악복합체골절, 상악골골절, 안와골절, 전두골골절, 치조골골절이있었다. 5. 술후합병증으로코막힘, 술후비변형, 후각저하가있었다. 결론 : 이번연구에서비골골절은전연령대에서비슷하게발생하며, 남성에서많이발생하였고, 2주이내에비관혈적으로성공적인정복을할수있었다. A Recent 9-year Retrospective Study On Nasal Bone Fracture Byung-Hun Kang *, Song-Je Choi, Sung-Hyuk Koh, Ji-Hun Chong, Jun-Hyeong An, Jeong Joon Han, Seunggon Jung, Hong-Ju Park, Hee-Kyun Oh, Min-Suk Kook Department of Oral and Maxillofacial Surgery, Dental Science Research Institute, School of Dentistry, Chonnam National University Introduction: Nasal bone is the most protruding bony structure of the facial bones. Symptoms that may occur during nasal bone fracture include facial dysmorphia, bleeding, and dyspnea. Patients & methods: This study was performed to investigate the nasal bone fracture incidence, type of fracture, treatment, associated fracture and complication in 179 patients with nasal bone fracture by evaluating clinical examination, patient s records and radiographic images in nasal bone fractures from 2009 to Result: 1. The age of the patients variably ranged from young to old, and the number of male was much more than of woman. 2. In the cause of the nasal bone fracture, traffic accident topped the list, followed by violence. 3. For the patterns of fracture, there were simple unilateral without displacement, simple bilateral without displacement, simple displaced, closed comminuted, open comminuted, any type of fracture with complications 4. Associated fractures were Le Fort I, II, III fracture, NOE fracture, ZMC fracture, maxillary bone fracture, orbital bone fracture, frontal bone fracture, and alveolar bone fracture. 5. There were some complications such as nasal obstruction, postoperative deformity, olfactory disturbances. Conclusion : In this study, nasal bone fracture occurred in all over ages and much more in men. The closed reduction could be performed successfully in two weeks. 62 대한악안면성형재건외과학회

63 PⅠ-08 악교정수술계획수립시기존수술계획과가상수술계획사이의시간및비용비교 박시연 *, 송재민, 이재열, 김용덕, 신상훈, 김욱규, 황대석부산대학교치의학전문대학원구강악안면외과학교실 악교정수술의성공적인진행을위해서는정확한환자분석을바탕으로한섬세한수술계획수립이필수적이다. 기존의수술계획은 2차원적인방사선사진과임상사진분석을기초로하여교합기에마운팅된 cast를이용하여 model surgery 를하는방식으로이루어졌다. 하지만최근 3차원분석프로그램이발전함에따라악교정수술계획수립방법이 3차원적으로변화하고있다. 가상수술계획은 3차원적인 Cone beam computed tomography (CBCT) 와안면스캔을분석한뒤 Computer-aided design (CAD) Computer aided manufacturing (CAM) 기술을바탕으로가상으로수술하는방식으로진행된다. 이번연구의목적은악교정수술계획수립시기존의방식과가상의방식을진행함에있어시간과비용을후향적으로비교하고자함이다. 본연구에서는 2018년 4월에서 2018년 8월의기간동안부산대학교치과병원구강악안면외과에서악교정수술계획을수립한환자 20명을대상으로분석을시행하였다. Comparison of Time & Cost between Conventional Surgical planning and Virtual Surgical planning in Orthognathic Surgery Si-Yeon Park *, Jae-Min Song, Jae-Yeol Lee, Yong-Deok Kim, Sang-Hun Shin, Uk-Kyu Kim, Dae-Seok Hwang Department of Oral and Maxillofacial Surgery, School of Dentistry, Pusan National University In order to successfully perform orthognathic surgery, it is essential to establish a detailed surgical plan based on accurate patient analysis. The existing surgical plan was based on two - dimensional radiographs and clinical photograph analysis, and model surgery was performed using casts mounted on articulators. However, as the 3 - dimensional analysis program develops, the method of orthognathic surgery planning is changing three - dimensionally. The virtual surgery plan is based on computer-aided design (CAD) computer aided manufacturing (CAM) technology after analyzing threedimensional cone-beam computed tomography (CBCT) and facial scan. The purpose of this study is to retrospectively compare the time and cost of conventional surgical planning(csp) with virtual surgical planning(vsp). In this study, we analyzed 20 patients who had orthognathic surgery plan in Oral and Maxillofacial Surgery of Dental Hospital of Pusan National University from April 2018 to August 제 57 차종합학술대회및정기총회 63

64 PⅠ-09 Clinical study of intraoperative bleeding in orthognathic surgery Keisuke Sugahara 1*, Akira Wada 2, Masahide Koyachi 1, Shuji Yoshida 2, Akira Watanabe 2, Hiroki Bessho 2, Kiyohiro Kasahara 1, Masayuki Takano 2, Takahiko Shibahara 2, Chikara Saito 2, Akira Katakura 1 1 Department of Oral Pathobiological Science and Surgery, Tokyo Dental College, Tokyo, Japan 2 Department of Oral and Maxillofacial Surgery, Tokyo Dental College, Tokyo, Japan Conclusion: Orthognathic surgery has been developed as a successful technique with low complications. It is almost established, and the procedure of the orthodontic surgery is performed smoothly, but further consideration and invention are expected now to perform it more safely. For the patients at elevated risk for bleeding, it is important that we conduct preparations for bleeding preoperatively. Introduction: The orthognathic surgery provides an effective means for the correction of facial disharmonies to provide patients with a functional occlusion. With any procedure including Le Fort I osteotomy (LF-1) and sagittal splitting ramus osteotomy (SSRO), complications may arise, as a bad split, neurosensory disturbance, infection, bleeding etc. In the present study, we focus about abnormal bleeding in orthognathic surgery and analyze a factor of bleeding. Subject and method: A retrospective study was conducted between 2014 and 2016, analyzing the clinical records of patients treated in Tokyo Dental College Suidobashi Hospital. 213 patients who underwent orthognathic surgery (LF-1 and SSRO) were included in the present study. As a factor associated with bleeding, we performed clinic statistical examination about gender, age, body mass index (BMI), moving quantity and direction of maxillary bone, nasal mucosa injury, bad split, blood type, and an operation time. A statistical analysis was done using chi square test and binomial logistic regression analysis, considering a statistical significance when P<0.05. Results: The study group was comprised of 136 subjects (63.8%) female and 77 subjects (36.2%) male. The average of the age at surgery was 27 years old (range: years old). Also, 20s was most common by the generation distinction, and 108 subjects (50.7%) followed by 30s were 50 subjects (23.5%). Mean operation time was 241 minutes. Although the mean bleeding was 273 g (range: g). After conducting univariate analysis about each factor and bleeding, and performing logistic regression analysis as multivariable analysis, association with the bleeding was shown in a movement direction of maxillary bone, BMI, and an operation time. 64 대한악안면성형재건외과학회

65 PⅠ-10 Technical report of Le Fort I osteotomy using Microsoft R HoloLens and 3D devices Masahide Koyachi 1*, Keisuke Sugahara 1, Mayu Shin 1, Yu koyama, Ryo Takagi 1, Kiyohiro Kasahara 2, Kento Odaka 2, Satoru Matsunaga 3, Shinichi Abe 3, Akira Katakura 1 1 Department of Oral Pathobiological Science and Surgery, Tokyo Dental College, Tokyo, Japan 2 Department of Oral and Maxillofacial Radiology, Tokyo Dental College, Tokyo, Japan 3 Department of Anatomy, Tokyo Dental College reproducibility of Le Fort I osteotomy. In the near future, we will be able to perform orthognathic surgery without laboratory works. Objectives: Mixed reality (MR) makes it possible to interact with the real environment using virtual reality which representations of patient-specific imaging data. MR assisted surgery is being conducted at various regions, such as digestive surgery, orthopedic surgery, neurosurgery. But it is not being conducted at oral surgery region. Conventional Le Fort I osteotomy did not have reproducibility, osteotomy line and translocation of the maxilla was different every operator and case. Many cases used surgical splint made from preoperative plaster cast. In this study, we report highlyreproducible and safety Le Fort I osteotomy using MR and 3D devices. Methods: We carried out virtual operation for deciding cutting line and translocation of the maxilla after Le Fort I osteotomy by Materialise Mimics and Materialise3- matic using pre-operation CT DICOM data. We made cutting device and guiding device of the maxilla using 3D printer. Furthermore, we took optical impression and made surgical splint reproduced maxillary dental arch. 3D devices and surgical splint had junction for switching devices. Subsequently, we made virtual reality (VR) application from virtual operation data and we projected that on patient by Microsoft HoloLens. VR can detect the vascular within preoperative CT angiography imaging. Thereby operators can see through the vascular and part with the risk. Results: At first, making mucoperiosteal flap, we adapted splint to maxillary dental arch. We jointed cutting device and carried out osteotomy. After down fracture of the maxilla, we switched cutting device for guiding device. We projected VR which reproduced translocation of the maxilla on patient and confirmed the correspondence. Then maxilla could be fixed with plates. Conclusion: MR assisted surgery and 3D devices improve 제 57 차종합학술대회및정기총회 65

66 PⅠ-11 악교정수술로인해발생한수면무호흡증에대한치료로써이설근전진술과구개수구개성형술의증례보고 김원재 *, 이백수, 최병준, 오주영, 이정우, 정준호, 권용대경희대학교치의학전문대학원구강악안면외과학교실 수면무호흡증은코골이, 주간졸림증, 집행기능장애, 전신질환등의증상과연관된상기도폐쇄로특징지어진다. 수면무호흡증의원인중하나는인후기도를포함한주변해부학적구조물들을변형시킬수있는악교정수술이다. 하지만악교정수술 ( 하악골후퇴술 ) 이수면무호흡증의명확한원인이라는것은아직논란의여지가있다. 수면무호흡증의치료를위해서, 상기도부위의수술적재건이행해져야한다. 이연구의목적은악교정수술로인한수면무호흡증에서이설근전진술과구개수구개성형술로성공적인치료의증례보고이다. 무호흡저호흡지수가수술후 6개월, 1년뒤각각향상되었음을볼수있었다. Genioglossus Advancement with Uvulopalatoplasty for the treatment of orthognathic surgery induced obstructive sleep apnea (OSA): A case report Weon Jae Kim *, Baek Soo Lee, Byung Joon Choi, Joo Young Ohe, Jung Woo Lee, Jun-ho Jung, Yong Dae Kwon Dept. of Oral & Maxillofacial surgery Kyung Hee University School of Dentistry Obstructive sleep apnea syndrome (OSAS) is characterized by obstructive events of the upper airway (UAW) during sleep, which can be associated with clinical signs and symptoms such as snoring, excessive daytime sleepiness, impaired executive function, and systemic diseases[1,7]. One possible cause for the incidence of OSAS is orthognathic surgery(ogs) which can alter the neighboring anatomical structures including the pharyngeal airway space. But it is still controversial that OGS(i.e. mandibular setback surgery) is a definite cause of OSA. For the treatment of OSA, surgical reconstructions of the upper airway must be carried out. The aim of this study was to present a successful case of genioglossus advancement with uvulopalatoplasty for the treatment of OGS induced OSA. The apnea-hypopnea index(ahi) was dramatically improved after six months and one year of treatment. 66 대한악안면성형재건외과학회

67 PⅠ-12 Use of CAD/CAM technology in maxillofacial reconstruction - 4 Cases presentation Ali Alqussair 1,2*, Choi Jin Young 1 1 Seoul National University Dental Hospital 2 Dammam Medical Complex, Ministry of Health, Saudi Arabia The abstract: Three-dimensional analysis, virtual surgical planning, and computer-aided design and manufacturing (CAD/CAM) techniques are leading to new and refined approaches to reconstructive surgery. While used mainly in craniofacial reconstruction so far, 3D planning and CAD/ CAM techniques have the potential for advances in practically every area of plastic and reconstructive surgery. And here to show everybody that preoperative virtual planning and the transfer of these plans to the operation theatre can aid to increase surgical precision, improve rehabilitation and decrease postoperative morbidity and operation time we are introducing 4 different maxillofacial cases (defected orbital wall zygomatic arch in Crouzon Syndrome patient, defect in mandibular ramus fractured mandibular ramus, ankylosed TMJ, and over resected mandible) were reconstructed in Seoul National University Hospital with titanium prosthesis using CAD/CAM technology. Finally, they said when the virtual surgical planning and CAD/CAM technology properly implemented, it will enhance efficiency, accuracy, reproducibility, and creativity in aesthetic and craniomaxillofacial surgery. 제 57 차종합학술대회및정기총회 67

68 PⅠ-13 안면비대칭과관골의위치연관성의 3 차원전산화단층촬영을이용한평가 최효원 *, 유한솔, 윤승규, 장효원, 박광호연세대학교치과대학구강악안면외과학교실 ( 강남세브란스병원 ) 목적 : 안면비대칭은하악골비대칭뿐아니라다양한정도의두개저비대칭을동반하는경우가많다. 두개저의형태는악골및턱관절의위치와형태에영향을줄수있다. 관골은환자의심미와밀접하게관련되어있는부위이지만관골의위치와안면비대칭과의관계에대한연구는드물다. 이연구의목적은안면비대칭으로진단된환자를대상으로관골의위치와안면비대칭과의관계를분석하여두개저의비대칭이하악비대칭에영향을주는지알아보기위함이다. 방법 : * 결과및결론 : * 3-dimensional computed tomography evaluation of relationship between zygomatic bone location and facial asymmetry Hyo-Won CHOI *, Han-Sol YOU, Seungkyu Yoon, Hyo-Won JANG, Kwang-Ho PARK Department of Oral and Maxillofacial surgery, Gangnam Severance Hospital, Yonsei University Colleage of Dentistry, Seoul, Korea Objective: Facial asymmetry is often accompanied by varying degrees of the cranial base as well as mandibular asymmetry. Morphology of cranial base has an effect on the positions of the maxilla, mandible, temporomandibular joint and mandibular shape. Associations between zygomatic bone location and facial asymmetry have not so far been studied, although closed association has been shown between zygomatic bone location and facial esthetics. The aim of this study was to analyze the location of the zygomatic bone and its relationship to facial asymmetry, so as to determine whether mandibular asymmetry is a result of primary mandibular deformity or if it is influenced by cranial base deformity. Method and Material:* Results and Conclusion:* 68 대한악안면성형재건외과학회

69 PⅠ-14 Reproducibility of Facial Images Taken with a Non-contact 3D Imaging System Hidenobu Sakuma *, Yusuke Kato, Daichi Hasebe, Daisuke Saito, Wataru Katagiri, and Tadaharu Kobayashi Division of Reconstructive Surgery for Oral and Maxillofacial Region, Graduate School of Medical and Dental Sciences, Niigata University acceptable and similar among positions. Introduction: Three-dimensional assessment of facial morphology using 3D-CT images or a non-contact 3D imaging system has been widely performed in recent years. However, the imaging conditions and the impact on facial morphologies have not been sufficiently examined. The objective of this study was to examine the reproducibility of facial images taken with a non-contact 3D imaging system and the effect of imaging conditions. Materials and methods: The subjects were 20 adults (10 men and 10 women) without jaw deformities. Informed consent to participate in this study was obtained from all subjects. We used a non-contact 3D imaging system (VECTRA H1) for 3D assessment of facial morphology and obtained facial images of each subject in five positions: standing position (the FH plane being parallel to the floor), backward head-tilt position (the FH plane being tilted upward by 15 degrees from the floor), forward head-tilt position (the FH plane being tilted downward by 15 degrees from the floor), supine position (the FH plane being perpendicular to the floor), and natural position (the head position taken by a subject when we only directed the subject to look forward). The same images were taken several times in each subject within several days. Facial images of each subject taken in the same positions were superimposed, and the differences in antero-posterior dimensions were analyzed in twelve regions. Results: The means and standard deviations of maximum differences in facial images in overall regions were 2.57±1.18 mm in the standing position, 2.46±0.79 mm in the backward head-tilt position, 2.68±1.53 mm in the forward head-tilt position, 2.53±0.72 mm in the supine position, and 2.65±1.26 mm in the natural position. Conclusion: Reproducible 3D facial morphology can be recorded with the non-contact 3D imaging system by preparing imaging conditions because the differences of superimposed facial images in each position were clinically 제 57 차종합학술대회및정기총회 69

70 PⅠ-15 Our Strategy for Orthognathic Surgery for Patients with Cleft Lip and Palate. Yuko Shintaku *, Tomonao Aikawa, Susumu Tanaka, and Mikihiko Kogo The First Department of Oral and Maxillofacial Surgery, Osaka University Graduate School of Dentistry molars. Speech function was not worsened significantly in both groups. MASDO and LF1 is both effective OGS for CLP-patients. Our strategy and indications will be discussed. Treatment of cleft lip and palate (CLP) is prolonged; it commences after birth and lasts until the child reaches adulthood or even into adulthood. Residual deformities, functional disturbances, or both, are frequently seen in adults with a repaired cleft. Problems are widely diverse, i.e. not only simple maxillary hypoplasia but also narrow transverse width, short anteroposterior length, and deformity of dental arch. Skeletal malocclusion due to CLP are often treated by surgical orthodontic treatment. Conventional surgical orthodontic treatment, Le Fort I osteotomy (LF1), however, may not resolve all the above problems. For example, LF1 advancement does not make eruption space to the small maxilla where no space for eruption of 2nd posterior molar. Furthermore, large advancement of LF1 worsen the speech function. Based on these backgrounds, we have used maxillary anterior segmental distraction osteogenesis (MASDO) as orthognathic surgery (OGS) for CLP. MASDO procedures are, briefly, 1) segmental osteotomy of anterior maxilla (usually osteotomy between U5 and U6), 2) place distraction devices across the osteotomy line, 3) activate device and distraction osteogenesis, 4) advancement anterior segment with or w/o rotation movement, and then 5) orthodontic alignment. In this study, we have investigated the efficacy of OGS on skeletal change, soft tissue changes, and dental arch. Objectives: CLP-patients treated by OGS at Osaka University Dentistry Hospital from 2009 to 2017 were 144 cases. LF1 group consisted 71 cases, and MASDO group consisted 40 cases. Others were surgical assisted rapid palatal expansion (25 cases) or mandibular osteotomy alone (8 cases). Pre- and post-operative cephalograms were analyzed. Result: Skeletal advancement of maxilla, and soft tissue change was significantly greater in MASDO group. Anteroposterior length of maxilla was enlarger in MASDO group. Interdental space made by MASDO were used for orthodontic alignment and/or anterior movement of posterior 70 대한악안면성형재건외과학회

71 PⅠ-16 증례보고 : 상악후퇴환자에서의 BAMF(Bone Anchored Face Mask) 사용 김태호 *, 박성민, 김문영, 한세진, 김철환, 이재훈단국대학교치과대학구강악안면외과학교실 페이스마스크는 1960년대이후로 3급부정교합의치료에서성공적으로사용되었다. 또한, 상악후퇴환자에서 BAMF의개념도현재널리사용되고있다. 이논문은상악후퇴환자에서미니플레이트와페이스마스크를이용한상악전방이동을시행한증례보고이다. 티타늄미니플레이트가코양측에고정되었으며, 방사선사진을이용한주기적평가가이루어졌다. Case Report: BAFM(Bone Anchored Face Mask) on Maxillary Retrusion Patient Tae Ho Kim *, Sung Min PARK, Moon Young KIM, Se Jin HAN, Chul Hwan KIM, Jae Hoon LEE 1 Dept. of Oral and maxillofacial surgery, College of Dentistry, Dankook University Facemask has been successfully used for the correction of Class III malocclusion since the late Also, The concept of BAMF is currently used for the Maxillary retrusion patients nowadays. This article is the case report of facemask treatment anchored with miniplates and Maxillary protrusion in the Maxillary retrusion patient. Facemask from the titanium miniplates was inserted on the lateral nasal wall of the maxilla, and periodic evaluation was done using radiographic image. 제 57 차종합학술대회및정기총회 71

72 PⅠ-17 External reference point using facial impression for settling maxillary position during Le Fort I osteotomy Ko ITO *, Kosuke TAKAHASHI, Mai Tajima, Teruo YANO, Suguru WATANABE, Fumie YAMAZAKI, Toshirou KONDOH Department of Maxillofacial Surgery Nihon University School of Dentistry at Mastsudo In recent years, technologies of 3D simulation and CAD/CAM have been developing. These techniques are already clinically applied, and they are also used for surgery. As a proposition, it is necessary to settle the position of bone fragments accurately in order to reflect the simulation properly. Especially in the double-sprint method for bimaxillary surgery, since the upper jaw is fixed on the path of the hinge movement of the mandible, it is important to determine the vertical position. As the reference of the vertical position of the maxilla, an internal reference point (IRP) or an external reference point (ERP) is often used. IRP is a reference point to be placed above and below the osteotomy line of Le Fort I, but the point set on the bone surface might not be measured after suturing, or the measurement becomes incorrect in cases where the anterior-posterior movement amount is quite a large. Although ERP is a method of settling a reference point in the nasal or the forehead part on skin, it is reported that ERP is unstable because it is easily displaced due to fluctuation of intubation tube and head position. In the method of placing a pin or screw in the frontal bone, scarring or infection should be concerned. For the purpose of improving unstable ERP, we used a method of imparting a facial impression using Colt Flux which is a silicone impression material before surgery, and setting a reference point on the prepared facial impression. We devised and examined the error of the vertical movement amount of the maxilla, which was measured intraoperatively and post-operatively. In our poster, how to make facial impression, how to use it, and the result of surgery are presented. 72 대한악안면성형재건외과학회

73 PⅠ-18 하악지수직골절단술후뒤로밀린근심골편의회전경향 박종찬 *1, 이준 1,2, 임헌준 1, 김봉철 1 1 원광대학교대전치과병원구강악안면외과 2 원광골재생연구소 본연구는하악지수직골절단술 (IVRO) 을시행후근심골편이뒤로밀린환자를 1년동안추적관찰하여분석하였다. IVRO를시행한 52개의편측하악골을분석하였다. 술후에근심골편이원심골편과겹쳐지지않고뒤로밀린 30개를실험군으로, 겹쳐진 22개를대조군으로설정하여 3차원전산단층화촬영을이용하여분석하였다. 하악과두의중점 (MCP), 하악과두의경사각 (Con) 및하악지후연의선분 (Ramus angle) 을설정하여수술후근심골편의움직임을관찰하였다. 결과적으로, 근심골편에서 MCP의시상면으로의회귀성향이모든군에서나타났으며, Ramus angle은실험군에서모든방향에서회귀가일어났으나, 대조군에서는시상면으로의회귀성향만이관찰되었다. 이에 IVRO 후뒤로밀린근심골편은원래의위치로돌아가려는경향을보임을알수있었다. Please cite this article as: Rotation tendency of the posteriorly displaced proximal segment after vertical ramus osteotomy. Park JC, Lee J, Lim HJ, Kim BC. J Craniomaxfac Surg. in press. This work was supported by the National Research Foundation of Korea (NRF) with a grant funded by the Korea government (MSIP) (No. NRF- 2017R1C1B ). Rotation tendency of the posteriorly displaced proximal segment after vertical ramus osteotomy Jong Chan Park *1, Jun Lee 1,2, Hun Jun Lim 1, Bong Chul Kim 1 1 Dept. of Oral and maxillofacial surgery, Daejeon Dental Hospital, Wonkwang University College of Dentistry 2 Wonkwang Bone Regeneration Research institute, Wonkwang University Intraoral Vertical Ramus Osteotomy (IVRO) is one of the operative techniques used for orthognathic surgery. The aim of this study was to assess the posterior displacement of the proximal segment in patients undergoing IVRO at 1-year follow-up. In total, 52 hemimandibles from 26 patients who underwent IVRO in whom the proximal segment was posteriorly displaced without overlap with the distal segment at immediate post-operation (Imm) (30 cases, experimental group), and 26 patients in whom the proximal segment was not posteriorly displaced with overlap with the distal segment (Imm) (22 cases, control group) under three-dimensional computed tomography were included in the study. To analyze the movement of segments, the positions of the mid condyle point (MCP) and angle of condyle line (Con) were determined and the movement of the ramus angle (posterior edge of proximal segments) was measured at the proximal segment. As a result, regression of the proximal segment in sagittal direction of the MCP was observed in both groups and all directions of the ramus angle in the experimental group, and only sagittal direction in the control group. In conclusion, posterior displacement of the proximal segment after IVRO showed tendency to regress its original position. 제 57 차종합학술대회및정기총회 73

74 PⅠ-19 구순 / 구개열환자의악교정수술후안정성에관한임상적연구 : 32 명의환자에대한후향적연구 최원혁 *, 송재민, 이재열, 황대석, 신상훈, 김욱규, 김용덕부산대학교치의학전문대학원구강악안면외과학교실 구순 / 구개열이란발생과정이상으로인해일어나는안면기형이며선천성기형중가장빈발하는질병이다. 구순 / 구개열을가진환자들은기능적및심미적요구를충족시키기위하여수많은수술적치료를요한다. 이러한수술에의해생긴흉터의경우상악의성장에악영향을미치고종종상악의저성장을초래한다. 그리하여많은구순 / 구개열환자들은골격부조화를해소하기위하여악교정수술을시행한다. 악교정수술의술중, 후부작용은여러가지가존재한다. 술중합병증의경우출혈, 부적절한골절단, 하치조신경의손상, 치근의손상이있다. 술후합병증의경우출혈, 부종, 감염, 감각이상, 유합의실패, 턱관절의소리및통증, 재발등이있다. 이번연구의목적은악교정수술을시행한구순 / 구개열환자들의발생가능한합병증및안정성에대해후향적으로알아보기위함이다. 본연구에서는 2013년 6월에서 2018년 3월의기간동안부산대학교치과병원구강악안면외과에서동일술자에게악교정수술을받은환자들중구순 / 구개열이있는환자 32명을대상으로분석을시행하였다. A clinical study of stability following orthognathic surgery for patients with cleft lip/ palate : A retrospective study of 32 patients Won-hyuk Choi *, Jae-Min Song, Jae-Yeol Lee, Dae-Seok Hwang, Sang-Hun Shin, Uk-Kyu Kim, Yong-Deok Kim Department of Oral and Maxillofacial Surgery, School of Dentistry, Pusan National University Cleft lip/palate is a facial anomaly caused by an abnormal developmental process and is the most common congenital anomaly. Patients with cleft lip/palate are born with a challenging deformity that requires multiple surgical interventions to meet the functional and aesthetic demands for improvement. The scar that results from surgical procedures has been shown to affect the growth of the maxilla, often leading to maxillary deficiency. So many patients with cleft lip/palate go on to require orthognathic surgery for correction of a skeletal asymmetry. There are many complications intraoperative & postoperative orthognathic surgery. In the case of intraoperative complications, hemorrhage, improper fracture, damage of inferior alveolar nerve, damage of root are present. In the case of postoperative complications, bleeding, edema, infection, paresthesia, failure of bone healing, sound and pain of temporomandibular joint, relapse are present. The purpose of this study is to retrospectively study of complications and stability of cleft lip/palate patients who underwent orthognathic surgery. A total 32 patients with cleft lip/palate had orthognathic surgery from June 2013 to March 2018 at Oral and Maxillofacial Surgery of Pusan National University Dental Hospital. All patients had surgery from the same surgeon. 74 대한악안면성형재건외과학회

75 PⅠ-20 하악전돌증환자의양악동시악교정수술후기도부피의변화의 3 차원적분석 최성환 *, 박진후, 임기현, 김준영, 정휘동, 정영수연세대학교치과대학구강악안면외과학교실 하악전돌증환자에서양악동시악교정수술후나타나는기도의변화는술후나타날수있는코골이와수면무호흡등의문제와연관되어특히중요하게생각하는부분이다. 하악전돌증환자에게하악을뒤로위치시키는악교정수술을적용한후환자에게기도공간의변화가나타날수있으며이로인해코골이, 수면무호흡등의양상이생길수있다. 예전부터수술후기도의변화를 2-D lateral cephalogram 을이용하여광범위하게연구되어왔다. 그동안의연구들에서는일반적으로하악골후퇴술의경우기도공간의축소가생긴다고알려져있었다. 하지만 2차원연구에서는기도의 3차원적인형태를반영하지는못한다. 근래에는 3차원 conebeam CT는연조직과기도공간의경계를명확하게구분할수있으며 airway의 3차원적인부피를예상할수있어유용하게사용되며, 이를이용한연구도활발히진행되고있다. 이제저자등은하악골전돌증의치료를위해양악동시악교정수술을시행한환자들에서술전, 술후 1개월, 12개월의 3 차원 cone-beam CT정보를이용하여 3차원 skull 및기도부피모형을재건하였다. Mimics R software 을사용하여설정된각기준평면에대한경조직의위치변화를관찰하였다. 또한 3-Matic R software을사용하여기도부피의변화양상을관찰하였다. 이를통해하악전돌증환자에서양악동시악교정수술후나타나는 3차원적인기도부피의변화를확인하고자한다. 또한하악골의후퇴술과인두기도부피변화및경조직의위치변화가상관관계가있는지를연구하고자한다. Changes of pharyngeal airway volume after mandibular setback: 3-Dimensional Analysis Sung-Hwan Choi *, Jin Hoo Park, Ki-Hyun Lim, JunYoung Kim, Hwi-Doing Jung, Young-soo Jung Dept. of Oral and Maxillofacial Surgery, College of Dentistry, Yonsei University The change in the pharyngeal airway after bimaxillary orthognathic surgery in mandibular prognathism pateints is a particularly important factor in relation to problems such as snoring and sleep apnea that may occur after surgery. After applying the orthognathic surgery to the mandibular prognathism patient to position the mandible backward, changes in airway space may occur in the patient, which can result in snoring and sleep apnea. Previously, postoperative changes in airway have been extensively studied using 2-D lateral cephalograms. Previous studies have reported that mandibular setback surgery is generally associated with airway narrowing. However, twodimensional studies do not reflect the three-dimensional shape of airway. In recent years, three-dimensional cone-beam CT can be used to clearly distinguish the boundary between the soft tissue and the airway space, predict the three-dimensional volume of the airway, and research using this has also been actively pursued. We used three-dimensional cone-beam computed tomography (CT) data obtained preoperatively, 1 month postoperatively, and 12 months postoperatively in patients underwent bimaxillary orthognathic surgery for the treatment of mandibular prognathism skull and airway volume models were reconstructed. Mimics software was used to observe changes in the position of the hard tissue in each reference plane. We also observed changes in airway volume using 3-Matic software.. The purpose of this study is to evaluate the changes of the airway volume in the mandibular prognathism patient after bimaxillary orthognathic surgery. And we also investigate whether there is a correlation between airway volume change and location of hard tissue in mandibular setback surgery. 제 57 차종합학술대회및정기총회 75

76 PⅠ-21 하악전돌중환자에서전방분절골절단술을동반한하악후퇴술후상기도공간변화에대한연구 조예원 *1, 권익재 1, 양훈주 2, 황순정 1,2 1 서울대학교치의학대학원구강악안면외과 2 서울대학교치과병원턱교정수술센터 서론 : 하악전돌증환자에서하악의후방이동은기도공간의감소를야기한다. 특히, 안모개선을위해수술전후많은양의하악이동의동반되는악교정수술환자의경우술후기도공간감소에의한수면무호흡, 코골이증상을호소할가능성이있다. 이들환자에서기도공간의감소를최소화하기위해서전방분절골절단술 (Anterior segmental osteotomy; ASO) 를동반한하악후퇴술이시도되었다. 그목적은측방안모상에서하악전치부의후방이동량을확보하되하악제1 소구치혹은제2소구치의발거공간을활용하여하악구치부의후방이동량을최소화하고자함에있다. 이방법은이론적으로합당한것으로받아들여졌으나, 현재까지위수술방법에서기도공간변화에대해서는보고된바가없다. 본연구에서는전ASO를동반한하악후퇴술후의기도공간의변화를평가하고자한다. 연구방법 : ASO를동반한하악후퇴술시행받은환자에서수술전, 수술직후, 수술 6개월후의 CT를촬영한환자를대상으로하였다. 하악전치부 ( 전방분절부 ) 의후퇴량과하악구치부의후퇴량을 CT 상에서 3D 분석을통해산출하였고, 해당환자들의술전, 수술직후, 수술후 6개월경과시점에서기도넓이및부피를측정하여분석시행하였다. 결과및토의 : 하악전치부 ( 전방분절부 ) 의후퇴량과하악구치부의후퇴량을 CT 상에서 3D 분석을통해산출한결과전방분절골절단술을시행한경우평균 6mm 가량하악골의후퇴량을줄일수있었다. 기도공간의변화는상악의정중부확장이이루어진경우와이루어지지않은경우에따라, 또혀절제술이동반된경우에따라상이한결과를보이나, ASO를하지않았을때를가정한하악제2대구치후방이동량과유사한이동량의수술을받은대조군환자와비교하여평균 15% 의기동공간증가효과가있었다. A study of the effect of SSRO combined with anterior segmental osteotomy for mandible setback surgery on the change of pharyngeal airway space Yewon Joh *1, Ik Jae Kwon 1, Hoon Joo Yang 2, Soon Jung Hwang 1,2 1 Department of Oral and Maxillofacial Surgery, School of Dentistry, Seoul National University 2 Department of Orthodontics, School of Dentistry, Seoul National University Introduction: The setback movement of the mandible on the patient with mandibular prognathism causes a decrease in the airway space. In particular, patients with orthognathic surgery with a large amount of mandibular setback movements during surgery may suffer from sleep apnea and snoring due to a reduction in airway space. To minimize the reduction of airway space in these patients, mandibular setback combined with anterior segmental osteotomy (ASO) was attempted. The purpose of this study is to minimize the amount of posterior movement of the mandibular posterior part by utilizing the extraction space of the mandibular first premolar or the second premolar, while securing the amount of posterior movement of the mandibular incisor. Although this method has been accepted as reasonable theoretically, no investigation has been reported in the airway space in the above surgical methods. The purpose of this study is to evaluate the changes of airway space after mandibular setback combined with ASO. Method: On patients who underwent mandibular setback with ASO, taken preoperative, immediate postoperative, and 6 months postoperate CT were enrolled in this study. The amount of posterior movement of the mandibular incisor (anterior segment) and the amount of posterior movement of the mandibular posterior were computed by 3D analysis. The width and volume of the airway were measured and measured before, during, and 6 months after surgery. Result and discussion: The amount of setback of the mandibular incisor (anterior segment) and the amount of setback of the mandibular posterior were computed through 3D analysis on CT. As a result, when an anterior segmental osteotomy was performed, the amount of retraction of the mandible was reduced by an average of 6mm. The changes of the airway space were different according to the cases with or without palatal expansion of maxilla, glossectomy. However, there was an average 15% increase of the airway space compared to the control group who underwent similar amount of movement of the mandibular anterior part assuming the absence of ASO. 76 대한악안면성형재건외과학회

77 PⅠ-22 안면비대칭이있는하악전돌환자에있어서선수술로양측시상골절단술 (BSSRO) 와구강내수직골절단술 IVRO 를시행한환자의과두위치변화평가 임이랑 *, 김수관, 문성용, 오지수, 유재식, 최해인, 신나라조선대학교치의학전문대학원구강악안면외과학교실 서론 : 이연구는안면비대칭이있는하악전돌환자에있어서선수술로 BSSRO와 IVRO를시행한환자의과두위치를평가하기위함이다. 방법 : 선수술로악교정수술을시행한 25명의환자 (50 과두 ) 를대상으로하였다. 환자는수술을한방법에따라 2개의그룹으로나누었다. 14명은 BSSRO를시행한그룹이고 11명은 IVRO를시행한그룹이다. 과두의위치를비교하기위해 CBCT는수술전, 수술직후 (1달이내 ) 그리고수술 1년후에촬영되었다. 과두의변화는 x축 ( 내외측 ), y축 ( 전후방 ), z축 ( 상하 ) 에서평가되었다. 결과 : BSSRO 그룹에서수술직후외측, 하방으로변하고수술 1년후에는내측, 상방으로돌아가는변화를보였다. IVRO 그룹에서는시간경과에따라유의미한변화를보이지않았다. 고찰및결론 : 안면비대칭이있는하악전돌환자에서선수술을시행한환자중BSSRO그룹보다 IVRO그룹이하악과두의위치변화가더적다. Changes in condylar position after bilateral sagittal split ramus osteotomy (BSSRO) and intraoral vertical ramus osteotomy (IVRO) via surgery-first approach in mandibular prognathism with facial asymmetry Lee-Rang Lim *, Su-Gwan Kim, Seong-Yong Mon, Ji-Su Oh, Jae-Seek You, Hae-In Choi, Na-Ra Shin Department of Oral and Maxillofacial Surgery, School of Dentistry, Chosun University Introduction: The purpose of this study was to compare changes in condylar position between bilateral sagittal split ramus osteotomy (BSSRO) and intraoral vertical ramus osteotomy (IVRO) via surgery-first approach in mandibular prognathism with facial asymmetry. Method and materials: 25 patients (50 condyles) who received surgical-orthodontic treatement using a SFA were included and divided into two groups depending on extent of surgery. 14 underwent BSSRO and 11 underwent IVRO. CBCT images were taken preoperately, immediately postoperatively, and 1 year postoperatively to compare the amount of condylar displacement. The condylar displacement were evaluated in the x- (medio-latetal), y- (antero-posterior), and z- (upward-downward) directions. Results: BSSRO group showed lateral and inferior displacement immediately after surgery, and medial and superior returning movement 1 year after surgery. There was no statistical different in time course changes in IVRO group. Conclusion: Among the patient who received surgicalorthodontic treatment using a SFA in mandibular prognathism with facial asymmetry, IVRO may cause less condylar displacement than BSSRO. 제 57 차종합학술대회및정기총회 77

78 PⅠ-23 Intraoral Le Fort II/III osteotomy를통한골신장술정필훈, 하성호 *, 정한울 서울대학교치과병원, 구강악안면외과학교실서론 : Nasomaxillary complex 성장결여가심해악교정수술만으로심미개선및교합개선이불가능할경우, Intraoral Le Fort II/III osteotomy를통한골신장술을적용하면우수한결과를얻을수있다고알려져있다. 본연구는 Intraoral Le Fort II/III osteotomy를통한골신장술을시행받은환자들의수술후경조직의장기간추적관찰을보고하기위함이다. 방법 : 서울대학교치과병원에서 1명의집도의에의해 Intraoral Le Fort II/III osteotomy를통한골신장술을시행받고경과관찰을시행한환자들 (Intraoral Le Fort II 20 명, Intraoral Le Fort III 2명 ) 을대상으로하였다. 분석을위하여술전 (T0), 골신장직후 (T1), 3개월후 (T2), 6개월후 (T3), 1년후 (T4), 2년후 (T5) 의측면두부규격방사선사진을사용하였다. 결과 : Intraoral Le Fort II/III osteotomy를통한골신장술을시행받은환자들의방사선영상을분석한결과, Nasomaxillary complex 전진양이1회의악교정수술으로전진시킬수있는양보다훨씬더많았으며, 술후에도안정적으로유지되고있음을확인할수있었다. 결론 : Intraoral Le Fort II/III osteotomy를통한골신장술은 Nasomaxillary complex 전진양이많이필요할경우예지성있는수술방법임에틀림없다. Distraction osteogenesis of Intraoral Le Fort II/III osteotomy Pill-Hoon Choung, Sung-Ho Ha *, Han-Wool Choung Dept. of Oral & Maxillofacial Surgery, Seoul National University Dental Hospital. Introduction: It is known that excellent results can be obtained by applying Distraction osteogenesis with Intraoral Le Fort II/III osteotomy when improvement of esthetic and occlusion is impossible by only orthognathic surgery because of amount lack of growth of nasomaxillary complex. The purpose of this study was to report long-term follow-up of the postoperative hard tissue in patients who underwent Distraction osteogenesis with Intraoral Le Fort II / III osteotomy. Method: Patients who underwent Distraction osteotomy with Intraoral Le Fort II / III osteotomy was enrolled in this study (Intraoral Le Fort II 20 patients, Intraoral Le Fort III 2 patients). For analysis, lateral cephalometric radiographs were used for preoperative(t0), immediately after bone extension(t1), 3 months(t2), 6 months(t3), 1 year(t4), and 2 years(t5). Results: Analysis of the radiographic images of the patients who underwent Distraction osteogenesis with Intraoral Le Fort II/III revealed that the amount of nasomaxillary complex advancement was much greater than the amount of advancement by one orthognathic surgery and it remained stable after surgery. Conclusion: Distraction osteogenesis with Intraoral Le Fort II/III may be one of stable and recommendable method if large amount of nasomaxillary complex advancement is needed. 78 대한악안면성형재건외과학회

79 PⅠ-24 선수술과투명교정장치를이용한빠른악교정치료환자에대한치험례 고성혁 *, 최송제, 강병훈, 정지훈, 안준형, 한정준, 정승곤, 박홍주, 오희균, 국민석전남대학교치의학전문대학원, 구강악안면외과학교실 선수술악교정치료는수술전교정없이악교정수술시행후수술후교정치료로교합부조화를해결하는방법이다. 이로인해정상적인골격관계가먼저이루어지므로, 전체치료기간이단축된다. 또한수술후 RAP (Regional Acceleratory Phenomenon) 에의해수술후교정치료에서빠른치아이동이일어난다. 투명교정장치는심미적일뿐만아니라구강내에밀착되기때문에연조직의통증이나발음장애를거의유발하지않는다. 또한구강위생관리가용이하다는장점때문에성인환자들이가장많이선호하는교정치료법이다. 많은장점에도불구하고투명교정장치는고정성교정장치에비해치료기간이많이걸린다는단점이있다. 이에본교실에서는선수술의전체치료기간의단축및빠른치아이동의장점을이용하여수술후투명교정장치를사용한환자에서수술전교정기간동안보상해소로인해발생하는안모의불균형없이즉각개선된안모및심미적인전치부배열과안정된구치부교합을얻어문헌고찰과함께보고하고자한다. Fast orthognathic treatment by a Surgery-First approach and using clear overlay orthodontic appliance : a Case Report Sung-Hyuk Koh *, Song-Je Choi, Byoung-Hun Kang, Ji-Hun Chong, Jun-Hyeong An, Jeong Joon Han, Seunggon Jung, Hong-Ju Park, Hee-Kyun Oh, Min-Suk Kook Department of Oral and Maxillofacial Surgery, School of Dentistry, Chonnam National University Surgery-First approach is a method of resolving malocclusion by orthodontic treatment after orthognathic surgery without preoperative correction. This leads to a normal skeletal relationship, thus shortening the entire treatment period. In addition, postoperative RAP (Regional Acceleratory Phenomenon) causes rapid tooth movement in orthodontic treatment after surgery. Clear overlay orthodontic appliance is not only aesthetic, but also does not cause pain or speech disturbance in the soft tissues because they are in contact with the oral cavity. And it is the most preferred orthodontic treatment for adult patients because of the advantage of easiness of oral hygiene management. Despite of its many advantages, the Clear overlay orthodontic appliance has a disadvantage that it requires a longer treatment period than a fixed orthodontic appliance. In this study, we report a case of a patient who had undergone postoperative orthodontic treatment with Clear overlay appliance and improved facial profile and aesthetic anterior alignment and stable posterior occlusion without facial imbalance caused by compensation during preoperative, using the advantages of shortening the entire treatment period and rapid tooth movement. 제 57 차종합학술대회및정기총회 79

80 PⅠ-25 Two Jaw Surgery 환자에서 Rocuronium 으로인한 anaphylaxis: 박병호 *, 전주홍서울아산병원구강악안면외과학교실 전신마취에서Anaphylaxis 또는 anaphylactoid 반응은드물다. 마취유도중 Anaphylaxis 는중요한합병증중하나로 3-6% 의사망률이보고되고있으며, 근이완제의사용과가장큰연관성을보인다. 본증례에서 20세남환의 rocuronium으로인한 anaphylaxis 반응을보고하고자한다. 환자는하악전돌증, 상악후퇴증으로하악각절제술을동반한양악수술예정이었다. Rocuronium이주입된후얼마지나지않아환자는빈맥, 기관지수축, 두드러기반응을보였다. Anaphylaxis 반응이보인 4주후 succinylcholine, vecuronium, cisatracurium을포함한알러지반응검사를시행하였다. 그결과 neuromuscular block 제제를사용하는것이위험판단되어, 근이완제를사용하지않고전신마취하에양악수술을시행하였다. 수술 3일후, 환자는합병증없이퇴원하였다. Rocuronium bromide induced anaphylaxis in Two Jaw Surgery patient: A case report Byungho park *, Ju-hong Dept. of Oral and Maxillofacial Surgery, Asan Medical Center, college of medicine, Ulsan University, Seoul, Korea Anaphylaxis or anaphylactoid reaction during anesthesia is rare. Anaphylaxis during induction of anesthesia is a dreaded complication with a mortality rate of 3-6%, most frequently associated with the use of muscle relaxants. We report a rocuronium induced anaphylactic reaction in a 20-year-old male. The patient was scheduled to undergo Two Jaw Surgery with Angle Ostectomy due to Mandibular prognathism, maxillary retrognathism. Shortly after injection of rocuronium, the patient developed tachycardia, bronchospasm, urticaria. 4 weeks after anaphylaxis, allergy testing was performed including succinylcholine, vecuronium, cisatracurium. As a result, the use of neuromuscular blocking agents is considered to be dangerous. Then, Two Jaw Surgery was performed under general anesthesia without using of muscle relaxant. After 3 days post-operative care, the patient was discharged without complication. 80 대한악안면성형재건외과학회

81 PⅠ-26 하악전돌증환자의전진이부성형술을동반한양악동시악교정수술후기도부피의변화의 3 차원적분석 박진후 *, 최성환, 임기현, 김준영, 정휘동, 정영수연세대학교치과대학구강악안면외과학교실 하악전돌증환자에서양악동시악교정수술후나타나는기도의변화는술후나타날수있는코골이와수면무호흡등의문제와연관되어특히중요하게생각하는부분이다. 전진이부성형술은악교정수술과동반되어서심미적인목적으로종종사용되며, 수면무호흡증환자에서기도확장의목적으로단독으로사용되기도한다. 예전부터수술후기도의변화를 2-D lateral cephalogram 을이용하여광범위하게연구되어왔다. 그동안의연구들에서는일반적으로하악골후퇴술의경우기도공간의축소가생긴다고알려져있었으며, 전진이부성형술의경우기도공간의확장이생긴다고알려져있었다. 하지만 2차원연구에서는기도의 3차원적인형태를반영하지는못한다. 근래에는 3차원 cone-beam CT는연조직과기도공간의경계를명확하게구분할수있으며 airway의 3차원적인부피를예상할수있어유용하게사용되며, 이를이용한연구도활발히진행되고있다. 이제저자등은하악골전돌증의치료를위해전진이부성형술을동반한양악동시악교정수술을시행한환자들에서술전, 술후 1개월, 12개월의 3차원 cone-beam CT정보를이용하여 3차원 skull 및기도부피모형을재건하였다. Mimics R software 을사용하여설정된각기준평면에대한경조직의위치변화를관찰하였다. 또한 3-Matic R software을사용하여기도부피의변화양상을관찰하였다. 이를통해하악전돌증환자에서전진이부성형술을동반한양악동시악교정수술후나타나는 3차원적인기도부피의변화를확인하고자한다. 또한전진이부성형술을동반한하악골의후퇴술과인두기도부피변화및경조직의위치변화가상관관계가있는지를연구하고자한다. Changes of pharyngeal airway volume after mandibular setback surgery combined with advancement genioplasty: 3-Dimensional Analysis Jin Hoo Park *, Sung-Hwan Choi, Ki Hyun Im, Jun-Young Kim, Hwi-Doing Jung, Young-Soo Jung Dept. of Oral and Maxillofacial Surgery, College of Dentistry, Yonsei University The change in the pharyngeal airway after bimaxillary orthognathic surgery in mandibular prognathism pateints is a particularly important factor in relation to problems such as snoring and sleep apnea that may occur after surgery. Advancement genioplasty is often used for aesthetic purposes in combined with orthognathic surgery and may be used solely for the purpose of relieving of airway obstruction in patients with sleep apnea. Previously, postoperative changes in airway have been extensively studied using 2-D lateral cephalograms. Previous studies have reported that mandibular setback surgery is generally associated with airway narrowing, and advancement genioplasty is generally associated with airway enlargement. However, two-dimensional studies do not reflect the three-dimensional shape of airway. In recent years, threedimensional cone-beam CT can be used to clearly distinguish the boundary between the soft tissue and the airway space, predict the three-dimensional volume of the airway, and research using this has also been actively pursued. We used three-dimensional cone-beam computed tomography (CT) data obtained preoperatively, 1 month postoperatively, and 12 months postoperatively in patients underwent bimaxillary orthognathic surgery combined with advancement genioplasty for the treatment of mandibular prognathism skull and airway volume models were reconstructed. Mimics software was used to observe changes in the position of the hard tissue in each reference plane. We also observed changes in airway volume using 3-Matic software.. The purpose of this study is to evaluate the changes of the airway volume in the mandibular prognathism patient after bimaxillary orthognathic surgery combined with advancement genioplasty. And we also investigate whether there is a correlation between airway volume change and location of hard tissue in mandibular setback surgery combined with advancement genioplasty. 제 57 차종합학술대회및정기총회 81

82 PⅠ-27 골격성 3 급부정교합환자에서부분혀절제술을동반한악교정수술이후 3D-CBCT 를이용한기도변화에대한연구 박지열 *, 이백수, 권용대, 최병준, 이정우, 정준호, 황보연, 오주영경희대학교치과병원구강악안면외과 목적 : 본연구의목적은하악후퇴수술에서의부분혀절제술을받은환자들의인두공간의 3 차원체적변화를관찰하고그필요성을결정하는것이다. 환자및방법 : 거대설을가지고골격성 III 급부정교합자로진단받은환자중시상면골절단술 (SSRO) 만을시행한 25 명의환자가본연구에포함되었다. 1 군은 BSSRO를, 2 군은 BSSRO를부분혀절제술과동시에시행하였다. 수술전 (T0), 수술후 3 개월 (T1), 수술후 6 개월 (T3) 에촬영한콘빔전산화단층촬영 (CBCT) 을 3 차원영상프로그램을이용하여기도 ( 구강인두및하인두 ) 를평가하였다. 결과 : 1 군에서기도공간은감소했지만유의하지는않았다. 2 군에서기도공간은수술전수술후 3 개월까지감소되었으나 3 개월후에증가하였다. 두군의구강인두및총기도공간의용적변화경향은수술후시간에따라통계적으로차이가있었다. 결론 : 부분혀절제술은하인두기도를증가시켜전체기도체적을증가시킨다. 하악의후퇴이동이많이필요하거나호흡장애가발생할가능성이높은환자에게수술후안정성의개선, 재발방지및기도유지에도움을준다. Airway changes in patients with skeletal class III malocclusion after orthognathic surgery with partial glossectomy: a three-dimensional cone-beam computed tomography study Jiyeol Bak *, Baeksoo Lee, Yongdae Kwon, Byungjoon Choi, Jungwoo Lee, Junho Jung, Boyeon Hwang, Jooyoung Ohe Dept. of Oral and Maxillofacial Surgery, Kyung Hee University Dental Hospital, Seoul, Korea Purpose: The purpose of this study was to observe threedimensional volumetric changes of the pharyngeal airway space and to determine the necessity of partial glossectomy with mandibular setback surgery Patients and Methods: 25 pseudomacroglossia patients diagnosed with skeletal class III malocclusion and underwent sagittal split ramus osteotomy (SSRO) only were enrolled in this study. Group 1 underwent BSSRO and Group 2 underwent BSSRO with partial glossectomy simultaneously. The airway (oropharyngeal & hypopharyngeal) were assessed with cone beam computed tomography (CBCT) using 3-D imaging program at one month before the operation (T0), three months (T1) and 6 months (T3) post-operation. Results: In group 1, airway spaces decreased, but not significantly. In group 2, airway spaces decreased from pre-operation to 3 months post-operative but increased after 3 months. The tendency of volumetric changes in oropharyngeal and total airway space of both groups showed statistical differences dependent on the time after surgery. Conclusions: Partial glossectomy increases hypopharyngeal airway, which increases the total airway volume. It helps improvement of post-operative stability, prevention from relapse, and keeping airway opened to patients who will need lots of backward movement of mandible or who will have high possibility of getting respiratory obstruction. Key words: airway, class III malocclusion, partial glossectomy, 3-dimensional CBCT 82 대한악안면성형재건외과학회

83 PⅠ-28 갈색종양에의한악안면변형환자의진단및치료 : 증례보고 홍석환 *, 김준영, 박진후, 정휘동, 정영수연세대학교치과대학구강악안면외과학교실 양성종양모양병변의부갑상선기능항진증에의한갈색종양은턱의중앙거대세포육아종과조직병리학적으로동일하며보통청소년과젊은성인에게영향을줍니다. 두병변은다혈성파골세포형거대세포의배경이되는혈관과립조직의과증식을특징으로합니다. 갈색종양은골격의어느부분에위치할수있지만갈비뼈, 쇄골, 사지및골반에서자주접하게됩니다. 두개안면골에서의임상적으로유의한병변은드뭅니다. 말기신부전으로신장이식을받았으며이차성부갑상선항진증으로인해상악과하악에갈색종양이있는환자가치열안면변형에대한진단및치료를위해본원내분비내과로부터구강악안면외과로의뢰되었습니다. 이증례보고에서우리는두개안면부위에발생한갈색종양에의해발생한치열안면병형증이있는환자에서의악교정수술및경과에대해보고하고자한다 Diagnosis and treatment of patients with craniofacial deformity due to brown tumor : Case report Seok-Hwan Hong *, Jun-young Kim, Jin-hoo Park, Hwi-Dong Jung, Young-Soo Jung Department of Oral & Maxillofacial Surgery, College of Dentistry, Yonsei University, Seoul, Korea The brown tumor of hyperparathyroidism is histopathologically identical to the central giant cell granuloma of the jaws, a benign tumorlike lesion that usually affects teenagers and young adults. Both lesions are characterized by a proliferation of exceedingly vascular granulation tissue, which serves as a background for numerous multinucleated osteoclast-type giant cells They can be located in any part of the skeleton, but are most frequently encountered in the ribs, clavicles, extremities, and pelvic girdle. Clinically significant lesions in the craniofacial bones are rare. One patient was diagnosed with end-stage renal disease and underwent renal transplantation. The patient with a maxillary and mandibular brown tumor due to secondary hyperparathyroidism was referred to department of oral maxillofacial surgery for diagnosis and treatment of dental facial deformity. In this case report, we report a case of orthognathic surgery and its progress in a patient with dentofacial deformity caused by a brown tumor of the craniofacial region 제 57 차종합학술대회및정기총회 83

84 PⅠ-29 3 급부정교합환자에서 Condyle positioner 를이용한악교정수술후하악과두의 3 차원적위치변화분석 강효선 *, 심유송, 고성혁, 허재진, 안준형, 한정준, 정승곤, 국민석, 오희균, 박홍주전남대학교치의학전문대학원, 구강악안면외과학교실, 전남대학교치의학연구소 서론 : 본연구의목적은악교정수술시 Condyle positioner 를이용하여과두위치를고정한환자에서의하악과두의 3 차원적인위치변화를분석하기위함이다. 방법 : 본연구는 2012년 1월부터 2016년 12월까지하악전돌증을주소로전남대학교병원구강외과에서악교정수술을시행한환자중수술시 condyle positioner를이용한 39명의환자를대상으로하였다. 이중 13명의환자는양악수술을, 26명의환자는편악수술을시행하였다. 모든환자는수술시반견고고정을시행받았으며, OnDemand3D 프로그램을이용하여수술전, 수술직후, 수술 6개월후촬영한전산화단층촬영을영상을분석하였다. 하악과두의위치변화는양측하악과두중심의수술시발생한위치변화와수술후발생한위치변화를통해평가분석하였다. 결과 : 편악수술과양악수술을시행한두그룹모두에서, 수술직후과두는외후방으로변위되는경향성을보였다. 평균후방변위량은편악수술환자에서각각 0.2±0.6mm, 양악수술환자에서우측 0.3±0.5mm, 좌측 0.5±0.6mm 으로나타났다. 경과관찰후과두는다시내전방으로변위되는양상을보였으며평균전방변화량은편악수술환자에서우측 -0.1±0.6mm, 좌측 -0.0±0.7mm, 양악수술환자에서우측 -0.2±0.4mm, 좌측 -0.4±0.5mm 으로나타났다. 수술전과경과관찰기간후의과두위치변화량을비교하였을때, 두그룹모두에서과두의변화는크지않았으나, 편악수술환자의좌측과두변화량은통계적으로유의하게나타났다. 고찰및결론 : 이상의결과는악교정수술직후과두는외후방으로변위되지만, 경과관찰후다시내전방으로회귀되는경향을보이는것을시사한다. 이와같은변화의경향성에도불구하고, 임상적으로수술전후의과두위치는유의할만한변화가없다는것을말해준다. Three-dimensional Analysis of Postoperative Condylar Positional Changes after Orthognathic Surgery using Condylar Positioner Hyo-Sun Kang *, You Song Sim, Yeon Woo Jeong, Jae-Jin Heo, Jun-Hyeong An, Jeong Joon Han, Seunggon Jung, Min- Suk Kook, Hee-Kyun Oh, Hong-Ju Park Department of Oral and Maxillofacial Surgery, School of Dentistry, Dental Science Research Institute, Chonnam National University Introduction: The purpose of this study was to analyze the change of three-dimensional position of the mandibular condyle using 3D CT after orthognathic surgery using condylar positioner. Method and materials: This study was performed on 39 patients who underwent orthognathic surgery from to at OMFS in Chonnam National University Hospital. 13 patients underwent orthognathic surgery with both jaw, and 26 patients were done one jaw surgery. All patients underwent semi - rigid fixation after surgery. The changes of mandibular condyle position were evaluated by analyzing preoperative, postoperative, and 6 months follow - up computed tomography using OnDemand3D program. The position of the mandibular condyle was evaluated by the change of the position during surgery and the change of the position after operation. Results: Immediately after operation, the condyle showed a tendency to displace posterolaterally in both one jaw and two jaw surgery groups. Mean posterior displacement was 0.2±0.6mm of both condyle one jaw patients, respectively. In two jaw surgery group, the values were shown 0.3±0.5mm on right side, 0.5±0.6mm on left side. After the follow up, the condyle moved to anteromedially. The mean anterior displacement was -0.1±0.6mm on right side and -0.0±0.7mm on left side in one jaw surgery group, -0.2±0.4mm on right side and -0.4±0.5mm on left side in two jaw surgery group. There was no significant difference in the amount of condylar changes in both groups before and after the operation, except the left condyle of one jaw surgery group. Conclusion: With respect to movements, the condyle moved posterolaterally immediate after surgery, but returned to the anteromedially during the postoperative retention period. In spite of this movement tendency, there is no significant change in the condylar position before and after surgery clinically. 84 대한악안면성형재건외과학회

85 PⅠ-30 양악수술시 CAD/CAM splint 의두가지다른시스템에대한비교연구 : Orapix versus simplant 조극제 *, 이성탁, 최소영, 김진욱, 권대근경북대학교치의학전문대학원구강악안면외과학교실 서론및목적 : Lefort 1 골절단술은중안모의골격부조화를개선하기위해일반적으로사용되는술식이다. 정확한수술을위해서는수술시악골을계획된위치로이동시키기위해사용되는수술용스플린트를정확하게제작하는것이필수적이다. 전통적으로 model surgery를시행하여기공실과정을통해 intermediate splint( 중간장치 ) 를제작하였으나, 최근컴퓨터를이용한가상모델을통하여중간장치를제작하여임상에이용되고있다. 본연구에서는두가지다른제작시스템하에서제작된중간장치의수술전예측치와수술후실측치차이에관하여비교하여각중간장치의정확도에대하여연구해보고자한다. 방법 : 2016년 2월부터 2018년 7월까지경북대학교치과병원구강악안면외과에서전신마취하 Lefort 1급골절단술을시행한환자중술전, 후데이터가모두갖추어진환자를대상으로하였다. 일부환자들 (n=28) 은수술시 orapix시스템을이용하여중간장치를제작하였고, 나머지환자들 (n=26) 은 Simplant 시스템을이용하여중간장치를제작하여 Lefort 1급골절단술에사용하였다. 각환자는수술전 1달이내의 CBCT와수술후 1달이내의 CBCT를 OnDemand3D (cybermed, Seoul, Korea) 를이용해중첩하여상악중절치및상악양측제 1대구치의수직적, 수평적위치를비교하였다. 결과 : Orapix system을이용한환자군에서상악중절치에서평균차이는 ()mm, 표준편차는 ()mm이고, 상악양측제 1대구치에서평균차이는 ()mm, 표준편차는 ()mm였다. Ceptech system을이용한환자군에서상악중절치에서평균차이는 ()mm, 표준편차는 ()mm이고, 상악양측제 1대구치에서평균차이는 ()mm, 표준편차는 ()mm였다. Orapix 및 Ceptech 시스템을이용하여수술한각환자에서수술전예측치와수술후실측치사이에유의한차이가없었다. (P= ) 결론 : Lefort 1급골절단술에서각기다른 CAD/CAM system을이용하여제작된중간장치는악교정수술의정확성을향상시키고, 효율적인수술을시행할수있게한다. 향후, CAD/CAM 시스템의발전과더불어수술의정확도를향상시키는방법에대한지속적인연구가필요할것으로생각된다. Comparison of the two different type of CAD/ CAM splint for maxillomandibular osteotomy ; Orapix versus Simplant Keuk-Je Cho *, Sung-Tak Lee, So-Young Choi, Jin-Wook Kim, Tae-Geon Kwon Dept. of Oral and Maxillofacial surgery, School of Dentistry, Kyungpook National University, Daegu, Republic of Korea Purpose: LeFort I osteotomy is a surgery commonly used to improve skeletal discrepancy. For accurate surgery, the surgical splint used to move the jaws to the planned position during surgery should be made correctly. Convetional model surgery was performed to fabricated an intermediate splint through the various laboratory steps. Recently, CAD/CAM system has been applied to fabricate an intermediate splint. In this study, we compare the pre-operative predictions and postoperative differences of the intermediated splint fabricated under two different CAD/CAM sytems to investigate the accuracy of each splint. Methods: Patients that underwent Lefort I osteotomy under general anesthesia from to in Department of Oral & Maxillofacial surgery, KyoungPook National University were investigated. One group(n=28) used the Orapix (Orapix, Seoul, Korea) system to fabricate an intermediate splint. Other group(n=26) used the ceptech (Ceptech, Seoul, Korea) system to fabricate an intermediate splint. Each patient compared CBCT taken within 1month before surgery, and CBCT within 1 month after surgery. Each CBCT were superimposed to compare the vertical and horizontal position of the maxillary central incisors and the maxillary first molars by OnDemand3D(cybermed, Seoul, Korea) program. Result: Group used the Orapix system s average difference in maxillary central incisor was ()mm(± mm). Average difference in maxillary first molar was ()mm (± mm). Group used the Ceptech system s average difference in maxillary central incisor was ()mm(± mm). Average difference in maxillary first molar was ()mm (± mm). There was no significant difference between the preoperative values and the postoperative values in each group. Conclusion: Intermediate devices made using different CAD/ CAM systems in Lefort I osteotomy improve the accuracy of orthognathic surgery and enable efficient surgery. In the future, we expect to continue research on how to improve the accuracy of surgery with the development of CAD/CAM system. 제 57 차종합학술대회및정기총회 85

86 PⅠ-31 Volumetric comparison of maxillofacial soft tissue morphology: CT in the supine position versus three-dimensional optical scanning in the sitting position Yoshihiro Yamaguchi *, Hikari Suzuki, Shinnosuke Nogami, Kensuke Yamauchi, Tetsu Takahashi Department of Oral and maxillofacial surgery, Graduate School of Dentistry Introduction: Three-dimensional (3D) surgical simulation has become popular, but the accuracy of such simulation is difficult to assess. Because maxillofacial soft tissue profiles vary with posture, we compared such profiles obtained in the supine and sitting positions. Materials and Methods: In total, 28 patients with skeletal class III jaw deformities underwent computed tomography (CT) in the supine position and 3D optical scanning in the sitting position. The two sets of 3D data were superimposed, and linear and volumetric differences were calculated. We evaluated the cheeks, the subauricular and infraorbital regions, the nose, the lips, and the chin. Statistical analyses were performed using paired Student s t-tests. Differences with P < 0.05 were considered to be significant. Results: Patients were divided into three groups based on body mass index (BMI). The facial profiles of the cheeks and subauricular areas differed significantly between the sitting and supine positions. The extent of variation increased with BMI. Conclusions: When a patient moves from a sitting to a supine position, maxillofacial soft tissue migrates from the cheeks to the subauricular regions. Thus, simulations for surgery based on supine CT alone do not accurately model the cheeks and subauricular areas. 86 대한악안면성형재건외과학회

87 PⅠ-32 3 급부정교합환자에서 Condyle positioner 를이용한악교정수술후하악과두의 3 차원적위치변화분석 강효선 *, 심유송, 고성혁, 허재진, 안준형, 한정준, 정승곤, 국민석, 오희균, 박홍주전남대학교치의학전문대학원, 구강악안면외과학교실, 전남대학교치의학연구소 서론 : 본연구의목적은악교정수술시 Condyle positioner 를이용하여과두위치를고정한환자에서의하악과두의 3 차원적인위치변화를분석하기위함이다. 방법 : 본연구는 2012년 1월부터 2016년 12월까지하악전돌증을주소로전남대학교병원구강외과에서악교정수술을시행한환자중수술시 condyle positioner를이용한 39명의환자를대상으로하였다. 이중 13명의환자는양악수술을, 26명의환자는편악수술을시행하였다. 모든환자는수술시반견고고정을시행받았으며, OnDemand3D 프로그램을이용하여수술전, 수술직후, 수술 6개월후촬영한전산화단층촬영을영상을분석하였다. 하악과두의위치변화는양측하악과두중심의수술시발생한위치변화와수술후발생한위치변화를통해평가분석하였다. 결과 : 편악수술과양악수술을시행한두그룹모두에서, 수술직후과두는외후방으로변위되는경향성을보였다. 평균후방변위량은편악수술환자에서각각 0.2±0.6mm, 양악수술환자에서우측 0.3±0.5mm, 좌측 0.5±0.6mm 으로나타났다. 경과관찰후과두는다시내전방으로변위되는양상을보였으며평균전방변화량은편악수술환자에서우측 -0.1±0.6mm, 좌측 -0.0±0.7mm, 양악수술환자에서우측 -0.2±0.4mm, 좌측 -0.4±0.5mm 으로나타났다. 수술전과경과관찰기간후의과두위치변화량을비교하였을때, 두그룹모두에서과두의변화는크지않았으나, 편악수술환자의좌측과두변화량은통계적으로유의하게나타났다. 고찰및결론 : 이상의결과는악교정수술직후과두는외후방으로변위되지만, 경과관찰후다시내전방으로회귀되는경향을보이는것을시사한다. 이와같은변화의경향성에도불구하고, 임상적으로수술전후의과두위치는유의할만한변화가없다는것을말해준다. Three-dimensional Analysis of Postoperative Condylar Positional Changes after Orthognathic Surgery using Condylar Positioner Hyo-Sun Kang *, You Song Sim, Yeon Woo Jeong, Jae-Jin Heo, Jun-Hyeong An, Jeong Joon Han, Seunggon Jung, Min- Suk Kook, Hee-Kyun Oh, Hong-Ju Park Department of Oral and Maxillofacial Surgery, School of Dentistry, Dental Science Research Institute, Chonnam National University Introduction: The purpose of this study was to analyze the change of three-dimensional position of the mandibular condyle using 3D CT after orthognathic surgery using condylar positioner. Method and materials: This study was performed on 39 patients who underwent orthognathic surgery from to at OMFS in Chonnam National University Hospital. 13 patients underwent orthognathic surgery with both jaw, and 26 patients were done one jaw surgery. All patients underwent semi - rigid fixation after surgery. The changes of mandibular condyle position were evaluated by analyzing preoperative, postoperative, and 6 months follow - up computed tomography using OnDemand3D program. The position of the mandibular condyle was evaluated by the change of the position during surgery and the change of the position after operation. Results: Immediately after operation, the condyle showed a tendency to displace posterolaterally in both one jaw and two jaw surgery groups. Mean posterior displacement was 0.2±0.6mm of both condyle one jaw patients, respectively. In two jaw surgery group, the values were shown 0.3±0.5mm on right side, 0.5±0.6mm on left side. After the follow up, the condyle moved to anteromedially. The mean anterior displacement was -0.1±0.6mm on right side and -0.0±0.7mm on left side in one jaw surgery group, -0.2±0.4mm on right side and -0.4±0.5mm on left side in two jaw surgery group. There was no significant difference in the amount of condylar changes in both groups before and after the operation, except the left condyle of one jaw surgery group. Conclusion: With respect to movements, the condyle moved posterolaterally immediate after surgery, but returned to the anteromedially during the postoperative retention period. In spite of this movement tendency, there is no significant change in the condylar position before and after surgery clinically. 제 57 차종합학술대회및정기총회 87

88 PⅠ-33 IVRO 를이용한선수술환자에서 Surgical occlusion setup 양상에따른술후안정성및치료기간에대한후향적연구 최한솔 *1, 김준영 1, 박진후 1, 정휘동 1, 정영수 1 1 연세대학교치과대학병원구강악안면외과학교실 본연구의목적은구내하악지수직골전달술을동반한선수술환자에서 Surgical occlusion setup과관련된요소들이술후안정성및총치료기간과의관계를후향적으로평가하는것이다. 하악전돌증또는비대칭환자중교정적으로발치를시행하지않고, 선수술을이용한양악동시악교정수술 ( 상악 Lefort I 골절단술, 하악골상행지수직골절단술 ) 을받은 40명의환자를대상으로하였다. 상악과하악의치아모형및모형스캔을시행한 stl file을이용하여 surgical occlusion setup과관련된변수들을측정하였으며다음과같다. 1) 치아접촉점의개수, 2) Canine & Molar key, 3) 전치부수직피개 / 수평피개, 4) 상악과하악의악궁폭, 5) 정중선변위정도, 6) Arch width discrepancy, 7) U1 to SN, IMPA 술전, 술후 1개월, 3개월, 6개월, 1년째 Cephalogram을촬영하였으며기준선에대한상하악의주요기준점의위치를측정하여술후안정성을평가하였다. 또한교정완료까지의총치료기간에대하여평가하였다. Postoperative stability and duration of treatment according to surgical occlusion setup in Surgery-First Approach using IVRO : A retrospective study Hansol CHOI *1, Jun-Young Kim 1, Jin Hoo Park 1, Hwi-Dong Jung 1, Young-Soo Jung 1 1 Department of Oral and Maxillofacial Surgery, College of Dentistry, Yonsei University, Seoul, Korea The purpose of this study was to evaluate the relationship between surgical occlusion setup in Surgery-First approach using IVRO and the post-operative stability, total duration of treatment retrospectively. The samples consisted of 40 patients with mandibular prognathism who underwent nonextraction orthodontic treatment and 2-jaw surgery-first (Le Fort I osteotomy impaction of the posterior maxilla, IVRO) The variables related to surgical occlusion setup were measured by using casts of maxilla and mandible, and scanning model stl file. The variables were as follows 1) the number of contact point, 2) Canine & Molar key, 3) Incisor Overbite/Overjet, 4) Maxilla and Mandible Arch width, 5) Midline discrepancy, 6) Arch width discrepancy, 7) U1 to SN, IMPA Cephalograms were taken at preoperative time and 1 month, 3 months, 6 months, and 1 year postoperatively. Postoperative stability was assessed by measuring location of the major landmarks of Maxilla and Mandible for the reference line. Also, the total duration of treatment until the completion of orthodontic treatment was evaluated. 88 대한악안면성형재건외과학회

89 PⅠ-34 서울대학교치과병원의폐쇄성수면무호흡 (OSA) 환자의수술적치료프로토콜 박상헌 *, 최진영서울대학교구강악안면외과학교실 개요 : 폐쇄성수면무호흡증은수면중상기도의폐쇄로인한심각한수면장애중하나이다. 이것은저산소혈증으로이어지고피로감을유발하며낮에는과도한졸음을유발한다. 다른일반적인특징으로는큰소리로코고는소리, 질식하는소리에서깨어나기, 인지기능의저하등이있다. 그리고당뇨병, 심장병, 고혈압, 뇌졸중과주간에졸음으로인한자동차사고의위험을높이는등심각한부정적인결과가있다. OSA화자에대한비외과적치료의경우지속적양압기가표준치료법이다. 외과적치료법으로는편도절제술, 구개수구개인두성형술, 이설근전진술, 설기저축소술, 상하악전진술, 견인골형성술이 SUNDH를방문한 OSA환자를위해서시행되었다. 재료및방법 : 2012 년부터 2018 년까지서울대학교치과병원에폐쇄성수면무호흡증의증세로외래에내원한환자들을연구했다. 진단및치료계획은한명의외과의사에의해수립되었다. 진단, 치료계획, 각수술및치료결과에대한연구를하기위해치과차트, 수면다원검사및CT가검토되었다. 치료는임상증상의심각도와해부학적위치에따라다양했다. 결과 : 총 37 명의환자가 OSA 증상에대해서치료를받았다. 성별은여성이 5명, 남성이 32명이었으며평균연령이 36세였다. SNUDH 에서는 MMA가 17 명, GMA가 16 명, TBR이 2 명, DO가 1 명, UP3 15 명이었다. 경험이풍부한한명의외과의사가모든수술을수행했으며심각한합병증은관찰되지않았다. 토의 : 여러치료방법을조합하면 OSA 환자의치료목표를달성할수있다. 술자가 OSA 환자의적응증을확인하고적용하는경우보존적인치료방법이실패한환자에게있어서외과적접근은훌륭한대안이될수있다. 직립상태에서앙와위상태로자세로바뀌면상부기도의단면적이혀밑면에서 32 %, 설측후방에서 50 % 감소한다는것이입증되었다. 따라서환자마다 OSA의원인을파악하는진단과이에대한적절한수술계획확립이환자의치료에있어서매우중요한과정이다. Protocol of Surgical Treatments for Obstructive Sleep Apnea in Seoul National University of Dental Hospital Sang Hun Park * Jin-Young Choi Department of Oral and Maxillofacial Surgery, Seoul National University, Dental Hospital, Seoul, Korea Introduction. Obstructive sleep apnea (OSA) is a potentially serious sleep disorder caused by upper airway collapsibility during sleep. This resulting to hypoxemia and provokes fatigue and, excessive daytime sleepiness. Other common features include loud snoring, awakening from gasping or choking, and decrease of cognitive functions. There are additional severe negative consequences including diabetes, heart disease, hypertension, stroke, and a higher risk of motor vehicle accidents from daytime somnolence. For non-surgical treatment for OSA patient, continuous positive airway pressure (CPAP) is the standard treatment of choice. For surgical treatment, uvulapalatopharryngoplasty, tonsillectomy, genioglossus muscle advancement(ga), tongue base reduction (TBR), maxillomandibular advancement (MMA), distraction osteogenesis (DO) is applied according to the severity of clinical symptom and obstruction location Patients and Methods: Between 2012 and 2018, we studied the patients who came to the out patient clinic with symptoms of obstructive sleep apnea. The diagnosis and treatment plan was established by one surgeon. Dental chart, polysomnography and CT scan were review to study the diagnosis, treatment plan, indication for each surgery and treatment outcome. The treatments varied according to the severity of clinical symptoms and anatomic location of obstruction. Results: Total 37 patient under went treatment for OSA. Gender ratio was 5 female and 32 male with average age of 36 years old. The age was ranged from 8 to 64. In SNUDH, we performed MMA to 17 patients, GMA to 16 patients, TBR to 2 patient, DO to 1 patient, and UP3 to 15 patients. The one experienced surgeon performed all cases and serious complication was not observed. Discussion: Several procedures can be achieved the goals of OSA patients. If surgeon identify and apply indications of OSA patients, surgical approach is the appropriate alternative for the failure of conservative treatments. It has been demonstrated that changing from an upright to a supine position decreases the cross sectional area of the upper airway by 32% at the tongue base and 50% at the level of the retrolingual airway. Therefore combination of procedures to address this problem have been developed and proper patient selection is important. 제 57 차종합학술대회및정기총회 89

90 PⅠ-35 구내수직 - 시상상행지분할골절단술후측두하악관절의 3 차원적관찰 정필훈, 김영우 *, 정한울서울대학교치과병원구강악안면외과 목적 : 전통적으로악교정수술에서의하악골절단술은 BSSRO 혹은 IVRO로시행되었다. 두수술법은골절선이하악체의실제시상면이아닌다소사선으로주행하며이에따른하악과두의변위가동반된다. 구내수직-시상상행지분할골절단술은하악체의실제시상면에평행한골절단을시행하여술후측두하악관절의변화없이이상적으로하악골을후방이동시킬수있다. 이에구내수직-시상상행지분할골절단술시행후측두하악관절의 3차원적변화를고찰하고자한다. 방법 : 구내수직-시상상행지분할골절단술시행전과후 CT 촬영을시행하였으며, 시상면, 관상면, 횡단면적위치변화와각도변화를관찰하였다. 결론 : 술자및환자에따라시상절단면이실제시상면과차이가있을수있으나골절단술전과두의위치및각도변화는적은것으로나타났다. 3D Findings of Temporomandibular Joint after Intraoral Vertico-Sagittal Ramus Osteotomy (IVSRO) Pil-hoon Choung, Yeong Woo Kim *, Han-Wool Choung Department of Oral and Maxillofacial Surgery, Seoul National University Objective: Traditionally, mandibular osteotomy in orthognathic surgery was performed with BSSRO or IVRO. Since the two surgical procedures have fracture line that crosses obliquely rather than true sagittal plane, condyle displacement is accompanied. Intraoral verticosagittal ramus osteotomy (IVSRO) can ideally move the mandibular backward without changing the position of temporomandibular joint by parallel to the true sagittal plane of the mandibular body. In this study, the three-dimensional changes of the temporomandibular joint are considered after operation of IVSRO. Method: CT scans were performed before and after field vertical-proportional segmentation fracture techniques were performed, and the changes in the sagittal plane, coronary plane, cross section position and angle changes were observed. Conclusion: Depending on the operator and the patient, the sagittal fracture line may differ from the true sagittal plane, but it has been shown that the position and angle changes of TMJ was little. 90 대한악안면성형재건외과학회

91 PⅠ-36 술후하악골의 3 차원기하학적형태비교분석 : 하악골수직골절단술과시상분할골절단술 김진규 *1, 하태욱 1, 김학진 1, 유상진 2, 이상휘 1 1 연세대학교치과대학구강악안면외과학교실 2 포스유구강악안면외과치과의원 구강악안면영역의골격적형태-기능문제를해결하기위해악교정수술은널리시행되고있다. 하악골에대한악교정수술법은하악지수직골절단술과시상분할절단술이주로사용되고있으며, 두방법은각자의장단점을가지고있어술자에따라선호수술방법에차이가있다. 하악골전돌증의치료를위한술식의적용은하악골이부혹은 Pogonion의전후방위치가두개골혹은 Nasion에대하여갖는상대적위치를기준으로사용한다. 이러한위치중심의수술방법적용이결과적으로정상적인하악골형태를가져오는지, 아니면그렇지않은지에대하여는관심이적었다. 따라서술후하악골의형태적특성을정상인들과비교하여평가할필요가있겠다. 저자들은이미 3차원전산화단층촬영영상데이터를기반으로하여하악골을크기와방향성을동시에분석할수있도록골격단위벡터 (skeletal unit vector) 를이용하여하악골형태를분석하였었다. 이에저자들은정상인의하악골과, 비대칭없는전돌증의하악골중양측성하악지수직골절단술과양측성시상분할절단술을시행한하악골에서수술전, 후의기하학적구조를벡터분석하고비교하였다. 이를통해각각의하악골수술법에따른하악골의구조적변화와이에따른정상인하악골과의관계를알아보고자한다. 3D morphometric comparison of postoperative mandibular structure after IVRO and SSRO Jin-kyu Kim *1, Tae-Wook Ha 1, Sang-Jin Yu 2, Sang-Hwy Lee 1 1 Department of Oral & Maxillofacial Surgery, Yonsei University College of Dentistry, Seoul, Korea 2 Department of Oral & Maxillofacial Surgery, FOS-U dental clinic, Seoul, Korea Orthognathic surgery is generally performed to treat the structural and/or functional problem in oral and maxillofacial area. Intraoral vertical ramus osteotomy (IVRO) and sagittal split ramus osteotomy (SSRO) are two representative surgical methods for mandibular orthognathic technique, and the surgeon has his/her own preference of technique based on philosophy and experiences. The surgical application for mandibular prognathism relies on the relative position of the chin or pogonion to the cranium or nasion. But it has not been well documented whether this position-based surgical application can be justified in terms of the structural integrity of the postoperative mandible. Authors already achieved three-dimensional mandibular skeletal unit vector analysis for mandibular structures. Here we wanted to analyze three-dimensional structures of postoperative mandibles after IVRO or SSRO and, to compare them with the normal mandible as well as their preoperative one. And this will reveal the critical relationship between the mandibular surgical technique and its dependent postoperative mandibular structures or normal mandibles. 제 57 차종합학술대회및정기총회 91

92 PⅠ-37 선수술접근법으로시행한악교정수술이측두하악관절에미치는영향에대한후향적연구 안준형 *, 한정준, 정승곤, 국민석, 박홍주, 오희균전남대학교치의학전문대학원구강악안면외과학교실 배경 : 치아골격성부정교합의교정을목적으로하는선교정접근법은상당한시간과노력이요구되는술전교정치료가필요하다. 그러므로, 최근에는선수술접근법이선호된다. 선교정접근법을이용한악교정수술이측두하악관절에미치는영향에대한연구는많이시행되었으나, 선수술접근법을통한악교정수술이측두하악관절에미치는영향에대한더많은연구가필요하다. 목적 : 선수술접근법으로악교정수술을시행한환자의수술전후의측두하악관절에미치는영향을평가하고자한다. 방법 : 2011년부터 2016년까지본원에내원하여선수술접근법으로악교정수술을시행받은 109 명의환자들의의무기록과영상검사를확인하였다. 결과 : 1. 술전턱관절부위통증은 8명 (7.3%), 턱관절음 2 명 (1.8%), 정복성관절원판변위가 3명 (2.8%) 에서존재하였다. 술후 6개월에술전과비슷한통증이존재하는환자는 1명이었으며나머지환자들은증상이개선되었다. 2. 술후 6개월에술전턱관절부위에증상이없었던환자들중, 턱관절부위통증은 2명 (1.8%), 개구제한은 2명 (1.8%) 이호소하였다. 결론 : 이상의결과들은선수술접근법으로시행한악교정수술시기존의측두하악관절의증상에개선효과가있으며, 새로운합병증을유발할확률이낮음을시사한다. A Retrospective Study on Influence of the Orthognathic Surgery via Surgery-First Approach(SFA) on the Temporomandibular Joint(TMJ) Jun-Hyeong An *, Jeong Joon Han, Seunggon Jung, Min-Suk Kook, Hong-Ju Park, Hee-Kyun Oh Department of Oral and Maxillofacial Surgery, School of Dentistry, Chonnam National University Background: The orthodontic-first approach(ofa) for correction of the dentoskeletal malocclusion needs preoperative orthodontic treatment which requires considerable time and effort. Therefore, SFA is preferred recently. Many studies on the influence of TMJ after orthognathic surgery via OFA reported. However, further study on the influence of TMJ after orthognathic surgery via SFA is needed. Purpose: To evaluate the effectiveness through a study on the patients who had the orthognathic surgery via surgeryfirst approach using bilateral sagittal split ramus osteotomy (BSSRO). Methods: We evaluated the clinical examination, patient s records and radiographic images in 109 cases of the patients from 2011 to Results: 1. Some of the patients showed preoperative pain on the TMJ (n=8, 7.3%), clicking sound (n=2, 1.8%), disc displacement with reduction (n=3, 2.8%). One of the patients who showed preoperative pain still showed similar symptom at 6 months follow-up. 2. Some of the patients who had no symptoms before the orthognathic surgery showed postoperative pain (n=2, 1.8%), mouth opening limitation (n=2, 1.8%). Conclusions: These results suggest that orthognathic surgery via SFA has improvement effect on the symptoms of the TMJ and has low probabilities in which new complications are induced. 92 대한악안면성형재건외과학회

93 PⅠ-38 반안면왜소증하악골 3 차원구조의성장시기별형태비교 Helios Bertin *1, 김봉철 2, 김학진 3, 강상훈 4, Jacques Mercier 1, Jean-Philippe Perrin 1, Pierre Corre 1, 이상휘 3 1 Stomatology and Maxillo-facial Surgery Unit, Nantes University Hospital, 1Place Alexis-Ricordeau, Nantes Cedex 1, France 2 원광대학교치과대학대전치과병원구강악안면외과 3 연세대학교치과대학구강악안면외과학교실 4 보험공단일산병원, 구강악안면외과 목적 : 본연구의목적은반안면왜소증 (Hemifacial macrosomia, HFM) 하악골의 3차원적골격특성을이해하는것이며, 특히치료를위해성장저하된골격부위를찾아골격단위에맞춰분석하는것이다. 또한치료시기와관련된성장잠재력을이해하기위해여러연령에따른반안면왜소증의하악골구조를비교하는것이다. 방법 : 본연구를위해우리는 HFM(N=28, II군 ) 과정상군 (N=27, I군 ) 의한국과프랑스환자를대상으로 3차원 CT 영상을재구성하였다. 각하악은 Pruzansky의 HFM 유형 I, II 및 III 및연령그룹 ( 아동, 청소년, 성인 ) 별로분류하였다. 하악은과두돌기부, 몸체부, 오훼돌기부및우각부를포함한골격단위로나뉘었다. 길이와각도를측정하고통계적으로분석하였다. 결과 : 그결과어린연령군에서제2형의 HFM 의과두돌기부와제 3형의과두 / 오훼돌기부가다른부위에비해작았다. 골격단위간의각도에서는제2형에서연령증가에따라정상치에가까워지는경향을보였으나, 정상치는아니었다. 결론 : 본연구에서는 HFM에서는주로과두돌기부가영향을받으며, 몸체부가다음으로영향을받는것을알수있었으며, 제2형에서연령증가에따라개선이되는것을확인하였다. 하악골골격단위분석은 HFM의성공적인재건을위한계획을수립하기위한시뮬레이션을포함해, 주요한병인발생부위및치료계획의확인을허용하는개별화된진단을위한유용한도구로생각된다. Structural comparison of hemifacial microsomia mandible in different age groups by three-dimensional skeletal unit analysis Helios Bertin *1, Bong Chul Kim 2, Hak-Jin Kim 3, Sang-Hoon Kang 4, Jacques Mercier 1, Jean-Philippe Perrin 1, Pierre Corre 1, Sang-Hwy Lee 3 1 Stomatology and Maxillo-facial Surgery Unit, Nantes University Hospital, 1 Place Alexis-Ricordeau, Nantes Cedex 1, France 2 Dept. of Oral and Maxillofacial Surgery, Daejeon Dental Hospital, Wonkwang University, College of Dentistry, Daejeon, Korea 3 Dept. of Oral and Maxillofacial Surgery, Yonsei University, College of Dentistry, Seoul, Korea 4 Dept. of Oral and Maxillofacial Surgery, National Health Insurance Service, Ilsan Hospital, Goyang-si, Korea Purpose: The goal of this study was to understand the threedimensional (3D) structural characteristics of hemifacial microsomia (HFM) mandible in terms of skeletal units, especially to locate the underdeveloped skeletal regions for treatment. Another goal was to compare the HFM structure of different age groups to understand growth potential relevant to treatment scheduling. Materials and Methods: We reconstructed 3D mandibles from computed tomographic images of French and Korean patients with HFM (N=28; group II) and normal subjects (N= 27; group I). Each mandible was classified by Pruzansky s HFM types I, II and III, and by age group (child, adolescent, and adult). The mandible was divided into skeletal units, and geometrical representation by skeletal unit line was performed, including the condylar, body, coronoid, and angular units. Their length and angulations were measured and statistically analyzed. Results: The results showed that the affected condylar unit in type II HFM and the condylar/coronoid unit in type III were smaller in young age groups than were other units. The angulation between the skeletal units in type II, though not type III, tended toward normalcy with age, but not to the normal degree of angulations in group I. Conclusion: Our study shows the major involvement of condylar unit and minor involvement of body unit for HFM, improving with age in type II. The mandibular skeletal unit analysis seems to be a useful tool for individualized diagnosis, allowing identification of the major etiopathogenic area and treatment planning, including a simulation to set up a regimen for successful reconstruction of HFM. 제 57 차종합학술대회및정기총회 93

94 PⅠ-39 다양한저작시윤곽수술을시행한하악골에대한응력분포의유한요소분석 윤영재 1*, 노건우 3, 권용대 2 1 경희대학교일반대학원구강악안면외과 2 경희대학교치과병원구강악안면외과 3 경북대학교공과대학기계공학부 서론 : 아시아에서는사각모양의얼굴형보다 V-line 얼굴형을더매력적이라고생각한다. 따라서하악골윤곽수술은동양국가에서널리보급되어있다. 많은문헌에따르면, 하악골윤곽수술은하악골의안정성을위태롭게할수있다. 이연구의목적은하악골윤곽수술후저작을할때하악골의응력을유한요소해석 (FEA) 을이용하여분석하는것이다. 방법 : 전산화단층촬영 (CT) 스캔과유한요소방법론을바탕으로인간하악골과치아의 3 차원 (3D) 모델을얻었다. 획득된 3 차원모델로가상의하악각윤곽수술 (S1), 하악각윤곽수술과함께하악피질골절제술 (S2) 을시행하였다. 하악골의물성은 CT 영상으로부터측정된 Hounsfield 단위에기초하였다. 경계조건은양쪽하악과두는모든방향고정하였고전치부, 오른쪽대구치, 오른쪽견치와구치부를 Z축고정하였다. 그리고각저작근육에해당하는힘을부여하였다. 하악과두, 각및수술부위에대한전체변형에너지와 Von Mises 응력분포를유한요소분석을사용하여평가하였다. 결과 : RMOL 저작시에 S2 모델은가장높은변형에너지와 Von Mises 응력을보였다. S0, S1 모델에서 angle과수술부위보다과두부위의스트레스가더높았다. 수술부위에서는 S2 모델에서가장높은스트레스를보였다. 결론 : 스트레스는수술부위, 하악과두및각에집중되었다. S2의경우, RMOL 저작시에골흡수가일어나고골절의가능성이있다. 이연구결과에서는수술로인해생체역학이크게바뀌기때문에하악골윤곽수술이하악골의취약성과관련이있을수있음을나타내며수술정도는하악골의스트레스및골절위험의결정요인이될수있다. 그러므로임상가들은수술후환자의안전한예후를위해정확하고올바른수술계획을수립하여야한다. A finite element analysis of the stress distribution to the mandible after contouring surgery with various clenching tasks. Young Jae Yoon 1*, Gunwoo Noh 3, Yong Dae Kwon 2 1 Department of Oral&Maxillofacial Surgery, Graduate School, Kyunghee University, Seoul, Korea. 2 Department of Oral&Maxillofacial Surgery, School of Dentistry, Kyunghee University, Seoul, Korea. 3 Department of Mechanical Engineering, School of Engineering, Kyungpook National University, Daegu, Korea. Introduction: In Asian countries, a square-shaped face is considered to be an unappealing feature. Oriental people want to have a V-line shape, which is thought to be more attraction. Therefore, mandibular contouring surgery have been popularized in oriental countries. According to many literatures, mandibular contouring surgery may jeopardize the mechanical stability. The aim of this study was to analyze the stress of mandible during function after mandibular contouring surgery, using a finite element analysis(fea). Method: Based on computed tomography (CT) scans and finite element methodology, three-dimensional (3D) models of the human mandible and full dentition were obtained. The obtained 3D models were prepared by performing mandibular contouring surgery: mandibular angle contouring surgery(s1), sagittal cortical ostectomy of mandibular ramus and body with angle contouring surgery(s2). Mechanical properties of the mandible were based on Hounsfield unit measured from CT images. Boundary conditions to restrict movement on both condyle and clenching task were simulated in this study : Incisal clench(inc), Right unilateral molar clench(rmol), Right group function(rgf). Loading conditions of the element representing the masticatory muscle. Strain energy of the whole model and Von Mises stress distributions to the mandibular condyle, angle and surgical areas were evaluated using finite element analysis. Result: S2 model had the highest strain energy and Von Mises stress during RMOL clench task. Stresses were higher on the condylar region than on the angle and surgical region in S0, S1 model. The surgical region had the highest stress in S2 model. Conclusion: The stress concentrated at the site of operation, mandibular condyle and angle. In the case of S2, bone resorption may occur and there is a possibility of fracture during RMOL clench task. These results suggest that mandibular contouring surgery can be related to the fragility of the mandible, since operation significantly alters its biomechanics. Degree of surgery can be a determining factor in stress and fracture risk of mandible. Therefore, clinicians should establish an accurate and correct treatment plan for the safe prognosis of patients after surgery. 94 대한악안면성형재건외과학회

95 PⅠ-40 STO 시에기하연속성과기계학습을이용한 Pogonion 의위치결정 강성현 *1,2, 임대호 1,2, 백진아 1,2, 염정호 2,3, 고승오 1,2 1 전북대학교치과대학구강악안면외과교실 2 전북대학교병원임상의생명연구소 3 전북대학교병원의과대학예방의학교실 서론 : Surgical treatment objective(sto) 시에상하악복합체는 ANS, PNS, Pog을이은삼각형의회전중심및회전각의변화를통해심미적인결과를얻게된다. 이때이부의전방및수직위치결정은 NB line, A-Pog line 등을이용한다. 기존에존재하는다양한계측점과계측선, 그리고분석법의조합은직관적으로심미적결과를주지못한다. 이에심미적으로중요한 Pog의이상적인위치를결정함에있어 chin curve(id, point B, Pog, Gn, Me을모두지나며기존의분석법을만족시키는 R 2 chin의벡터방정식 ) 의기하연속성의해석을위해기계학습을도입해보고자한다. 방법 : Sella와 Nasion 및 TVL을축으로하는직교좌표계 R 을설정한다. ANS, PNS, point A/B, Pog, Menton을 R 2 의매개변수로설정하고, 기존분석법에서제시하는 Pog의위치를만족시키는이상적인 chin curve를가정한다. 기존의악교정수술환자에서최종부여된 Pog과다른기준점과의관계를기계학습시킨후에얻은매개변수를이용해수술대상환자의 Pog 위치를결정한후기존분석법으로검증한다. 결과 : 이미수술이이루어진환자로부터 Pog 값을학습시킨신경망모델을도출해낼수있었다. 또한, 기존의분석법으로검증해나가는과정을반복시켜학습시킨결과 STO시에 Pog 위치의예측모델을더욱단순화시킬수있었다. 고찰및결론 : 기계학습을통한기존악교정수술환자의 Pog 과다른기준점과의관계를해석할수있었다. 학습된 Pog 위치산출방식과기존의분석법들을모두만족시키는 chin curve를통합할수있었다. STO시에수리및임상적으로이상적인 Pog의위치를예측해낼수있을것으로기대된다. Positioning of the pogonion in STO using geometric continuity with machine learning Sung-Hyun Kang *1,2, Dae-Ho Leem 1,2, Jin-A Baek 1,2, Jung-Ho Youm 2,3, Seung-O Ko 1,2 1 Department of Oral and Maxillofacial Surgery, School of Dentistry, Chonbuk National Universityl, Jeonju, Korea 2 Research Institute of Clinical Medicine-Biomedical Research Institute, Chonbuk National University Hospital, Jeonju, Korea. 3 Department of Preventive Medicine, Chonbuk National University Medical School, Chonbuk National University Hospital, Jeonju, Korea. Introduction: At surgical treatment objective(sto), the maxillary and mandibular complexes will have aesthetic results by changing the center of rotation and rotation angle of the triangle with ANS, PNS, and Pog. Conventional studies have used the NB line, A-Pog line to determine the position of the chin. The combination of existing measurement points, lines, and analytical methods does not give intuitive aesthetic results. In determining the ideal position of an aesthetically important Pog, we intend to introduce machine learning to analyze the continuity of the chin curve(vector equation of R 2 chin that satisfies the existing method while passing through Id, point B, Pog, Gn, and Me). Method and materials: Set the Cartesian coordinate system R around Sella, Nasion and TVL. ANS, PNS, point A/B, Pog, and Menton are set as parameters or R 2, and an ideal chin curve that satisfies the position of the Pog presented in the existing method is assumed. After the machine learning of the relationship between the Pog and other reference points in the existing orghognathic surgery patients, the Pog position of the patient is determined using the obtained parameters and then verified by the existing method. Results: We could derive a neural network model that learned the Pog value from patients who had already undergone surgery. In addition, it is possible to further simplify the prediction model of the Pog position at STO by repeating the process of verifying with the existing method. Conclusion: We could interpret the relationship between Pog and other reference points of existing orthognathic surgery patients through machine learning. We could integrate the chin curve satisfying both the learned Pog position calculation nmethod and the existing analysis methods. At STO, it is expected to be able to predict the location of mathematically and clinically ideal Pog. 제 57 차종합학술대회및정기총회 95

96 PⅡ-01 측인두공간에서발생한다형선종기원암종의경부접근법을이용한수술례 : 증례보고및문헌고찰 유한솔 *, 최효원, 허종기, 김재영연세대학교치과대학구강악안면외과학교실 1 ( 강남세브란스병원 ) 다형선종기원암종은타액선의드문악성병소로다형선종에서야기된다. 임상적특징은양성타액선종양과비슷하며, 다양한조직학적분화를보인다. 고도로분화된암종인경우는 5년생존율은 90% 정도되고, 불량한분화암종에서는예후가아주불량하다. 치료는광범위한절제술혹은국소림프절절제술로제거하고, 부수적으로방사선치료도한다. 측인두공간에발생하는종양은두경부종양의 0.5% 정도이며, pre-styloid space에서는다형선종이호발하고 poststyloid space에는 paraganglioma, 신경초종이호발한다. 측인두공간에발생한종양을제거하기위한수술적방법중주로경부접근법, 경구접근법, transparotid, 하악접근법이쓰인다. 본증례보고에서는측인두공간에발생한다형선종을경구접근법을이용하여수술한후재발한다형선종기원암종으로경부접근법이용한종괴적출술시행받은증례에대하여문헌고찰과함께보고하고자한다. Transcervical approach for carcinoma ex pleomorphic adenoma on parapharyngeal space : A case report with literature review Han-Sol YOU *, Hyo-Won CHOI, Jong-Ki HUH, Jae-Young KIM Department of Oral and Maxillofacial Surgery, Gangnam Severance Hospital, Yonsei University College of Dentistry, Seoul, Korea 1 Carcinoma ex pleomorphic adenoma is rare malignancy in salivary gland arising from benign pleomorphic adenoma. Clinical features are similar to benign salivary gland tumors and histologic differentiation is various. In highly differentiated carcinomas, the 5-year survival rate is about 90%. Prognosis is very poor in poorly differentiated carcinoma. Treatment for carcinoma ex pleomorphic adenoma often involves wide excision or local lymph node dissection which may be followed by radiotherapy. Parapharyngeal space tumors are about 0.5% of all head and neck tumors. In pre-styloid space, pleomorphic adenomas are most common. In post-styloid space, paragangliomas and schwannomas are most common. Among the surgical approachs to remove parapharyngeal space tumors, mainly transcervical, transoral, transparotid and transmandibular approaches are used. In this case report, we present transcervical approach used for patient who had carcinoma ex pleomorphic adenoma on parapharyngeal space reccured from pleomorphic adenoma which was removed by transoral approach with literature review. 96 대한악안면성형재건외과학회

97 PⅡ-02 하악하도서형피판을이용한구강내결손부재건임세정 1*, 전도현 1, 김대영 2, 손승환 2, 손장호 1, 조영철 1, 성일용 1 1 울산대학교의과대학울산대학교병원구강악안면외과학교실 2 울산대학교의과대학울산대학교병원통합치의학과목적 : 구강에발생한종양은그크기에따라절제후재건이필요할수있다. 재건을위해서는결손부의크기와위치를비롯한여러요소들을고려해야한다. 다양한피판들이존재하며그중에서하악하도서형피판은머리와목부위의결손부재건에유용하게사용할수있다. 거상이쉽고혈관화가잘이루어지는것이이피판의주요한장점이며, 긴유경성과우수한회전력을가지고있다. 이연구의목적은구강내결손부재건에사용된하악하도서형피판의유용성여부를보기위함이다. 방법 : 울산대학교병원구강악안면외과에서편평상피세포암종으로진단받고절제술을받은환자들중하악하도서형피판으로재건을시행한 3명의환자에대해조사를시행하였다. 결과 : 총 3명의환자가치료를받았으며재건은성공적이었다. 수술후피판은국소적괴사없이생존했고창상열개의소견도보이지않았다. 공여부역시잘치유되었고반흔은거의보이지않았다. 환자의기능 ( 말하기, 저작과연하 ) 도정상적으로수행되고있으며재발없이경과관찰중에있다. 결론 : 구강결손부재건을위해고려해야할여러가지요소들이있으며하악하도서형피판은구강결손부재건에유용하게사용될수있다. Reconstruction of defected oral cavity with submental island flap Se-Jeong Lim 1*, Do-Hyun Jeon 1, Dae-Young Kim 2, Seung- Hwan Son 2, Jang-Ho Son 1, Yeong-Cheol Cho 1, Iel-Yong Sung 1 1 Department of Oral and Maxillofacial Surgery, University of Ulsan Hospital, University of Ulsan College of Medicine 2 Department of Advanced General Dentistry, University of Ulsan Hospital, University of Ulsan College of Medicine Purpose: Tumor on the oral cavity may require reconstruction after resection depending on their size. Reconstruction should be considered with several factors, including the size and site of the defect. The submental island flap is a pedicled flap based on the submental artery. This flap is very versatile and ideal method for reconstruction in head and neck. It is easy to raise and its vascularity is the primary advantage. Also, it has long pedicle length and excellent rotation. The purpose of this study is to evaluate the effectiveness of the submental island flap in the reconstruction of defected oral cavity. Materials and methods: Case review was conducted on patients who visited Department of Oral and Maxillofacial Surgery, University of Ulsan Hospital, diagnosed and treated as Squamous Cell Carcinoma(SCC). Total of 3 patients had received resection. Simultaneously using submental island flap, reconstruction was done on the defected oral cavity. Result: Total of 3 patients were treated. And reconstruction was successful. Flap survived after operation, without local necrosis. There was no evidence of wound dehiscence. Donor site healing was good and the scar was invisible. The patient s functions of speech, chewing and swallowing were normal. And there is no evidence of recurrence in all patients. Conclusion: Depending on various considerations for reconstruction of defected oral cavity, the submental island flap may be a reliable option. 제 57 차종합학술대회및정기총회 97

98 PⅡ-03 하악에발생한중심성치성섬유종 : 2 례의증례보고 전영태 *, 이한얼, 박성민, 김문영, 한세진, 김철환, 이재훈단국대학교치과대학구강악안면외과학교실 Central odontogenic fibroma(cof) 는악골에서드물게발생하는성장이느린종양으로, COF는전체치성종양중 0.1% 를차지한다. 또한 WHO에서치성조직의간엽세포에서발생한양성치성신생물로간주되고있다. COF는하악에호발하며, 호발연령은평균 34세이다. 방사선사진과관련하여보면, COF는보통잘경계지어진단방성병소로나타나며, 몇몇의경우에서는 Scalloped margin 과함께다방성으로나타나기도한다몇몇의드문케이스에서는방사선투과상및불투과상이혼재된양상및경계가명확하지않는등의모습을보이기도한다이번임상증례는하악에서발생한 central odontogenic fibroma에대한것이며, 총 2명의환자가포함되었다. Central odontogenic fibroma located in the mandible: Two case reports Young Tae JEON *, Han Eol LEE, Sung Min PARK, Moon Young KIM, Se Jin HAN, Chul Hwan KIM, Jae Hoon LEE 1 Dept. of Oral and maxillofacial surgery, College of Dentistry, Dankook University Central odontogenic fibroma(cof) is an extremely rare benign tumor that accounts for 0.1% of all odontogenic tumor. COF is regarded by the World Health Organization(WHO) as a benign odontogenic neoplasm derived from mesenchymal odontogenic tissue. The lesion occurs most commonly in the mandible and patients ranging in age from11 to 80years with mean age of 34years. In this article, we report two case of COF. COF is commonly well-defined monocellular lesion, but sometimes multi-cellular lesion with scalloped margin is reported. Case I was associated odontoma and impacted tooth. Odontoma and impacted tooth was removal under general anesthesia. After microscopic examination, finally we diagnosis this lesion as COF. Patients of case II showed radiolucent lesion at the mandible. Lesion was enucleated under general anesthesia. After microscopic examination, finally we diagnosis this lesion as COF. The patients which we presented did not complain any specific complications, showed good prognosis. 98 대한악안면성형재건외과학회

99 PⅡ-04 하악에발생한골아세포종 : 증례보고김민규 *, 신우진, 박성민, 김문영, 한세진, 김철환, 이재훈 단국대학교치과대학구강악안면외과학교실 Osteoblastoma(OB) 는상악골에발생하는종양중 1% 미만의발생하는드문뼈에발생하는종양입니다. 병변은보통척추, 천골, 장골에서나타나지만하악이나상악에서는드물게발생합니다. 병변은 3세에서 78세까지의나이에가장흔하게발생하며평균나이는 22-23세입니다. 본글에서는하악에발생한 Osteoblastoma(OB) 한케이스입니다. 임상적검사와방사선학적진단결과섬유-골병변, 골수염또는 cementoblastoma로예비진단받았습니다. 전신마취하에관련치아를발치하고절제생검을시행하였습니다. 현미경검사후 OB로진단되었습니다. 특별한합병증없이좋은예후를보였습니다. Osteoblastoma located in the mandible : A Case Report. Min Gyu Kim *, Woo Jin Shin, Sung Min Park, Moon Young Kim, Se Jin Han, Chul Hwan Kim, Jae Hoon Lee 1Dept. of Oral and maxillofacial surgery, College of Dentistry, Dankook University Osteoblastoma(OB) is a rare tumor of bone representing less than 1% of all tumors of the maxillofacial region. The lesion usually appears in vertebral column, sacrum, long bones but rare in mandible or maxilla. The lesion occurs most commonly at age from 3 to 78 years with the mean age of years. In this article, we report one case of OB occurred in mandible. With clinical examination and radiological diagnosis, preliminary diagnosis was made as Fibro-osseous lesion, osteomyelitis or cementoblastoma. Under general anesthesia, associated tooth was extracted and excisional biopsy was done. After microscopic examination, it was diagnosed as OB. The patients which we presented did not complain any specific complications, and showed good prognosis. 제 57 차종합학술대회및정기총회 99

100 PⅡ-05 구강저에발생한거대한유피낭종김지관 *, 구철홍, 박성민, 김문영, 한세진, 김철환, 이재훈 단국대학교치과대학구강악안면외과학교실일반적으로구강내에발생하는유피낭종은드문질환으로알려져있다. 1778년 Jourdain이그의저술에서가장처음발표하였으며, New등이 1495명의전신에발생한유피낭종환자에서두경부에발생한예는 103명, 구강저에발생한예는 24명 (1.6%) 으로보고한바가있다. 유피낭종은피지선분비물과유사한물질로채워져있으며배자의발육부진으로인한피부부속물등을함유하는낭종으로서, 1859년 Roger에의해설하부에발생한증례들이하마종혹은피지선낭종과혼돈되어보고되었으나, 1891년 Cham가이들중태생기에상피세포의함몰에의해발생된경우를보고한이래유피낭종이별도의질환으로인식되면서많은증례들이발표되었다. Giant Dermoid Cyst in Mouth Floor Ji Kwan KIM *, Chul Hong KOO, Sung Min PARK, Moon Young KIM, Se Jin HAN, Chul Hwan KIM, Jae Hoon LEE 1 Dept. of Oral and maxillofacial surgery, College of Dentistry, Dankook University Dermoid cyst is a benign neoplasm, so called by teratoma that is derived from both ectoderm and mesoderm during embryonic period. The majority of dermoid cysts are found in the ovaries and approximately only 7% of dermoid cysts are found in the head and neck. The growth of dermoid cysts in the floor of the mouth is considered a rare condition. We report one case of huge dermoid cyst in the floor of mouth suffered with double chin appearance and difficulty in pronunciation and respiration. The cyst was excised successfully only intra-oral incision. Clinical progress was uneventful and postoperative recovery excellent without recurrence. 100 대한악안면성형재건외과학회

101 PⅡ-06 이하선에발생한와르틴종양김지관 *, 구철홍, 박성민, 김문영, 한세진, 김철환, 이재훈 단국대학교치과대학구강악안면외과학교실와르틴종양은이하선에발생하는양성종양중다형성선종다음으로흔한종양으로, 유두낭포종림프종이라고불리기도한다. 임상적으로성장속도가느리며, 무통성의종양으로, 촉진시에는단단하거나파동성이있다. 90% 의사례에서증상이없으며, 60~70세에호발한다. 조직학적으로 oncocytic epithelium과 lymphoid stroma가같이보인다는특징이있다. 방사선특징으로는경계가명확하며, 원형또는타원형의형태를갖는다. 와르틴종양의경우치료를위해서는수술적제거가필요하다. 수술방법으로는표면적이하선절제술, 부분표면적이하선절제술, 완전이하선절제술이있다. 각각의수술방법에따라신경손상및합병증발생정도, 재발율, 수술후심미적요소, 병원내원기간등에서차이가발생할수있다. Warthin s Tumor of Parotid Gland Ji Kwan KIM *, Chul Hong KOO, Sung Min PARK, Moon Young KIM, Se Jin HAN, Chul Hwan KIM, Jae Hoon LEE 1 Dept. of Oral and maxillofacial surgery, College of Dentistry, Dankook University Warthin s tumors are the second most common benign tumors of the parotid gland, following pleomorphic adenomas. They are also called papillary cystadenoma lymphomatosum. It is a clinically slow-growing, painless tumor that is firm to fluctuant at palpation. In 90% of cases, there is no symptom, and most in 60 ~ 70 years. The oncocytic epithelium and lymphoid stroma are seen histologically. Radiation features have clear boundaries, and are circular or oval in shape. In the case of Warthin s tumor, surgical removal is necessary for treatment. Surgical methods include superficial parotidectomy, partial superficial parotidectomy, and total parotidectomy. There are differences in the degree of nerve injury, complications, recurrence rate, aesthetic factors, and duration of hospital visit depending on each surgical method. 제 57 차종합학술대회및정기총회 101

102 PⅡ-07 상악골, 하악골, 및두개저에서관찰된광범위한 Myelolipoma: 문헌검토및새로운증례보고 최재원 *, 안재명, 홍종락, 팽준영성균관대학교의과대학삼성서울병원구강악안면외과 서론 : 지방종은경계가잘구분되는양성종양으로지방조직이존재하는체내의모든곳에서발생할수있다. 대부분의지방종은피하조직층에서발견되지만일부는근육층, 복막층, 또는골내에서발생하기도한다. 구강의지방종은협점막에서 45.7%, 혀에서 13%, 입술에서 13%, 그리고구강저에서 10.9% 의비율로발견되었다. 골내종양중에서지방종이차지하는비율은 0.1% 정도이며, 그중에서도악골에서발생하는지방종의비율은극히낮다. 최초로보고된악골내부의지방종사례는 1948년에 Oringer 에의하여보고되었고, 그이후로 2015년까지총 24건의악골내부의지방종사례가보고되었다. 1948년부터 2015년까지보고된악골내부의지방종사례들은모두하악골내부에서발견되었고, 경계가뚜렷하고격벽이업는 1개의엽 ( 葉 ) 형태를보였다. 본증례보고에서는악골에서는희귀하게나타나는골내지방종이하악골의대부분과상악골및구개저를포함하는광범위한영역에서나타나, 문헌고찰과함께보고하는바이다. 증례보고 : 60세남환으로 1년전 Multiple myeloma(mm) 진단을받았다. 그후로 1년간 Velcade, Thalidomide, Dexamethasone, 및 Pamidronate 투약하였으나호전되지않아 Peripheral blood stem cell collection(pbscc) 시행하기로결정하였다. PBSCC 전 w/u 위하여구강악안면외과에서검진하였으며, 이때촬영한 panorama 상에서상, 하악골에광범위하게분포한방사선투과상의병소가발견되었다. 병소는경계가뚜렷하였고내부에다수의격벽이관찰되었다. 추가적으로촬영한 facial bone CT 상에서병소의팽창으로인한상, 하악골의피질골파괴양상이두드러졌다. 또한 CT를통해서같은양상을보이는병소가두개저에서도관찰되었다. 국소마취하에하악좌측부에서골조직생검을시행하여 myelolipoma로진단되었다. myelolipoma의범위가광범위하고환자의주관적인자각증상이없어절제하지않고주기적경과관찰을하기로하였다. Intraosseous multiple myelolipoma on mandible, maxilla and cranial base: Contribution of a new case and review of the literature Jaewon Choi *, Jaemyung Ahn, Jongrak Hong, Jun-Young Paeng Dept. of Oral and Maxillofacial Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine Introduction: Lipoma is a benign mass covered with thin, separated layer which consists of well-defined adipocyte. This benign tumor could be formed in whole body, especially soft tissue with lipid cells. Small portion of this tumor would be found in intramuscular, retroperitoneal, or intraosseous area. Intraoral lipoma would be formed in buccal mucosa(45.7%), tongue(13%), lip(13%), and oral floor(10.9%). The proportion of lipoma as a intraosseous tumor is about 0.1% and there are few cases about intraosseous lipoma on the jaw. The first intraosseous lipoma was reported by Oringer in 1948 and there had been 24 cases about intraosseous lipoma on the jaw from 1948 to every case showed well circumscribed, a single lobe intraosseous lipoma on mandible. The aim of this case report is to present the patient with multiple intraosseous myelolipoma on mandible, maxilla, and cranial base with literature review. Case report: A 60 year-old male patient was diagnosed with multiple myeloma (MM) 1 year ago. He had taken chemo treatment with Velcade, Thalidomide, Dexamethasone, and Pamidronate for 1 year. Without upturn, the patient prepared for peripheral blood stem cell collection(pbscc) and had clinical evaluation at Dept. of Oral and maxillofacial surgery, Samsung Medical Center. The panoramic radiography showed widespread multiple radiolucent lesions on mandible and maxilla. The facial bone CT showed cortical bone swelling and destruction of mandible, maxilla, and cranial base. Curettage and bone biopsy was done on Lt. mandible and the histological result was myelolipoma. Considering the extensive involve area, periodic observation without resection was recommended. 102 대한악안면성형재건외과학회

103 PⅡ-08 하악에발생한투명세포치성암종 : 증례보고이승준 *1), 최민호 1), 김진수 1), 박재억 1), 김창현 1) 가톨릭대학교서울성모병원구강악안면외과 1) 서론 : 투명세포치성암종은극히드물게발견되는신생물이다. 호발부위는하악으로, 일반적으로 50대에서 70대사이에나타난다. 여성에게서더많이나타나며하악전방부에자주보이고, 투명세포의시트와소엽을특징으로한다. 증례보고 : 본연구에서, 좌측하악에투명세포치성암종이발생한매우드문경우를보고했다. 53세의여성이하악골변연절제술을시행받았다. 환자는초기상담, 수술전, 수술직후및수술 6개월후임상및방사선학적검사를시행했다. 조직병리학적검사결과투명세포치성암종으로진단되었다. 다른부위로의전이는없었으며, 환자는수술후양호한상태를보였다. 고찰및결론 : 투명세포치성암종은악골에악성의잠재성이높은매우드문경우이다. 투명세포치성암종진단시, 조직학적특징이유사한점액표피양암종또는투명세포선암종과같은타액선암과감별진단하는것은중요하다. 본증례의환자에서, 추가적인평가및장기간의추적관찰이필요하다. Clear cell odontogenic carcinoma of the mandible: Case report SeungJoon Lee * 1), MinHo Choi 1), JinSu Kim 1), Je-Uk Park 1), Chang-Hyen Kim 1) Department of oral and maxillofacial surgery, Seoul St.Mary s hospital, The catholic University of Korea 1) Introduction: Clear cell odontogenic carcinoma (CCOC) is an extremely rare neoplasm. It displays a propensity for the mandible, most commonly presenting in the fifth to seventh decades. It is female predilection occurring in the anterior region of the mandible, characterized by sheets and lobules of vacuolated and clear cells. Case report: In this study, we reported a very unusual case of a patient with clear cell odontogenic carcinoma of left mandible. A female aged 53 years was treated with marginal mandibulectomy. Patient underwent standardized clinical and radiological examination at initial consultation, before surgery, immediately after surgery, and 6 months after surgery. It was diagnosed as clear cell odontogenic carcinoma in histopathologic examination. There was no metastasis, and patient was in good state after operation. Conclusions: CCOC is extremely rare type of epithelial malignancy of the jaw. When diagnosing CCOC, ruling out salivary gland tumors, such as mucoepidermoid carcinoma or clear cell adenocarcinoma is important because they have overlapping histologic features with CCOC. In present case, further evaluation and long-term follow-up check are needed. 제 57 차종합학술대회및정기총회 103

104 PⅡ-09 치근단병소를닮은외상성골낭조주연 * 계명대학교동산의료원치과치근을둘러싼방사선투과상의병소는치수변화를동반한근단치주염이나치근단낭으로진단되기도한다. 게다가치은이나안면부종을동반하는경우에는더욱쉽게치수염을동반한치근단농양으로잘못진단되는경우가많다. 외상성골낭은방사선사진을이용한검진에서우연히발견되기도하는, 무증상의방사선투과성골내병소이다. 외상성골낭의주된특징은, 증상이없고단방성의방사선투과상의골내병소가치수생활력이있는치아와연관되어나타나는것이다. 이러한외상성골낭은외과적으로제거하면거의완치된다. 이증례는급작스런치은부종을동반하고, 치근단농양과흡사한양상을보여서혼란을가져왔던외상성골낭에관한것이다. 상기증상을호소하며내원한 16세의남환은경미한외상후특이증상없이 4개월간지내다가갑자기치은부종이나타났고, 방사선투과상이치근단에관찰되어, 최초에치근단병소로진단하였다. 그러나절개했을때장액성삼출물이관찰되었고, 조직학적으로치근낭을배재할수있는소견을보였다. 외과적시술후 7개월간추적관찰한결과임상적및방사선학적으로치수의생활력은보존되고있었다. Traumatic bone cyst mimicking a periapical lesion: A confusing case Juyeon Cho * Department of Dentistry, Dongsan Medical Center, College of Medicine, Keimyung University The radiolucent areas surrounding the apices of a tooth may be diagnosed as apical periodontitis or periradicular cyst with pulpal involvement. Moreover, if gingival or facial swelling accompanied with such circumstances, they can be easily misdiagnosed as periapical abscess with pulpal infection. Traumatic bone cyst is known as a symptomless, radiolucent bony lesion incidentally found during routine radiographic examinations. The main characters of traumatic bone cyst are asymptomatic and unicystic radiolucent bony lesion with vital tooth. The traumatic cyst can be almost healed after surgical intervention. This case is a confusing case of a traumatic bone cyst with sudden gingival swelling and appearance like a periapical abscess. A 16-yr-old male patient visited our clinic with above symptoms. At first, it was diagnosed as periapical lesion due to the apical radiolucency and swelling. However he has been free of any symptom for 4 months after slight physical trauma. After surgical exploration and drainage, serous transudate was present and periapical cyst could be ruled out as a histological result. Clinical and radiographic examination showed bony healing with pulpal vitality preserved after 7 months postoperatively. 104 대한악안면성형재건외과학회

105 PⅡ-10 구강저와하악에광범위하게이환된기저양편평세포암종의치험례 증례보고와논문고찰 이준상 *, 최나래, 백영재, 송재민, 이재열, 황대석김용덕, 신상훈, 김욱규부산대학교치의학전문대학원구강악안면외과학교실. Basaloid Squamous Cell Carcinoma (BSCC) 는다양한해부학적부위에서발생하는편평상피암의드문공격적인변종이다. 이암종은주로혀, 신위개후두 (hypraglottic larynx) 및하인두 (hypopharynx) 에발생한다. 다른경우는구강, 구강점막및구개에서도발생한다. 기존의 SCC와마찬가지로 BSCC는 세노인층에서우세하며알코올및흡연은위험요인으로알려져있다. 임상소견도정상 SCC와유사하게나타난다. 이전에보고된대부분의 BSCCs에서는중앙부궤양을가진편평하고약간상승된병변으로보고되었다. 이연구는구강저와하악골에광범위하게이환된 BSCC 환자의치험례를기술하고, BSCC에대한전반적인고찰과증례토론을해보고자한다. Basaloid squamous cell carcinoma on floor of mouth and mandible A case report and literature review Jun Sang Lee *, Na-rae Choi, Young-Jae Baek, Jae-Min Song, Jae-Yeol Lee, Dae-Seok Hwang, Sang Hun Shin, Dae-Seok Hwang, Uk-Kyu Kim Dept. of Oral and maxillofacial surgery, School of Dentistry, Pusan National University Basaloid Squamous Cell Carcinoma (BSCC) is a rare and aggressive variant of squamous cell carcinoma arising in various anatomical sites. This carcinoma is predominantly in the base of tongue, supraglottic larynx, and hypopharynx1). Other cases also occur in oral cavity, oral mucosa, and palate. Like the conventional SCC, BSCC is predominant in the elderly population aged 60 to 80, and alcohol and smoking are known as risk factors. Clinical findings also appear similar to normal SCC. In most previously reported BSCCs, it appears as a flat, slightly elevated lesion with a central ulceration. This study describes a case history of BSCC of the floor of mouth with mandibular involvement, and further discusses the appropriate management of such case with reference to the literature review. 제 57 차종합학술대회및정기총회 105

106 PⅡ-11 골수염과유사한임상적특성을보이는상피세포암종 : 4 개의사례리뷰 김호준 *, 김진욱, 이성탁. 권대근, 최소영경북대학교치과대학구강악안면외과학교실 서론 : 하악에서골융해성 (Osteolytic) 병소는흔하며, 이를특징으로하는골수염과 (Osteomyelitis) Squamous Cell Carcinoma (SCC) 의감별진단은중요하다. 따라서처음환자가내원하였을시노출된골과주변의비정상적인연조직반응이있을때악성병소혹은양성병소의여부를감별진단하는것이중요하지만그감별진단이어려움이존재한다. 이에 2013년부터 2018년까지경북대를내원한환자중 Cancer screening을시행한환자중에서처음내원시임상적증상및방사선학적소견상골수염으로잠정진단된 4명의환자사례에대해발표하고자한다. 증례보고 : 발표하고자하는 4명의환자모두치아및임플란트발거이후회복불량을주소로내원하였다. 초진시시행한임상적검사및 X-ray 상모두병소주위의회복이불량한연조직및하악골부위의 ill-defined osteolysis가관찰되었으며임상가적판단및판독모두골수염으로잠정진단되었다. 4명중 3명은건강한환자였으나 1명은내원당시로부터 10년전신장암및담낭암진단하 OP 시행한 hx. 가존재하였다. 4명중 3명은하악골의골수염으로잠정진단하전신마취하외과적소파술을시행하였으며한명은하악전치부부위에절개생검을시행하였다. 4명의환자모두조직검사결과 SCC로진단되었으며 3명의환자모두전신마취하수술을시행하였다. 남은한명은다른병원으로전원시행하였다. 고찰 : OM과 SCC의발병기전은서로다르지만, 임상적및조직병리학적으로는비슷한특성을보일수있다. 임상가가숙달됨에따라조직학적검사를소홀히하는경우가있을수있는데이러한사례는병리학적조직검사의중요성을보여준다할수있겠다. 따라서의심스러운질환이있다면이는임상적증상, 방사선학적특징, 조직병리학적검사, 경과관찰등의다양한진단학적도구등을이용하여진단하여야할것이다. Squamous cell carcinoma mimicking osteomyelitis : 4 case series review Ho-Joon Kim *, Jin-Wook Kim, Seong-Tak Lee, Tae-Geon Kwon, So-Young Choi Dept. of Oral amd maxillofacial surgery, Kyunhpook National University, Daegu, Korea Introduction: Osteolytic lesions on the mandible are common and since Osteomyelitis(OM) and Squamous Cell Carcinoma (SCC) has this characteristic so it s differential diagnosis is important. Therefore, it is important to differentiate between malignant lesions and benign lesions when there is an abnormal soft tissue reaction around the exposed bone on first visited patient. However, differential diagnosis is difficult. We report four patients who were diagnosed as osteomyelitis via clinical symptoms and radiologic findings at the first visit among the patients who carried out cancer screening from 2013 to 2018 in Kyungpook National University. Case Report: All 4 patients visited our OPD with poor healing after tooth and implant extraction. Clinical examination at the first visit were poory healed soft tissue & ill-defined osteolysis of the mandible and same was on X-ray images. Clinical & radiographic provisional diagnosis were both osteomyelitis. Three out of four patients were healthy, but one patient had renal cancer and gallbladder cancer diagnosed 10 years ago and went through excision OP. Three of the 4 patients underwent surgical curettage under general anesthesia and one underwent incision biopsy at the the mandibular ant. area. All 4 patients were diagnosed as SCC by pathological examination and all three patients underwent surgery under general anesthesia. The remaining one patient were sent to another hospital. Discussion & Conclusion: Although the pathogenesis of OM and SCC is different, but they can have similar clinical and histopathologic characteristics. As the clinician s skills are improved, there may be cases in which the pathological examination is neglected. This case shows the importance of pathological & histologic examination. Therefore, if there is suspicious disease that is difficult to diagnosis, it should be diagnosed using various diagnostic tools such as clinical impression, radiological findings, histopathological examination, and follow-up, etc 대한악안면성형재건외과학회

107 PⅡ-12 증례보고 : 우측하악골에서발생한광범위한낭종성법랑모세포종의치험례 손정완 *1, 김봉철 1, 이준 1,2, 윤정훈 3, 임헌준 1 1 원광대학교대전치과병원구강악안면외과 2 원광골재생연구소 3 원광대학교대전치과병원병리과 구강내에서발생하는낭종및종양은각각의크기나공격성, 발생부위등병소의특징에따라적용되는치료법이달라진다. 크기가작거나악성전환및재발가능성이낮은낭종및종양은대부분단순소파술이나적출술같은보존적인치료를한다. 반면, 크기가크거나악성으로전환될가능성이큰낭종및종양의경우병소의광범위한제거가필요하며병소제거후골결손부를재건하기위해자가골이식이나피판이식등의부가적인방법이필요하다. 우리는 14세남환의우측하악골에서발생한낭종성법랑모세포종을골이식등을동반하지않고병소를제거한후골결손부가성공적으로재생된증례를보고하고자한다. A case report : The treatment of the large unicystic ameloblastoma of the right mandible. Jeong Wan Son *1, Bong Chul Kim 1, Jun Lee 1,2, Jung Hoon Yoon 3, Hun Jun Lim 1 1 Dept. of Oral and maxillofacial surgery, Daejeon Dental Hospital, College of Dentistry, Wonkwang University 2 Wonkwang Bone Regeneration Research institute, Wonkwang University 3 Dept. of Oral and Maxillofacial Pathology, Daejeon Dental Hospital, College of Dentistry, Wonkwang Cyst and tumors in the oral cavity have different treatment plans by its size, aggression, location, etc. Cystic or tumorous lesions with small size, low recurrence rate and low malignant transformation are usually treated with conservative treatment as curettage and enucleation. But, lesions with large size, high recurrence rate and high malignant transformation rate are treated with more radical surgery. The latter result is large bone defects, and the defects may need to be reconstructed by various surgical technique such as autologous bone grafts and free flap transfers. We report the case of mandibular regeneration without any bone grafts and flap transfers, followed by mass removal in patient with an unicystic ameloblastoma at the right mandibular angle and ramus. This work was supported by Wonkwang University in 제 57 차종합학술대회및정기총회 107

108 PⅡ-13 경부림프절전이를모방한이소성갑상선증례 권순모 1*, 조은애산드라 2,3, 김현실 2,3, 남웅 1 연세대학교치과대학구강악안면외과학교실 1, 구강병리학교실 2, 구강종양연구소 3 구강편평세포암의치료로경부림프절절제술이시행되는경우가많다. 경부림프절절제술시행중우연히갑상선이아닌부위에서갑상선조직이발견되는경우가있고, 이경우전이성갑상선암인지이소성갑상선인지감별진단이필요하다. 정상적인갑상선은 2 개의엽으로이루어져있고, 2~4 번째기관연골앞에위치한다. 조직학적으로갑상선은다양한크기의 follicle 로이루어져있으며, follicle 사이는혈관구조가존재한다. 이소성갑상선이란 2~4 번째기관연골전방이아닌다른위치에갑상성조직이존재하는것을말한며발생과정에서갑상선발생이정상적인경로로일어나지않아발생한다. 전이성갑상선암이란갑상선에서원발암이발생한후경부림프절로전이된것을의미한다. 문헌에따르면갑상선조직이정상적인위치가아닌경부측방에서발견된경우양성이경우가대부분 (76%) 이지만, 갑상선암 (12%) 인경우도적지않다. 경부림프절에서얻은갑상선조직이조직학적으로갑상선암으로진단된경우에서대부분은전이성갑상선암으로보고되었다. 그러나일부증례에서는경부측방의갑상선조직은갑상선암이지만갑상선은정상이었으며이경우이소성갑상선의악성변환으로발생한원발성갑상선암이라고한다. Fliegelman, Lawrence J. 등은경부림프절절제술후갑상선조직이발견된증례를보고했는데, 3 개의증례는전이성갑상선암이고, 1 개증례는이소성갑상선에서악성변환이발생한경우였다. Yamamoto, Tetsuya 등은경부림프절절제술후경부측방에서갑상선암을발견하였으나갑상선은정상이었던 3 개의증례를보고하였다.. 이소성갑상선은갑상선이발생하는경로를따라나타나는경우가많고두경부가아닌원발부위에서발견되기도한다. 설갑상선이 90% 로흔하며경부측방에발생하는경우는 1~3% 로드물다. 보고된바에의하면이소성대부분 (70%) 은내분비기능을갖고갑상선은정상적이못한경우가많아절제하게될경우갑상선저하증이유발되어대체요법이필요할수있다. 본증례에서는설암의치료를위한수술과정에서시행한경부림프절절제술시에갑상선조직이발견되었다. 갑상선기능검사와경부초음파검사를통하여전이성갑상선암과이소성갑상선인지감별하였고최종적으로이소성갑상선으로진단되었다. 과거보고된바에의하면이소성갑상선은갑상선기원이아닌두경부원발암수술시시행한경부림프절절제술과정에서우연히발견된경우가대부분이었으나, 최근에는술전검사를통하여이소성갑상선을진단하는증례가보고되고있다. 이소성갑상선은내분비기능을갖는경우가많아보존적치료가선호되고, 절제할경우합병증이유발될가능성이있어술전검사를통한진단의이점이크다. 구강악안면외과적영역에서이소성갑상선은드문증례로, 본증례에서는수술전이소성갑상선을확인하지못하였다. 본증례를통하여이소성갑상선이라는드문증례를보고하고, 진단과치료에대한새로운경향을논하고자한다. Ectopic thyroid mimicking metastasis cervical lymph node : case report Sunmo Kwon 1*, Eunae Sandra Cho 2, Hyun Sil Kim 3, Woong Nam 1 Department of Oral and Maxillofacial surgery 1, Department of Oral Pathology 2, Oral Cancer Research 3 Institute, College of Dentistry, Yonsei University, Seoul, Korea Cervical neck dissection is a frequent technique during treatment for oral squamous cell carcinoma (SCC). Occasionally, specimens harvested as cervical lymph nodes reveal thyroid tissue and need differentiation with metastatic thyroid cancer and ectopic thyroid tissue. The human thyroid gland consists of two lateral lobes and located in front of the second to fourth tracheal cartilage.. Histologically, Follicles, the functional units of the gland, vary in size and shape. Each follicle is surrounded by a network of capillaries. Ectopic thyroid refers to the presence of thyroid tissue in locations other than the normal location. Thyroid ectopia can occur when the process of thyroid embryogenesis fails. Metastatic thyroid cancer means metastasis to the cervical lymph node after primary carcinogenesis in the thyroid gland. According to the literature, most cases (76%) are benign when the thyroid tissue is found in the lateral side of the neck. Thyroid cancer (12%) is also rare. Most cases of thyroid cancer were diagnosed as histologically diagnosed as metastaic thyroid cancinoma. However, in some cases, the thyroid tissue in the lateral neck is thyroid cancer, but the thyroid is normal. In this case, it is called primary thyroid cancer due to malignant transformation of ectopic thyroid. Fliegelman and Lawrence J. et al. reported a case of thyroid tissue after cervical neck dissection. Three cases were metastatic thyroid cancer and one case was malignant transformation of ectopic thyroid. Yamamoto, Tetsuya, et al. reported three cases of thyroid cancer of the neck after lateral cervical neck dissection, and the thyroid was normal. The ectopic thyroid gland often appears along the path of the thyroid embriogenesis and may be found on the distal part. The lingual thyroid gland is common in 90% of cases, and 1 to 3% of cases in the side of the neck are rare. It is reported that most of the ectopic thyroid(70%) have endocrine function and the thyroid gland is not normal. Therefore, when it is resected, hypothyroidism may be induced and replacement therapy may be needed. In this case, thyroid tissue was found during the cervical neck dissection for the treatment of tongue cancer. Thyroid function test and cervical ultrasonography were used to differentiate between metastatic thyroid cancer and ectopic thyroid. Finally, ectopic thyroid was diagnosed. Previous reports have shown that ectopic thyroid tissue was found incidentally in the cervical neck dissection due to non thyroid head and neck primary cancer. Recently, the cases of ectopic thyroid diagnosed preoperatively have been reported. The ectopic thyroid often has endocrine function, so conservative treatment is preferred. If it is resected, there is a possibility of complication. Ectopic thyroid is rare condition in the oral and maxillofacial region. In this case, preoperative ectopic thyroid is not identified. We report a rare case of ectopic thyroid gland and discuss new trends in diagnosis and treatment. 108 대한악안면성형재건외과학회

109 PⅡ-14 르포씨제 1 형절골을이용한상악동내종물제거 : 증례보고및술기고찰 우재만 * 제주대학교병원치과 서론 / 목적 : 상악의르포씨제1형절골술은하악의시상분할절골술, 수직절골술과함께악교정수술의대표적인수술법이다. 하지만상악절골술의시초는 1859년 von Langenbeck 이비강내의용종을제거하기위한접근방법으로고안한것이라알려져있다. 이처럼르포씨제1형절골술을통해접근하면비강과상악동내부에직접접근이가능하고, 병소의크기가크거나상악동상방또는후벽부에위치할경우에특히유용하다. 본증례에서는우측의상악동저와상악동후벽부위에이르는비교적큰치아종의제거를위해르포씨제1 형절골술을적용한증례를공유하고수술시의고려사항에관해알아보고자한다. 환자및방법 : 23세여자환자가우측상악동내의종물을주소로개인치과에서의뢰되어2018 년 5월제주대학교병원치과에내원하였다. CT상우측상악동저와후벽을채우는비교적큰방사선불투과성병소와병소의상방으로전위되어있는제3대구치로보이는치아가관찰되어전신마취하에르포씨제1형절골술을통해접근하여종물을제거하였다. 반대측상악의깊이위치한매복제3대구치도함께발거하였다. 채취한종물의조직검사결과복잡치아종으로밝혀졌다. 고찰 : 종물제거를위한르포씨제1형절골술의경우악교정수술과달리상악골이원래의위치에놓이게되기때문에골편간의접촉이긴밀하여미세한간섭도교합의변형을초래할수있다. 특히 osteotome을이용해분리하는후방부는절골면이불규칙하거나골파편이생길수있기때문에간섭여부를면밀히검사하고간섭부위를제거하는것이술후구치부조기접촉으로인한전치부개방교합을방지하는데도움이될것이다. Removal of a benign tumor in maxillary sinus via Le Fort I osteotomy approach: case report and procedural notes Jaeman Woo * Jeju National University Hospital Department of Dentistry Introduction/Purpose: Le Fort I osteotomy, along with mandibular sagittal split or vertical osteotomies, is one of the representative surgical procedures in orthognathic surgery. The beginning of maxillary osteotomy dating back to 1859, however, was a mode to access difficult-to-reach locations in nasal and paranasal sinus cavities. Le Fort I osteotomy allows direct vision and access to maxillary sinus, facilitating removal of large lesions in the posterior wall or superior region. This study aims to report a case where Le Fort I osteotomy was employed to remove a large compound odontoma from the floor and posterior wall of maxillary sinus, and share the clinical experience. Patient and Procedure: A 23-year-old female patient was referred from a local dentist regarding large radiopaque mass within right maxillary sinus. CT showed a large mixed radiopaque and radiolucent lesion filling floor and posterior wall of maxillary sinus and displaced 3rd molar antero-superior to the lesion. Mass excision along with removal of displaced 3rd molars was performed under general anesthesia, and Le Fort I osteotomy was employed for access. Biopsy indicated that the mass was an unusually large complex odontoma. Discussion: Unlike during orthognathic surgery, Le Fort I osteotomy as access procedure entails repositioning of segment to the original position where minimal to no intersegmental gap is allowed. Small interferences indiscernible on radiographic exam can cause occlusal changes such as anterior open-bite. Meticulous examination and removal of interferences in the posterior region where osteotomy line is irregular due to the use of osteotome is important in preventing such complications. 제 57 차종합학술대회및정기총회 109

110 PⅡ-15 증례보고 : 크고파괴적인비구개관낭김병수 *1, 윤정훈 2, 김봉철 1, 이준 1,3, 임헌준 1 1 원광대학교대전치과병원구강악안면외과 2 원광대학교대전치과병원구강병리과 3 원광골재생연구소서론 : 보통의비구개관낭과는다른, 크기가크며과잉치를포함하였고파괴적인양상의상악전치부비구개관낭에대해보고하려한다. 증례 : 49세남자환자가상악좌측중절치가변위되었다는주소로본원구강악안면외과에내원하였다. 내원 1달전부터상악전치부경구개의통증을동반한종창이발생하였다. 임상검사상상악전치부구개측의종창이있었으며병소에포함된영구치에서동요도있었으며좌측상악중절치는구개측으로변위되어있었다. 방사선검사상과잉치 1개가병소에포함되어있으며양측상악중절치, 측절치치근이흡수된양상이었다. 콘빔전산화단층촬영사진상병소크기 4 3 3cm으로측정되었으며, 절개생검결과에서비구개관낭으로진단되었다. 전신마취하에병소내부의과잉치, 상악좌측중절치발거및낭종적출술을시행후장골이식을시행하였다. 수술시시행한생검결과에서비구개관낭으로확진되었다. 고찰 : 비구개관낭은절치관의잔존상피에서기원하는가장흔한상악의발육성비치성낭종이며, 비파괴적인양상으로나타난다. 비구개관낭의크기는직경약 15mm로나타나며, 본증례의경우크기가 4 3 3cm 으로크기가크고과잉치를포함하고있으며, 영구치의치근흡수를나타낸다는점에서특이점을띤다. Case Report : An unusually large destructive nasopalatine duct cyst Byung Soo Kim *1, Jung Hoon Yoon 2, Bong Chul Kim 1, Jun Lee 1,3, Hun Jun Lim 1 1 Dept. of Oral and maxillofacial surgery, Daejeon Dental Hospital, College of Dentistry, Wonkwang University 2 Dept. of Oral and maxillofacial pathology, Daejeon Dental Hospital, College of Dentistry, Wonkwang University 3 Wonkwang Bone Regeneration Research institute, Wonkwang University Introduction: This case report is about nasopalatine duct cyst that is larger, more destructive than typical nasopalatine duct cyst, including supernumerary tooth Case report: A 49-year-old male complained of an maxillary left central incisor dislocation. History taking revealed that the dislocation of the tooth and swelling of the palate area are noticed 1 month before. On intraoral examination, swelling was noticeable at anterior part of palate. There was mobility from right maxillary incisor to left first premolar. Left maxillary incisor was dislocated to palatine side. On radiographic examination, both maxillary central, lateral incisor root was resorbted and the lesion includes a supernumerary teeth. The size of lesion was 4 3 3cm on conebeam CT. Incisional biopsy performed and diagnosed nasopalatine duct cyst. Under general anaesthesia, supernumerary tooth and left maxillary central incisor was extracted, cyst enucleation with iliac bone graft. Also, It was diagnosed same as before. Discussion: Nasopalatine duct cyst is the most common maxillary cystic lesion originating from the residual epithelium of the incisor, and it appears to be nondestructive. Cysts range in size, with an average diameter of approximately 15 mm. Unlike typical nasopalatine duct cyst, this case shows unusual size (4 3 3cm) and contains supernumerary tooth. Also shows root resorption of the permanent teeth. This work was supported by Wonkwang University in 대한악안면성형재건외과학회

111 PⅡ-16 하악지에발생한양성섬유성조직구증이악성으로전환된증례 안재명 *, 홍종락, 팽준영성균관대학교의과대학삼성서울병원구강악안면외과 개요 : Deep Benign Fibrous Histiocytoma(BFH) 는이름그대로양성의섬유조직세포종이다. 주로, 피하조직이나깊은연조직부위에서발견되며, 호발부위는상하지부위이고, 악안면부위에는드물게발생한다고보고되어있다. Malignant Fibrous Histiocytoma(MFH) 는 elongated histiocytes and fibroblasts 세포들과유사한조직학적소견때문에 Undifferentiated Pleomorphic Sarcoma(UPS) 로수정되었다 (2017 WHO classification). 하악골에서의 UPS는주로 50~70대및남성에게호발하며, 임상적양상은수주혹은수개월에걸쳐확산되는통증으로보고된다. 본증례는이와는다르게젊은여성의하악지에서발생한 BFH가 MFH 즉, UPS로전환된증례이다. 증례환자 : F/23Y, 전신병력 (-) 경과 : 우측하악지주변의통증 조직검사시행 결과 : BFH 종양제거및늑연골이용한하악골재건조직검사결과 : UPS, FNCLCC grade 2/ ~05 술후방사선치료 64Gy/27Fx ~ 주기적인추적관찰 CT 및 PET에서재발소견 종양을포함한하악골절제술및견갑골이용한재건수술 현재까지재발소견없음. 결론 : BFH는악안면영역에서는드문질환임에도불구하고, UPS로의악성전환의가능성이있고, 악성이라하더라도초기조직검사에서위양성이나올수있으므로영상검사와종양의성격에따라반드시주의를요하며, 이러한환자에대한면밀하고주기적인추적관찰이반드시필요하겠다. Case report: Transformation of Benign Fibrous Histiocytoma into Malignant Fibrous Histiocytoma (Undifferentiated Pleomorphic Sarcoma) in the Mandibular Ramus Jaemyung Ahn *, Jongrak Hong, Jun-Young Paeng Dept. of Oral and maxillofacial surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine Introduction: Deep Benign Fibrous Histiocytoma (BFH) is mainly found in subcutaneous tissues or deep soft tissues. It is reported to occur in the upper and lower parts, and rarely in the maxillofacial region. Malignant Fibrous Histiocytoma (MFH) has been modified with Undifferentiated Pleomorphic Sarcoma (UPS) due to histologic findings similar to elongated histiocytes and fibroblasts (2017 WHO classification). UPS in the mandible is predominantly in the 50's and 70's and males, and its clinical manifestations are spreading over weeks or months. In this case, BFH developed in the mandibular region of young women was converted to MFH, or UPS. Case : Patient: F / 23Y, PMH(-) Progress note: Pain near the right mandible Biopsy Result: BFH Removal of the tumor and reconstruction of mandible with costochondral graft Bx. result: UPS, FNCLCC grade 2/ ~05 Postoperative radiotherapy 64Gy / 27Fx to Periodic follow-up Recurrence finding in CT and PET Mandibular resection including tumor and Reconstructive surgery using scapula No recurrence seen until now. Conclusion: Although BFH is a rare disease in the maxillofacial region, there is a possibility of malignant transformation to the UPS, and even if it is malignant, the initial biopsy may lead to false positives, so be careful according to the image test and the nature of the tumor. Careful and periodic follow-up is essential. 제 57 차종합학술대회및정기총회 111

112 PⅡ-17 술중메틸렌블루주사를이용한혈관종의경계설정 : 증례보고 오지현 *, 박영욱, 김성곤, 김민근, 권광준강릉원주대학교치과병원구강악안면외과 혈관종은구강의가장흔한양성연조직종양이다. 혈관종은발달성혈관이상이며 50% 이상의병변이입술, 혀, 구강점막및구개부등의두경부에서발생한다. 출생시또는출생후종종발생하며부드러운혈관성부종처럼보이고, 남성보다여성에서 3배더흔하게발생한다. 임상적으로혈관종은부드럽고매끄럽거나소엽상, 무경성, 또는유경성으로특징지어지고수밀리미터에서수센티미터의크기로볼수있다. 병변의색깔은분홍색에서적자주색까지이며종양은압력을가하면희미해지고출혈은자연적으로나경미한외상후에발생할수있다. 일반적으로통증은없다. 혈관종의관리는다양한요인에달려있으며대부분의진성혈관종은치료가필요하지않다. 그러나 10-20% 는크기, 정확한위치, 성장단계또는재생성때문에치료가필요하다. 경과관찰, 병변내및전신적코르티코스테로이드치료, 색전술, 경화요법및외과적절제를포함한많은치료방법들이있다. 작고안정된혈관종은치료가필요하지않을수있으며크고문제가있는병변은경화요법과외과적절제의병용으로치료할수있다. 58세여환이 3-4년전부터왼쪽어금니쪽의볼점막이부었고점점커지면서최근에는통증이있다는주소로내원하였다. 임상검사상좌측협점막에푸른색으로도드라져있는 2 cm 가량의종물이관찰되었다. 전신마취하에병소의경계를명확히하기위해methylene blue를병소에주입한후절제하였다. 절제한후발생한결손부위는 buccal fat pad를이용하여재건하였다. 수술 1개월후, 결손부위는연조직으로완전히치유되었다. Intraoperative localization of hemangioma on the buccal mucosa by methylene blue injection: A case report Ji-Hyeon Oh *, Young-Wook Park, Seong-Gon Kim, Min- Keun Kim, Kwang-Jun Kwon Department of Oral and MaxilloFacial Surgery, Dental hospital, Gangneung-Wonju National University Hemangiomas are the most common benign soft tissue tumor of the oral cavity. Hemangiomas are developmental vascular abnormalities and more than 50% of these lesions occur in the head and neck legion, with the lips, tongue, buccal mucosa, and palate most commonly involved. It often presents at birth or soon after, and appears as a soft and vascular swelling. They are more common in women than men (3:1). Clinically hemangiomas are characterized as a soft, smooth or lobulated, sessile or pedunculated and may be seen in any size from a few milli-meters to several centi-meters. The color of the lesion ranges from pink to red purple and tumor blanches on the application of pressure, and hemorrhage may occur either spontaneously or after minor trauma. They are generally painless Management of hemangioma depends on a variety of factors, and most true hemangioma requires no intervention. However, 10-20% requires treatment because of the size, exact location, stages of growth or regeneration. There are many treatment modalities including wait and see policy, intralesional and systemic corticosteroid treatment, embolization, sclerotherapy, and surgical excision. Small, stable hemangiomas may not require treatment. Larger, problematic lesions may be treated with a combination of sclerotherapy and surgical excision. A 58-year-old female have been suffering from pain recently, as the buccal mucosa of left posterior mandible was swollen and grew gradually from 3~4 years ago. On clinical examination, a bluish mass of 2 cm was found in the left buccal mucosa. Under general anesthesia, methylene blue was injected into the lesion for exact localization. The tumor was resected, and the defect was reconstructed using a buccal fat pad. One month after surgery, the defect site was completely healed with soft tissue. 112 대한악안면성형재건외과학회

113 PⅡ-18 OK-432를사용한구강저낭성림프관종의경화술박슬마로 *, 이상훈, 차인호 연세대학교치과대학구강악안면외과학교실림프관종은대부분의병소가태어날때부터존재하고 10세이하에서호발하며남녀동률로나타난다. 구강내의림프관종은혀에가장호발하고협점막, 구개, 치은및입술부위에도나타난다. 얕은병소들은약간붉은색소를띄는유두상의병소로나타나고혀에이환된경우에는특히급성상기도감염증후급격히증대되는양상을보여거대설을나타내며심한경우에는개교증을타나내기도한다. 병리조직학적소견은내피세포에의해경계되어있는림프액을함유한확장된림프관으로구성되며혈액이차있는경우도있다. 치료는외과적절제를시행하며주위와경계가불분명하여치료후에재발하는경향이많다. 외과적절제술외에도방사선치료, 경화치료, CO2 치료, 레이저치료, 스테로이드주입등을시행하기도한다. 이번케이스보고는연세대학교치과대학병원구강악안면외과로내원한 13개월남아의우측구강저에발생한림프관종을 OK-432를사용하여경화치료를전신마취하에 , 로 2차례시행하였다 에 MRI f/u 하여기존의 MRI와비교하였다. OK-432는요열성연쇄상구균제제로낭성림프관종에염증을야기하여심각한합병증없이병소가치유되도록한다. 림프관종, 특히낭성림프관종에서안전하고효과적인대안치료가될수있을것으로사료된다. Sclerotherapy of cystic lymphangioma on floor of mouth using OK-432 Slmaro Park *, Sanghoon Lee, In-Ho Cha Yonsei University College of Dentistry, Dept. of Oral & Maxillofacial Surgery Lymphangioma is benign and congenital malformation of lymphatic system. There are 4 types of orofacial lumpahngioma, localized lymphangioma simplex is consisted of thin walled capillary-like channels, Carvenous llymphangioma has large dilated lymphatic channels, Cystic lymphangioma or hygroma is comprised of endotheliallined cysts ranging in diameter from a few millimeters to severeal centimeters, and diffuse systemic lymphangioma. The treatment of lymphangioma are surgical excision, radiotherpay, sclerosing therapy, CO2 therapy, laser therapy and steriod injection. This case presents 13 months old infant with cystic lymphangioma on floor of mouth, right. OK-432 was used for sclerotherapy 2 times under general anesthesia. The size of lymphangioma was notably diminished followed by MRI. OK-432 is lyophilized incubation mixture group of group A streptococcus pyogenes of human origin. It causes cystic lymphangioma to become inflamed and led to a subsequent cure of the lesion, without serious complications. Sclerotherapy using OK-432 can be safe and effective alternative therapy for lymphangioma, especially for cystic lymphangioma. 제 57 차종합학술대회및정기총회 113

114 PⅡ-19 하악골에생긴 Parosteal osteosarcoma : 증례보고 신승우 *1, 남웅 1 1 연세대학교치과대학병원구강악안면외과학교실 서론 : Osteosarcoma는신생골형성능력을가진간엽세포에서기원하여발생하는원발성악성골종양이다. 조직학적으로는간엽조직의유골형성이가장특징적이며경우에따라연골조직, 섬유성결합조직의형성을보일때도있다. 방사선학적으로는투과상과불투과상을모두보일수있으며방사상의골막증식을보일때도있다. Osteosarcoma의치료원칙은광범위한외과적절제이며최근의보고들에따르면악골에발생한 osteosarcoma의술후5년생존률은 60% 정도로예후는비교적좋지않은것으로알려져있다. Osteosarcoma는병소의임상, 방사선학적, 조직학적양상에따라 intermedullary type과 surface type으로나눌수있으며대부분 intermedullary type에해당하는것으로알려져있다. Osteosarcoma의 surface type의일종인parosteal osteosarcoma는악골에드물게발생하며골막세포에서기원하여발생하며조직학적으로잘분화된 bony trabeculae, spindle cell fibroblast-like proliferation을보이는것이특징이다. Parosteal osteosarcoma는비교적재발율과전이율이낮아 Osteosarcoma에비해예후가좋은것으로알려져있다. 증례보고 : 본환자는고혈압, 당뇨외다른과거력이없는 64세남자환자이며, 하악좌측의병소를주소로내원하여절개생검술시행결과 Parosteal osteosarcoma로진단되었다. 전신마취하광범위절제술, 피질골박리술, 하악좌측제 1대구치, 제3대구치의발치시행받았으며, 림프절및다른장기로의전이는발견되지않았다. 상기환자에대한증례를발표하고자하며, 조직학적및임상적특징에대하여논의하고자한다. Parosteal osteosarcoma occurred in Mandible : A Case Report Seung Woo Shin *1, Woong Nam 1 1 Department of Oral and Maxillofacial Surgery, College of Dentistry, Yonsei University, Seoul, Korea Osteosarcoma is the primary malignant bone tumor originating from mesenchymal cells which have the ability to produce bone formation. The most common histopathological feature of osteosarcoma is osteoid production by malignant mesenchymal cells. Also in some cases, the tumor cells produce chondroid and fibrous connective tissue. Radiographical features of osteosarcoma contain both radiolucency and radiopacity. And osteosarcoma may show sun-ray appearance periosteal reaction. The treatment principle of osteosarcoma is wide excision and in recent researches, it is reported that osteosarcoma occurred in jaw has poor prognosis which is about 60% of 5-years survival rate. Osteosarcoma can be divided into intermedullary type and surface type due to their characteristics. It is known that common type of osteosarcoma is intermedullary type. Parosteal osteosarcoma, which is one type of the surface type of osteosarcoma, rarely occurs in jaw. Parosteal osteosarcoma originate from the periosteum, and histopathologically, it has well-developed bony trabeculae, spindle cell fibroblast-like proliferation. Parosteal osteosarcoma is known to have better prognosis than other sarcoma, due to low recurrence rate and metastatic rate. Case Report: This 64-years old patient had hypertension and diabetics history. His chief complaint was the lesion at mandible left. Incisional biopsy was done and the diagnosis was parosteal osteosarcoma. Under general anesthesia, wide excision, decortication and surgical extraction of mandibular left first molar and third molar. There was no evidence of metastasis to other lymph nodes or organs. The objective of this study is to report the case of the above patient, and discuss about the histopathological and clinical features of this case. 114 대한악안면성형재건외과학회

115 PⅡ-20 Abbe flap을이용한상순재건술 : 증례및고찰양현우 *, 이천의, 최병호 연세대학교원주의과대학치과학교실원주세브란스기독병원구강악안면외과입술은심미적인역할이외에도식이, 언어등에있어서중추적인요소이다. 암, 외상, 선천적기형은입술기형을유발하는원인이며대다수의경우재건이필수적이다. 피부, 점막, 근육으로구성된입술의복잡한해부학적구조는심미적이며기능적인재건을난해하게하나 Abbe flap은상, 하순혈관경에기초한피부, 근육, 점막의복합조직이식이가능하며임상보고에의하면재신경분포화를포함한기능적재건을가능하게한다. 이전통적인술식은술후안전성, 심미성, 기능성등을보장하여현재에도많은외과의에의해다양한임상상황에사용되고있으며최근보고들에의하면다양한국소피판술식에접목되고있다. 본보고에서상순기형환자에대한 Abbe flap을이용한상순재건을통하여심미적이며기능적인결과를얻었기에보고하는바이다. Upper lip reconstruction with Abbe flap : Case study Yang Hyun Woo *, Lee Chunui, Choi Byung Ho Dept. of Oral and maxillofacial surgery, Yonsei university of medicine, Wonju Severance Christian Hospital Lips are structures that play an essential role in aesthetics and in different functions such as nutrition and speech. Certain conditions such as cancer, trauma, and congenital deformities are the major causes of lip deformity that require reconstruction. This type of surgery can be challenging due to the complex anatomy of the lips composed of three different layers (skin, mucosa, and muscles). The Abbe flap is a full-thickness lip-switch flap in which a portion of the uninvolved lip (upper or lower) is rotated across the mouth and into the defect of the involved lip. Use of this flap for the reconstruction of large defects with low risk of necrosis is possible given the abundant blood supply of the lips. Although this technique was described more than a century ago, it is currently used in many cases due to its efficiency, safety, good hemostasis, functionality, and positive cosmetic results. Recent reports show that many surgeons still use it in combination with other flaps. We hereby report cases of surgical reconstruction of the upper lip using an Abbe flap and contemplate on its various aspects. 제 57 차종합학술대회및정기총회 115

116 PⅡ-21 비골유리피판술을이용한하악골재건환자에서이식골편의변위및근돌기의신장 : 증례보고 신승호 *, 박영욱, 김성곤, 김민근, 권광준강릉원주대학교치과대학구강악안면외과학교실 서론 : 하악골연속성의상실은양성및악성종양, 감염, 외상등에의해발생할수있다. 하악골에이러한결손부가발생하였을경우, 재건용금속판이나유리피판술등을이용해하악골을재건해주는방법이많이이용되고있다. 비골을사용한유리피판이식후, 피판의괴사, 스크류나고정용금속판의파절로인한부정유합혹은이식편의변위는보고된바있으나근돌기의신장에대해서는보고된바가아직없다. 이연구에서는법랑모세포종으로인해하악골절제술을시행하고비골유리피판술을시행한환자에서관찰된근돌기의신장및이식편의변위에대해보고하고자한다. 방법 : 1984년및 2001년, 하악골의양성종양을주소로타원에서수술받았던환자가수술부위의불편감을주소로내원하였다. 병소의크기가커하악우측견치부부터우측하악골의상행지부위까지하악골절제술을시행하고비골유리피판을이용하여하악골을재건하였다. 결과 : 술후 3개월후근돌기의신장과함께이식편이경도의상방변위를보였다. 술후 1년 7개월째, 이식편의첫번째분절부에서골흡수소견과함께이식편의심한상병변위가관찰되었다. 고찰및결론 : 이식편의상방변위및근돌기의신장은측두근에의해발생되었을확률이높으며, 이를해결하기위해수술시근돌기절제술을함께시행하거나, 술후보톨리늄톡신주사등을통해측두근의활성을낮추어주는것을고려해볼필요가있다. Elongation of coronoid process and displacement of grafted bone after mandible reconstruction after Fibula free flap Sung Ho Shin *, Young-Wook Park, Seong-Gon Kim, Min- Keun Kim, Kwang-Jun Kweun Department of Oral and Maxillofacial surgery, College of Dentistry, Gangneung-Wonju National University Introduction: The loss of continuity of mandible can be occurred by benign or malignant tumor, infection and trauma. If this occurs, mandible reconstruction is needed using reconstruction plate or vascularized osseocutaneous flaps. Some complications like flap necrosis, mal-union or displacement of grafted bone due to screw loosening or plate fracture has been reported, however, none of them reports about elongation of coronoid process. In this case report, we report a patients showed coronoid process elongation and displacement of grafted bone after mandible reconstruction with fibula. Method and materials: The patient who had got the surgery from other hospital because of benign tumor of right mandible came to our clinic due to discomfort of operation site. Manibulectomy from #43 to right ascending ramus was done and the defect was reconstructed with fibula. Results: After 3months of surgery, slight elongation of coronoid process and displacement of grafted bone was started. After 19months of surgery, the first segmental area of grafted bone was resorbed and more displacement was observed. Conclusion: The displacement of bone and elongation of coronoid process is may be due to temporal muscle. To prevent this, coronoidectomy during the surgery or Botulinum toxin injection can be accompanied. 116 대한악안면성형재건외과학회

117 PⅡ-22 표층이하선적출술, 로봇을이용한선택적경부청소술및악하선적출술에서이개후부절개술의유용성 김영관 1*, 남웅 1, 이상훈 1 연세대학교치과대학구강악안면외과학교실 1 Terris et al. 이표층이하선적출을위한대안적접근법으로이개후부절개술에대해보고한이래로, 다양한수술에서이에대한유용성과심미적장점에대한연구들이발표되고있다. 좋은심미적결과를보인다양한수술방법들이소개되고있는가운데, 최근 Koh et al. 은이개후부절개술을통해심미적불편없이로봇을이용한경부청소술이실현가능하다고보고하였다. 우리는또한이개후부절개를통해, 로봇을사용한악하선절제술이가능하다고보고한바있다. 이에우리는이개후부절개술을이용한표층이하선적출술 2증례, 로봇을이용한견갑설골상부경부청소술 1증례, 로봇을이용한악하선적출술 3증례를소개하고, 이에대한유용성에대해고찰해보고자한다. Versatility of retroauricular incision for superficial parotidectomy, robot-assisted SOND and submandibular gland excision: case series Youngkwan Kim 1*, Sanghoon Lee 1, Woong Nam 1 Department of Oral and Maxillofacial Surgery, Yonsei University, College of Dentistry, Seoul, Korea 1 Since Terris et al. reported that retroauricular incision is an alternative approach to parotidectomy for selected patients, there have been many reports about versatilities and esthetic advantages of retroauricular incision in various surgeries. Recently, among various surgical methods introduced to optimize esthetic results, robotic surgery has gradually expanded in scope, Koh et al. having reported that robotassisted neck dissection is feasible via retroauricular incision without compromising cosmetics. We also reported that robotassisted submandibular gland excision via retroauricular approach is possible. In this paper, we report 2 cases of superficial parotidectomy, a case of robot-assisted SOND and 3 case of robot-assisted submandibular gland excision via retroauricular approach and discuss the versatility of retroauricular inicision 제 57 차종합학술대회및정기총회 117

118 PⅡ-23 악하부위에외과적절제술후발생한고분화지방육종 : 증례보고 정지훈 *, 허재진, 강병훈, 최송제, 안준형, 한정준, 국민석, 박홍주, 오희균, 정승곤전남대학교치의학전문대학원, 구강악안면외과학교실, 전남대학교치의학연구소 성인에서지방종은양성종양의약 50% 로가장흔하다. 지방육종은가장흔한연조직악성종양으로고분화, 점액상, 다형성, 탈분화등의 4가지아류형으로분류할수있다. 고분화지방육종의예후는양호하지만, 나머지 3가지아류형은보다심화된형태로나타나며, 5년생존율이 50% 미만으로매우불량한예후를보인다. 또한저분화지방육종의전이는매우흔하다. 말초부위에발생한지방종은전이가능성이거의없으며보통완전절제술로치료가능하여비정형지방종성종양이라한다. 후복막강, 종격등해부학적으로깊은부위에종양이위치한경우, 병소완전절제의어려움으로국소적재발, 탈분화및사망률증가로고분화지방육종이라명명한다. 62세여자환자가 1년전부터점점크기가증가하는우측하악각부위의종물을주소로전남대학교병원구강악안면외과로내원하였다. Facial CT (enhance) 및 Face MRI (enhance) 상지방종으로진단하고구강내접근법을통해외과적절제술을시행하였다. 조직병리학적검사상지방종으로진단되었으나, 수술 2년후부터다시수술부위종물촉진되었고, 영상검사상우측하악각부위피하층의병소재발소견보여외과적절제술재시행하였으며, 조직병리학적검사결과 Atypical lipomatous tumor/well differentiated liposarcoma로진단되었다. 조직병리학적검사결과 resection margin에서 positive margin 관찰되어항암치료전경과관찰시행하여필요시 wide surgical excision 시행예정이다. 본교실에서는이의치료와결과에대하여문헌고찰과함께보고하는바이다. Well-differentiated liposarcoma arisen on submandibular after excision of lipoma: A case report. Ji-Hun Chong *, Jae-Jin Heo, Byoung-Hun Kang, Song- Je Choi, Jun-Hyeong An, Jeong Joon Han, Min-Suk Kook, Hong-Ju Park, Hee-Kyun Oh,, Seunggon Jung Department of Oral and Maxillofacial Surgery, School of Dentistry, Chonnam National University Lipomas are the most common soft-tissue mass encountered, accounting for 50% of soft-tissue masses. Liposarcomas are among the most common soft tissue malignancy in adults. 4 categories have been recognized: well-differentiated, myxoid (including round cell), pleomorphic, and dedifferentiated. Though well-differentiated liposarcomas often carry a generally benign prognosis, all the other subtypes are higher grade lesions with a more worrisome prognosis, with the overall 5-year survival rate of patients with deep high grade liposarcomas being less than 50%. Metastases are common in poorly differentiated liposarcomas. Tumors located in the periphery have no risk of metastasis and complete resection is generally curative, naming atypical lipomatous tumor (ALT). If the tumor is deep seated (retroperitoneum, mediastinum), achieving negative margins is significantly diminished and the risk of local recurrence, dedifferentiation (DDL) and death are increased, naming well differentiated liposarcoma is more appropriate. A 62-year-old female patient visited department of Oral and Maxillofacial Surgery, Chonnam National University Hospital with chief complaint of increasing mass on right mandible angle area from 1 year ago. After radiographic examination of facial CT and MRI, surgical excision of the mass was done via intra-oral approach. Biopsy result was lipoma. However, with 2 years of follow-up, palpable increasing mass detected on the similar location. Patient underwent surgical excision under general anesthesia with tentative diagnosis of recurrence of lipoma after which immunohistochemical test revealed that the lesion was atypical lipomatous tumor / well differentiated liposarcoma. We here report this rare case of well-differentiated liposarcoma arisen on submandibular after excision of lipoma. 118 대한악안면성형재건외과학회

119 PⅡ-24 한국인의구강악안면영역에발생한악성흑색종에관한임상연구 채연수 1,2*, 이진용 1,2, 이정우 3, 장현석 2, 임재석 2, 이의석 2, 김성민 1,3, 김명진 1,3, 이종호 1,3 1 서울대학교치의학대학원구강악안면외과 2 고려대학교임상치의학대학원구강악안면외과 3 서울대학교치과병원구강악안면외과 목적 : 구강악안면영역의악성흑색종의예후는다른부위의흑색종에비해매우불량하나발생빈도가매우낮다. 이때문에대규모의임상연구가어려운실정이다. 본연구에서는구강악안면영역에발생한악성흑색종증례들을고찰해보고이의치료방침에대해논의해보고자한다. 재료및방법 : 2002년부터 2018년까지서울대학교치과병원구강악안면외과에서악성흑색종으로진단받은 76명의환자를대상으로병기, 수술방법, 수술전후의추가적인치료시행여부및예후등을조사하였다. 결과 : 환자의평균연령은 58.8세 (26~87세에분포 ) 였으며. 남자 44명, 여자 32명이었다. 평균내원기간은 30개월이었으며원발부위는구개부가 30례 (39.47%), 상악전치부치은이 16례 (21.05%), 하악이 13례 (17.11%), 상악구치부치은이 9례 (11.84%), 협점막이 4례 (5.26%), 상악동과상순이각2례 (5.26%) 였다. 55명의환자가본원에서치료를시행받았으며, 이중 27명이종물절제술을, 25명이종물절제술및경부청소술을, 2명이종물절제술및경부림프절생검을시행받았다. 15명은술후화학요법, 6명은술후방사선요법, 3명은술후방사선요법및화학요법, 6명은술후면역화학요법을시행받았다. 수술을받지않은 14명중 2명은방사선요법을, 2명은면역화학요법을, 1명은면역화학요법및방사선요법을시행받았다. 사망이확인된 14명의환자 (18.42%) 중, 12명이원격전이로, 1명은치료거부, 1명은고식적방사선요법도중사망하였다. 총확인된원격전이는 30명 (39.47%) 이었다. 결론 : 일반적으로, 수술이가능한환자에서는종물절제술이시행되었으며, 전이가진행되거나수술이불가능할경우엔고농도의인터페론-알파를이용한면역화학요법을시행하는것이추천된다. 방사선요법은병소의진행을억제하는데큰효과가없었다. * 본연구는보건복지부보건의료연구개발사업의지원에의하여이루어진것임. (A121035) Clinical study on the malignant melanoma of oral and maxillofacial area in Korea Yeon-Su Chae 1,2*, Jin-Yong Lee 1,2, Jung-Woo Lee 3, Hyonseok Jang 2, Jae-suk Rim 2, Eui-seok Lee 2, Sung-Min Kim 1,3, Myung-Jin Kim 1,3, Jong-Ho Lee 1,3 1 Department of Oral and Maxillofacial Surgery, Graduate School, Seoul National University 2 Department of Oral and Maxillofacial Surgery, Graduate School of Clinical Dentistry, Korea University 3 Department of Oral and Maxillofacial Surgery, Seoul National University Dental Hospital Purpose: Malignant melanoma in the oral and maxillofacial area has an extremely poor prognosis, but large-scale clinical study is difficult due to its rareness. compared with that of the skin. In this study, we performed the cases review to discuss its effective management. Patients & Methods: From 2002 to 2018, we analyzed 76 cases of malignant melanoma in SNUDH OMFS. We surveyed TNM stage, type of surgery, perioperative therapy, complications, prognosis and so on. Results: Mean age of patients was 58.8 years old (26~87 years old), 44 men and 32 women. Average follow up period was 30 months. Primary sites were as following: 30 cases of palate (39.47%), 16 cases of anterior maxillary gingiva (21.05%), 13 cases o mandibule(17.11%), 9 cases of posterior maxillary gingiva (11.84%), 4 cases of buccal mucosa (5.26%), 2 cases of each maxillary sinus and lip (2.63% for each) %). 55 patients were managed in SNUDH OMFS: 27 patients for mass resection, 25 patients for mass resection with neck dissection and 2 patients for mass resection and lymph node biopsy. Fifteen patients received postoperative chemotherapy, 6 patients received postoperative radiation therapy, 3 patients received postoperative radio-chemotherapy and 6 patient received postoperative immunotherapy. Out of 14 patients who died, 12 patients died due to the distant metastasis, one patient rejected the treatment and the other due to the rapid progression during palliative radiation therapy. Total 30 patients were diagnosed for distant metastasis. Conclusion : In general, surgical resection was performed if possible and immunotherapy with high dose interferonalpha is a generally accepted protocol when tumor resection is impossible or distant metastasis is confirmed. Radiation therapy could not control the progression of disease. Acknowledgement : This study was supported by a grant of the Korea Health technology R&D Project, Ministry of Health & Welfare, Republic of Korea. (A121035) 제 57 차종합학술대회및정기총회 119

120 PⅡ-25 구강암수술후노출된티타늄금속판폐쇄를위한협부지방피판을이용한치료증례 강미주 *, 류동목, 지유진, 이덕원, 김세원, 양선인, 정상필강동경희대학교치과병원구강악안면외과교실 서론 : 악안면영역에서선천성혹은후천성으로다양한구강내결손이발생할수있다. 협부지방피판은술식이비교적간단하며, 풍부한혈액공급과위치상의이점으로구강내결함의재건에사용되어왔다. 목적 : 본연구는구강암수술후발생한구강내결함의재건에협부지방피판을이용한치료증례를소개하고이에대한효과및예후를소개하기위함이다. 환자및방법 : 54세여자환자로우측하악구치부잇몸병소를주소로로컬에서의뢰되어본과처음내원하였다. 내원당시좌측협측치은부의악성변화양상관찰되어 inicisonal biopsy 시행하였으며그결과, SCC로확인되었다. neck dissection, 및좌측 mandibulectomy 시행하였으며 fibula free flap을이용하여재건술시행하였다. 그러나이후이식한 flap 일부에서 necrotic change 확인되었으며하방의 plate 및 bone노출되어 buccal fat pad를이용하여재건술다시시행하였다. 결과 : 수술후노출되어있던 plate 와 bone은 buccal fat pad에의해적절히폐쇄되었으며약 3주후상피화가확인되었다. 환자는술후감염및재발등의합병증을호소하지않았으며양호한치유결과를보였다., 결론 : 협부지방피판은수술후발생한구강내결함의재건을위해사용할수있는효과적이고신뢰할수있는방법중하나이다. The use of the buccal fat pad for closure of the exposed titanium plate after oral cancer surgery; A case report Miju Kang *, Dong-mok Ryu, You-jin Jee, Deok won Lee, Sewon Kim, Suning Yang, Sang-pil Jung Dept. of Oral and maxillofacial surgery, Kyung-Hee University Dental Hospital at Gangdong Introduction: Many congenital and acquired defects occur in the maxillofacial area. The buccal fat pad flap (BFP) is a simple and reliable flap for the treatment of many of these defects because of its rich blood supply and location, which is close to the location of various intraoral defects. Purpose: This study introduces the case of using the buccal fat pad (BFP) for the reconstruction of tumor defects and evaluates its effectiveness and prognosis. Patients and methods: A 54-years old female patient reported to a private dental clinic with pain and swelling in the right lower molar region for the past 3 months. Intraoral examination revealed the presence of reddish buccal gingival growth in relation to molars. A previously performed incisional biopsy had reported the lesion to be histopathologically well-differentiated SCC (T4N2bM0) and she underwent tumor resection (neck dissection, mandibulectomy) and simultaneous reconstruction with a titanium mandibular reconstruction plate and vascularized fibula free flap. However, necrotic change was confirmed in a part of the grafted flap, and reconstruction was re-performed using a buccal fat pad (BFP). Results: After the surgery, adequate closure of the exposed plate and bone defects was achieved by buccal fat pad (BFP) and the flap was epithelialized within 3 weeks. Postoperative infection and complications of dehiscence or flap failure were not existed and uneventful healing was seen. Conclusions: Buccal fat pad (BFP) is one of the effective and reliable methods which can be used for the replacement and reconstruction of the oral mucosa due to postsurgical defect. BFP is an excellent choice for reconstruction of small to medium size defects. 120 대한악안면성형재건외과학회

121 PⅡ-26 구강내와폐에동시에발생한편평상피세포암 : 증례보고 정상필 *, 류동목, 지유진, 이덕원, 김세원, 양선인, 강미주강동경희대학교치과병원구강악안면외과교실 서론 : 구강암의폐전이는 4%-33% 로, 드물게발생하며원발병소의크기가큰경우확률이증가한다. Level IV의림프절전이가있을경우폐로의전이가더자주발견된다. 흉부 CT 촬영을통해확인할수있으나, 진단학적가치는높지않으므로, 주기적인 Chest x-ray촬영후이상소견을확인하는것이필요할수있다. 이포스터는구강과폐에동시에발병한증례를보고한다. 증례 : 50세남성환자로, 구강내부종을주소로내원하였다. 절개생검시행결과 Verrucous carcinoma로진단되어원발병소의안전영역을고려한절제및요측전완유리피판으로재건을시행하였다. 수술후항암치료중시행한흉부방사선사진에서폐부위경화양상확인되었다. 기관지내초음파를통한조직검사후비소세포암종으로진단되었다. 폐부위방사선치료시행후수술이가능한크기로감소되어병소의절제술을시행하였다. 수술후 24개월경과관찰에서재발소견은없으며, 호흡기기능및구강내상태는양호하다. 결론 : 환자의구강내원발부병소는 T2(2.5x1.6cm) 으로, 구강암의경우폐로의원격전이는드물게보고되고있다. 이환자의경우별도의원발병소로도판단될수있다. 구강암환자의경우흉부 CT의일반적인촬영은고려되지않으나, 주기적인 Chest x-ray 촬영을통해원격전이여부의확인이필요하다. Squamous Cell Carcinoma Occuring Simultaneously in the Oral and Lung: A Case Report Sang-Pil Jung *, Dong-Mok Ryu, Yu-Jin Jee, Deok-Won Lee, Se-won Kim, Suning Yang, Miju Kang Dept. of Oral and maxillofacial surgery, Kyung Hee University Dental Hospital at Gangdong Introduction: Pulmonary metastases from oral cancer occur rarely, ranging from 4%-33%, and the probability increases as the size of the primary tumor increases. When there is lymph node metastasis in Level IV, metastasis to the lung is more frequently found. Therefore, Chest CT could be performed for confirm the diagnosis, but the diagnostic value is not high. So it may be necessary to check the chest x-ray for finding abnormality. This poster reports case of occurred cancer simultaneously in oral and pulmonary. Case report: 50 years old male patient visited our clinic for intraoral swelling. Incisional biopsy proven that mass was verrucous carcinoma. Resection with safety margin and reconstruction using radial forearm free flap was performed. After surgery, in period of chemotherapy, chest x-ray showed consolidation of pulmonary area. Endobronchial ultrasound(ebus) guided biopsy was performed and confirmed that the consolidation was nonsmall cell carcinoma. After radiation therapy, the tumor size was decreased to resectable size and the tumor resected by surgical approach. There was no recurrence at 24 months postoperative follow up and respiratory function is within normal range and oral status were good. Conclusion: The oral tumor T stage was T2(2.5 x 1.6cm), and distant metastasis to the lung was rarely reported. In this patient, the lung cancer could be either metastatic cancer or a separately occurred cancer in the lung. In the oral cancer patient, routinely taking of the chest CT was not recommended, but periodic chest x-ray imaging could be necessary to check the distant metastasis. 제 57 차종합학술대회및정기총회 121

122 PⅡ-27 안면부에발생한모기질종의진단및적출 : 증례보고 조제호 * 정지혜최순규허성휘양수남청주한국병원구강악안면외과 서론 : 모기질종은모낭기질세포에서기원한양성피부종양으로두경부영역에서호발하며, 주로 20세이하에서많고, 노인들에서도종종나타난다. 모기질종은임상적으로진단하기어렵고다른피부종양과혼동될수있으며, 악성종양과유사한소견을보일수있어오진되는경우도있다. 본증례에서는초기검사시악성질환으로의심되었다가조직검사를통해모기질종으로확진을할수있었으며, 본증례를통해악성질환으로오인할수있는모기질종의진단과정에대해보고하고자한다. 방법 : 37세여환으로얼굴에무언가났다는주소로본원구강외과로내원하였다. 내원시우측중안면부에 3cm 가량의덩어리가만져지는상태였으며, 한달전부터조금씩커졌다고하였다. 조영증강전산화단층영상촬영술을시행하였으며, 소엽화된경계를가진단단한결절로악성가능성이높아보인다는소견이나와조직검사를통해확인을하기위해절제생검을시행하였다. 결과 : 절제생검시행시종양내부에갈색또는노란색의 0.2cc 정도의연조직이나왔으며, 모기질종으로진단되었다. 이후추가적인절제는시행하지않았으며, 봉합이후상처부위는잘치유되었다. 고찰및결론 : 모기질종은임상적으로진단하기어려우며, 표피하낭종이나피지선낭종, 이하선종양과의감별뿐아니라기저세포또는편평세포암종이나두경부의악성질환도감별해야한다. 그리고수술적완전절제가필요하며, 절개및소파술은병변재발및악성변이가능성이있어시행하지않는다. 악성질환이의심되는소견이있을경우모기질종을배제하는것이필요할것으로보이며, 이에본증례를통해모기질종의진단과정을보고하고자한다. Diagnosis and excision of pilomatricoma occurring in the face : case report JEHO CHO *, JI HAE JUNG, SUN GYU CHOI, SUNG HYUI HUA, SOO NAM YANG Department of Oral and Maxillofacial surgery, Cheongju Hankook Hospital Introduction: Pilomatricoma is a benign skin tumor originating from hair follicle stromal cells, mainly found in people younger than 20 years old, and often in old people. Pilomatricoma is clinically difficult to diagnose and confused with other skin tumors, sometimes misdiagnosed to malignant tumor. In this case the initial diagnosis was suspected to be a malignant disease, but could confirm it as a pilomatricoma by excisional biopsy. So I want to report process of diagnosis of pilomatricoma which can be confused with malignant disease. Method: A 37-year-old female patient visited our hospital and her cheif complain was that she had a boil on her face. A mass that size is about 3cm was touched on the right mid-face, and it was gradually increased from a month ago. We performed enhanced Computed tomography(ct) and suspected as a malignant potential beacause it has a solid nodule with lobulated border. Excisional biopsy was performed to confirm diagnosis of the mass. Result: During the excisional biopsy, about 0.2cc of brown or yellowish soft tissue was found inside the tumor and diagnosed as pilomatricoma. No additional resection was performed and the operation site healed well after suturing. Conculsion: The pilomatricoma is difficult to diagnose clinically. It should be distinguished form epidermoid cyst, sebaceous cyst, parotid tumors, as well as basal cell or squamous cell carcinoma or malignant disease of the head and neck. Surgical resection is necessary because incision and currettage can recurrence of lesion and have possibility of malignant transformation. If there is any suspicion of malignant disease, it is necessary to rule out pilomatricoma, so I report the diagnosis process of pilomatricoma. 122 대한악안면성형재건외과학회

123 PⅡ-28 피부에발생한편평상피세포암 ; 증례보고정지혜 *, 조제호, 최순규, 허성휘, 양수남청주한국병원구강악안면외과서론 : 편평상피세포암은피부에발생하는암중에두번째로자주발생한다. 피부에발생한편평상피세포암 (cutaneous squamous cell carcinoma,cscc) 은크기, 위치, 병소의깊이등등에따라저위험도와고위험도로분류할수있다. 2cm미만의크기, 4mm 미만의두께이며, 이전에치료받은적이없다면저위험도로분류된다. 이러한경우대부분림프절로의전이가발생하지않는다. 저위험도로진단된경우외과적절제로기능적, 심미적손상을최소화할수있으며, 재발의위험도를낮춰수술만으로치료할수있다. 본증례는본원에서편평상피세포암으로진단되어외과적절제로치료한증례를보고하고자한다. 증례 : 환자는 85세여성으로우측협부로종괴가잘낫지않는다는주소로내원하였으며, 병소의일부를조직검사하여편평상피세포암으로진단받았다. 병소는우측협부의융기되고단단한경계를가졌으며, 피부와피하조직을포함한 1cm 정도의크기였다. 주변구조물로의침윤, 림프절로의전이는없었다. 방사선치료및항암치료없이외과적으로절제하기로하였다. 전신마취하에주변정상조직을포함하여 4mm이상의경계를두고, 1:3의비율로방추형절제하였다. 고찰및결론 : 저위험도의편평상피세포암의경우 4~6mm 의정상적인경계를두고절제한다. 조직검사결과절제된조직의경계가편평상피세포가없는정상조직임을확인하는것이필요하다. D. G. Brodland and J. A. Zitelli의연구에따르면 4mm이상의경계를둘경우 97% 가깨끗한경계로완전제거되는것에비해, 2mm의경계를둘경우 78% 로감소하게되므로 4mm 이상의경계를두고절제하는것이추천된다. 만약, 절제된조직의조직검사에서경계에편평상피세포가존재한다면재수술이필요하다. 본증례는저위험도의편평세포암으로진단된병소를외과적으로절제하였다. 현재까지재발이나전이없이양호한결과를보여보고하는바이다. Cutaneous squamous cell carcinoma; a case report JI HYE JEONG *, JEHO CHO, SUN GYU CHOI, SUNG HWI HUR, SOO NAM YANG Department of Oral and Maxillofacial surgery, Cheongju Hankook Hospital Introduction: Cutaneous squamous cell carcinoma(cscc) is the second most frequent skin tumor. It is classified into lowrisk and high-risk depending on location, size, thick, recurrent lesions, and the presence of perineural invasion. A small (<2 cm), thin (<4 mm), and previously untreated cscc will not develop nodal metastases and can be classified as low-risk. cscc detected at an early stage and removed promptly are almost always curable and cause minimal damage. We report a case treated with surgical excision. Case: The patient in this case is 85 years, Female, who had unhealed mass on the right cheek. Incisional biopsy was performed as cscc. The lesion had a raised and rigid border of the right cheek. It was about 1cm in size including skin and subcutaneous tissue. There was no invasion to the surrounding structures or metastasis to the lymph nodes. Surgical excision was planned without radiation or chemotherapy. Under general anesthesia, we cut an elliptical (football) shape around the 4mm margin at a ratio of 1: 3. Conclusions: Low-risk cscc is excised with a 4 to 6mm margin. A tissue sample (biopsy) will be examined under a microscope to ensure the entire cancerous tumor along with a surrounding border of presumably normal skin as a safety margin. According to D. G. Brodland and J. A. Zitelli, excised cscc a 4mm surgical margin resulted in clearance in 97% of cases compared with a 2mmexcision margin achieving this in only 78% of cases. Surgery is recommended excision with a 4 to 6mm margin. If tumor cells are present, treatment is required. The physician uses a scalpel to remove, or excise, the entire cancerous tumor along with a surrounding border of presumably normal skin as a safety margin. The physician closes the skin around the surgical site with stitches and sends the tissue specimen to a lab to verify that all cancerous cells have been removed. If the lab finds evidence of skin cancer beyond the safety margin, the patient may need to return for further surgery. In this case, We performed surgical excision for a lesion diagnosed as lowrisk cscc. No recurrence was noted yet. 제 57 차종합학술대회및정기총회 123

124 PⅡ-29 섬유성골형성이상의장골이식치료정준홍 *, 이한빈, 하현빈, 오현준, 서병무 서울대학교치과병원구강악안면외과섬유성골형성이상은국소적으로혹은다수의골에발생하는종양유사특징을가지는발육성질환이다. GNAS 유전자의돌연변이로인한모자이크성병소로뼈의모든성분이나타나나성숙한구조로분화되지못한다는특징을가지고있다. 섬유조직의과잉증식은정상골을점차대체하게되고, 골전체가팽창하지만구조적으로약화된다. 일반적으로무증상이지만부피증가가계속되면정상측에비해이환측이비대칭적으로커진것을확인할수있고, 두개골부위에서는특히신경관압박으로인하여시각소실, 청각소실등부가적인증상이나타날수있다. 악안면부위에서발생한섬유성골형성이상의치료는일반적으로팽창이일어난부위를삭제하는부분절제술을시행하여, 좌우대칭을맞춰주는수술을시행하는것이기존의치료방법으로알려져있다. 환자의나이에따라서성장이진행중이고병소의크기가작다면일차적으로완전절제를시도하기도한다. 이와관련하여골결손부가생기면이를재건하기위한방법으로골이식을고려할수있는데이방법에대해서는원발병소의완전절제가불가능한경우병소의재발과형태적이상의재현이우려된다는점때문에반대가있다. 본보고는성장기에있는단방성섬유성골형성이상증례에대해가능한많은부위의병소를제거한후장골이식을통해수복한환자의장기적인결과를추적하여결과를보고하고자한다. Iliac bone graft as a treatment option for fibrous dysplasia Junhong Jung *, Hanbin Lee, Hyunbin Ha, Hyun Jun Oh, Byoung-Moo Seo Department of Oral and Maxillofacial Surgery, Seoul National University Dental Hospital Fibrous dysplasia is a benign tumor-like disease which usually develops in a single bone but sometimes in multiple bones. It is a mosaic lesion caused by the mutation of the GNAS gene. It is characterized that the lesion contains all components of the bone but does not develop mature structures. Overgrowth of the fibrous tissue gradually replaces the normal bone, so the bone becomes weak. This is generally asymptomatic. However, if the volume increase sustained, the affected side is asymmetrically enlarged compared to the normal side. In the skull area, additional symptoms such as visual loss, and hearing loss may occur due to neural tube compression. In the treatment of fibrous dysplasia of the maxillofacial region, it is generally known that partial resection is considered as a choice to remove the enlarged region and adjust the symmetry of the face. If the size of lesion is small enough to be removed completely or the lesion is expected to grow continuously, a complete resection may be attempted at first. In this regard, bone grafting can be considered as a method for reconstructing bone defects. This method implies the controversy about the possible recurrence after partial resection where complete removal of the lesion is impossible. The purpose of this report is to present the long-term outcome of patients recovering from iliac bone graft after removal of large lesions for monostotic fibrous dysplasia. 124 대한악안면성형재건외과학회

125 PⅡ-30 3 차원적 CT 체적분석을통한구강내낭성병소의낭종강감압술의효과연구 권예진 *, Puneet Wadhwa, 김충남, 김민수, 김규태, 김수호, 임호경, 이의석고려대학교부속구로병원구강악안면외과 구강내낭성병소는구강악안면영역에서매우흔히볼수있는질환중하나이다. 낭성병소의치료는병소의크기, 위치, 환자의나이, 골경계부의연속성, 그리고치아, 하치조신경관, 상악동, 비강등의구조물과낭성병소의거리를고려하여결정한다. 인접구조물을손상시키지않는범위의낭성병소는낭종적출술을시행한다. 병소의크기가큰경우에는, 먼저낭종감압술또는낭종조대술을시행하기도한다. 낭종감압술과낭종조대술은방법이매우유사하며, 낭종강안의액체의압력을감소시키고, 낭종경계부쪽의골을형성하게함으로써결과적으로낭종의크기를줄여주는술식이다. 이러한술식의장점중의하나는낭종강의점진적인감소로, 이를통해치수생활력을유지하고, 치아를보존하며, 주요해부학적구조물의외과적손상이나골절을피할수있고, 병소의재발을줄일수있다. 낭종감압술전, 후의 CT 데이터를이용한낭종강체적변화분석을통해, 본술식의효과를평가할수있다. 본연구는 2012년부터 2017년사이고려대구로병원구강악안면외과에서구강내낭성병소에낭종강감압술을시행한 30명의환자를후향적으로분석하였다. 모든환자는낭종강감압술시행전, 후로 3차원 CT를촬영하였다. Invivo5(Anatomage, San Jose, USA) program을이용하여낭종강의체적을측정하고, 나이, 성별, 병소의위치및초기크기, 병리학적진단명등변수에따른낭종강의체적변화를분석하였다. Effect of decompression of Intraoral cystic lesion based on computed tomography Volumetric analysis. Yeh-Jin Kwon *, Punnet Wadhwa, Choong-Nam Kim *, Min- Su Kim, Gyu-Tae Kim, Soo-Ho Kim, Ho-Kyoung Lim, Eui- Suk Lee Department of Oral and Maxillofacial Surgery, Guro Hospital, Korea University Intraoral cystic lesions are one of the most common pathologies in the oral and maxillofacial lesion. Treatment for cystic lesions depends on the size, location, patient age, and the continuity of the bony margins, as well as proximity to vital structures such as teeth, inferior alveolar canal, maxillary sinus, and nasal cavity. Enucleation is the treatment of choice if it can be performed without damage to adjacent structures. In the management of large cystic lesions, it can be treated by either decompression or marsupialization first. Decompression and marsupialization are very similar surgical procedures aimed at decreasing the cystic size by reducing the pressure of the cystic fluid and bony apposition to the cystic walls. The benefits of these methods include gradual decrease in the cystic cavity; maintenance if pulp vitality; prevention of tooth extractions; avoidance of surgical damage to important anatomical structures and fracture; and low risk of recurrence. Computed tomography is an efficient method for evaluating effect of decompression by measuring changes in cystic volume before and after decompression. We investigated 30 patients who had undergone decompression for intraoral cystic lesions at the Department of Oral and Maxillofacial Surgery in KUMC Guro hospital between 2012 and 2017 retrospectively. Three-dimentional CT scans were taken to all patients before and after surgery. We measured the volume of cystic lesions using the invivo5(anatomage, San Jose, USA) program and evaluated the volumetric changes after decompression according to various parameters(age, sex, location and initial size of lesion, pathologic diagnosis etc). 제 57 차종합학술대회및정기총회 125

126 PⅡ-31 재발성법랑모세포종의악성변이에대한증례김근환 *, 장성백, 이성탁, 최소영, 김진욱, 권대근 경북대학교치과병원구강악안면외과학교실서론 : 법랑모세포종은다양한위치에서의발생및전이성, 악성으로의변이, 경과중높은재발율을특징으로하는치성종양이다. 법랑모세포종의 subtype중극세포형법랑모세포종은보기드문형태이며, 악성으로의전이가여러문헌에서보고되고있다. 침습성이강하고, 재발되는경향또한다른 type에비하여높다고알려져있으며증례의환자도 5차례의수술후최종적으로법랑모세포암종으로진단되었으며이에증례보고및고찰을하고자한다. 증례보고 : 60세남환으로 2015년우측상악동의염증및동통주소로최초내원하였으며총 3회의 surgical curettage 및 2회의상악골절제술을시행하였다. 최초조직검사에서극세포형법랑모세포종으로진단되었으며병소부위의지속적인 pain과 pus discharge 소견이반복되었다. 증상이발생할때마다 conservative surgery와 radical surgery를시행하였다. 5번째재발시시행한조직검사상법랑모세포암종으로진단되어수술적치료중단후방사선종양학과협진하 6회의방사선치료진행하였으며현재까지재발없이 f/u진행중이다. 고찰및결론 : 상악에발생하는극세포형법랑모세포종은흔치않은증례이다. 증례의환자는초진이후약 3년동안 5 차례의수술적치료를진행하였으며, 최종적으로법랑모세포암종으로진단되었다. 극세포형의경우조직학적으로 SCC와유사한형태의편평세포분화를특징으로하기때문에최초의조직학적진단에서악성과의감별진단이매우중요하다. 또한극세포형은악성으로의전이가다른 subtype에비하여높기때문에환자의 f/u 기간동안면밀한관찰이필요하다. 지속적인재발이발생할경우진단에따라앞으로의치료방향에큰차이를가져오기때문에이전의조직학적소견에서악성으로의변이형태가보였는지, 그렇지않다면악성으로의이행상태에있을가능성을항상고려해야할것이다. A case on the Malignant transformation of Recurrent Ameloblastoma : A case report Keun-Hwan Kim *, Sung-Back Jang, Sung-Tak Lee, So-young Choi, Jin-wook Kim, Tae-Geon Kwon 1 Dept. of Oral and Maxillofacial surgery, School of Dentistry, Kyungpook National University, Daegu, Republic of Korea Introduction: Ameloblastoma is a odontogenic tumor characterized by various locations of metastasis, malignant transformation, and a high recurrence rate over time. Among the subtypes of ameloblastoma, acanthomatous ameloblastoma is an unusual form and metastasis to malignancy has been reported in various literature. It is known that the invasion is strong and recurrence is also higher than other types. The patient was also diagnosed as ameloblastic carcinoma after 5 operations. We report this case and review it. Case report: A 60-year-old man with a history of inflammation and pain at the right maxillary sinus in Three surgical curettage and two maxillectomy were performed. The initial biopsy was diagnosed as acanthomatous ameloblastoma and repeated pain and pus discharge findings were repeated. Conservative surgery and radical surgery were performed whenever symptoms occurred. On the 5th recurrence, the tumor was diagnosed as ameloblastic carcinoma. the patient underwent radiation therapy for 6 times with radiation oncology. The patient has been symptom-free until now. Discussion & Conclusion: acnathomatous ameloblastoma in the maxilla is a rare case. The patient underwent five surgical treatments for about 3 years after initial diagnosis, and ultimately diagnosed as ameloblastic carcinoma. In the case of acanthomatous type, it is very important to distinguish malignancy from the initial histologic diagnosis because it is characterized by squamous cell differentiation similar to SCC histologically. In addition, because of the high rate of metastasis to the malignant type compared with other subtypes, careful observation during the f / u period of the patient is needed. In the case of continuous recurrence, it is always necessary to consider the possibility of transition from malignant to malignant, if not, from the previous tissue slide. This is because the diagnosis leads to a big difference in the direction of future treatment. 126 대한악안면성형재건외과학회

127 PⅡ-32 타액선암치료결과 : 13 증례장완희 *, 안강민 울산대학교의과대학구강악안면외과서울아산병원서론 : 구강악안면에발생한타액선암은비교적드물게발생하며서서히자라는경향이있어서조기발견이어렵고다양한조직병리학적소견을가지고있어서치료방법이다양하다. 본연구의목적은구강악안면에발생한타액선암을외과적처치후에예후를관찰함에있다. 재료및방법 : 본연구는 2007년 4월부터 2018년 1월까지서울아산병원구강악안면외과에서한명의외과의사에게시행된연속적인타액선암 13 증례를분석하여병리학적소견, 수술후방사선치료및예후에대한내용을조사하였다. 결과 : 수술을시행받은타액선암중 mucoepidermoid carcinoma가 6례, adenoid cystic carcinoma가 5례, adenocarcinoma가 1례와 salivary duct carcinoma가 1 례있었다. 대타액선에발생한암종이각각 6례있었으며소타액선에발생한암종이 7례있었다. 13명중 1기에해당하는환자를제외한 8명이수술후방사선치료를받았다. 13 명환자모두수술후에생존 (100%) 하였으며 1명은재발로인하여추가적인수술을받았다. 결론 : 구강악안면재건에발생하는타액선암은비교적다양한부위에서발생하며조직학적소견도다양하다. Adenoid cystic carcinoma 와같이국소재발과원격전이가잘발생하는암종의경우수술후방사선치료가필요하다. 타액선암은충분한외과적절제와수술후추가적인치료로높은생존율을기대할수있다. Salivary gland cancer: 13 cases Wanhee Jang *, Kang-Min Ahn Department of oral and maxillofacial surgery, College of medicine, University of Ulsan Introduction: Salivary gland cancer in the oral and maxillofacial region shows slow growth pattern and symptomless swelling, which makes it difficult to early detect the lesion. The purpose of this study was to report survival rate and pathologic features of salivary gland cancer after surgical resection and/or postoperative radiotherapy. Materials and methods: This study included the patients who underwent surgical resection from April 2007 to January 2018 in the department of oral and maxillofacial surgery of Asan medical center by one experienced surgeon. A total of 13 cases were reviewed retrospectively. Survival rate of patients, pathological classification, postoperative radiotherapy and treatment results were examined. Results: The list of pathologic diagnosis showed mucoepidermoid carcinoma (n=6), adenoid cystic carcinoma (n=5), adenocarcinoma (n=1) and salivary duct carcinoma (n=1). Major salivary glands origin cancer was found 6 cases and minor salivary gland in 7 cases. Eight patients underwent postoperative radiotherapy to prevent local recurrence and distant metastasis. All patients were survived after treatment (100% survival). One patients who had mucoepidermoid carcinoma in the sublingual gland reported recurrence. Further resection was performed without further recurrence. Conclusion: Salivary gland cancer in the oral and maxillofacial regions showed diverse pathologic entities and primary sites. Certain cancer such as adenoid cystic carcinoma which has a tendency to local and distant metastasis required postoperative radiotherapy. Survival rate and prognosis of salivary gland cancer is excellent if proper surgical margin and adjunctive therapy were performed. 제 57 차종합학술대회및정기총회 127

128 PⅡ-33 법랑아세포종과각화성치성종양의재발률비교장완희 *, 안강민 울산대학교의과대학구강악안면외과서울아산병원서론 : 치성종양중가장높은빈도로발생하는법랑아세포종과각화성치성종양은높은재발률로인하여장기간의관찰이필요한질환이다. 각질환의재발율은연구자에따라다양하게발표되며수술법에따라서도차이가많이난다. 본연구에서는병소제거후변연골절제를이용한수술법후재발에관하여조사하고자하였다. 재료및방법 : 본연구는서울아산병원구강악안면외과에서한명의외과의사에게수술받은법랑아세포종환자 32명과각화성치성종양환자 47명총 79명을대상으로하였다. 수술은종양의제거후에변연골절제를시행하였으며치근이흡수된치아는발치를하였으며모든환자에게서동일한수술법이적용되었다. Fisher s exact test를이용하여두군간의재발율의차이를비교하였다. 결과 : 법랑아세포종환자 32명중 5명 (15.6%) 에게서재발이관찰되었으며각화성치성종양환자 47명중 6명 (12.8%) 에서재발이관찰되었다. P value는 , 로서통계적으로유의미한차이는없었다. 법랑아세포종환자 1명과각화성치성종양환자 1명은 2번의재발을보여 3차례수술을시행받았다. 병소의크기와재발율의관계에서는 5cm를기준으로조사하였으며재발율의차이는없었다. 결론 : 법랑아세포종과각화성치성종양은약 15% 의재발율을보였으며이는장기간의관찰을요하는질환으로판단된다. 두질환의재발율은유의미한차이가없었으며변연골절제술은환자의술후합병증이적어서적절한수술법이라판단된다. Comparison of recurrence rate between ameloblastoma and keratocystic odontogenic tumor Wanhee Jang *, Kang-Min Ahn Department of oral and maxillofacial surgery, College of medicine, University of Ulsan Introduction: Ameloblastoma and keratocystic odontogenic tumor(kot) is the two most common odontogenic tumor arising in the jaw bone. Those two entities are infamous for recurrence rate. The recurrence rates are diverse due to different surgical technique from curettage to block resection. The purpose of this study was to compare the recurrence rate between ameloblastoma and KOT with one surgical technique of peripheral ostectomy. Materials and methods: This study included 79 patients who referred to treat the jaw bone tumor in the department of oral and maxillofacial surgery of Asan medical center by one experienced surgeon. All patients underwent operation under general anesthesia to remove jaw bone tumor. Ameloblastoma was found in 32 patients and KOT was reported in 47 patients. Same surgical protocol was performed with mass excision and peripheral ostectomy. Long-term prognosis, recurrence and clinical and radiographic analysis were performed. Comparison of recurrence rate was evaluated by Fisher s exact test. Results: Five out of 32 ameloblastoma patients (15.6%) showed recurrence while six out of 47 KOT patients (12.8%) reported recurrence. The two-sided P value is , which was considered not significant. One patient of each group showed two times recurrence which required third operation to remove recurred mass. Mass size over 5cm and less 5cm did not show any difference in recurrence. Conclusion: Both odontogenic tumor showed about 15% recurrence rate during follow-up period. There was no differences in recurrence rate between both groups. Peripheral ostectomy is adequate treatment option because of less discomfort and minimal complications in treating ameloblastoma and KOT. 128 대한악안면성형재건외과학회

129 PⅡ-34 하악골에서발생한연골점액유사섬유종 : Case report 김정헌 1, 이상훈 1*, 남웅 1 연세대학교치과대학구강악안면외과학교실 1 연골점액유사섬유종은주로장골의골간단부위에발생하는양성종양으로서천천히자란다. 드믈게발생하는종양이기도하지만그중에서도두개안면골에서는 2% 정도에서발생한다고보고되었다. 조직병리학적으로연골점액유사섬유종은결합조직에의해분획되는분엽화된양상을띄고있으며점액유사물질로채워져있다. 또한연골육종에서와마찬가지로조직병리학적으로큰다형성세포가관찰된다는점에서유사하므로이와감별하는것이중요하다. 본증례에서는하악골에서발생한연골점액유사섬유종에대한증례를소개하고치료및경과에대해보고하고자한다. Chondromyxoid fibroma arising in mandible : Case report Junghun Kim 1, Sanghoon Lee 1*, Woong Nam 1 Department of Oral and Maxillofacial Surgery, Yonsei University, College of Dentistry, Seoul, Korea 1 Chondromyxoid fibroma is cartilaginous neoplasm usually involving the metaphyseal region of long bones. It is benign and slow growing. It is rare neoplasm and it has been reported that only 2% of cases arise in the craniofacial bones. Histologically it has lobulated structure which is separated by connective tissue and filled with myxoid material. It is important to differentiate from chondrosarcoma because both presents large pleomorphic cells. In this case, we are presenting chondromyxoid fibroma which arise in mandible and introduce the surgical treatment and progress. 제 57 차종합학술대회및정기총회 129

130 PⅡ-35 협측점막에발생한 Syringoid Eccrine Carcinoma (SEC) 의치험례 - 증례보고와논문고찰 이준호 *, 최나래, 백영재, 이재열, 황대석김용덕, 신상훈, 김욱규, 송재민 * 부산대학교치의학전문대학원구강악안면외과학교실 Syringoid eccrine carcinoma (SEC) 는에크린땀샘기원의매운드문피부부속기악성종양이다. 또한국소적으로침습적이고, 파괴적이며. 국소적인림프절전이는매우드물다. 본증례보고는우측볼점막에발생한 Syringoid eccrine carcinoma (SEC) 환자에대한보고이며, 본질환은특히두 경부에서매우드문질환이다. 환자는정기적인내원을통해 경과관찰을하였다. 또한본질환에대해살펴보고, 증례보고및문헌을통해고찰 해보고자한다. Syringoid Eccrine Carcinoma (SEC) of the buccal mucosa A case report and literature review Jun-Ho Lee *, Na-rae Choi, Young-Jae Baek, Jae-Yeol Lee, Dae-Seok Hwang, Yong-Deok Kim, Sang Hun Shin, Uk-Kyu Kim, Jae-Min Song * Department of Oral and Maxillofacial Surgery, School of Dentistry, Pusan National University Syringoid eccrine carcinoma (SEC) is a very rare and uncommonly diagnosed tumor, thought to be derived from eccrine sweat apparatus. It is locally invasive, destructive and often shows recurrences. Metastases in the regional lymph nodes are extremely rare as are disseminated metastases This case report is a report on Syringoid eccrine carcinoma (SEC) of right buccal mucosa that has been rarely reported in the Head & Neck region. The patient was followed up by regularly outpatient visit. The disease was studied though case report and literature reviews. 130 대한악안면성형재건외과학회

131 PⅡ-36 상악골에발생한간엽성연골육종 : 증례보고윤민영 1*, 남웅 1 연세대학교치과대학구강악안면외과학교실 1 연골육종은연조직및경조직에서드물게발생하는악성종양으로, 그중간엽성연골육종은전체연골육종중약 2% 미만으로보고된다. 두경부에서연골육종은주로상악골에서발생하며, 대부분은증상없이천천히성장한다. 방사선학적으로, 간엽성연골육종은주로방사선불투과성, 혹은투과성과불투과성이혼재된양상을보이며, 뚜렷한특징을갖지않아다른질환과의감별이어렵다. 조직학적으로는연골상분화와방추상혹은원형세포가혼재된이중상을나타낸다. 저자등은 27세여자환자에서상악골에발생한연골육종을경험하였기에이를보고하고자하며, 조직학적및임상적특징에대하여논의하고자한다. Mesenchymal chondrosarcoma in Maxilla : A Case Report Min Yeong Yoon 1*, Woong Nam 1 Department of Oral and Maxillofacial Surgery, College of Dentistry, Yonsei University, Seoul, Korea 1 Chondrosarcoma is a rare malignant tumor arising from the soft and hard tissues. Mesenchymal chondrosarcoma, as one of the types of chondrosarcoma, is reported to make up fewer than 2% of chondrosarcoma. Usually, mesenchymal chondrosarcoma of head and neck region arises from the maxilla and majority of them are aymptomatic. Radiologically, it consists of radio-opaque or mixed mass. There is no characteristic appearance, so it is difficult to differentiate mesenchymal chondrosarcoma from other diseases. Histopathologically, it is characterized by a biphasic tumor with areas comprising sheet like proliferation of spindle or round cells interspersed with areas of chondoid differentiation. Thus, We report the mesenchymal chondrosarcoma that was detected in Maxilla, a 27-year-old female. 제 57 차종합학술대회및정기총회 131

132 PⅡ-37 심한상악치조골결손이존재하는환자에서구개골을이용한임플란트식립 : 증례보고 유한창 *1, 윤필영 1, 김영균 1,2 1 분당서울대학교병원, 치과, 구강악안면외과 2 서울대학교치의학대학원치의학과, 치의학연구소 서론 : 임플란트식립시초기고정은임플란트의성공에매우중요한요소이다. 치성, 또는비치성낭종, 심한상악동염등으로인해상악치조골의심한결손이발생할수있다. 골이식을시행하여결손부를재건한후임플란트를식립하는것이가장좋지만골이식이불가능한경우가있을수있으며, 이와같은경우엔잔존구개골을이용한임플란트식립을시도해볼수있다. 증례보고 : 남자3명, 여자1명의총 4명의환자들에게구개골을이용한임플란트식립이시행되었으며, 환자들의연령은 40세부터 73세로다양했다. 환자들은식립전상악동질환, 구강상악동누공, 치성낭종등의상악동관련질환이있었으며, 3개증례는질환처치후상악동거상술시행후실패하였다. 임플란트식립시구개골에서초기고정을얻기위해치조정에서구개측으로위치하고, 협측경사를주어식립하였고, 초기고정은 osstel mentor 측정시평균 65였다. 술후회복기간은평균 8.6개월이었으며, 상부보철물은단일치관보철물혹은 2개이상의치관이연결된브릿지형태였다. 모든증례에서술후, 보철후합병증은발견되지않았고, 문제없이사용되고있음을확인하였다. 고찰및결론 : 상악골의광범위한치조골결손이존재하지만골이식술을통한재건술이불가능하거나임플란트식립시초기고정을얻기힘든상황에서구개측골을이용하여임플란트의초기고정을얻고상부보철치료를완료하는방법이대체치료법으로선택될수있다. Implant placement using the palatine bone in patients with severe maxillary alveolar bone defect : Case report Han-Chang YU *1, Pil-Young Yun 1, Young-Kyun Kim 1,2 1 Department of Dentistry, Seoul National University Bundang Hospital, Seongnam, Korea 2 Department of Dentistry & Dental Research Institute, School of Dentistry, Seoul National University, Seoul, Korea Introduction: Initial stability is very important factor for implant success and it s very important to secure initial fixation at a certain level when installing the fixture. Dentigerous cyst, and severe maxillary sinusitis may cause alveolar bone defects of the maxilla. In some special circumstances, reconstruction with bone grafting is not possible. This makes it difficult to obtain the initial stability of the implant in the alveolar bone. Case report: Total 4 patients, 3males and 1 female, underwent implant placement with a palatine bone. Their age varied from 40 to 73 years old. The patients had maxillary sinus related diseases, such as anteronasal fistula, dentigerous cyst before the implantation, and 3 cases failed after the maxillary sinus lift after the sinus related diseases treatment. In order to obtain the initial stability in palatine bone, implants were placed on the palatal side, and buccaly tiled. Initial stability was an average 65 for osstel mentor measurements. Postoperative recovery period was 8.6 months. The upper prosthesis was a single crown or a bridge with two or more crown connected. Postoperative complications weren t found in all cases, and it is confirmed that it is used without any problem. Conclusion: In the situation where it is difficult to obtain the initial stability due to the extensive alveolar bone defect of the maxilla, the implant fixation can be successfully performed by obtaining the initial stability of the implant using the palatal bone 132 대한악안면성형재건외과학회

133 PⅡ-38 상악동막수압거상기의개발과예비평가노성수 *1, 천무철 2, 문종훈 2, 노정훈 2, 황경균 1, 박창주 1 1 한양대학교의과대학치과학교실구강악안면외과 2 부산대학교의학전문대학원의공학교실목적 : 본연구는상악동에임플란트를식립하기위해상악동막을수압거상기를이용하여박리, 거상할때의거상압력측정에관한연구이다. 방법 : 본연구를위해서인체와유사한구조와특성을가진상악동막구강모델에수압을이용하여막이박리, 거상될때의압력을측정하기위해거상수압측정기를설계하여이를구현하였다. 거상수압압력측정기는식염수주입부, 시린지펌프부, 디스플레이부, 제어패널부, 압력측정부 (IBP 센서 ), 제어부 (Arduino), PC 모니터링프로그램으로구성하여제작하였다. 상악동막모델의박리, 거상시의수압압력을측정하기위해식염수주입속도는 3 가지모드 (0.5 mm/ s, 1.0 mm/s, 1.5 mm/s) 로설정하였다. 결과 : 상악동막박리, 거상압력을측정한결과초기박리시최대압력이나타났으며이러한현상은막이초기박리되는과정이다. 최고정점을지난후일정시간동안불응기를유지한다. 이러한불응기는상악동막은박리가진행되고있는상황이며, 불응기이후압력은서서히감소하였으며이러한현상또한상악동막이박리되는과정을나타낸다. 3 가지주입속도모두박리, 거상시동일한패턴의그래프가나타남을알수있었다. 주입속도 0.5, 1.0, 1.5mm/s의경우멤브레인박리, 거상측정압력은최고정점에서최소값은 6.97, 7.48, 8.88 kpa, 최대값은 10.45, 11.76, kpa이며평균은 8.20 ± 0.97, 9.72 ± 1.29, ± 1.05 kpa로나타났다. 결론 : 전체적으로박리, 거상시압력의범위는최소 6.97 최대 kpa로나타났으며, 주입속도가높아질수록막이받는압력은차이가크지는않지만점점높아지는경향이있었다. Development and Preliminary Assessment of a Hydraulic Membrane Lifter for the Sinus Membrane Seong-Su Ro *1, Moo-Cheol Cheon 2, Jong-Hoon Moon 2, Jung- Hoon Ro 2, Kyung-Gyun Hwang 1, Chang-Joo Park 1 1 Division of Oral and Maxillofacial Surgery, Department of Dentistry, College of Medicine, Hanyang University 2 Biomedical Engineering, School of Medicine, Pusan National University, Yangsan, Republic of Korea Purpose: To develop and assess a hydraulic lifter and pressure measurement system for the study on the measurement of elevation pressure during the detachment and elevation of the membrane inside the maxillary sinus that is performed in order to place an implant in the maxillary sinus. Methods: A maxillary sinus membrane dental-form model, which has similar structures and characteristics to the human, was used to assess the system. A saline injecting system composed of a syringe pump, a display, a controller using an Arduino platform and a pressure measurement system was implemented for the study. The saline infusion rate was set to 3 modes (0.5 mm / s, 1.0 mm / s, 1.5 mm / s) to measure the hydrodynamic pressure of the membrane detachment and elevation of the maxillary sinus membrane model. Results: It was found that the maximum pressure appeared at the time of the initial detachment, and the refractory period was maintained for a certain period after the peak of the pressure, and the pressure gradually decreases after the refractory period. This phenomenon also indicates the process of detachment of the maxillary sinus membrane. The same graphic pattern appeared at all injection speeds ranging from 0.5 mm/s to 1.5 mm/s using a 3 cc syringe. At the injection speed of 0.5, 1.0 and 1.5 mm/s, the measured detachment and elevation pressure of the membrane was a minimum of 6.97, 7.48, and 8.88 kpa and a maximum of 10.45, and 12.43kPa at the maximum peak, and an average of 8.20 ± 0.97, 9.72 ± 1.29 and ± 1.05 kpa Conclusion: On the whole, the range of the pressure during detachment and elevation was kpa. As the injection speed increased, the pressure of the membrane tended to increase gradually, though the difference was not great. 제 57 차종합학술대회및정기총회 133

134 PⅡ-39 임플란트주위염의수술적치료증례김인수, 김지혜 *, 이원, 조승연, 김수연, 안혜선 가톨릭대학교의정부성모병원치과구강악안면외과연구목적 : 임플란트주위염은임플란트를지지하는치조골및주변점막하에존재하는염증성병변이다. 임플란트주위염의비외과적치료는일시적인효과를보이기는하나예후가확실하지않다. 이연구는본원치과외래에서외과적치료를받은 4명의임플란트주위염환자에대한고찰을목적으로한다. 실험방법 : 4명의환자 ( 총 6개의임플란트 ) 모두동일하게술전임상및방사선학적검사를시행하였으며, 그들모두 5mm 이상의치주낭및현저한치조골흡수소견을보였다. 염증성육아조직을제거한후오염된임플란트주변을깨끗이연마하였다. 인공뼈이식은 2명의환자에게만진행되었다. 재생형혹은비재생형외과적치료를선택할지여부는해당부위의심미적요구, 골소실의형태, 인접치혹은임플란트의존재여부에의해결정하였다. 술후임상및방사선학적검사는 3-15개월후진행되었다. 결과및결론 : 골흡수로인해치주낭깊이가 5mm 이상이며, 탐침시출혈소견을보인 4명의환자에외과적치료를시행하였다. 그결과, 탐침시출혈및치주낭깊이의감소가모든환자에게서나타났다. 뿐만아니라방사선학적검사결과신생골형성역시관찰되었다. 이를통해 5mm 이상의치주낭깊이를보이는심한치조골소실을보이는임플란트주위염의치료에외과적치료가매우효과적임을알수있다. Surgical Therapeutic Approaches on Periimplantitis Defects InSoo Kim, Gee Hae Kim *, Won Lee, SeungYeon Cho, SuYeon Kim, Hye Sun An Department of Dentistry, Uijeongbu St. Mary s Hospital, College of Medicine, The Catholic University of Korea Purpose: Peri-implantitis is an inflammatory lesion of the supporting bone that resides in the mucosa. The outcome of non-surgical treatment of peri-implantitis is not predictable while surgical treatment shows satisfactory results in general. Therefore, we are to report 4 surgical treatment cases of periimplantitis. Materials&Methods: All 4 patients(6 implants) underwent pre-operative clinical and radiographic examinations. They all showed pocket depth greater than 5mm around the implant fixtures and evident alveolar bone loss. The granulation tissue around the implant fixture was removed. The contaminated surface of the fixture was mechanically polished. The bone graft was performed in 2 cases only. The decision to employ either a regenerative or non-regenerative surgical treatment depended among other things upon aesthetic demands of the site, the morphology of the defect, and the presence of adjacent teeth or implants. Post-operative clinical and radiographic examinations were performed 3-15 months after the flap surgery. Results&Conclusion: All patients with peri-implantitis that shows evident alveolar bone loss and pocket depth greater than 5mm (with BOP/Pus) were surgically treated. Clinically, the inflammatory signs were reduced in all cases as follows; BOP(-)/Pus(-)/PD <5mm. The bone formation was also observed on radiographs. As a result, the surgical treatment seems to be effective in managing peri-implantitis. 134 대한악안면성형재건외과학회

135 PⅡ-40 제거된임플란트의원인및조직형태계측학적분석을통한골 - 임플란트접촉비율평가 이중곤 *1, 윤필영 1, 김영균 1,2 1 분당서울대학교병원, 치과, 구강악안면외과 2 서울대학교치의학대학원치의학과, 치의학연구소 서론및목적 : 임플란트식립후다양한원인들로인해임플란트가제거될수있다. 본연구의목적은제거된임플란트들의원인을분석하고조직-형태계측학적분석을통해골- 임플란트접촉률 (BIC ratio) 을평가하는것이다. 방법 : 분당서울대학교병원에내원한 9명의환자에서제거된 12개의임플란트를대상으로조직학적시편을제작하였고, 조직학적분석및조직형태계측학적분석을진행하여 BIC ratio를평가하였다. BIC ratio에따라다음과같이 2개의그룹으로나누었다 ; group`1( 평균나이 :67세, 여성비율 : 75%) - BIC ratio>40%; group2( 평균나이 :61.8세, 여성비율 : 20%) BIC ratio<10%. 각그룹의임플란트종류를문진및방사선사진을통해추정하였고제거하기전임상증상과식립이후제거된날까지의기간을기록하였다. 결과 : Group 1의속한 4명의환자에서제거된 6개의임플란트평균 BIC ratio는 63.26% 였다. Group 2의경우 5명의환자에서제거된 6개임플란트평균 BIC ratio는 3.03% 였다. Group1의경우임플란트제거될때까지평균기간은 58.7 개월이였고 group2에서평균기간은 21.5개월로 Group1에서제거까지의기간이더긴것으로나왔다. Group1 에서식립후제거될때까지의기간이길수록 BIC가큰양상을보였고 Group2의경우상관관계를보이지않았다. Group2의경우대부분통증및임플란트유동성등으로인해조기에제거되었으나 Group1의경우통증과 fistula, 임플란트파절, 상악동염등다양한원인에의해제거하였다. 결론 : 제거시 BIC가낮은그룹일수록조기에제거되는경우가많았으며대부분통증및동요도에의해제거되었다. 이경우식립후제거까지의기간이비교적짧았다. BIC가높은그룹에서는식립후제거까지의기간이길수록 BIC가더높은경향을나타내었다. The causes of removed implats and Evaluation of bone-to-implant contact ratio by histomorphometric analysis Joong-Gon Lee *1, Pil-Young Yun 1, Young-Kyun Kim 1,2 1 Department of Dentistry, Seoul National University Bundang Hospital, Seongnam, Korea 2 Department of Dentistry & Dental Research Institute, School of dentistry, Seoul National University, seoul, Korea Introduction and Objective: After implant therapy, implants can be removed due to various causes. The purpose of this study is to analyse the causes of the removed implants and evaluate bone-to-implants contract(bic) ratio through histomorphometric analysis. Methods : The implant-inbone specimens were prepared from 12implants removed from 9 patients visiting Seoul National University Bundang Hospital. We evaluate BIC ratio by conducting histologic and histomorphometric analysis. According to the BIC ratio, two groups were divided; group1-bic>40%, (mean age : 67years, female ratio : 75%) group2-bic<10% (mena age : 61.8years, female ratio : 20%). The types of implants in each group were estimated through the diagnosis and radiographes, recording the clinical symptoms and the period up to the date that they were removed. Result: The six implant average BIC ratio removed from the four patients in Group 1 was 63.26%. For Group 2, the average BIC ratio of six implants removed from five patients was 3.03%. For Group1, the average period was 58.7 months until the implant was removed, and group2 showed that the mean period was 21.5 months, which is longer than Group1 to remove. the longer period up to the date that implants were removed, the larger BIC ratio in group1. But, group2 was less correlated. Group2 was mostly eliminated early due to pain and implant mobility, but Group1 was eliminated due to pain, fistula, implant fracture, and sinusitis. Conclusions : The lower the BICs when implants was removed, the earlier the implants was often removed, most of which were eliminated by pain and mobility. In this case, the period between implantation and removing was relatively short. In groups with higher BICs, the longer the period between implantation and removing, the higher the BIC. 제 57 차종합학술대회및정기총회 135

136 PⅡ-41 Micro-hole 이있거나없는탈회또는불완전탈회된인간치아상아질블록이식의비교조직학적분석 : 토끼실험연구 우라현 *1, 손동석대구가톨릭의료원구강악안면외과 내용미립자치아뼈의탈회는다양한성장인자를방출하여골재생을유도하는것으로알려져있다. 그러나탈회의치아뼈의골재생에대한효율성은잘알려져있지않다. 이동물연구의목적은치아블록의처리방법에따라비교조직학분석에의해토끼의두개골에이식된치아뼈의신생골형성을평가하는것이다. Micro-hole이형성하고탈회된상아질블록은골재생을위한새로운골이식재로사용될수있다. Comparative histologic analysis of demineralized or undemineralized human dentin block graft with and without microholes: An experimental study in rabbits Ra-hyeon Woo *1, Dong-seok Sohn 2 1 Resident, Dept. of Dentistry, Oral and Maxillofacial Surgery, Daegu Catholic University Medical Center 2 Professor, Department of Anatomy, School of Medicine, Catholic University of Daegu, Republic of Korea Resident, Dept. of Dentistry, Oral and Maxillofacial Surgery, Daegu Catholic University Medical Center Demineralization of particulate tooth bone is known to release diverse growth factors to induce bone regeneration. However the efficacy of demineralization of tooth block bone for bone regeneration is not well known. The aim of this animal study is to evaluate, according to preparation methods of tooth block bone, new bone formation in tooth block bone grafted on rabbit s calvarias by comparative histologic analysis. Micro-perforated and demineralized dentin block can be used as novel bone graft for bone regeneration 136 대한악안면성형재건외과학회

137 PⅡ-42 발치후즉시식립한임플란트의변연골소실에관한장기관찰연구 강동우 *1, 유한창 1, 윤필영 1, 김영균 1,2 1 분당서울대학교병원, 치과, 구강악안면외과 2 서울대학교치의학대학원치의학과, 치의학연구소 목적 : 발치후즉시식립한임플란트의경우유지력과주변골의부족으로인해예후가좋지않거나임플란트골유착이실패할위험성이있다. 본연구는발치후즉시식립한 Osstem TS III SA, US II 와 Implantium 증례를대상으로생존율과성공율, 변연골소실량등을후향적비교, 분석하였다. 환자및방법 : 2005 년부터 2011 년까지분당서울대학교병원, 치과구강악안면외과에내원하여발치후즉시 Osstem 과 Dentium 사임플란트가식립된환자들을연구대상으로선정하였다. 30 명의환자들에서 44 개임플란트가식립되었다. 1 군은 Osstem 사 TS III(10 명, 16 개 ) 와 2 군 USII(5 명, 9 개 ), 3 군은 Implantium(15 명, 19 개 ) 로분류하였다. 의무기록을후향적으로분석하여성별, 연령, 식립위치, 식립된임플란트의직경및길이, 변연골소실량, 임플란트성공율및생존율을조사하였다. 파노라마, 치근단방사선사진을통해임플란트식립시, 보철물장착후, 보철물장착 1 년후, 최종관찰시의변연골소실량을측정하여분석하였다. 임플란트간의변연골소실통계분석은 One-way ANOVA test 를시행하였다. 결과 : 식립한위치는 1 군은대구치 5 개, 소구치 9 개, 전치부 2 개으로총 16 개, 2 군은대구치 4 개, 소구치 2 개, 전치부 3 개로총 9 개, 3 군은대구치 5 개, 소구치 10 개, 전치부 4 개로총 19 개였다. 변연골소실량측정은정기관찰시의파노라마, 치근단방사선사진을이용하였다. 1 군은 GBR 14 개, 추가술식없는경우 2 개, 2 군은 GBR 8 개, 추가술식없는경우 1 개, 3 군은 GBR 14 개, 추가술식없는경우 5 개였다. 평균추적기간은 1 군 4 년 4 개월, 2 군 8 년 7 개월, 3 군 8 년 2 개월이었다. 1 년후평균변연골소실량은 1 군 0.55mm, 2 군 0.13mm, 3 군 0.24mm 였으며, 최종변연골소실량은 1 군 0.63mm, 2 군은 0.21mm, 3 군 0.26mm 였다. 세비교군간의변연골소실통계분석결과 p 값은 으로통계적으로유의한차이가없었다. 조사기간동안실패한임플란트는 3 군에서 1 증례있었다. 합병증이발생한경우는 3 군에서나사풀린경우 1 증례를제외하고는없었다. 조사기간동안 1 군에서는생존율 100%, 성공율 88%, 2 군은생존율 100%, 성공율 100%, 3 군은 95% 생존율, 성공율 84% 였다. 결론 : 발치후즉시임플란트를식립할경우에 Osstem 사및 Implantium 모두유의한차이없이임상적으로우수한예후를보여주어적응증에해당하는증례에서좋은치료방안이될수있다. Long-term observation on the marginal bone loss in immediately-installed implants after extraction Dong-Woo Kang *1, Han-Chang Yu 1, Pil-Young Yun 1, Young- Kyun Kim 1,2 1 Department of Dentistry, Seoul National University Bundang Hospital, Seongnam, Korea 2 Department of Dentistry & Dental Research Institute, School of Dentistry, Seoul National University, Seoul, Korea Purpose: In the case of an implant immediately after extraction, osseointegration often fails due to lack of retention and surrounding bone deficient. To evaluate the clinical usefulness of Osstem 's TS III SA and US II, we retrospectively reviewed the long-term marginal bone loss in implants. Patients and materials: From 2005 to 2011, we reviewed 44 implants, 30 patients who visited SNUBH. The group 1 was classified as Osstem TS III (10 patients, 16 implants) and group 2 Osstem US II (5, 9), and group 3 as Implantium (15, 19). The medical records were retrospectively analyzed to determine the sex, age, location of implants, diameter and length of implants, and marginal bone loss. Panoramic and periapical radiographs were used to measure the loss of marginal after prosthesis, one year after implantation, and the final examination. The One-Way ANOVA test was performed. Result: Group 1 was placed in the 5 molar, 9 premolars, and 5 anterior teeth., group 2 was 4, 2, 3, group 3 was 5, 10, 4, respectively. In group 1, 14 implants were with GBR, and 2 implants with no additional procedures, group 2, 8 GBR, 1 no procedure, group 3, 14 GBR, 5 no procedure. The mean marginal bone loss was group1, 0.63mm, group 2, 0.21mm, group 3, 0.26mm. There was no statistically significant difference between the three groups with the p-value of During the period, the failed implants were 1 in group 3. There was 1 complication of screw loosening in group 3. The survival rate during the study was 100% and the success rate is 88% in group 1, group 2(100%, 100%), group 3(95%, 84%). Conclusion: Osstem TS III SA and US II implants show a clinically good prognosis when implanted immediately after extraction, which may be a good treatment option for clinicians. 제 57 차종합학술대회및정기총회 137

138 PⅡ-43 임플란트주위염환자에서엑소덴분말치약을사용한후구강내세균의변화 이영철 *, 문성용, 오지수, 유재식, 김수관조선대학교치의학전문대학원구강악안면외과학교실 서론 : 임플란트주위질환의원인은유전적소인, 구강세균등에의해발생되는것으로알려진다. 세균에의한면역반응으로염증및골소실로인해자연치뿐만아니라임플란트의소실까지이어지며다른장기에도영향을끼쳐암또는전신질환과도연관이있다고학회에보고된다. 미국, 일본, 유럽에서는이미유전자분석기술을이용한구강병원성미생물분석이도입되어예방및치료가이드로활용되고있으며, 이는환자의구강건강에큰도움이되고있다. 이지페리오는최신의유전자검사 (Multiplex Realtime-PCR) 를이용하여구강병원성미생물, 사이토카인, SNP 등을분석, 확인하는치과전용유전자검사서비스이다. 방법 : 본연구에서는 2017년 10월부터 2018년 8월동안임플란트주위염진단을받고염증처치를시행하는환자에대하여외과적임플란트주위염처치시행후 6주동안분말치약을사용하여구강위생관리를시행한환자와분말치약을사용하여구강위생관리를시행하지않은환자의구강병원성미생물검사인 Eazyperio를통하여구강내세균의균수를비교연구하였다. 결과 : 분말치약을사용하여구강위생관리를시행한임플란트주위염환자에서분말치약을사용하지않고구강위생관리를시행한임플란트주위염환자보다염증성구강병원성미생물수의감소가나타났다. 고찰및결론 : 구강내외과적수술후환자, 틀니착용환자, 잇몸이부어칫솔을사용하여양치질을하기힘든환자들의구강위생관리가더욱효과적이될수있을것으로기대한다. Changes in Oral Bacteria after Exogenous Powder Toothpaste Treatment in Patients with peri-implantits Young-Cheol Lee *, Seong-Yong, Moon, Ji-Su Oh, Jae-Seak You, Su-Gwan Kim Department of Oral and Maxillofacial Surgery, School of Dentistry, Chosun University Introduction: The cause of the peri-implantitis is known to be caused by genetic factors, mouth bacteria, etc. It is reported that immune response from bacteria leads to not only inflammation and loss of the bone, but also to the loss of implants and other organs, which is linked to cancer or general disease. In other countries, oral pathogenic microbial analysis using genetic analysis techniques has already been introduced, and is used as a guide to prevention and treatment, which greatly contributes to patients' oral health. Eazyperio is a dental genetic testing service that analyzes and verifies oral pathogenic microorganisms, cytokines, and SNPs using the latest multiplex Realtime PCR. Method and materials: In this study, during October 2017 to August 2018 a comparative study was conducted on the distribution of bacteria in the mouth of patients with and without powder for six weeks among patients diagnosed with peri-imlantitis after surgical treatment by using Eazyperio. Results: In patients diagnosed with peri-implantitis, the number of inflammatory oral pathogenic microorganisms decreased compared to those without the use of powder. Conclusion: Oral hygiene can be more effective for patients who had surgery intraoral surgery, wearing dentures, and those who cannot brush their teeth with swollen gums. 138 대한악안면성형재건외과학회

139 PⅡ-44 자외선처리를통한치과용임플란트의표면개질과골형성효과에대한연구 신현서 1*, 임헌준 1, 김봉철 1, 이준 1,2 1 원광대학교대전치과병원구강악안면외과 2 원광골재생연구소 목표 : 본연구에서는자외선처리를시행한임플란트의젖음성및토끼의경골에자외선처리를시행한임플란트를식립하여골-임플란트계면에서의신생골부피율을측정하였다. 재료및방법 : 임플란트는기계절삭형, SLA(Sand blasted, Large grit, Acid Etched) 방식과, RBM(Resorbable Blast Media) 를사용하였고, 군을자외선을처리한군과처리하지않은군으로나누었다. 임플란트디스크에정제수를떨어뜨려접촉각과젖음성을계산하였다. 토끼의경골에실험군과대조군의임플란트를식립하여매식 4 주후에미세전산단층촬영을시행하여골-임플란트계면의신생골부피율을측정하였다. 결과 : 자외선을처리한임플란트에서모든군에서접촉각감소를보였고, 젖음성이증가하였다 (P < 0.01). 또한, 토끼의경골에임플란트를식립한경우에자외선처리후 Machine, RBM군에서는신생골부피율이증가하는경향성을보였지만, 유의성은없었다. 그러나, SLA 임플란트에서는자외선처리후신생골부피율이증가하는것을확인하였다 (P < 0.05). 결론 : 자외선처리를티타늄임플란트에시행하게되면임플란트표면의젖음성을증가시킬수있고, 임플란트의골유착시에골-임플란트계면에서신생골부피율을증가시킬수있다. 특히, SLA 임플란트에서자외선의효과가가장좋음을알수있었다. The Study on the Surface Modification and Osteogenesis of Dental Implants by Ultraviolet Treatment Hyeon seo Shin 1*, Hun Jun Lim 1, Bong Chul Kim 1, Jun Lee 1,2 1 Dept. of Oral and maxillofacial surgery, Daejeon Dental Hospital, College of Dentistry, Wonkwang University 2 Wonkwang Bone Regeneration Research Institute, Wonkwang University Purpose: In this study, we investigated the effect of UV treatment on the wettability of the implants. Also, UV treated implants were placed on the tibia of the rabbits, and volume of newly formed bone between bone-implant interface was measured. Materials and Methods: Implants were used machine, SLA(Sand blasted, Large grit, Acid Etched) and RBM (Resorbable Blast Media) surface and groups were classified by treating UV or non-treated. The contact angle and wettability were calculated by dropping purified water on the implant disk. Also, implants of the experimental group and the control group were placed in the tibia of the rabbit, and measuring volume of newly formed bone between bone-implant interface was performed by Micro computedtomography (Micro CT) after 4 weeks. Results: In the UV treated implants, contact angle was decreased and wettability was increased in all groups (P < 0.01). Also, in the case of placing the implant in the tibia of the rabbit, there was no significant difference in the newly formed bone volume ratio in the machine and RBM groups after UV treatment. However, in the UV treated SLA implant, the rate of new bone volume increased (P < 0.05). Conclusions: UV treated titanium implants can increase the wettability on the surface, and the volume of newly formed bone between bone-implant interface in osseointegration. In particular, SLA implants were found to be most effective. This work was supported by the National Research Foundation of Korea(NRF) grant funded by the Korea government(msit)(nrf-2018r1a2b ) 제 57 차종합학술대회및정기총회 139

140 PⅡ-45 3D 프린트로제작된임플란트수술가이드사용의장점과단점 허재진 *, 강효선, 정연우, 한정준, 정승곤, 박홍주, 오희균, 국민석전남대학교치의학전문대학원, 구강악안면외과학교실 현재임플란트는무치악부의수복치료로서널리사용되고있다. 임플란트의높은성공률과장기적성공에는여러가지요소가관여하는것으로알려져있다. 그중임플란트의기능적, 심미적인성공을위해서는환자치조골에적합한식립위치와방향으로임플란트를식립하는것이중요하다. 임플란트가처음도입되었을당시에는적절한임플란트의식립위치와방향을결정하기위해석고모형에서수술가이드를제작하여임플란트식립에사용하였다. 이러한방법은임플란트식립중식립위치가잘못될가능성이크며, 술중안정성이떨어지고시술결과가임상가숙련도에따라크게달라지는단점이있다. 3D 프린터가대중화된이후디지털기술로수술가이드를제작하고, 전용식립기구를이용하여임플란트식립에사용하고있다. 문헌에서언급된 3D 프린터를이용한임플란트식립의장점으로는다음과같다.: 임플란트의정확한배치, 해부학적구조의보존, 짧은수술시간, 덜침습적인술식등이이다. 우리는시중에시판되고있는 R2gate 시스템을이용하여임플란트식립을시행하였고, 시술전후과정에대한장단점을문헌고찰과함께보고하고자한다. Advantage and Disadvantage of using the Implant Surgical Guide made by 3D Printing Jae-Jin Heo *, Hyo-Sun Kang, Yeon Woo Jeong, Jeong Joon Han, Seung-Gon Jung, Hong-Ju Park, Hee-Kyun Oh, Min- Suk Kook Department of Oral and Maxillofacial Surgery, School of Dentistry, Chonnam National University Currently, implants are widely used for restorative treatment in edentulous patients. Several factors are known to be involved in the high success rate and long term success of implants. For the functional and aesthetic success of the implant, it is important to place the implant in the appropriate position and orientation of the patient's alveolar bone. When the implant was first introduced, a surgical guide was made on a dental cast and used for implant installation to determine the proper implant placement and orientation. This method has the disadvantage that the position of the implant is likely to be wrong during implant installation, the stability during the operation is poor, and the result of the procedure varies greatly according to the skill level of the clinician. Since 3D printers have become popular, surgical guides have been created with digital technology, and they are being used for implant installation using special implantation kits. Advantages of implant installation using the 3D printer mentioned in the literature include: more precise placement of implant, more preservation of anatomic structures, shorter surgery times. less invasive. We performed implant installation using commercially available R2gate system and reported the result with a review of the literature. 140 대한악안면성형재건외과학회

141 PⅡ-46 연세대학교치과대학병원구강악안면외과학교실에서시행한 explantation 원인에관한임상적연구 송상현 *, 이상훈, 차인호연세대학교치과대학구강악안면외과학교실 과거에비해임플란트를식립하는환자가증가하며, 임플란트골유착실패, 임플란트주위염등으로인해임플란트를제거하는환자또한많아지고있는추세이다. 하지만본교실에서접하는임플란트를제거하게되는합병증은실로단순한임플란트의골유착실패나임플란트주위염뿐만이아니며, 골수염, 악골괴사증, 상악동염등이임플란트의제거를하게되는더많은합병증으로보여진다. 따라서본교실에서는 2014년부터 2018년까지임플란트제거술을받은환자를대상으로후향적조사를시행하여구강악안면영역에서대두되는주된문제를분석하였다. A clinical study on the causes of explantation in Oral and Maxillofaciial Surgery, Yonsei University College of Dentistry Sang Hyun Song *, Sang Hoon Lee, In-Ho Cha Department of Oral and Maxillofacial Surgery, College of Dentistry, Yonsei University, Seoul, Korea The number of patients who were performed dental implant is increased compared to the past, and the number of patients whowere performed explantation due to the failure of osseointegration and peri-implantitis is increasing. However, the complications that remove the implants in our department are not merely the failure of osseointegration or peri-implantitis, but osteomyelitis, osteonecrosis of the jaw, and maxillary sinusitis are seen as more complications to remove the implant. Therefore, we analyzed the main problems arising in the oral maxillofacial surgery department by retrospective survey of patients who underwent explantation from 2014 to 제 57 차종합학술대회및정기총회 141

142 PⅡ-47 디지털가이드를이용한임플란트수술후즉시부하 : 전악수복의증례 * 태양열, 박관수, 윤규호, 박재안인제대학교상계백병원구강악안면외과 서론 : 최근 CT(computed tomography, 전산화단층촬영 ) 와임플란트계획소프트웨어의발달로가이드수술에대한관심이날로증가하면서이상적인각도와위치로임플란트를식립하기위한다양한도전이시도되고있다. 또한, 디지털작업으로계획되고만들어진임시보철물은식립후즉시부하를더욱용이하게한다. 본증례에서는 66세무치악환자의사례를통해디지털가이드수술을통한전악임플란트식립과함께즉시부하를시행한경험을나누어보고가능성과한계점을짚어보고자한다. 방법 : 66세남환이하악양측견치만잔존한상태로본원에내원하였다. 내원당시잔존한양측견치는심한동요도및골흡수소견보여발거후상하악총의치치료를시행받았으나저작기능에만족하지못하였고전악임플란트수복을진행하기로하였다. CT및스캔한구강모델을이용하여컴퓨터상에서미리계획하고제작한수술가이드 (One guide, Osstem, Seoul, Korea) 를통해상악 8개, 하악 8개의임플란트를절개없이식립하였고 CAD/CAM 작업을통해미리제작된지대주를장착후역시컴퓨터상에서미리제작된전악임시브릿지를당일장착한후즉시부하를가하였다. 결과 : 술후특이증상및합병증은발생하지않았으며, 즉시부하로인한문제점도발견되지않았다. 최종적으로전악수복완료된후에도별다른부작용및특이사항은관찰되지않았다. 고찰및결론 : 가이드를이용한수술은환자와술자모두에게편의와만족스러운결과를가져온다. 컴퓨터에서미리계획한위치와각도로임플란트식립을가능하게하는디지털수술가이드의보급이늘어나면서외과의는더자유롭게치료에임할수있게되었지만, 비외과의의수술에대한적극성도점차늘어나고있다. 다수의임플란트를식립하면서전악무치악환자의저작기능을즉시회복하기위한수복물을미리설계하고장착하는것은여전히간단한치료는아니다. 특히외과의는수복치료에익숙하지않기때문에이러한분야에서다소소외되어왔다. 디지털기술의발달로설계를실제수술에적용시발생하는오차가줄어들어이러한어려움은점점줄어들고있다. 가이드를이용한수술및컴퓨터를이용한디지털수복물의제작과장착의과정에서외과의도이러한장점을충분히이해하고활용함으로써수술과수복의융합이라는새로운추세에적극적으로대처해나아가야할것이다. Digital-Guided Implant Surgery with Immediate Loading : A Case of Full Mouth Rehabilitation * Yang-Yeol Tae, Kwan-Soo Park, Kyu-Ho Yoon, Jae-An Park Department of Oral and Maxillofacial Surgery, Inje University Sanggye-Paik Hospital Introduction: Recently, the development of computerized tomography (CT) and implant planning software has increased interest in guided surgery, leading to various attempts to install implants at ideal angles and locations. In addition, prefabricated temporary prosthesis which can be designed and fabricated through the digital work-flow makes immediate loading easier. In this case, through the example of a 66-year-old edentulous patient, we would like to share an experience of full mouth implant placement through a digital-guided surgery with immediate loading and point out the possibility and limitations. Method and materials: A 66-year-old male patient came to our hospital with only two left mandibular canine teeth. At the time of the first examination, both mandibular canines showed severe mobility and bone resorption. After extraction, maxillary and mandibular complete dentures were delivered, but he was not satisfied with masticatory function. So, we decided to restore the full arch dental implant restoration. The pre-planned and pre-made surgical guides (one guide, Osstem, Seoul, Korea) on the computer using computed tomographic data and digitally scanned model were used to install eight upper and eight lower implants without incision. After mounting the pre-made abutments through CAD/CAM operations, the temporary bridge also pre-built on the computer was delivered on the day of operation and immediate loading was performed. Results: No specific symptoms or complications occurred after the surgery and no problems were detected due to the immediate loading. No special side effects were observed after the final rehabilitation. Conclusion: Guide surgery brings both patients and clinician with convenience and satisfaction. The diffusion of digital surgical guides, which enable implantation at pre-planned locations and angles in computers, allows surgeons to practice more freely, but there is increasing activity in experienced surgeon s field among general practitioners. It is still not a simple treatment to design and install restorations to immediately restore the masticatory function of a fully edentulous patient while placing a number of implants. Surgeons, in particular, have been struggling in this field since they are not familiar with the restorative treatment. This difficulty is being reduced by the development of digital technology as errors in applying design to actual surgery are reduced. In the process of creating and installing guided surgery and computer-based digital prosthesis, surgeons will also need to actively cope with the new trend of combining surgery and restoration. 142 대한악안면성형재건외과학회

143 PⅡ-48 Dental Implants Placement on Autogenous Iliac Block Bone Graft Akram Abdo Almansoori 1,2*, Mohammed Mousa Bakri 1, Han- Wool Choung 1, Bongju Kim 2, Soung-Min Kim 1, Jong-Ho Lee 1,2,3 1 Department of Oral & Maxillofacial Surgery, School of Dentistry, Seoul National University, Korea 2 Clinical Translational Research Center for Dental Science, Seoul National University 3 Oral Cancer Center, Seoul National University Dental Hospital, Seoul, Korea Achieving optimal implant stability with long term survivability has been challenged by deficiency of the hosting alveolar bone in respect to height, width and well-maintained bony walls. Autogenous bone graft has been the standard approach to reconstruct the alveolar bony defects owing to its osseoinductive, osseoconductive, and osteogenic properties. Objectives: To evaluate the implants survival rate and marginal bone loss associated with autogenous iliac bone grafts. Patients and Methods: The study entailed 49 iliac block bone grafts with 189 dental implants placement in the period between 2005 and Twenty five grafts were placed on maxilla, 11 on mandible, and 13 over fibular-reconstructed mandible. Twelve grafts applied for horizontal augmentation where 10 of them on maxilla and 2 on mandible. Twenty three grafts applied for vertical augmentation; 5 on maxilla, 5 on mandible, and 13 on fibula-reconstructed mandible. Evaluation was performed through assessment of dental implants survival rate and marginal bone loss as revealed clinically and through the periodic panoramic radiographs. Results: The over survival rate was 92 % and the average of the marginal bone loss was 1.24 mm. In maxilla the implant survival rate was 94.7% while it was 91.9 % in mandible and 87.2 % in fibula-reconstructed mandible. In regarding the augmentation method, the implant survival rate was 91.7 % with horizontal augmentation compared to 87.4 % with vertical augmentation. Marginal bone loss was higher with vertical augmentation (1.9 mm) compared to horizontal augmentation (0.8 mm). Conclusion: Iliac block bone graft is reliable for moderate and large bony defects. Both horizontal and vertical bony augmentation can be performed with optimum survival of dental implants. Horizontal bony augmentation tends to have less marginal bone loss compared to vertical bony augmentation. 제 57 차종합학술대회및정기총회 143

144 PⅡ-49 3D 프린트로제작된임플란트수술가이드사용의장점과단점 허재진 *, 강효선, 정연우, 한정준, 정승곤, 박홍주, 오희균, 국민석전남대학교치의학전문대학원, 구강악안면외과학교실 현재임플란트는무치악부의수복치료로서널리사용되고있다. 임플란트의높은성공률과장기적성공에는여러가지요소가관여하는것으로알려져있다. 그중임플란트의기능적, 심미적인성공을위해서는환자치조골에적합한식립위치와방향으로임플란트를식립하는것이중요하다. 임플란트가처음도입되었을당시에는적절한임플란트의식립위치와방향을결정하기위해석고모형에서수술가이드를제작하여임플란트식립에사용하였다. 이러한방법은임플란트식립중식립위치가잘못될가능성이크며, 술중안정성이떨어지고시술결과가임상가숙련도에따라크게달라지는단점이있다. 3D 프린터가대중화된이후디지털기술로수술가이드를제작하고, 전용식립기구를이용하여임플란트식립에사용하고있다. 문헌에서언급된 3D 프린터를이용한임플란트식립의장점으로는다음과같다.: 임플란트의정확한배치, 해부학적구조의보존, 짧은수술시간, 덜침습적인술식등이이다. 우리는시중에시판되고있는수술가이드를이용하여임플란트식립을시행하였고, 시술전후과정에대한장단점을문헌고찰과함께보고하고자한다. Advantage and Disadvantage of using the Implant Surgical Guide made by 3D Printing Jae-Jin Heo *, Hyo-Sun Kang, Yeon Woo Jeong, Jeong Joon Han, Seung-Gon Jung, Hong-Ju Park, Hee-Kyun Oh, Min- Suk Kook Department of Oral and Maxillofacial Surgery, School of Dentistry, Chonnam National University Currently, implants are widely used for restorative treatment in edentulous patients. Several factors are known to be involved in the high success rate and long term success of implants. For the functional and aesthetic success of the implant, it is important to place the implant in the appropriate position and orientation of the patient's alveolar bone. When the implant was first introduced, a surgical guide was made on a dental cast and used for implant installation to determine the proper implant placement and orientation. This method has the disadvantage that the position of the implant is likely to be wrong during implant installation, the stability during the operation is poor, and the result of the procedure varies greatly according to the skill level of the clinician. Since 3D printers have become popular, surgical guides have been created with digital technology, and they are being used for implant installation using special implantation kits. Advantages of implant installation using the 3D printer mentioned in the literature include: more precise placement of implant, more preservation of anatomic structures, shorter surgery times. less invasive. We performed implant installation using commercially available surgical guide and reported the result with a review of the literature. 144 대한악안면성형재건외과학회

145 PⅡ-50 상악동거상술후발생한상악동염의치험례정지상 *, 김영권, 심의섭, 양수남 청주한국병원구강악안면외과서론 : 상악동거상술후발생하는상악동염은비교적드물게발생하는합병증으로, 증상이개선되지않을경우에는골이식재를제거해야할수도있다. 치료방법으로는약물치료, 비내시경수술, Caldwell-Luc 수술등이있으며, 본증례에서는골이식후발생한상악동염을상악동전벽상방천공술을이용하여골이식재제거없이치료하였기에보고하는바이다. 증례 : 43세남자환자가상악좌측구치부임플란트식립을위해내원하였다. 임플란트를식립할부위 (#26,27) 잔존골의수직적높이는 2mm정도였으며, 해당부위에상악동거상술 (lateral approach) 을계획하였다. 임플란트식립과동시에상악동거상술을시행하였고한달후, 좌측얼굴부위의종창과동통을주소로내원하였다. 상악동거상술을시행한부위로농이관찰되었으며, CT를촬영하여상악동염을확인후상악동전벽상방천공술을시행하였다. 좌측제1소구치상방으로천공하였더니농이배출되었고, 그부위를통하여생리식염수를이용한세척을한후실리콘드레인을삽입하였다. 이와함께항생제를처방한후매일상악동세척을시행하였다. 결과 : 일주일동안농과악취등의임상증상이서서히개선되었으며, 한달후촬영한CT에서좌측상악동내의방사선불투과상이확연히사라진것을확인할수있었다. 임플란트식립및상악동거상술후 8개월이지난시점에서해당부위임플란트 2차수술및보철수복을시행하였다. 고찰및결론 : 상악동거상술후상악동염이발생시상악동전벽상방천공술을이용할경우, 골이식재상부로접근이가능하여골이식실패가능성을낮출수있다. 또한술식도간단하여환자의불편감도크지않다. 따라서상악동거상술과관련된상악동염치료에있어서상악동전벽상방천공술은비내시경수술이나 Caldwell-Luc수술에앞서우선적으로고려해볼만한방법이라고생각된다. TEATMENT OF MAXILLARY SINUSITIS AFTER MAXILLARY SINUS ELEVATION : A CASE REPORT Ji Sang Jeong *, Young Kwon Kim, Uie Sub Shim, Soo Nam Yang Department of Oral and Maxillofacial surgery, Cheongju Hankook Hospital Introduction: Maxillary sinusitis after maxillary sinus elevation is a relatively rare complication and may require removal of bone graft material if symptoms do not improve. Treatment options include medication, nasal endoscopic surgery, and Caldwell-Luc surgery. In this case, maxillary sinusitis after bone graft was treated without removal of bone graft using upper wall anterior perforation technique. Case: A 43 - year - old male patient visited our hospital for the left maxillary posterior implant placement. The vertical height of the residual bone was about 2 mm, and a lateral approach was planned for the that area (# 26, 27) Implant placement and simultaneous elevation of the maxillary sinus with bone gaft were performed. One month later, the patient presented with swelling and pain in the left side of the face. The pus was drained on the surgical areas, and the maxillary sinusitis was confirmed by CT scan. After the perforation was made above the left first premolar, the pus was drained, and the silicone drain was inserted through the area after washing with physiological saline. In addition, antibiotics were prescribed and the maxillary sinus was washed every day. Result: Clinical symptoms such as pus drainage and odor were gradually improved for a week, and the radiopaque image in the left maxillary sinus was clearly disappeared from CT taken one month later. At 8 months after implant placement and maxillary sinus lift, secondary implant surgery and prosthetic restoration were performed. Discuss: In case of maxillary sinusitis after maxillary sinus elevation, the possibility of bone graft failure can be lowered by accessing upper part of bone graft using upper wall anterior perforation technique. In addition, the procedure is simple and the patient's discomfort is not great. Therefore, in the treatment of maxillary sinusitis associated with maxillary sinus elevation, the upper wall anterior perforation technique of the maxillary sinus should be considered as a preferential method prior to nasal-endoscopic or Caldwell-Luc surgery. 제 57 차종합학술대회및정기총회 145

146 PⅡ-51 상악골절로플레이트고정술이시행된환자에서측방접근법을통한상악동거상술 : 증례보고 심의섭 *, 김영권, 정지상, 양수남청주한국병원구강악안면외과 서론 : 상악구치부에성공적인임플란트식립을위해부딪히게되는가장흔한문제점은수직적골의부족이다. 현재이러한문제점은측방접근법을통해해결하고있으며, 상악동거상술시상악동내중격, 상악동질환, 상악동외측골벽내동맥분지등이측방접근법에있어장애물로알려져있다. 본증례는상악골골절로플레이트고정술이시행된환자에서플레이트가측방접근법에의한상악동거상술에방해가되었으며, 플레이트절단및플레이트를포함한 trap door를형성하여상악동거상술을성공적으로시행하였기에이에보고하자고한다. 증례보고 : 46세남환이상악양쪽구치부에임플란트식립을위해본원에내원하였다. 환자는 3년전상악골골절로플레이트고정술을시행하였으며, 양쪽구치부의잔존치조골은 3mm 가량이었다. 상악우측의플레이트는고정위치가높았으며 (25mm) 좌측의플레이트는측방접근법을위한 trap door의위치에있었다. 상악우측에위치한플레이트는 1개의홀이노출되는곳까지판막박리후플레이트를절단후스크류를제거하였다. 스크류제거시상악동점막에천공이발생하였다. 상악좌측에위치한플레이트는판막박리후스크류제거시상악동점막의천공가능성이높아플레이트를포함한 trap door를형성하여측방접근법을시행하였다. 상악동거상술 5개월후임플란트 1차수술을시행하였으며, 이식한골은초기고정력을얻기에충분할만큼성숙하였다. 고찰및결론 : 측방접근법을통한상악동거상술은예지성이높은술식으로알려져있으며많은장애물들역시잘알려져있다. 한편치료목적으로고정된플레이트역시측방접근법을어렵게하는요소로작용할수있다. 플레이트를제거하는것이가장바람직하겠으나식립위치가높거나, 플레이트제거시상악동점막의천공및 trap door의파절이예상될경우수술의난이도가높아진다. 본증례에서는플레이트를절단및플레이트를포함한 trap door를형성하여상악동거상술을시행하였으며, 현재까지는별다른합병증이발생되지않았다. 장기적예후를위해서는주기적인관찰이필요할것이다. Maxillary Sinus Lift by Lateral Approach in Patient with Plate Fixation with Maxillary Fracture: Case Report Eui Sub Shim *, Young Kwon Kim,Ji Sang Jung, Soo Nam Yang Department of Oral and maxillofacial surgery, CheongjuHankook hospital Introduction: The most common problem encountered for successful implant placement in the maxillary posterior teeth is the lack of vertical bone. At present, these problems are solved by lateral approach. In the case of maxillary sinus elevation, the septum in the maxillary sinus, maxillary sinus disease, and the arterial branch of the lateral wall of the maxillary sinus are known obstacles to the lateral approach. The purpose of this study is to report a case in which plate was interrupted by lateral approach to the maxillary sinus lift in a patient who had undergone plate fixation with maxillary fracture and successfully performed a maxillary sinus lift by forming a trap door with plate and cutting and plate. Case Report: A 46 - year - old male was referred to our hospital for implant placement in both maxillary and posterior teeth. The patient underwent plate fixation with a maxillary bone fracture 3 years ago, and the residual alveolar bone in both posterior teeth was about 3 mm. The plate on the maxillary right side was high (25 mm) and the plate on the left side was at the position of the trap door for lateral approach. The plate located on the upper right side was peeled to the position where one hole was exposed, and after the plate was cut, the screw was removed. Perforation occurred in maxillary sinus mucosa during screw removal. The plate located on the maxillary left side was removed after removal of the valve, and the possibility of perforation of the maxillary sinus mucosa was high. Five months after the maxillary sinus lift, the first implant was performed and the implanted bone was mature enough to obtain initial fixation Conclusion: The lateral approach through the maxillary sinus lift is known to be a promising procedure and many obstacles are well known. On the other hand, a fixed plate for therapeutic purposes may also act as an obstacle to lateral approach. It is most desirable to remove the plate, but when the placement is high or when the plate is removed, the perforation of the maxillary sinus mucosa and the breakage of the trap door are expected to increase the difficulty of the operation. In this case, the plate was cut and the trap door including the plate was formed and the maxillary sinus lift was performed. Until now, no complication occurred. Periodic observations will be needed for long-term prognosis. 146 대한악안면성형재건외과학회

147 PⅡ-52 격벽의골절을활용한측방접근법 : 증례보고허성휘 *, 정지혜, 조제호, 최순규, 양수남 청주한국병원구강악안면외과서론 : 측방접근법은상악구치부의골이식에가장효과적이고전통적인방법이다. 하지만측방접근법의적용을어렵게하는여러요소들이있으며상악동에존재하는격벽은가장빈번하게마주하게되는것들중하나이다. 상악동내의격벽은약 1/3의환자들에게서발견된다. 이러한격벽은상악동점막의천공가능성을높이고골이식재의적용을어렵게한다. 이런이유로격벽이존재하는상악동을가진환자에게서측방접근법은상대적인금기증으로여겨져왔다. 이를극복하기위해격벽을기준으로 2개의골창을형성하거나 W- 모양의골창을형성하는등변형된디자인의측방접근법이고려되어왔지만이런방법들은술자에게더높은기술과노력, 시간이요구된다. 본연구는기존의방법의단점을보완할수있는방법을제시하고그접근법을적용한증례를보고하고자한다. 방법 : panorama방사선사진과 CBCT를통해격벽의위치를파악하여협측골에마킹펜으로표시한다. 격벽으로나누어진앞쪽부분에하나의골창을형성하여상악동점막의거상을시행한다. 이후형성된골창을통해 osteotome을상악동내로삽입하여격벽에접촉시킨후말렛팅을시행, 격벽을적당한범위로골절시킨다. 골절시킨격벽과함께격벽의뒤쪽부분의상악동점막을거상한다. 거상된상악동내부로골이식재를뒤쪽부분부터밀어넣어순차적으로앞쪽부분까지골이식을시행한다. 증례 : 76세남환으로임플란트를하고싶다는주소로본원에내원하였다. 상악양측구치부가모두무치악인상태였고, panorama방사선사진과 CBCT를통해좌측상악동내에격벽의존재가확인되었다. 제시한방법을통해상악동거상술을시행하고골이식재를삽입하였고, 이후흡수성차단막으로골창을덮은뒤봉합하여골이식을완료하였다. 고찰및결론 : 본연구에서제시한방법은기존의방법보다상대적으로간단하며적은시간이소요되었고, 상악동점막의천공가능성을줄일수있었다. 이방법은격벽이존재하는상악동을가진환자에게서효과적으로상악동거상술을가능하게하는하나의좋은방법이될수있을것이다. Lateral approach using Septa Fracture in Maxillary Sinus: Case Report SUNG HWI HUR *, JI HYE JEONG, JEHO CHO, SUN GYU CHOI, SOO NAM YANG Department of Oral and Maxillofacial surgery, CheongjuHankook Hospital Introduction: The lateral approach is the most effective and traditional method for bone grafting in maxillary posterior teeth. However, there are several factors that make it difficult to apply the lateral approach, and the septa present in the maxillary sinus are one of the most frequently encountered. The septa in the maxillary sinus are found in about one third of the patients. These septa increase the possibility of perforation of the maxillary sinus membrane and make it difficult to apply bone graft materials. For this reason, the lateral approach has been considered a relative contraindication in patients with a maxillary sinus with septa. In order to overcome this problem, a lateral approach of modified design has been considered, such as forming two windows or forming a W-shaped window, but these techniques require more skill, effort and time. This study proposes a method to overcome the shortcomings of conventional methods and report a case applying the approach. Method: Panoramic radiographs and CBCT are used to identify the location of the septum and mark them with a marking pen on the buccal bone. A single window is formed on the anterior part divided by the septum, and the maxillary membrane is elevated. The osteotome is inserted into the maxillary sinus through the formed window to make contact with the septum and then perform malletting. Fracture the septum to an appropriate extent. Along with the fractured wall, the maxillary membrane of the posterior part of the septum is elevated. The bone graft material is inserted from the posterior part to the anterior part. Case: The 76-year-old man visited our hospital with chief complain that he wanted to have an implant. Both side of maxilla posterior teeth were edentulous. Panoramic radiographs and CBCT showed the presence of a septum in the left maxillary sinus. The first operation was completed by using the proposed method, covering the window with an absorbable membrane, and suturing. Conclusion: The proposed method in this study was relatively simple and less time consuming than the conventional method, reducing the possibility of perforation of the maxillary sinus membrane. This method may be a good option for effective maxillary sinus lift in a patient with a maxillary sinus with septa. 제 57 차종합학술대회및정기총회 147

148 PⅢ-01 외상으로상악전치부결손된성장기환자의악교정수술을동반한임플란트수복 : 증례보고 김경진 *, 김무성, 장국원, 황희성, 김복주, 김정한, 장국원, 김무성, 김철훈동아대학교의료원구강악안면외과 성공적인상악전치부의임플란트의수복을위해서는심미적, 기능적요소를모두고려해야한다. 상악저성장이있는환자의경우, 심미적인상악전치부임플란트식립이어려우며, 불리한교합력이작용하게된다. 이경우악간관계개선을위해악교정수술을시행한후에임플란트를식립하는것이유리하다. 이상적인결과를얻기위해서는교정의, 보철의, 구강악안면외과의간의협력을통하여치료계획을세우는것이중요하다. 이증례보고에서는외상으로상악전치부가결손된성장기환자에서악교정수술및골이식술을동반한임플란트수복을통하여성공적인결과를얻었기에이에대하여보고하고자한다. Implant restoration with orthognathic surgery in a growing patient with maxillary anterior defect due trauma : Case Report Kyung-Jin Kim *, Moo-Sung Kim, Kuk-Won Jang, Hee-Sung Hawng, Bok-Joo Kim, Jung-Han Kim, Chul-Hun Kim Department of Oral and Maxillofacial Surgery, College of Medicine, Donga-A University, Busan, Korea Successful restoration of the maxillary anterior implants requires consideration of both aesthetic and functional factors. In the case of a patient with maxillary deficiency, the aesthetic placement of the anterior maxillary teeth is difficult and an unfavorable occlusal force is applied. In this case, it is advantageous to placement the implant after orthognathic surgery to improve the interjaw relationship. It is important to establish a treatment plan through collaboration between orthodontist, prosthodontist, oral and maxillofacial surgeons to achieve the ideal result. In this case report, we report a successful result of implant placement with orthognathic surgery and bone graft in a growing patient with a maxillary anterior defect due trauma. 148 대한악안면성형재건외과학회

149 PⅢ-02 인공원판대치물과관절치환보철물을이용한악관절재건술 : 증례보고 김헌영 *1, 성태환 1, 장동규 1, 박정현 1, 김진우 1, 김선종 1 1 이화여자대학교의료원목동병원구강악안면외과 외상, 종양, 흡수, 그리고유착과같은질병으로인하여턱관절의구조적인손상이발생하게되면병적구조물을제거하고재건을필요로하는경우가있다. 이러한재건은하악골의기능과형태를회복하고환자의불편감을줄이고질병이진행되는것을막아주는것을목표로하고있다. 하지만재건의방법에대해서는논란이되어왔고많은술기와재료들이소개되어왔다. 최근에는인공원판대치물과관절치환보철물을이용한악관절재건술이증가하고있고안정적인결과가보고되고있다. 이에저자등은본원에서 Biomet R사인공원판대치물과관절치환보철물을이용하여악관절재건술을시행한증례를문헌고찰과함께보고하는바이다. Temporomandibular joint replacement with alloplastic prosthesis: Case series Heon-young Kim *1, Tae-Whan Seong 1, Dong-gyu Jang 1, Jung-hyun Park 1, Jin-woo Kim 1, Sun-Jong Kim 1 Dept. of Oral and maxillofacial surgery, Ewha Womans University Medical center Anatomic structural damages of temporomandibular joints such as trauma, tumor, resorption, and ankylosis require removal of pathologic structures and reconstruction of TMJs. The aims of reconstruction include the restoration of mandibular function and form, decreased patient disability and suffering, and the prevention of disease progression. The method of reconstruction, however, is controversial and numerous techniques both autogenous and alloplastic have been described. Recently, as the use of alloplastic TMJ prosthesis has increased, several studies have reported stable and satisfactory results. The following is the case study of four patients who were treated TMJ reconstruction with stock Biomet R TMJ prosthesis 제 57 차종합학술대회및정기총회 149

150 PⅢ-03 하악과두과증식에의한안면비대칭 : 증례보고최민호 *1), 이승준 1), 김진수 1), 박재억 1), 김창현 1) 가톨릭대학교서울성모병원구강악안면외과 1) 서론 : 안면비대칭은흔한악안면기형의하나이다. 모든환자들이약간의비대칭을가지지만, 심한비대칭은기능적, 심미적문제를유발할수있다. 병인으로는선천성질환, 후천적질병, 외상, 발육장애등이있다. 하악과두과증식은안면의비대칭을유발한다. 증례보고 : 48세의여성이골격성비대칭을주소로교정과로부터의뢰되었다. 그녀는 3년전섬유근육통으로진단받은병력이있었다. 그녀는초기상담, 수술전, 수술직후에임상적및방사선학적검사를시행하였다. 검사를통해턱의좌측변위를동반한심한비대칭과우측하악과두의과증식을관찰할수있었다. 환자는전이개접근법을통한과두절제술을시행받았다. 환자의안면비대칭은치료후에과두크기의교정을통해개선되는결과를보였다. 고찰및결론 : 하악과두과증식은하악의비종양성기형이다. 병인에대해서는아직정확히밝혀지지않았지만, 하악의비대칭을유발하는골연골종, 과두흡수, 외상또는감염등과는구분할필요가있다. 본증례에서는추가적인평가및장기간의추적관찰이필요하다. 하지만, 임상적인결과를고려할때, 우리는과두절제술이안면비대칭의치료를위한좋은치료법이라고결론내릴수있다. Facial asymmetry caused by unilateral condylar hyperplasia: Case report Minho Choi *1), Seungjoon Lee 1), Jin-Su Kim 1), Je-Uk Park 1), Chang-Hyen Kim 1) Department of oral and maxillofacial surgery, Seoul St.Mary s hospital, The catholic University of Korea 1) Introduction: Facial asymmetry is a common maxillofacial deformity. All patients have some degree of asymmetry, but marked facial asymmetry can cause functional and esthetic problems. The etiology includes congenital disorders, acquired diseases, trauma and developmental deformities. Condylar hyperplasia is a pathology that causes facial asymmetries. Case report: A 48 year old woman is referred by her orthodontist for skeletal asymmetry. She was diagnosed as fibromyalgia 3 years ago. Patient underwent standardized clinical and radiological examination at initial consultation, before surgery, immediately after surgery. Clinical and radiological examination showed marked asymmetry with deviation of the chin to the left side and overgrowth of right condyle. The patient underwent right condylectomy via a preauricular approach. After treatment, asymmetry was improved by correction of condylar size Conclusion: Condylar hyperplasia is a non-neoplastic malformation of the mandible. Although its etiology is still uncertain, it is important to differentiate it from other causes of mandibular asymmetry such as osetochondromas, condylar resorption, trauma or infection related. In this case, further evaluation and long-term follow-up are needed. However, considering the clinical results, we can conclude that the condylectomy is a good treatment option to facial asymmetry. 150 대한악안면성형재건외과학회

151 PⅢ-04 국소마취실패의기여요인들 : 증례보고이원범 *, 최나래, 백영재, 이재열, 황대석김용덕, 신상훈, 김욱규, 송재민 부산대학교치의학전문대학원구강악안면외과학교실구강악안면영역의시술에있어서첫걸음은성공적인국소마취라고할수있다. 마취의실패는환자와의사와의관계에서신뢰를주지못하는요인일뿐아니라실제시술의성패에도영향을미치기에구강악안면외과영역에서는국소마취에대한교육및수련이중요하게인식되고있다. 구강악안면외과에서는치과치료시마취가잘되지않는다는주소로내원하는환자를만나게되며, 대다수의환자들은일정경력의전문의에의해서국소마취가성공적으로이루어지는경험을하게된다. 하지만극히일부환자들은여러차례에걸친국소마취에도마취가되지않아전신마취를이용하여시술을하는경우가있다. 문헌에서는국소마취의실패를해부학적요인, 병리학적요인, 심리학적및유전적요인으로꼽고있다. 해부학적요인과관련하여서, 마취부위의골밀도의정도, 신경문합유무등이마취의성공여부에영향을준다고보고되고있다. 염증이있거나통증에대한역치가낮은환자들의경우도국소마취실패의원인이다. 이러한국소적인요인들이외최근유전자분석에대한연구는 SCN5A 라는유전자의돌연변이에의한나트륨채널결함이원인이라고하는연구가있다. 이에본연구에서는이러한유전자돌연변이가원인일수있다는가정하에국소마취실패로전신마취를시행하였던환자에대하여유전자검사를시행하여국소마취실패에대한원인을알아보고자하였다. Contributing Factors of Failure of Local Anesthesia : Case report Won-bum Lee *, Na-rae Choi, Young-Jae Baek, Jae-Yeol Lee, Dae-Seok Hwang, Yong-Deok Kim, Sang Hun Shin, Uk-Kyu Kim, Jae-Min Song Dept. of Oral and maxillofacial surgery, School of Dentistry, Pusan National University Local anesthesia is important for the success of any surgical procedure. The failure of anesthesia is not only a factor that can not be trusted in the relationship between the patient and the physician, but also affects the success or failure of the actual operation. Therefore, education and training for local anesthesia are important in the oral and maxillofacial surgery. Although most patients experience a successful local anesthesia by a specialist of the Oral & Maxillofacial surgery, a few patients have local anesthetics resistance. Many factors are responsible for local anesthetic failure. These factors can generally classified into anatomical, pathologic, psychologic and genetic factors..in anatomical factors, degree of bone density and nerve anastomoses were reported. Inflammation or low threshold to pain is also causes of anesthetic failure. In addition to these local factors, Clendenen et al reported in 2016 that some people with genetic defect relating to a specific sodium channel in the body, known as Nav1.5 have resistant to local anesthetics. They also noted the A572D mutation in the SCN5A gene encoding for Nav1.5 in 4 family members with a history of local anesthetics resistance The purpose of this study is to determine the cause of local anesthetic failure by genetic test under the assumption that A572D mutation may be the cause. 제 57 차종합학술대회및정기총회 151

152 PⅢ-05 Exosomes secreted from bone marrowderived mesenchymal stem cells promote bone regeneration Ryoko TAKEUCHI *1, Wataru KATAGIRI 1, Satoshi ENDO 1, Daisuke SUDA 1, Hidenobu SAKUMA 1, Syohei KANEMARU 1, Kanae NIIMI 1, Kohei SAKAGUCHI 2, Junna WATANABE 2, Tadaharu KOBAYASHI 1 1 Division of Oral and Maxillofacial Surgery, Department of Tissue Regeneration and Reconstruction, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan 2 Department of Oral and Maxillofacial Surgery, Nagoya University Graduate School of Medicine, Aichi, Japan Conclusion: These results suggest that MSC-Exo have great osteogenic potentials as we reported previously in MSC-CM. Exosomes contained MSC-CM may play important roles in bone regeneration by stem cells or their secretomes. Our findings also indicate that MSC-Exo can be used as bioactive agents for bone regeneration. Introduction: Mesenchymal stem cells (MSCs) are already known as multipotent stem cells that can differentiate into various kinds of cell types and contribute to tissue regeneration. As the secretomes from MSCs contain numerous kinds of soluble factors giving several biological effects to the host tissues, they are also expected to be applied to regenerative medicine. Our previous studies have shown that serum-free conditioned media from human bone marrowderived mesenchymal stem cells (MSC-CM) contain several growth factors, which are effective in bone regeneration. Exosomes are nanovesicles with bilaminar membranes released by all cell types and also contained in MSC-CM, and act as intercellular communication vehicles. In this study, we investigated the effects of MSC-Exo, which are exosomes contained in MSC-CM, in bone regeneration. Method and materials: MSC-Exo were isolated from MSC- CM by the centrifugation methods. Transmission electron microscope, western blotting and nanoparticle tracking analysis were used to identify MSC-Exo. MSCs were coincubated with MSC-Exo. Osteogenic characters of MSC- Exo treated MSCs were examined by alizarin red staining and real-time polymerase chain reaction. Also, we used rats calvaria bone defects models to evaluate the bone regeneration by MSC-Exo. MSC-Exo were implanted with atelo-collagen sponges into rat calvaria bone defects and bone regeneration were evaluated by microcomputed tomography and histological analysis after 2 and 4 weeks. Results: The results in vitro showed that MSC-Exo enhanced the mineralized matrix deposition and the expressions of osteogenic marker genes. In vivo, we found that MSC-Exo promoted bone regeneration as almost equally as MSC-CM did. 152 대한악안면성형재건외과학회

153 PⅢ-06 가토에서폴리디옥시리보뉴클레오티드의골유도효과에대한연구 양지호 *1, 임헌준 1, 김봉철 1, 이준 1,2 1 원광대학교대전치과병원구강악안면외과 2 원광골재생연구소 목적 : 본연구는가토의두개골결손부에서폴리디옥시리보뉴클레오티드 (PDRN) 의골유도능을평가하기위하여수행되었다. 재료및방법 : 생후 3개월이상의수컷토끼 16마리를이용하였고, 각토끼의두개골에외경 8mm 의골결손부를 3 개씩형성하였다. 각결손부는자가혈병유도, 합성골이식, 합성골을 PDRN 에수화한혼합물이식하였다. 수술 1, 2, 4, 8 주차에실험동물을희생하여미세전산화단층촬영을통한관찰및분석, 조직학적분석, 면역학적분석시행하였다. 결과 : 미세전산화단층촬영결과, 합성골을 PDRN 에수화한혼합물을이식한군에서다른군과비교하여우수한골형성이관찰되었고, 조직학적관찰시에도초기에더많은염증반응이보였으며, 실험 4, 8주차에다른군과비교하여가장우수한결손부피개율을보였다. 면역학적분석시이식재사이로우수한혈관신생이관찰되었다. 결론 : 이상의결과를바탕으로, 폴리디옥시리보뉴클레오티드는골모세포의성장및분화를자극함으로써골재생을증진시키는것을확인할수있었다. Osteoinductive Effect of Polydeoxyribonucleotide Sodium in Rabbit Calvarial Defect Ji Ho Yang *1, Hun Jun Lim 1, Bong Chul Kim 1, Jun Lee 1,2 1 Dept. of Oral and maxillofacial surgery, Daejeon Dental Hospital, College of Dentistry, Wonkwang University 2 Wonkwang Bone Regeneration Research institute, Wonkwang University Purpose: The purpose of this study was to evaluate osteoinductive effect of Polydeoxyribonucleotide(PDRN) sodium in rabbit calvarial bone defects. Materials and methods: Three defects with a diameter 8 mm sere prepared in the rabbit calvarial bone. Defects filled with different compounds: empty, synthetic bone, synthetic bone soaked with PDRN. Bone regeneration of the defects was analysed by micro-computed tomographic, histology, immunohistochemistry at 1, 2, 4, 8 weeks. Results: In the micro computed tomographic finding synthetic bone soaked with PDRN group showed best performance compared with the control group. Histologic findings were excellent in the early inflammatory response and angiogenesis in the synthetic bone soaked with PDRN group, and showed the best defect closure rate at 4, 8 weeks. And immunological analysis showed the synthetic bone soaked with PDRN group showed the best results in angiogenesis. Conclusions: Our data demonstrate that PDRN promotes bone regeneration by acting as and osteoblast growth stimulator in vivo. This work was supported by the National Research Foundation of Korea(NRF) grant funded by the Korea government(msit)(nrf-2018r1a2b ) 제 57 차종합학술대회및정기총회 153

154 PⅢ-07 MRONJ 수술후 Bone-spect 평가에대한고찰김창우 *, 이동건, 강몽헌, 송인석, 전상호 고려대학교안암병원구강악안면외과학교실서론 : 요즘, MRONJ의인지도와경험이증가함에따라외과적치료가병의진행을멈추게하고조직학적진단을가능하게하는것으로받아들여지고있다. 그러나부골적출술의수술후평가방법에대해서는아직도논란이있다. 이연구의목적은절제술후수술후평가방법으로서 Bone-spect를임상증상과비교하여평가하고자한다. 재료및방법 : 2014년 3월부터 2018년 8월까지고려대학교안암병원에내원하여부골적출술을시행한환자들에대하여연구를진행하였다. 한명의술자에의해시행한 23 명의환자 ( 남 2명, 여21명, 59-87세 ) 의수술전후 Bone-spect 검사결과와임상적증상에대한평가를시행하였다. 결과 : 통계분석결과, 부골적출술후 Bone-spect 검사결과와임상적평가결과간에상이한결론을보이는경우가있었다. 결론 : 본연구의결과수술후 MRONJ재발여부평가에 Bone-spect 이외의다양한검사가필요함을알수있었다. Review of Postoperative Evaluation after MRONJ Surgery by Bone-spect. Chang-Woo Kim *, Dong-Keon Lee, Mong-Heun Kang, Tae- Hyun Jeon, In-Seok Song, Sang-Ho Jun Dept. of Oral and Maxillofacial Surgery, Korea University Anam Hospital Introduction: Nowadays, with the increased awareness and experience of MRONJ, it has been shown that surgical treatment can stop the progression of the disease and enable a histologically based diagnosis. However, there are still controversies about method for pre-and/or postoperative evaluation. The purpose of this study is to evaluate the postoperative bone-spect for postoperative evaluation method after sequestrectomy. Materials and Methods: We studied patients from March, 2014 to August, 2018, who underwent sequestrectomy at Korea University Anam Hospital. The results of bone-spect tests and clinical symptoms were compared and evaluated in 13 patients (2 males, 21 females, years) who were operated by one surgeon. Results: Statistical analysis showed that there were different conclusions between the results of Bone-spect test and clinical evaluation after the extraction. Conclusions: The results of this study suggest that various tests including Bone-spect are necessary to evaluate the recurrence of MRONJ after surgery. 154 대한악안면성형재건외과학회

155 PⅢ-08 골막기원줄기세포및산소함유지지체를이용한악골골수염의처치 변준호 1,*, 변성훈 1, 오세행 2 1 경상대학교병원치과 / 구강악안면외과 2 단국대학교나노바이오의과학과 골수염은골수를포함한골의전반적인부분에걸쳐골소실을야기하는화농성염증을일으키는병변이다. 최근에는다양한골소실질환에대한골재생기술이많이향상되고있으나현재까지도골수염과관련하여서는병적골절및재발등과관련된합병증이지속적으로발생하곤한다. 이와관련하여해결에있어서중요한점은골수염처치시골수염의염증성상황의해결에만치우치지말고치유를촉진시키기위한원활한혈류공급의제공이골수염치료의중요한요소로인식되고있다. 이에본연구에서는골막기원줄기세포와산소함유지지체를이용하여미니돼지의하악골에유발시킨악골골수염에대한처치기술에관하여기술하고자한다. Development of bone regeneration strategy for jaw osteomyelitis using periosteumderived mesenchymal stem cells oxygen carrier-loaded scaffold June-Ho Byun 1,*, Sung-Hoon Byun 1, Se Heang Oh 2 1 Department of Oral and Maxillofacial Surgery, Gyeongsang National University Hospital, 2 Department of Nanobiomedical Science, Dankook University Osteomyelitis is a purulent inflammation that can encompasses all of the bone components, including the bone marrow. Along with technical advances for bone regeneration, the treatment of osteomyelitis have been improved over the previous decades, however, the treatment of osteomyelitis of jaw can cause complications, including recurrence and pathologic fractures, often requiring further surgical procedures. In relation to therapeutic failure and recurrence of osteomyelitis, the remarkable aspect is that the treatment should allow reestablishment of sufficient blood supply to minimize recurrence in predisposed wounds and improve wound healing in affected areas, in addition to infection control. The purpose of this study was to develop staphylococcal mandibular osteomyelitis in miniature pigs and examine the tissue-engineered bony reconstruction using human periosteum-derived mesenchymal stem cells and perfluorooctane-loaded hollow PCL microparticle in the osteomyelitis pig model. 제 57 차종합학술대회및정기총회 155

156 PⅢ-09 만성방사선장해에대한고압산소치료양현우 *, 이천의, 최병호 연세대학교원주의과대학치과학교실원주세브란스기독병원구강악안면외과고압산소치료는다양한종류의만성방사선장해에사용되고있는치료요법중하나이다. 방사선치료는치료범위에해당되는정상조직의이온화및혈관염을유발하는것으로알려져있으며이로이한혈관소실은방사선조사된조직의 hypoperfused, hypoxic, hypocellular 상태를촉진하여조직의만성방사선장해가발생한다는고전적인견해가근래까지지배적이었다. 하지만최근방사선종양학회등은지연된방사선장해의병태생리를조직의섬유위축효과로주장하고있다. 고압산소요법은통상적으로산소라디칼을이용한호중구의항박테리아작용을촉진하고, 조직재생과신생혈관생성을촉진시키는작용을통하여방사선골괴사, 방사선연조직괴사에도움이된다고알려져있으나최근의연구에의하면섬유모세포성간질세포와혈관신생줄기세포등이방사선장해가진행되는조직에긍정적인역할을한다는주장이지배적이다. 본보고를통하여만성방사선장해중하나인근육섬유증으로인한아관긴급환자에대한고압산소치료후임상적인변화와더불어방사선장해에대한최근고압산소치료요법에대하여고찰하고자한다. Hyperbaric oxygen therapy in chronic radiation injury Yang Hyun Woo *, Lee Chunui, Choi Byung Ho Dept. of Oral and maxillofacial surgery, Yonsei university of medicine, Wonju Severance Christian Hospital Hyperbaric oxygen (HBO) therapy often is used clinically to treat various forms of chronic radiation tissue injury. It is known that radiation therapy induces an endarteritis in normal tissues that also are exposed to ionization within the therapeutic field. The resultant capillary loss leads to the development of a hypoperfused, hypoxic, hypocellular state in previously irradiated tissue. It was believed traditionally that this was the primary mechanism of chronic tissue radiation injury. More recently, the radiation oncology community has emphasized the concept of the fibroatrophic effect as a key pathophysiologic process in the development of delayed radiation injury. Traditionally, the mechanism for benefit from HBO in STRN and ORN has been attributed to the angiogenesis and capillary regrowth stimulated by the large plasma to tissue oxygen gradients present during HBO therapy. Recent studies suggest that mediation of the fibroblastic stromal process and also stimulation of vasculogenic stem cells may play significant roles in the clinical response of radiation injury to HBO. We report here the results of our experience treating a patient with radiation tissue injury and present current clinical reports and studies on HBO therapy. 156 대한악안면성형재건외과학회

157 PⅢ-10 TRAV7-2 * 02-expressing CD8 + T cells are responsible for Palladium allergy Yuri Takeda *1,2, Kouetsu Ogasawara 1, Tetsu Takahashi 2 1 Department of Immunobiology, Institute of Development, Aging and Cancer, Tohoku University 4-1 Seiryo-machi, Aoba-ku, Sendai , Japan. 2 Department of Oral and maxillofacial surgery, Graduate School of Dentistry, Tohoku University, 4-1 Seiryo-machi, Aoba-ku, Sendai, Miyagi , Japan. Introduction: While the use of metallic biomaterials, especially in dental care, has led to an improvement in quality of life, the incidence of metal allergies is increasing recently. Palladium (Pd) is arguably the most important metal for modern dental care, and as a result, the rate of allergic response to this metal in particular has significantly risen in recent years. Metal allergy is known to be a T cell-mediated delayed-type hypersensitivity (DTH), however, the pathogenic T cells have not been characterized, nor has the specific T cell receptor (TCR) been identified. Objective: We attempted to identify the T cell subsets responsible for Pd allergy and investigated whether a specific TCR exists on the pathogenic T cells. Methods: Using Pd allergic mice, the pathogenic T cells and TCR repertoires were characterized by flow cytometry and next generation sequencer. Results: We found that interaction between major histocompatibility complex I (MHC I) and CD8 + T cells is essential for the development of Pd allergy. IFN-γ producing CD8 + T cells, rather than CD4 + T cells, were found to be the proinflammatory mediators. In addition, we found a skewing in Pd allergic mice toward the TRAV7-2*02 TCRα chain. Furthermore, adoptive transfer experiments revealed that in vitro cultured Pd antigen presenting cells (APCs) function as memory APCs with recipient mice developing Pd allergy and increasing the frequency of TRAV7-2*02. In contrast, Pd allergy and increase of TRAV7-2*02-expressing CD8 + T cells did not observed in MHC I-deficient Pd-APCs transferred mice. We also identified the CDR3 consensus motif of pathogenic TCRs as CAAXSGSWQLIF in TRAV7-2*02/TRAJ22*01 positive cells. Conclusion: TRAV7-2*02-expressing CD8 + T cells are responsible for Pd allergy and thus, the specific TCRs represent novel targets for the development of diagnostics and treatments for metal allergy. 제 57 차종합학술대회및정기총회 157

158 PⅢ-11 하악제 3 대구치매복양상과난이도분석의임상적연구 신경수 *, 서경현, 조선경, 김기태, 정영곤, 박원종, 최은주, 최문기, 권경환원광대학교치과대학구강악안면외과학교실원광치의학연구소 하악사랑니발거는구강악안면외과에서일반적으로시행되는행위이다. 매복치의경우, 빈번하게치관주위염, 낭종형성을일으킨다. 따라서, 우리는하악매복치발거의중요성을간과하지않을수없다. 하지만. 완전히맹출된치아에비해매복된양상에따라매복치는발거후더많은위험성의합병증들이발생할수있다. 매복치의다양한양상에따라발치테크닉의어려움과발생가능한합병증의위험성이다양하다. 원광대학교치과병원구강악안면외과를방문한환자들을조사대상으로선정하였다. 우리는 4가지기준을설정하였다 : Septal relationship, depth, ramus relationship/space available, distance between inferior alveolar nerve and mandibular impacted tooth. 현재, 매복치는단순, 복잡, 완전의분류형태를가지고있다. 우리는이연구의결과에따라난이도의더세세한분류의필요성을보고하고자한다. A clinical study on aspects of impacted mandibular third molar and analysis of difficulty index Kyung Su Shin *, Kyung-hyun Seo, Seon-gyeong Jo, Gi Tae Kim, Yeong Kon Jeong, Won Jong Park, Eun Joo Choi, Moon Gi Choi, Kyung-hwan Kwon Department of Oral and Macillofacial Surgery, ColleGe of Dentistry, Wonkwang University.Wonkwang Dental Research Institute. Mandibular Impacted tooth extraction is tired of being done in general practice most common in Oral and Maxillofacial Surgery. In case of impacted tooth, it causes frequently pericoronitis, cystic formation around crown. So, we can t overemphasize the value of importance of extraction on mandibular impacted tooth. However, with regard to the impacted aspect compared to the fully erupted tooth, there are more high risk of complications that occur after extraction in case of impacted tooth. In similar vein, even if such a impacted tooth, there is variety of the risk of possible complications and the difficulty of extraction technique depending on the different aspects of impacted tooth. Patients visited to Wonkwang University Hospital of Dentistry Oral and Maxillofacial Surgery were the subject of investigation. We considered four criteria ; Septal relationship, depth, ramus relationship/space available, distance between inferior alveolar nerve and mandibular impacted tooth. Currently, mandibular impacted tooth is classified into simple, complex, complete. We report that there is the need for detailed classification of difficulty index that according to the result of this study. 158 대한악안면성형재건외과학회

159 PⅢ-12 하치조신경이카노이용액에노출되었을때발생하는하순과이부의감각이상에대한후향적평가 *1,2 박윤하, 1,2 임대호, 1,2 백진아, 2,3 염정호, 1,2 고승오 1 전북대학교치의학전문대학원구강악안면외과학교실 2 전북대학교병원의생명공학연구소 3 전북대학교의학전문대학원예방의학교실 이연구의목적은하악양성종양의적출시노출된하치조신경에화학적소작이가해질경우발생하는하순과이부의감각이상에대한평가이다. 이연구는하악에법랑모세포종, 치성각화낭, 함치성낭등으로인해낭종적출술을시행하는10명의환자 ( 남자 8, 여자 2) 에대한후향적연구이다. 모든환자는방사선사진상병소가하치조신경관을파괴한소견을가지고있었으며, 수술전에는하순과이부에서의감각이상은호소하지않았다. 전신마취하병소의외과적적출후카노이용액을 3분간적용하였다. 모든환자는수술후감각이상에대한평가를시행하였다. 평가는 NRS를통한주관적평가였으며, 감각이상이전혀없는정상의상태를 10으로하고어떠한감각도느낄수없는상태를 0으로표현하였다. 총 10명의환자중수술직후감각이상을호소한환자는 5명이었다. 나머지 5명의환자는수술직후에도감각이상을호소하지않았다. 감각이상을호소한 5명의환자중 2명의환자는수술후한달이내에하순과이부의감각이정상으로돌아왔다고진술하였다. 감각이완전히호전되지않은 3명의환자중 2명은 1년이상의시간이흘렀음에도불구하고수술직후와비교하여전혀나아지지않았다고진술하였다. 감각이상이잔존한 3명모두일상생활에서의불편감은느끼지못한다고하였다. 노출된하치조신경에화학적소작의시행여부를결정하는것은구강악안면외과의사에게큰고민을안겨준다. 병소의재발을막는의미에서유의미한역할을하는것은분명하지만, 신경의손상으로인한비가역적감각이상의발생가능성은이러한유의미한이점을감소시키기때문이다. 하지만본연구를통해노출된하치조신경에화학적소작을적용하더라도비교적단기간에감각이상이회복되는것을확인할수있었다. 비록적은수의환자군으로인해본연구의결론을일반화하는것은조심스러울수있으나, 하치조신경노출시카노이용액적용을고민하는많은술자들에게작은도움이될수있을거라생각되어본연구를보고하고자한다. A retrospective evaluation hypoesthesia of the lower lip and chin when the inferior alveolar nerve is exposed to the Carnoy solution *1,2 Yun-Ha Park, 1,2 Dae-Ho Leem, 1,2 Jin-A Baek, 2,3 Jung-Ho Youm, 1,2 Seoung-O Ko 1 Department of Oral and Maxillofacial Surgery, School of Dentistry, Chonbuk National University Jeonju, Korea 2 Research Institute of Clinical Medicine-Biomedical, Chonbuk National University hospital, Jeonju, Korea 3 Department of Preventive Medicine, Chonbuk National University Medical School, Jeonju, Korea The purpose of this study was to evaluate the hypoesthesia of the lower lip and chin that occur when chemical cauterization is applied to the exposed inferior alveolar nerve(ian) in the enucleation of mandibular benign tumors. This is a retrospective study of 10 patients (8 males and 2 females) who underwent enucelation for mandibular ameloblastoma or odontogenic keratocyst or dentigerous cyst. All of the patients had a radiographic evidence of destruction of the nerve canal. Before surgery, there were no hypoesthesia in the lower lip and chin. After surgical enucleation of the lesion under general anesthesia, the Carnoy solution was applied for 3 minutes.all patients underwent evaluation of hypoesthesia after surgery. The evaluation was subjective evaluation through Number Rating Scales(NRS). The state of normal with hypoesthesia at 10 and the state at which no sensation could be felt was expressed as zero. Of the 10 patients, 5 patients complained sensation abnormality after surgery. The remaining 5 patients did not complain of sensory abnormalities after surgery.two of the five patients complaining of sensory abnormality stated that the sensation of the lower lip and chin returned to normal within one month after the operation. Two of the three patients whose sensations did not fully recover were stated to have not improved at all compared to immediately after surgery, even though the time was over a year. All three patients with sensory abnormalities did not feel discomfort in daily life. Deciding whether or not to apply chemical cauterization to the exposed IAN is a major concern for oral maxillofacial surgeons. Although it is clear that it plays a significant role in preventing the recurrence of the lesion, the possibility of irreversible hypoesthesia resulting from nerve damage may reduce this significant benefit. However, this study showed that even if chemical cauterization was applied to exposed IAN, sensory abnormalities were restored in a relatively short period of time. Although we may be careful to generalize the conclusions of this study because of the small number of patient groups, we think that this study may be helpful for many sergeons who are concerned about the application of carnoy solution to the IAN. 제 57 차종합학술대회및정기총회 159

160 PⅢ-13 Assessment of biomarkers in Medication- Related Osteonecrosis of the Jaw (MRONJ) patients: Preliminary results Heon-Kyoung Moon, Michidgerel Odkhuu *, SY Kim, HY Kim, TW Seong, DK Jang, JH Park, Jin-Woo Kim, Sun-Jong Kim Department of Oral and Maxillofacial surgery, Ewha Womans University Mok-dong Hospital, Seoul, Korea Introduction: Various bone biomarkers have been suggested for the diagnosis and risk assessment for osteonecrosis of the jaw, a serious complication associated with bisphosphonate (BP) use; however, no consensus has been reached. This study investigated possible biomarkers for medication-related osteonecrosis of the jaw (MRONJ). Purpose: The aim of this study is detect and identificate possible biomarkers in MRONJ patients. Materials and Methods: Thirty-three patients with current or previous IV BPs or denosumab administration were enrolled in this case-control study and were subjected to blood sampling. After 8 weeks (T1), patients diagnosed with MRONJ were classified into case group (n=17) and those who did not show disease progression, to control group (n=16) followed by blood sampling. After their respective management surgical treatments and/or drug holiday (T2), case group was further divided into ONJ group and healed group and were subjected to blood sampling. The same protocol was done at 4-8 months (T3). Evaluated biomarkers include the following: CTN, CTX, NTX, PYRILINKS-D, OC, Bone specific ALP, PTH (Intact), 1.25-(OH)2 Vit D, Total calcium, TRACP 5b, CTX α/β ratio, RANKL/OPG ratio, DKK-1, Sclerostin, PINP, DPD, VEGF, Urinary creatinine. Results: TRACP 5b, CTX and RANKL were decreased over time in the case group compared with control group at T1, T2 and T3. For the analysis of potential biomarkers of MRONJ, we analyzed the biomarker concentrations over time between the control group and the case group. RM-ANOVA revealed the significant lower value of TRACP 5b and RANKL/OPG ratio in case group over time compared with case group. Conclusions: This study demonstrated that lower serum TRACP 5b levels and reduced RANKL/OPG ratios were possibly associated with MRONJ. 160 대한악안면성형재건외과학회

161 PⅢ-14 RAW 세포에서 PDRN 의항소염작용이덕원 * 경희대학교강동경희대병원구강악안면외과골질환과관계된치유제로많이쓰이는 Bisphosphonates는그유용성에도불구하고최근에서난치성골괴사를발생시키는원인으로주목되면서많은연구와보고가이어지고있다. 발생한난치성골괴사의치료를위하여여러방법들이제시되고있다. PDRN은 A2A receptor agonist 로서여러연구를통하여그소염작용이이러한골괴사와연관되치유에긍정적역할을할수있음을추정해볼수있다. 이에 RAW cells 을이용하여세포단위에서 PDRN의긍정적치유효과를확인해보고자한다. (NRF 2016R1A2B ). Anti-inflammatory effect of olydeoxyribonucleotide on zoledronic acidpretreated and lipopolysaccharide-stimulated RAW cells Deok-Won Lee * Department of Oral & Maxillofacial Surgery, Kyung Hee University Dental Hospital at Gangdong, Kyung Hee University, Seoul, Republic of Korea Bisphosphonates are generally used as therapeutic agents for bone diseases. However, previous reports on bisphosphonates related osteonecrosis of the jaw (BRONJ) demonstrated that inflammation triggers and worsens the disease. Recently, polydeoxynucleotide (PDRN), an A2A receptor agonist, has been suggested for the treatment of various diseases and broadly studied for its anti inflammatory effect. The present study aimed to measure the effect of PDRN on macrophage cells treated with zoledronic acid (ZA) and lipopolysaccharide (LPS). PDRN treatment of macrophages inhibits the inflammatory cytokines induced by ZA and LPS stimulation. It was hypothesized that the inflammatory cytokines were inhibited through A2A activa tion by PDRN. In addition, increased VEGF expression may contribute to increased vascularization and subsequently improve the pathological condition in BRONJ. As inflamma tion and LPS may stimulate the occurrence of BRONJ, the present study postulated that PDRN is possibly a candidate for the therapeutic management of BRONJ by decreasing inflam mation and increasing vascularization. This study was supported by a grant from the National Research Foundation of Korea (NRF 2016R1A2B ). 제 57 차종합학술대회및정기총회 161

162 PⅢ-15 난치성골괴사치유를위한 PDRN의적용이덕원 * 경희대학교강동경희대병원구강악안면외과 Bisphosphonates에의하여발생되는난치성골괴사는여러노력을통하여연구가이루어지고있는중이고많은발전을이루고있다. 그러나아직까지명확한기전과치료방법이정립되지는못하고있다. PDRN 은이러한골괴사상태의치유에도움이될수있는가능성을가지고있기에동물실험모델에적용하여그치료제로서의가능성을확인해보고자한다. (NRF 2016R1A2B ). Polydeoxyribonucleotide may help restoration for bisphosphonate-related osteonecrosis of jaw Deok-Won Lee * Department of Oral & Maxillofacial Surgery, Kyung Hee University Dental Hospital at Gangdong, Kyung Hee University, Seoul, Republic of Korea Bisphosphonates (BPs) induces bisphosphonate-related osteonecrosis of the jaw (BRONJ), however, despite many efforts, complete remedies have not yet established. In the present study, we investigated the feasibility of polydeoxyribonecleotide (PDRN) on BRONJ-induced rabbit model. Compared with BRONJ-induced sample, PDRNtreated samples exhibited lower necrotic bone change, and larger amount of blood vessel and attached osteocyte productions. The local administration of PDRN may have clinical potential for BRONJ treatment. This study was supported by a grant from the National Research Foundation of Korea (NRF 2016R1A2B ). 162 대한악안면성형재건외과학회

163 PⅢ-16 구강상악동누공환자에대한후향적연구장성백 *, 이성탁, 최소영, 김진욱, 권대근, 경북대학교치과대학구강악안면외과학교실목적 : 본연구에서는구강-상악동누공환자의발생원인, 수술방법, 항생제사용, 재발유무, 그리고추후경과관찰기간에이르는데이터분석을통하여, 구강-상악누공환자에대한올바른처치법에대하여논의하고자한다. 방법 : 2015년 1월부터 2017년12월까지경북대학교치과병원구강악안면외과에서구강-상악동누공폐쇄술을시행받은 30명을대상으로후향적연구를시행하였다. 결과 : 총 30명의구강-상악동누공환자중발치로인한환자는 17명, 임플란트식립및제거관련해서는 10명, 그리고종양및골수염수술관련하여서는 3명이었다. 재발한 2명을제외한 28명에게시행한수술은협부점막피판전위술이 16명, 협부지방이식을동반한협부점막피판전위술이 10명, 그리고구개피판전위술이 2명이었다. 재발한 1 명은 1, 2차모두협부점막피판전위술을, 나머지 1명은협부지방이식을동반한협부점막피판술을 1차에받았고, 이후재발한다음에는구개피판전위술을받았다. 평균항생제사용기간은 6.47주였으며, 지속적으로본원외래내원이가능하였던 24명의평균경과관찰은기간은 17.73주였다. 결론 : 구강상악동누공은상악후방부위의치아발치, 임플란트식립및제거, 그리고종양및골수염에대한수술등과관련하여발생할수있다. 구강상악동누공폐쇄술은협부전진피판술 ( 협부지방이식술동시가능 ) 과구개피판전위술을이용하여효과적으로폐쇄시킬수있다. Retrospective study of patients with oroantral fistula : Seong-Baek Jang *, Sung-Tak Lee, So-Young Choi, Jin-Wook Kim, Tae-Geon Kwon Dept. of Oral and maxillofacial surgery, School of Dentistry, Kyungpook National University, Daegu, Korea Purpose: The purpose of this study is to discuss the proper treatment methods for oroantralr fistula patients by analyzing the data of the cause of oroantral fistula, surgical methods, antibiotic use, recurrence, and follow - up observation period. Methods: From January 2015 to December 2017, we retrospectively studied thirty patients who underwent oroantral fistula closure in Oral Maxillofacial Surgery, Kyungpook National University Hospital. Result: Of the thirty oroantral fistula patients, seventeen patients were involved in tooth extraction, ten were involved in implant placement or removal, and three were involved in tumor and osteomyelitis surgery. Twenty - eight patients except two recurred patients underwent only buccal advancement flap in sixteen patients, buccal advancemet flap with buccal fat pad graft in ten patients, and palatal rotation flap in two patients. One patient with recurrence underwent both buccal advancement flap on first and second operation. Ant the other patient with recurrence underwent buccal advancement flap on first operation and palatal rotation flap on second surgery. The mean duration of antibiotics use was 6.47 weeks and the mean follow-up period of twenty-four patients ( Of the thirty oroantral fistula patients, five patients was follow up loss and one patient was followed on local dental clinic) was weeks. Conclusions: Oroantral fistula may occur in relation to tooth extraction, implant placement and removal of the tumor in the posterior maxilla. And oroantral fistula closure can be effectively done by using buccal advancement (with or without buccal fat pad graft) and palatal rotation flap. 제 57 차종합학술대회및정기총회 163

164 PⅢ-17 Long-term follow up of bone augmentation with ramal bone graft Yoojin Shin *, Kang-Mi Pang, Han-Wool Choung, Jong-Ho Lee Department of Oral and Maxillofacial Surgery, Seoul National University Dental Hospital Background: The use of autogenous bone grafts has been reported effective in increasing alveolar volume both vertically and laterally in edentulous and partially edentulous patients for placement of oral implants. The aim of this study was to evaluate the results of alveolar ridge augmentation with block bone grafts harvested from the mandibular ramus. Patients and methods: A retrospective study was done from 2002 to 2017 on 49 cases (19 male: 30 female with mean age of 50.84±16.32) initially with bone defect that were treated autogenous bone grafts harvested from the mandibular ramus. Out of 49 cases, 9 cases received immediate implant placement after bone graft and 40 cases underwent a 2-stage approach. 23 cases were done with veneer bone graft and 27 with onlay bone graft. Clinical and radiographic evaluation including postoperative complications, healing period, and survival rates of implants were done. Results: Out of 49 cases, the total success rate of ramal bone graft was 73.5% (13 failed out of 49 cases, 10 from onlay type and 3 from veneer type). Total of 97 implants were placed after donor site healing (mean of 7.5 months). The mean follow up period for the successful bone graft with implants was 72.4 months having the longest follow up for up to 13 years. Recipient site complication occurred in 8 cases and persistent buccal nerve paresthesia more than 6 months in 1 case. Conclusion: Overall, veneer type and a 2-stage approach had the best long-term outcome in this study. Bone resorption after bone graft were predictable from 6 months postoperatively and that implants were placed after healing period. 164 대한악안면성형재건외과학회

165 PⅢ-18 하치조신경과하악매복제 3 대구치의 3 차원형태학적분석 김효준 *, 김병무, 서봉건, 정준오, 문성용조선대학교치과대학구강악안면외과학교실 목적 : 하치조신경은하악소구치, 대구치와인접치은을담당하는삼차신경의가지로하악공을통하여하악내부로들어오게되어전방으로주행하며하악의감각을담당한다. 실제임상에서매복사랑니의발치, 하악지시상절골술 (SSRO), 하악구치부임플란트시술등에서하치조신경의손상이발생하는경우가있으며이를예방하기위해 CBCT 등을통한하치조신경과주요구조물간의위치관계를분석하게된다. 본연구에서는하치조신경의주행위치과주요해부학적구조물과의위치관계를삼차원적으로분석하고자한다. 연구재료및방법 : 사랑니발치를위하여조선대학교치과병원구강외과에내원한환자중하치조신경관과사랑니와의위치관계파악을위하여 CBCT를촬영한 200명 CBCT 원본파일을 (DICOM) 이용하여분석하였다. MimicsR 21, (Materialise) 소프트웨어 ( 이하 Mimics) 를이용하여환자의하악골을 3D 모형화하였고제2대구치와사랑니, 하치조신경을 segmentation 하였다. 또한 lingula, antilingula, sigmoid notch, internal oblique ridge, external oblique ridge, mental foramen 등의주요구조물의위치를표시한뒤각구조물과하치조신경과의위치관계를삼차원적으로분석하였다. 고찰 : 총 200명의 CBCT영상을분석하였으며각해부학적구조물과하치조신경의평균거리를측정할수있었다. 하치조신경과매복사랑니위치관계의삼차원적인분석은사랑니발치시생길수있는신경손상을예방하는데도움이되며 lingula, antilingula, mental foramen 등은하악의절골술시행시신경의위치를예상할수있는주요표지자가될수있다. Three Dimensional Morphometric Analysis between Inferior Alveolar Nerve and Impacted Mandibular Third Molar Hyo-Joon Kim *, Kim Byung moo, Seo bong geon, Cheong Juno, Seong-Yong Moon, Dept of Oral and maxillofacial Surgery, School of Dentistry, Chosun University Purpose: Inferior Alveolar Nerves are branches of the trigeminal nerve that are responsible for the mandibular premolars, molars, and adjacent gingiva. They enter the mandible through the mandibular canal and travel forward to assume the mandibular sensation. In actual clinical practice, damage to IANs is occasionally occurred in the extraction of impacted wisdom tooth, mandibular posterior osteotomy (SSRO), and mandibular posterior implant surgery. In order to prevent this, the positional relationship between IANs and the main structure is analyzed through CBCT. The purpose of this study is to analyze the position of IANs in relation to the location of major anatomical structures in three dimensions. Materials and Methods: We analyzed 200 CBCT original files (DICOM) of CBCT which were taken from the Department of Oral and Maxillofacial Surgery, Chosun University. The model of the patient's mandible was 3D modeled using Mimics 21 (Materialize) software (hereinafter referred to as Mimics), and segmented the mandibular second molar, wisdom tooth, and Inferior Alveolar Nerves. In addition, the locations of major structures such as lingula, antilingula, sigmoid notch, internal oblique ridge, external oblique ridge, and mental foramen were shown and analyzed in three dimensions. Discussion: A total of 200 CBCT images were analyzed and the mean distance between each anatomic structure and Inferior Alveolar Nerves were measured. The threedimensional analysis of the positional relationship of IANs and impacted wisdom tooth helps to prevent nerve damage during wisdom tooth extraction. The lingual, antilingual, and mental foramen are major markers for predicting the location of the nerve during mandibular osteotomy. 제 57 차종합학술대회및정기총회 165

166 PⅢ-19 설피판을이용한치조열증대술 - 증례보고김태흥 *, 최나래, 백영재, 송재민, 이재열, 황대석김용덕, 김욱규, 신상훈 * 부산대학교치의학전문대학원구강악안면외과학교실설피판은구강내상악동누공또는구비강누공등의큰결함부의폐쇄뿐만아니라치조열, 입술의재건에유용하게사용될수있다. 피판은측면, 배면, 전방부기저, 후방부기저등다양한디자인으로거상할수있다. 설피판은동측의설동맥에의해혈행이유지되므로혈류공급이유리하고안전하며합병증이적다는장점이있다. 하지만이동반경이제한적이고환자의협조가요구되며 2차수술이필요하다는단점이있다. 본연구는교통사고로상악골의광범위한결손과함께상순및상악치조열의결함을가진환자에게서설피판을이용하여치조열재건술을시행한증례이다. 후방기저형피판을거상하였고치조열의연조직증대술을시행하여양호한경과를보였기에이를보고하고자한다. Augmentation of alveolus using tongue flap case report Tae-heung Kim *, Na-rae Choi, Young-Jae Baek, Jae-Min Song, Jae-Yeol Lee, Dae-Seok Hwang, Yong-Deok Kim, Uk- Kyu Kim, Sang Hun Shin * Dept. of Oral and maxillofacial surgery, School of Dentistry, Pusan National University The tongue flap can be useful for reconstruction of alveolusand lips, as well as for the closure of large defects such as oroantral fistula or oronasal fistula in the oral cavity. The flap can be elevated in a variety of designs including dorsal, lateral, anterior based, and posterior based. The tongue flap is advantageous because blood flow is maintained by the ipsilateral lingual artery and therefore the supply of blood flow is advantageous, safe, and less complicated. However, there is a disadvantage in that the range of motion is limited, patient cooperation is required, and secondary surgery is required. This study is a case of alveolar reconstruction using a tongue flap in a patient with a defect of the upper labial alveolus with extensive defect of the maxillary bone in a traffic accident. We report a case of posterior based flap elevated and soft tissue augmentation of alveolar soft tissue. 166 대한악안면성형재건외과학회

167 PⅢ-20 류마티스관절염환자에서의 MRONJ 에대한외과및보철치료 : 증례보고 김민아 *, 이백수, 최병준, 오주영, 이정우, 정준호, 황보연, 권용대경희대학교치과병원구강악안면외과 서론 : 턱의약물관련골괴사 (Medication-related osteonecrosis, MRONJ) 는드물지만심각한질환으로하악골또는상악골에서괴사성뼈의형태로나타난다. ONJ을유발하는약물로는 bisphosphonate를포함한 antiresorptive medications 뿐만아니라 antiangiogenic medications이있다. MRONJ 환자에게여러 risk factor가있으며, 임상가는환자의 systemic disease를고려야하는데, 이러한 factor 중에는 Rhumatoid arthritis가있다. 본연구에서는류마티스관절염환자에서의 MRONJ에대한외과및보철치료에대한증례를보고하고자한다. 증례보고 : 67세의여환이 L/C에서의임플란트수술이후하악전방부의광범위한골괴사소견을주소로본원을내원하였다. 임상및방사선검사상하악전방부의임플란트식립체주위로골노출및광범위한골파괴소견을보였다. 환자는고혈압을앓고있었고, 골다공증으로인하여 SERM 제재및류마티스관절염으로인하여Methotrexate를복용하고있었다. 환자는전신마취하에하악전방부위의골수염부위에대하여부골절제술및병소에포함된 implant 제거수술을시행하였고, 술후주기적인검사결과안정적인치유가관찰되어, 하악전방부에추가적인임플란트수술을하고 magnetic attachment을이용한 implant retained denture로최종적인보철치료를진행하였다. 결과 : 다른전신적인질환을앓고있는 MRONJ 환자에있어서, 적절한수술과술후지속적인보조적치료가필요하며, 장기적으로수술부위가유지될수있는방향으로보철치료계획을수립해야한다. 고찰 : MRONJ의 dental risk factor로는치아발치, 치주치료등을포함한 dental operation이있을수있으며, 그러므로 MRONJ 고위험도의환자들에있어서추후의침습적인치료를미리방지하는것과이를위해구강의염증과감염을조기에조절하는것이중요하다. 이를위해서는임상가들에게환자의전신적인질병에대한사전조사와이를고려한치료계획수립이필수적이다. Oral Medication Related Osteonecrosis of the Jaw(MRONJ) in rheumatoid arthritis patient After Surgery and Prosthetic treatment : A Case Report Minah Kim *, Baeksoo Lee, Byungjoon Choi, Jooyoung Ohe, Jungwoo Lee, Junho Jung, Boyeon Hwang, Yongdae Kwon Dept. of Oral and Maxillofacial Surgery, Kyung Hee University Dental Hospital, Seoul, Korea Introduction: Medication-related osteonecrosis of the jaws (MRONJ) is an uncommon but serious disease that presents as areas of necrotic bone in the mandible or maxilla. Drugs that cause ONJ include antiresorptive medications, including bisphosphonates, as well as antiangiogenic medications. There are several risk factors for MRONJ patients, and clinicians should consider patients' systemic diseases, among which are rhumatoid arthritis. This case report describes the clinical and surgical management of a patient with Medication Related Osteonecrosis of the Jaw in rheumatoid arthritis Case report: A 67-year-old female patient was transferred from a local clinic because broad osteonecrosis on anterior mandibular area after implant operation. Clinical and radiological examinations revealed bone exposures and extensive bone destruction around the implants in the anterior mandibular region. The patient was suffering from hypertension and taking SERM for osteoporosis and methotrexate for rheumatoid arthritis. Under general anesthesia, the patient underwent sequestrectomy for osteomyelitis of the mandibular anterior portion and removal of implants included in the lesion. After periodic examination, stable healing was observed. Additional implant surgery was performed on the anterior mandibular region and the final prosthetic treatment was performed with an implant retained denture using a magnetic attachment. Conclussion: In MRONJ patients with other systemic diseases, appropriate surgery and continuous postoperative adjuvant treatment are needed, and a prosthetic treatment plan should be established in the direction that the surgical site can be maintained in the long term. Discussion: The dental risk factors of MRONJ may include dental operation including tooth extraction and periodontal treatment. Therefore, it is necessary to prevent future invasive treatment in patients with MRONJ high risk and to regulate oral inflammation and infection early. To do this, it is essential for clinicians to take a preliminary investigation of the patient's systemic diseases and to plan treatment plans accordingly. 제 57 차종합학술대회및정기총회 167

168 PⅢ-21 흡수성콜라겐스폰지의제 3 대구치발치와에서골재생능력에대한평가 손준배 *1, 진기수 1, 이호 1,2, 한윤식 1,2 1 서울대학교보라매병원구강악안면외과 2 서울대학교치의학대학원구강악안면외과학교실 서론 : 제 3 대구치발치이후발생한골결손은인접한제 2 대구치의치주상태에많은영향을준다. 이러한연유로제3 대구치발치와의골재생을위한많은연구들이진행되어왔다. 이연구의목적은주로지혈목적으로사용되는흡수성콜라겐스펀지의사용이제3대구치발치와의골재생에어떠한영향을미치는지평가해보기위함이다. 방법 : 하악양측제 3대구치를발치예정인14명의환자를대상으로하였다. 양측하악제3대구치의 Pell-Gregory Level 및Class는유사하였으며, 발치는 2번에나누어시행하였다. 개별환자의편측에는흡수성콜라겐스폰지를사용하였으며 ( 실험군, n=14), 반대측은자연치유를도모하였다 ( 대조군, n=14). 술전과술후 6개월, 2번에걸쳐원심면의백악법랑경계부 (cementoenamel junction, CEJ) 에서제2대구치원심부치조정까지의길이를측정하여평가하였다. 결과 : 술후 6개월경과관찰시, 제 2대구치원심면의평균골재생높이는대조군에서 1.37mm, 실험군에서 2.15mm 로콜라겐스폰지를사용한부위에서더많은골재생이일어났지만통계적유의성은찾을수없었다. (p =0.566) 평균경과관찰기간은대조군에서 ± 일, 실험군에서 ± 34.74일이었다. 결론 : 제 3대구치발치와에흡수성콜라겐스폰지를적용하는것은자연적치유와비교시제 2 대구치원심면의골재생에유의한차이는없다. Assessment of regeneration of bone in the extracted third molar sockets augmented using absorbable collagen sponges Jun-Bae Sohn *1, Ki-Su Jin 1, Ho Lee 1,2, Yoon-Sic Han 1,2 1 Department of Oral and Maxillofacial Surgery, SMG-SNU Boramae Medical Center 2 Department of Oral and Maxillofacial Surgery, School of Dentistry, Seoul National University Introduction: Extraction of impacted mandibular third molar(m3) has been cited as causing osseous defect at the distal aspect of the adjacent second molar(m2). This study was aimed to evaluate the effect of collagen sponges for regeneration of periodontal osseous defect distal to the M2 compared with spontaneous healling after impacted M3 removal Materials and methods: Fourteen patients who underwent 14 bilateral and symmetric mandibular third molar extractions were included in this study. Both Pell-Gregory level and Class of both mandibular third molar were similar After two tooth extractions at two different occasions in the same patient, one socket was filled with absorbable collagen sponge (test group, n=14) and the other socket received nothing but the blood clot (control group, n=14). We estimated the length from cementoenalmel junction(cej) of the second molar to the crest of distal bone before extraction and 6 months after surgery. Results: At 6 months after surgery, the mean regeneration of bone was 1.37 mm in the control group, and 2.15 mm in the test group. There was no statistical significant between 2 groups.(p= 0.566) The mean of the follw-up period were ± days in control group, 198 ± 34.74days in test group. Conclusion: On the basis of this study, the use of absorbable collagen sponge appears to be no beneficial to the patient in bone formation. 168 대한악안면성형재건외과학회

169 PⅢ-22 경상돌기증후군의수술적치료 : 거대한경상돌기의증례보고 전도현 *, 임세정, 김대영, 이수호, 손승환, 서정민, 하진희, 손장호, 성일용, 조영철울산대학교병원의과대학울산대학교병원구강악안면외과학교실 서론 : 경상돌기증후군 (eagle syndrome) 은경상돌기가비정상적으로길거나경상돌기인대의석회화로인해경상돌기가비정상적으로연장되어생기는증후군이다. 경상돌기가 30mm 이상인경우를비정상적으로연장된것이라고간주하며, 이런환자중 4-10% 정도만이증상을나타낸다고한다. 주요증상으로는인후통, 연하곤란, 이명, 안면및경부통증, 이통이있을수있고심한경우고개를돌릴때일시적인허혈이나뇌졸중을유발할수도있다. 증례보고 : 본증례의환자는입벌리면찌릿한증상과두통이있으며금일증상이심해져서본원응급실로내원하였다. 방사선사진검사상연장된경상돌기가관찰되었고다른질환과의감별을위해 MRI를추가적으로진행하였다. 구외접근으로양측경상돌기제거술 (Styloidectomy) 을시행하였고증상이소실되었다. 고찰및결론 : 경상돌기절제술의수술은크게구내접근과구외접근으로시행가능하다. 구내접근은심미적이지만수술이어렵고감염을야기할가능성이높다. 구외접근은비심미적이지만수술이용이하고감염의위험은상대적으로완화된다. 본증례에서는구외접근을택하였고성공적인수술결과를이루어증례를보고하고자한다. Surgical management of Eagle syndrome: Report of huge styloid process Do-Hyun Jeon *, Se-Jeong Lim, Dae-Young Kim, Su-ho Lee, Seung-Hwan Son, Jung-Min Seo, Jinhee Ha, Jang-ho Son, Iel-Yong Sung, Yeong-Cheol Cho Department of Oral and Maxillofacial Surgery, University of Ulsan Hospital, College of Medicine, University of Ulsan Introduction: Eagle syndrome is a syndrome associated with elongated styloid process due to abnormality or calcification of stylohyoid ligament. Styloid process longer than 30mm is considered abnormal and among these patient only 4~10% show symptoms. Main symptoms are odynophagia, dysphagia, tinnitus, cervicofacial pain, etc. In severe cases, transient ischemia or stroke can occur. Case report: Patient in this case had electric sensation and headache which worsened and visited emergency department in our hospital. Through x-ray exam, elongated styloid process was observed and MRI was conducted to rule out other possible factors. Styloidectomy was performed via transcervical approach and symptoms were relieved. Discussion and Conclusion: Surgical approach of styloidectomy can be performed in two ways: transoral or transcervical. Transoral approach is esthetic but surgical procedure is difficult and more vulnerable to postoperative infection, Transcervical approach is not esthetic but surgery is easier and has less probability of surgical infection. In this case, transcervical approach was chosen and we would like to report this case with successful result. 제 57 차종합학술대회및정기총회 169

170 PⅢ-23 구순열비변형환자에서이차교정술치험례심유송 *, 강효선, 허재진, 한정준, 정승곤, 국민석, 오희균, 박홍주, 전남대학교치의학전문대학원구강악안면외과학교실, 전남대학교치의학연구소배경 : 많은구순열환자에서일차구순성형술을통해해부학적구조의정확한재배치를이루었음에도, 안모성장과관련하여, 정상측과환측의성장차이, 주위근육의장력차이, 골조직의차이, 반흔존재의차이등으로인해여러형태의이차구순열비변형 (secondary cleft lip nose deformity) 을관찰할수있다. 이러한이차구순열비변형이잔존하는경우이차교정술이요구되며, 이는주로안면부성장이끝난시점에시행하게된다. 목적 : 편측성구순비변형을가진환자들에서일차구순성형술이후, 개방접근법및비내접근법을통한비익연골및비중격연골의재배치, 현수봉합, 늑연골이식술을시행한후, 개선된안모및기능에대하여문헌고찰과함께보고하고자한다. 증례 : 첫번째증례는20세여자환자로편측성구순구개열로일차구순성형술을시행받은이후, 비대칭적비공, 낮은비첨, 비중격편향의개선을위해늑연골을이용한증강술과추가적인비교정술을시행하였다. 두번째증례는 19세남자환자로편측성구순구개열로일차구순구성형술을시행받은이후, 환측으로편위된비주및비익연골과비강저의함몰이관찰되었으며, 이의개선을위하여비내접근법을통한비중격연골및비익연골의재배치를시행하였다. 결론 : 본보고에서제시한수술방법들을통해이차성구순비변형환자에서전반적인대칭성회복을포함한심미적개선을이룰수있을것으로사료된다. The correction of secondary cleft lip and nasal deformities : Report of two cases You Song Sim *, Hyo Sun Kang, Jae Jin Heo, Jeong Joon Han, Seung-gon Jung, Hee-Kyun Oh, Min-Suk Kook, Hong- Ju Park Department of Oral and Maxillofacial Surgery, School of Dentistry, Dental Science Research Institute, Chonnam National University Background: Various secondary cleft lip and nose deformities, which can be caused by growth difference, muscle tension difference, hard tissue difference, and scar existence differences between ordinary side and cleft side can be seen even when anatomical reconstruction is performed accurately in primary cheiloplasty. When these deformities remain, a secondary correction is usually required at the end of facial growth. Purpose: After rearrangement of the alar cartilage and septal cartilage, suspension suture, costal cartilage graft using open approach and endonasal approach, we could get improved function and facial profile. Therefore we are planning to report a case with review. Case presentation: A 20-year-old female patient, who had received primary cheiloplasty for treatment of unilateral cleft lip and palate, visited Department of Oral and Maxillofacial Surgery in Chonnam National University Hospital for correction of asymmetrical nostril, flared alar base and septal deviation. To correct the secondary cleft lip and nasal deformities, augmentation using costochondral cartilage and additional rhinoplasty were performed via open approach. A 19-year-old male patient, who had received primary cheiloplasty for treatment of unilateral cleft lip and palate, had deviated columella and alar cartilage, nasal floor depression. To correct the deformities, rearrangement of alar cartilage with septal cartilage reorientation was performed via endonasal approach. Conclusion : In the patients who has secondary cleft lip and nose deformities, we could get improved esthetic result including recovery of symmetry presented surgical method. 170 대한악안면성형재건외과학회

171 PⅢ-24 Botulinum toxin과 filler를이용한안면회춘술김상윤 *1, 윤필영 1, 김영균 1,2 1 분당서울대학교병원, 치과, 구강악안면외과 2 서울대학교치의학대학원치의학과, 치학연구소서론 : 안면부에서심미적인문제점이존재할경우, 그정도가심하지않거나연조직이원인이라면보툴리눔독소나필러등을이용하여간단하게해결할수있다. 본연구에서는보툴리눔독소와필러를이용하여안면부의심미적문제점을해결한증례들에대하여보고하고자한다. 방법 : 총 248명의환자들을대상으로 654개부위에보툴리눔독소와필러주입을시행하였다. 본시술은모두1인의구강악안면외과전공의에의해시행되었다. 192명은여성, 38명은남성이었으며, 평균연령은 38세였다. 총 654 개의증례들중보툴리눔독소증례는 555개였고시술부위는눈가, 미간, 이마, 사각턱, 콧등. 입술, 입꼬리, 턱끝, 승모근등이었다. 필러증례는 99개로, 시술부위는팔자주름, 미간, 이마, 입술, 코였다. 사용된필러는모두용해가가능한 hyaluronic acid 제품이었으며, Restylane(Q-Med, Sweden), YVOIRE(LG Bio, Korea), Monalisa(Dentium, Korea), Neuramis(MedyTox, Korea) 로총 4종류였다. 보툴리눔독소는 Innotox(MedyTox, Korea) 1종류만사용하였다. 문진표를이용하여치료만족도와통증정도를평가하였고, 주사후발생한합병증들을조사하였다. 결과 : 총 654개의증례들중 15개에서합병증이발생하였다. 필러에의한합병증은 8개로, 일시적부종과발적으로경미한수준의합병증이었다. 해당합병증들은소독과항생제투여를통하여몇일내에빠르게개선되었다. 보툴리눔독소에의한합병증은 7개로, 3개는입술시술후일시적으로입술움직임이부자연스러운것이었고, 4개는이마에시술후표정을지을때눈썹이올라가는것이었으며, 반대작용의근육에보툴리눔독소를추가적으로놓음으로써바로해결이가능하였다. 만족도와통증은 VAS를이용하여 10점만점으로평가하였으며, 만족도는평균 8.4점으로좋은결과를보였고, 통증은평균 3.8점이었다. 이마시술을받은환자 2명이특히 VAS 5점으로가장심하게통증을호소하였다. 결론 : 보툴리눔독소와필러를이용하여연조직외형을회복시키는것은임상적으로매우유용하다. 일반적으로필러는부작용이심하다고알려져있으나, 정확한해부학적지식을바탕으로흡인등을통하여안전하게시술한다면충분히예방할수있다. 따라서, 중등도이하의심미적문제가존재하는경우수술적방법없이보툴리눔독소와필러만으로도충분히만족할만한결과를가져올수있다고판단된다. Facial rejuvenation using Botulinum toxin and filler Sang-Yun Kim *1, Pil-Young Yun 1, Young-Kyun Kim 1,2 1 Department of Oral and Maxillofacial Surgery, Section of Dentistry, Seoul National University Bundang Hospital 2 Department of Dentistry & Dental Research Institute, School of Dentistry, Seoul National University Introduction: In cases of aesthetic problems in the facial area, if the degree is not severe or if it is caused by soft tissues, it can be solved simply by using botulinum toxin or filler. In this study, we report cases in which a facial esthetic problem was solved using botulinum toxin and filler. Method and materials: A total of 248 patients were treated with botulinum toxin and filler injections at 654 sites. All of these procedures were performed by a single oral and maxillofacial surgeon. 192 were female and 38 were male, and the average age was 38 years. Among the 654 cases, there were 555 cases of botulinum toxin. The procedure sites were eyes, glabella, forehead, square jaws, nose, lips, oral angle, chin, and trapezius. There were 99 cases of filler, and the procedure sites were nasolabial folds, glabella, forehead, lips and nose. All of the fillers used were soluble hyaluronic acid products. There were four types of filler: Restylane (Q-Med, Sweden), YVOIRE (LG Bio, Korea), Monalisa (Dentium, Korea) and Neuramis (MedyTox, Korea). Botulinum toxin was used only one type of Innotox (MedyTox, Korea). The satisfaction of the treatment and the degree of pain were evaluated using the questionnaire and the complications after the injection were investigated. Results: Complications occurred in 15 of 654 cases. Filler complications were 8, which was a mild level of complication due to transient edema and redness. The complications quickly improved within a few days through dressing and antibiotic administration. There were seven complications caused by botulinum toxin. Three were transient unnatural lip movements after the lips procedure. Four were eyebrows lifting when they make faces after the forehead procedure, and by placing an additional botulinum toxin in the opposing muscle, rapid resolution was possible. Satisfaction and pain were rated on a scale of 10 out of 10 using the VAS. Satisfaction was good with an average of 8.4 points and pain was 3.8 points on average. 2 patients who underwent forehead surgery complained most severely with VAS score of 5. Conclusion: It is clinically useful to restore the soft tissue contour using botulinum toxin and filler. Generally, the filler is known to have serious side effects, but it can be sufficiently prevented if it is safely applied through aspiration etc. and based on accurate anatomical knowledge. Therefore, a satisfactory result can be obtained only by botulinum toxin and filler without a surgical method if there is an esthetic problem below the moderate degree. 제 57 차종합학술대회및정기총회 171

172 PⅢ-25 Hemifacial macrosomia, bifid tongue, ankyloglossia 그리고 ear deformify 를동반한 lower lip 의 median fleft : 증례보고 *1,2 엄병구, 1,2 백진아, 1,2 고승오, 1,2 임대호 1 전북대학교치의학전문대학원구강악안면외과학교실 2 전북대학교병원의생명공학연구소 Median cleft of lower lip and mandible 은 craniofacial clefts 의드문형태이다. 이 cleft 는 Tessier s classification 의 30번 cleft 로묘사된다. Median mandibular cleft 는 lower lip 의 minor cleft 부터 hyoid bone, thyroid cartilage 그리고 manubrium 의부재를동반하는mandible 의 complete clefts 까지다양하다. tongue 의 cleft, ankyloglossia, oligodontia, hart anomalies, 그리고 sternum 과 extremitis 의변형을동반하는 lower lip 과 mandible 의 median cleft 의 cases 가현재까지보고되었다. 또한, congenital heart deformities, cleft palate, facial anomalies, hand anomalies, foot deformities and chromosomal aberration 등의기형이동반될수있다. Median cleft 는 1819년에 Couronne 에의해처음보고되었으며보고된이래로다양한변이와함께매우적은 cases 만이보고가되었다. 우리는 hemifacial macrosomia, bifid tongue, ankyloglossia 그리고 ear deformity 를동반한 incomplete median cleft of lower lip 에대해보고하고자한다. Median cleft of lower lip with hemifacial microsomia, bifid tongue, ankyloglossia and ear deformity : a case report *1,2 Byung-Koo Um, 1,2 Jin-A Baek, 1,2 Seoung-O Ko, 1,2 Dae-Ho Leem. 1 Department of Oral and Maxillofacial Surgery, School of Dentistry, Chonbuk National University 2 Research Institute of Clinical medicine of Chonbuk National University-Biomedical Research Institute of Chonbuk National University Hospital, Jeonju, Korea Median cleft of lower lip and mandible are rare craniofacial clefts. This cleft has also been described as No.30 of Tessier s classification. Median mandibular clefts vary in their presentation, ranging from minor cleft of the lower lip to complete clefts of the mandible with absence of the hyoid bone, thyroid cartilage, and manubrium. Preiviously reported cases showed median cleft of the lower lip and mandible, with various associated anomalies, including a cleft of the tongue, ankyloglossia, oligodontia, heart anomalies, and malformation of the sternum and extremitis. Possible associated anomalies are congenital heart deformities, cleft palate, facial anomalies, hand anomalies, foot deformities and chromosomal aberration. The earliest report of this anomaly was by Couronne in Since then very few cases have been reported in literature with variations. We present a case of incomplete median cleft of lower lip with hemifacial microsomia, bifid tongue, ankyloglossia and ear deformity. 172 대한악안면성형재건외과학회

173 PⅢ-26 성장기백서하악과두에서저작근활성감소후의골 / 연골유전자발현변화 탁혜진 *1, 김학진 2, 문주원 1, 박경미 3, 이상휘 1,2 1 연세대학교치과대학구강과학연구소 2 연세대학교치과대학구강악안면외과학교실 3 연세대학교치과대학통합진료학과 목적 : 저작계의골격구조와근육은기능적으로해부학적으로밀접하게연결되어있다. 보툴리눔독소 (Botulinum toxin, BTX) 는아세틸콜린의방출을억제하여근육의마비를유도하는것으로알려져있다. 본연구의목적은저작근육의활성감소가하악골의과두성장과연관된골과연골관련유전자발현에미치는효과를연구하는것이다. 방법 : 본연구를위하여 4 주령웅성백서 (Sprague-Dawley rat) 를 3 군으로나누었다. 대조군에는양측식염수를저작근육으로주입하였고, 편측군에는 BTX가저작근육의한쪽으로주입, 양측군은양측 BTX 주사하였다. 실험 4 주후에동물을희생시키고조직분석및유전자발현분석을평가하였다. 결과 : 조직분석결과하악과두의관절면연골의두께와골소주두께의유의한감소를보였다. 유전자발현분석결과 SOX9, RUNX2, β-catenin 및 TGFβ 관련유전자발현이변화되었다. 결론 : 저작근의활성은연골과골의성장과그관련유전자의조절에밀접히관련이있으며, 연골과골성장, 유전자발현과저작력의관계를이해하는것이중요하다하겠다. Altered expression of bone- and cartilagerelated genes after the diminished masticatory muscle activity in growing rat mandibular condyle Hye Jin TAK *1, Hak Jin KIM 2, Joo Won MOON 1, Kyeong Mee PARK 3, Sang Hwy LEE 1,2 1 Oral Science Research Institute, College of Dentistry, Yonsei University, Seoul, Korea 2 Department of Oral and Maxillofacial Surgery, College of Dentistry, Yonsei University, Seoul, Korea 3 Department of Advanced General Dentistry, College of Dentistry, Yonsei University, Seoul, Korea Objective: The masticatory skeletal structure and muscles are functionally and anatomically intimate-connected. Botulinum toxin (BTX) is known to induce muscle paralysis by inhibiting the release of acetylcholine. The aim of this study was to investigate the effect of reduced masticatory muscle activity on the bone- and cartilage-related gene expressions during the condylar growth of the mandible. Methods: Four week old male Sprague-Dawley rats were divided into three groups: control group with the bilateral saline injection into masticatory muscles; unilateral group with BTX injected into one side of masticatory muscles; and bilateral group for bilateral BTX injections. Rats were sacrificed after 4 weeks and assessed for histology and gene expression analysis. Results: The histological data showed the significant reduction of cartilage thickness and bone trabeculae in condyle. The gene expression analysis showed altered SOX9, RUNX2, β-catenin and TGFβ-related gene expressions. Conclusion: The muscle activity was closed related to the regulation of cartilage and bone growth and its related genes, which would be important to understand the relationship between the growth of cartilage/bone, gene expressions, and masticatory mechanical force. 제 57 차종합학술대회및정기총회 173

174 PⅢ-27 이개복합조직이식을이용한비익증대술 : 증례보고 최송제 *, 강병훈, 정지훈, 안준형, 한정준, 정승곤, 박홍주, 오희균, 국민석전남대학교치의학전문대학원, 구강악안면외과학교실, 전남대학교치의학연구소 대부분의완전구순구개열혹은안면열환아에있어서한번의수술만으로안면기형을충분히교정하기는쉽지않다. 일차수술후, 만족스럽지못한반흔, 조직의결핍, 짧은홍순, 입술랜드마크의비정상위치와같은이차구순열비변형이잔존하는경우가많다. 일측성구순구개열을가진환자에서상순에반흔이남아있고수직길이가짧은경우에 Z-성형술을변형시킨전위피판을이용함으로써반흔을제거함과동시에짧은상순을길게늘려줄수있다. 비주연장술은증례에따라상태에맞게적용하는것이임상적으로중요하다. 상순, 비첨및비익의관계가비교적양호한상태에서비주길이만을연장시킬때에는이개복합조직이식이유용하다. 비강저조직이부족하고입술의흉터조직을제거해야하는경우에는 Millard 포크피판또는 V-Y 전진술이적절하고, 입술의흉터는받아들일만하지만비강저가좁은경우비익피판또는이개복합조직이식을이용한비익교정이유용하여이에대한수술기볍과결과에대하여고찰하고자한다. Augmentation of Ala in CLND Patient with Auricular Composite Graft: Case Report Song-Jay Choi *, Byung-Hun Kang, Ji-Hun Chong, Jun- Hyeong An, Jeong Joon Han, Seunggon Jung, Hong-Ju Park, Hee-Kyun Oh, Min-Suk Kook Department of Oral and Maxillofacial Surgery, School of Dentistry, Dental Science Research Institute, Chonnam National University Early in the scar after the first operation of cleft lip, upper lip of excessive stress, such as a lack of early secondary cleft lip unmodified tissue often remains. If there is excessive tension or scarring of these early using the end of the organization as a way to solve this problem, you can use the Abbe flap to modify the beginning. But it is early to involve more than two-thirds of the nervous tissue loss indications Cupid palace, the beginning of the deflection, the marginal discrepancy of the flap, the end of the asymmetry, the beginning and the end of the scar, the color of the incongruity, an incomplete exercise in early has the disadvantage that results. Way is to create a two triangular flaps peel the infrastructure and procedures as in the transition to the closure position by crossing each other, preventing traumatic deformity caused by shrinkage and such. It is important to apply right Columellar lengthening as its state. Auricular Composite Graft is available when only columellar has to be lengthened in relatively favorable position of upper lip, nasal tip, and ala. In case of lack of ala base tissue necessary to remove the scar of lip area, it is adequate to apply Millard forked flap or V-Y advancement. When scar of lip area is tolerable but ala base is narrow, Ala flap or Auricular Composite Graft is very useful. Therefore, we report the case of using Auricular Composite Graft to augment the ala in CLND patient with respect to the surgical technique. 174 대한악안면성형재건외과학회

175 PⅢ-28 악골수염분류와이에따른치료및예후 김기태 *, 권경환, 최문기, 박원종, 정영곤, 최은주 원광대학교치과대학구강악안면외과학교실 원광치의학연구소 서론 : 다양한골수염분류방법이존재한다. 하지만, 증후군 연관된골수염을제외하면임의의 4 주의기간으로급성 / 만 성골수염을나누는분류체계가주로쓰이고있다. 본연구의목적은골수염의새로운분류체계의필요성을평가하는것이다. 방법 : 2016 년부터 2018 년 4 월까지원광대학교치과병원익산본원에내원한환자중악골의통증을호소하며명확한치아또는치주문제를보이지않는 189 명의환자를대상으로후향적연구를시행하였다. 환자의 CT, Bone scintigraphy 영상및내원당시 ESR, WBC, CRP 를측정하였으며, 행해진치료방법과예후를평가하였다. 환자는 CT 상골변화상과 bone scintigraphy 의 uptake 양상이일치하는그룹 1, bone scintigraphy 에서 uptake 양상을보이나, CT 상저명한골변화양상을보이지않는그룹 2, bone scintigraphy 에서 cold spot 양상을보이나, CT 상골변화양상을보이는그룹 3 로분류하였다. 환자의치료방법은크게항생요법단일, 수술적처치를동반한항생요법으로나누었다. 결과 : 총 189 명의환자중그룹 1 이 167 명, 그룹 2 가 18 명, 그룹 3 가 4 명이었다. 그룹 1 의경우, 30 명의환자가항생요법단일치료를받았으며, 132 명이수술적처치를동반한항생요법을받았다. 그룹 2 의경우, 3 명의환자가항생요법단일치료를받았으며, 15 명이수술적처치를동반한항생요법을받았다. 그룹 3 의경우, 4 명전원이수술적처치를동반한항생요법을받았다. 예후의경우, F/U 이끊긴 14 명의환자를제외한나머지환자의경우, 별다른특이소견없이호전되었다. 결론및고찰 : 골수염의치료에있어항생단일요법과수술적처치를동반한치료모두좋은예후를보였다. 특히그룹 3 의경우, 오래진행된만성골수염의양상을보이며, 모두수술적처치가필요했던것으로사료된다. 그룹 1 의경우, 기존의만성골수염과유사하며, 그룹 2 의경우급성골수염의양상과비슷하나, 그룹 2 의경우에서 ESR, WBC, CRP 모두정상수치를보이는 6 명의경우, 염증수치증가없는급성골수염소견을보였다. 이는현재제시된분류기준에부합하지못한다. 단순히 4 주의임의의시간으로분류한것이아닌새로운골수염의분류체계가필요할것으로생각되며, 추후연구가필요할것으로사료된다. Classification, treatment and prognosis of osteomyelitis Gi Tae Kim *, Kyung-hwan Kwon, Moon Gi Choi, Won Jong Park, Yeong Kon Jeong, Eun Joo Choi Department of Oral and Maxillofacial Surgery, College of Dentistry, Wonkwang UniversityWonkwang Dental Research Institute There are various classifications of osteomyelitis. However except for syndrome-related osteomyelitis, classification system, which distinguishes acute / chronic osteomyelitis by arbitrary time limit of 4 weeks, mainly used. The purpose of this study is to evaluate necessity of new classification system of osteomyelitis. Method & materials: Medical records of 189 patients with jaw pain without notable dental or periodontal problem, who visit Wonkwang Dental hospital, Iksan from January, 2016 to April, 2018, were screened and relevant clinical data was reviewed retrospectively. CT images, Bone scintigraphy, and ESR, WBC, CRP of the patients were checked and treatment methods and prognosis were evaluated. Patients with uptake in bone scintigraphy and bone change in CT scan were grouped in group 1. Patients with uptake in bone scintigraphy and no bone change in CT scan were grouped in group 2. Patients with cold-spot in bone scintigraphy and bone change in CT scan were grouped in group 3. Treatment methods were sorted in to 2 groups, which include antibiotic therapy with or without surgical intervention. Result: Among 189 patients, 167 patients are group 1, 18 patients are group 2, 4 patients are group patients out of 167 patients of groups 1 treated with antibiotic therapy without surgical intervention. 3 patients out of 18 patients of groups 2 treated without surgical intervention. All patients in group3 treated with surgical intervention. In prognosis, all patients recovered without specific complication except for 14 patients, who follow-up loss happened. Conclusion: Antibiotic therapy, with or without surgical intervention, show good prognosis. In group 3, all patients need surgical intervention, because they show the feature of long-lasting chronic osteomyelitis. Group 1 shows similar features of chronic osteomyelitis and group 2 shows similar features of acute osteomyelitis. However, 6 patients of group 2, show normal range value of WBC, ESR and CRP. These patients cannot be categorized by current classification system. Thus, in my opinion, new classification system other than current classification system is needed. Further study should be done in future 제 57 차종합학술대회및정기총회 175

176 PⅢ-29 치성기원의뇌농양치료증례 : 증례보고강동우 *1, 윤필영 1, 김영균 1,2 1 분당서울대학교병원, 치과, 구강악안면외과 2 서울대학교치의학대학원치의학과, 치의학연구소서론 : 뇌농양 (brain abscess) 은뇌실질 (brain parenchyma) 내에형성된국소적인화농상태를보이는질환이며드물지만치과적원인으로인해발생할수도있다. 주로치근단병소, 치주병소, 발치, 근관치료, 치아수복및치과용국소마취시주사침자입등에의해발생가능하다. 증례보고 : 39세의특이기저질환이없는남환으로, 5주간미열이있었고혈액검사상 WBC 24,000, CRP 15인상태로응급실에내원하였다. 개구량은 10mm 미만인상태였고 CT, MRI 상에서 #16,17,18 부위치근단병소및우측상악동염, 뇌농양소견이관찰되어신경외과에입원하여우측측두엽의농양흡인술을응급으로진행하였고동시에 #16,17,18 치아들을발치한후약물치료를시행하여치유되었다. 62세의소아마비병력이있던남환이의식이혼미한상태로응급실에내원하였다. 혈액검사상 WBC 25,000, CRP 7.5였으며CT 및 MRI 촬영결과전두엽뇌농양, 우측전두동, 부비동, 상악동에감염소견이확인되었다. 신경외과에입원하여뇌실외배액술시행한후이비인후과에서내시경을이용한부비동수술, 구강악안면외과에서 #21 낭종적출술및우측상악동근치술 (CLOP) 을시행한후호전되었다. 고찰및결론 : 치성기원뇌농양은매우드물게발생하지만생명을위협하는감염성질환으로, 항생제요법과농제거를위한개두술, 감압술이필요하며발생소인을확실하게제거하고농배양검사를통한집중적인항생제요법및타과와의긴밀한협진이중요하다. Brain abscess of odontogenic origin: Case reports Dong-Woo Kang *1, Pil-Young Yun 1, Young-Kyun Kim 1,2 1 Department of Dentistry, Seoul National University Bundang Hospital, Seongnam, Korea 2 Department of Dentistry & Dental Research Institute, School of Dentistry, Seoul National University, Seoul, Korea Introduction: Brain abscess is a disease that shows focal infection formed within the brain parenchyma. Odontogenic infections implicated in the formation of brain abscess are rare. It can be caused mainly by periapical lesions, periodontal disease, tooth extraction, endodontic treatment, needle injection during dental anesthesia. Case reports: A 39-year-old man with previous healthy, he had a fever for five weeks and was hospitalized in the emergency room with a blood test of WBC and CRP 15. The mouth opening was less than 10mm and in CT and MRI view, #16,17,18 periapical lesions, right maxillary sinusitis, brain abscess on temporal lobe were observed. After being admitted to neurosurgery, navi-guided brain abscess aspiration was done, then #16,27,18 were extracted, extened antibiotics and then he was improved. A 62-year-old male patient with infantile paralysis came to the emergency room with a blood test of WBC, a CRP of 7.5. In CT and MRI views, a brain abscess on frontal lobe, infection on right frontal sinus, ethmoidal sinus, and maxillary sinus were observed. After being admitted to neurosurgery, extra ventricular drainage at neurosurgery, endoscopic pansinus surgery at otorhinolaryngology, #21 extraction, cyst enucleation on #21, right maxillary Caldwell-Luc operation at oral&maxillofacial surgery were done. Conclusions: A brain abscess linked to a odontogenic orign is a rare occurrence but life-threatening infectious disease that requires neurological surgery, removal of odontogenic source, pus culture, intensive antibiotic therapy and co-treatment with other clinics. 176 대한악안면성형재건외과학회

177 PⅢ-30 흉쇄유돌근에발생한화농성근염 : 증례보고용해성 *, 김보라, 김재영, 박광호 연세대학교치과대학구강악안면외과학교실 ( 강남세브란스병원 ) 화농성근염은횡문근에발생하는세균감염성질환으로, 주로열대지방에서호발하며일반적으로황색포도상구균감염에의해발생하는것으로알려져있다. 화농성근염은당뇨, 에이즈, 조혈장애와같은면역력이저하된환자나부신피질호르몬제, 면역억제제와같은약물복용환자에서주로발생한다. 흉쇄유돌근은우수한혈행으로인하여화농성근염에이환되기쉽지않다. 경부근육의화농성감염은전체증례의 0.5-4% 에해당할만큼흔치않으며대부분치성감염, 편도감염, 외상에의해발생한다. 본증례보고에서는흉쇄유돌근에발생한화농성근염의증례를문헌고찰과함께보고하는바이다. Pomyositis of the sternocleidomastoid muscle: A case report Hae-Seong YONG *, Bola KIM, Jae-Young KIM, Kwang-Ho PARK Department of Oral and Maxillofacial Surgery, Gangnam Severance Hospital, Yonsei University College of Dentistry Pyogenic myositis (pyomyositis) represents a bacterial infection of striated muscle, predominantly associated with tropical regions and commonly caused by Staphylococcus aureus. Pyomyositis is more common in immunocompromised individuals. Including diabetes mellitus (DM), aquired immune deficiency syndrome (AIDS) and hematopoietic disorders. Patients receiving drugs such as prednisolone, azathioprine and intravenous drug are also predisposed to infective complications. The sternocleidomastoid muscle may be rarely involved in pyomyositis because of the excellent segmental blood supply. Cervical pyomyositis has been described in up to 0.5%-4% of the cases, with the most frequent origins being dental, tonsil infections and trauma in the area. In this study, we present an uncommon case of pyomyositis of sternocleidomastoid muscle with a literature review. 제 57 차종합학술대회및정기총회 177

178 PⅢ-31 두경부영역의근막간극감염에서혈청 procalcitonin 의임상적의의 신경수 *, 김기태, 정영곤, 박원종, 최은주, 최문기, 권경환원광대학교치과대학구강악안면외과학교실원광치의학연구소 Background: 두경부영역의감염은두경부의근막간극을따라확산될수있으며, 높은합병증발생관련된생명을위협하는심부간극감염을포함한다. Procalcitonin(PCT) 는세균감염의생물학적지표로 sepsis 진단, 심각도평가또는항생제처치기준으로써유용하다고보고되고있다. Objective: 본연구의목적은기존에사용하고있던세균감염의지표들과 Procalcitonin(PCT) 과의상관관계를분석하고, 두경부영역의근막간극의진단과치료예후에있어 Procalcitonin(PCT) 의임상적인의의에대하여평가하는것이다. Methods: 본연구에서는 2017년부터 2018년 8월까지원광대학교치과병원구강악안면외과에내원한환자중두경부의근막간극감염으로진단받은환자 36명에대하여, 처음내원일에 Body temperature(bt), procalcitonin(pct), white blood cell (WBC), erythrocyte sedimentation rate(esr), C-reactive protein(crp) Neutrophil cell count(anc, percentage;%) 측정값및입원일수를평가하였다. Results: PCT는 CRP, Neutrophil ANC 그리고 Neutrophil % 와양의상관관계를보였다. 입원일수는 CRP와 Neutrophil ANC 및 Neutrophil % 와양의상관관계를보였다. 그러나 PCT와는유의한상관관계를나타내지않았다. Conclusion: PCT는두경부영억의근막간극감염에서진단및예후평가를위한보조적인도구로사용될수있었다. Clinical significance of procalcitonin(pct) in patient of maxillofacial space infection Kyung Su Shin *, Gi Tae Kim, Yeong Kon Jeong, Won Jong Park, Eun Joo Choi, Moon Gi Choi, Kyung-hwan Kwon Department of Oral and Macillofacial Surgery, ColleGe of Dentistry, Wonkwang University.Wonkwang Dental Research Institute. Background: Maxillofacial space infections and spread along the fascial spaces of the head and neck, inducing lifethreatening deep space infection associated with a high risk of complications. Procalcitonin(PCT) is a biomarker of bacterial infection and has been reported to be useful for sepsis diagnosis, severity assessment or antibiotics stewardship. Objective: This study reported an analysis of relationships between conventional infection biomarkers and Procalcitonin(PCT). And we evaluated the clinical significance of Procalcitonin(PCT) for diagnosis and prognosis of maxillofacial space infection. Methods: We reviewed the medical records of 36 patients diagnosed with maxillofacial space abscess from January 2017 to August Body temperature(bt), procalcitonin(pct), white blood cell (WBC), erythrocyte sedimentation rate(esr), C-reactive protein(crp), Neutrophil cell count(anc, percentage;%) and hospital day were measured on this study. Results: PCT showed a positive correlation with CRP, Neutrophil ANC and Neutrophil %. Hospital day showed a positive correlation with CRP, Neutrophil ANC & Neutrophil %. But, there is no significant correlation between PCT and Hospital day. Conclusion: In patients diagnosed with maxillofacial space abscess, PCT was a supplementary parameter to diagnosis of disease and a predictor of prognosis. 178 대한악안면성형재건외과학회

179 PⅢ-32 폐쇄흡인배액관을이용한근막간극농양의외과적치료에대한연구 온도현 *, 김성범, 조진용, 류재영가천대길병원구강악안면외과 목적 : 근막간극의저류된농양을배출하는데있어수술후배농로로써개방배액관또는폐쇄흡인배액관이이용되며음압배액관은고름의배출정도를정량화하여파악할수있는장점이있다. 본연구에서는폐쇄흡인배액관의임상적적용에대해소개하며, 배액량의변화에따른임상양상과의연관성에대해조사하고자하였다. 방법 : 2012년부터 2017년까지근막간극농양으로본원에내원하여전신마취하에절개및배농술과함께폐쇄흡인배액관을삽입하여술후처치를받은환자를대상으로치료기간동안의배액량의변화, 임상징후, 혈액검사결과등에대해조사하여그결과를비교, 분석하였다. 결과 : 총환자수는 57명이었으며, 이중배액관의변화량을평가할수있는자료가확보된 53명에대해연구가진행되었다. 연구대상자의평균나이는 59세 (18~86세) 이며, 성별은각각남자 32명과여자 21명이었다. 대상자중 27명은초진후 24시간이내에수술이진행되었다. 대부분의환자들에서정상범위의체온과 CRP 및 WBC 수치이면서 24시간배액량 10cc 이내인경우에서배액관이제거되었다. 결론 : 폐쇄흡인배액관은개방배액관과비교하여수술부위를청결하게유지할수있고창상의반흔관리에유리하며배액량을정량적으로평가할수있는장점이있다. 배액량과임상및혈액검사들간의비교를통하여유의미한관계를확인할수있었다. 폐쇄흡인배액관을통한배액량을확인하여환자의호전양상을간편하게추정할수있을것으로생각된다. Study of Surgical Treatment for Fascial Space Abscess Using Closed Suction Drainage Dohyun On *, Sungbeom Kim, Jinyong Cho, Jaeyoung Ryu Dept. of Oral and Maxillofacial Surgery, Gachon University Gil Medical Center Introduction: An open drainage or a closed suction drainage system is used as a postoperative drainage of pus in the fascial space, and the latter has the advantage of quantifying the output of the pus. The purpose of this study was to present the clinical application of the closed suction drainage and the relationship between drainage volume and clinical manifestations. Method and materials: Medical records of all patients, that had fascial space infection with postoperative closed suction drainage, operated by the Department of Oral and Maxillofacial Surgery at the Gachon University Gil Medical Center (between 2012 and 2017) were retrospectively investigated. Patients were evaluated for changes in drainage volume, clinical signs, hematologic test, etc. The results were compared and analyzed. Results: The total number of patients was 57, and the study was conducted on 53 patients who were able to be calculated the changes of the drainage volume. The mean age of the patients was 59 years (18 ~ 86 years), and the sex distribution is 32 males and 21 females, respectively. 27 patients underwent surgery within 24 hours after the initial visit. In most patients, the drain was removed in the normal range of body temperature, CRP and WBC levels, and drainage of less than 10 cc within 24 hours. Conclusion: The closed suction drainage, that compared with an open drainage, can keep the surgical site clean, has esthetic advantages of wound scar, and can quantitatively assess drainage volume. There was a significant relationship between drain volume and clinical and hematologic tests. It can be assumed that the improvement aspect of the patient can be easily estimated using the drainage amount through the closed suction drainage. 제 57 차종합학술대회및정기총회 179

180 PⅢ-33 낭종성병소의적출술시행후의합병증발현에대한후향적연구 이한빈 *, 하현빈, 오현준, 정준홍, 서병무서울대학교치과병원구강악안면외과 서론 : 구강악안면외과영역에서낭은흔한병소이다. 낭종의치료로는낭종의적출이후물샐틈없이봉합하는것이낭종치료에가장대표적인치료법으로알려져있으며, 병소의크기가매우크거나결손부가치유에매우불리한경우를제외하고는양호한예후를보이는것으로알려져있다. 최근에는골이식재의발달로, 사강의감소를통한감염예방, 낭종적출술을시행한이후에빠른치유, 낭종적출술후결손부로의조직의함몰방지등의목적을가지고낭종적출술과동시에골이식이행해지는경우가많이있다. 목적 : 이번연구의목적은낭종적출술이후에발생한주요한합병증들의발현율을알아보고, 흔한합병증중인하나인술후감염이골이식의시행여부, 골이식재의종류와어떤관계가있는지알아보고자한다. 방법 : 2013년에서 2017년까지서울대학교치과병원에서구강악안면외과에서한명의외과의사에게낭종적출술을시행받아병리적으로낭종으로진단된 249명의환자의의무기록을후향적으로분석하여감각이상, 병적골절, 술후감염의발현율을알아보았다. 또한, 골이식시행여부및방법이술후감염과의관계를조사해보았다. 결과 : 총 249명의환자 ( 남 :178명여 :71) 를조사하였고이들의수술받을당시평균나이는 37.6세였다. 조직병리검사결과 Dentigerous cyst(135례 ), Periapical cyst(57례 ), Odontogenic keratocyst(37례 ), Nasopalatine duct cyst(26례 ), Glandular odontogenic cyst(2례 ), Inflamed cyst(1례 ), Residual cyst(1례 ), Lateral radicular cyst(1례 ) 으로조사되었다. 술후감각이상을호소한환자는 38명 (14.5%) 이었다. 술후병적골절을보인환자는 4명이었다 (1.5%) 술후감염은총 249명의환자중 59(22.5%) 의환자에서감염이발생했다. 이종골이식재를이용하여골이식을시행한경우총 41 증례중 12(29.3%) 증례에서감염이발생했다. 자가장골을이식한경우총 11 증례중 7(63.6%) 증례에서감염이발생했다. 아무이식재도사용하지않은경우총 210 증례중 42(19.5%) 증례에서감염이발생했다. 결론 : 골이식재를사용한경우높은술후감염률을보인다. Retrospective study of complication after enucleation of cystic lesion HanBin Lee *, Hyun Bin Ha, Hyun Jun Oh, Junhong Jung. Byoung-Moo Seo Department of oral and maxillofacial surgery, Seoul National University Dental Hospital Introduction: Cystic lesions are common lesion in the oral an maxillofacial region. Enucleation of the cystic lesion and watertight primary closure of the defects has been the treatment of choice and prognosis of that method was satisfactory, Unless either the size of defects was too large or shape of defects was unfavorable. With the advancement of Bone graft material, Bone graft was often performed simultaneously with enucleation of Cyst to reduce infection rate by reducing dead space, acclate bone healing and prevent soft tissue collapse into defects area. Objective: The purposes of this study were to find out incidence of major complication and relationship between post-operative infection rate and various bone graft methods. Method and materials: We retrospectively investigated the medical records of the 249 patients who underwent cyst enucleation procedure by one surgeon at the oral and maxillofacial surgery departments at The seoul national university dental hospital from 2013 to We analyzed retrospectively incidence of post operative infection, paresthesia, pathologic fracture. We analyzed the relationship between infection rate and various bone graft methods and various contributing factors. Result: Total number of 249 patients( male:178, female:71) was investigated. Mean age at the time of surgery was Pathologic results was reported as Dentigerous cyst(135 cases), Periapical cyst(57 cases), Odontogenic keratocyst(37 cases), Nasopalatine duct cyst(26 cases), Glandular odontogenic cyst(2 cases), Inflamed cyst(1 case), Residual cyst(1 case), Lateral radicular cyst(1 case). 38(14.5%) patients complained about paresthesia. Pathologic fracture was observed in 4(1.5%) patients. Conclusion: Post operative infection rate was higher in the patients who underwent bone graft procedure. 180 대한악안면성형재건외과학회

181 PⅢ-34 발열을동반한림프절비대 기쿠치후지모토병의 corticosteroid 를이용한치료증례 장한슬 *, 김진욱, 최소영, 이성탁, 권대근경북대학교치과병원구강악안면외과학교실 목적 : 두경부영역을다루는구강악안면외과의사로서지속적인발열, 경부림프절비대, 통증호소하는환자내원시 Kikuchi-Fujimoto 병의진단및 corticosteroid를이용한치료증례에대해보고하고자한다. 방법 : 4일간지속적인 38 이상의발열, 우측경부부종, 통증및피로등의증상을동반한 52세여성이본병원에내원하였다. 발열의원인을찾기위한방사선학적및이학적검사결과 CRP 5.96 mg/dl, ESR 41 mm/h, ferritin 421.6ng/ml, 염증수치상승및우측경부림프절비대관찰되나, venous blood culture test 음성, 특별한감염원은없었다. Kikuchi-Fujumoto 병으로추정진단하에치료시작하였다. 결과 : Prednisolone(PSL) 15mg/day경구투여하였으며, 약 12시간후정상체온으로회복및우측경부통증감소되었다. Prednisolone(PSL) 15mg/day 경구투여 14일유지후경과관찰결과정상체온, 우측경부통증및림프절비대호전되었다. 이후 PSL 5mg/day로감량하여 7일복용후치료종결하였으며, 3개월지난현재까지재발소견관찰되지않는다. 고찰및결론 : KFD는일반적으로특정한치료없이1-4개월이내에치유되는자기한정성질환이다. KFD 흔히동반되어나타나는경부임파선비대또한양성이며, 자기한정성특징을갖는다. 비록 KFD가일정하게한정된경과를나타내는특징을가지지만지속적인발열, 경부임파선비대, 통증등의증상심화시 corticosteroid 약물치료가증상의빠른개선에도움을준다. 두경부영역을다루는구강악안면외과의사로서지속적인발열및통증을호소하는 KFD 환자의경우 corticosteroid 약물을 1차적으로사용하며, KFD발생시고려해야하는 SLE 동반여부판단위한이학적검사도시행하여관련과와협진하여야할것이다. Fever with lymphadenopathy Kikuchi Fujimoto disease successfully treated by corticosteroids : A case report Han-Seul Jang *, Jin-Wook Kim, So-Young Choi, Seong-Tak Lee, Tae-Geon Kwon Dept. of Oral and Maxillofacial surgery, School of Dentistry, Kyungpook National University, Daegu, Republic of Korea Objective : Kikuchi-fujimoto disease(kfd), also known as Kikuchi disease or histiocystic necrotizing lymphadenitis, is a lymphohistiocytic disorder of unknown etiology that was first described in japan by Kikuchi and Fujimoto in We report a case of Kikuchi-Fujimoto disease as a oral and maxillofacial surgeon who deals with the head and neck area treated with corticosteroid for persistent fever, cervical lymphadenopathy, pain complaint. Method: We report the case of a 52-year old Korean woman who was admitted to our hospital with fever and Right neck swelling, and fatigue. At the time of visit she had presented with a fever (38.5 ), Right neck lymphadenopathy, fatigue and chilling. Radiologic and physical examination to detect the cause of the fever revealed CRP 5.96 mg/dl, ESR 41mm/ h, ferritin of 421.6ng/ml, elevated inflammation and right cervical lymph node enlargement but venous blood culture test negative. There is no clear infectious focus. Treatment with Kikuchi-Fujimoto disease was started under the diagnosis. Result: Prednisolone(PSL) at 15mg/day was orally administered. Afer oral administration, Her fever and lymphadenopathy improved rapidly in 12 hours. PSL at 15mg/day was maintained for 14days. Her symptoms fever(normal range), Rt. neck lymphadenopathy and pain were improved. Thereafter, PSL dose was reduced to 5mg/ day, and the treatment was terminated after 7 days. No recurrence of KFD or adverse events was observed until 3months. Conclusion: KFD is typically a self-limited disease that rarely required specific treatment and resolves within 1 to 4 months. Cervical lymphadenopathy is benign and self-limiting. Although KFD is a self-limited disease, PSL medication is helpful for rapid treatment if patients have persistent fever, cervical lymphadenopathy, pain, fatigue etc. 제 57 차종합학술대회및정기총회 181

182 PⅢ-35 두경부괴사성근막염환자의진단및치료 : 증례보고 최순규 * 정지혜조제호허성휘양수남청주한국병원구강악안면외과 서론 : 괴사성근막염은피하조직과근막을빠르게괴사시키는급성감염질환이다. 두경부영역에서드물게발생하며, 조기에진단과치료가시행되지않으면생명을위협할수있다. 특히당뇨, 신부전, 악성종양, 스테로이드치료환자와같이신체저항기전이약화된환자에서더욱호발하며심화된양상으로나타난다. 본증례에서는두경부에발생한괴사성근막염환자를조기에진단하여외과적수술을시행하였고적극적인항생제요법을병용하여치료하였기에문헌고찰과함께보고하는바이다. 증례 : 74세여자환자로 3일전부터발생한좌측안면부통증및부종을주소로본원에내원하였다. 내원당시좌측측두부, 협부, 악하부에부종과열감, 압통이있었고개구제한, 연하곤란, 호흡곤란이동반된상태였다. 기저질환으로고혈압이있었고혈액생화학검사결과요소질소수치가높았으며저칼륨혈증을보였다. 또한음식섭취가불량하여전신적으로약화된상태였다. 컴퓨터단층촬영결과측두간극, 협부간극, 악하간극에가스및농양이관찰되었다. 괴사성근막염으로잠정진단하였고내원당일전신마취하에절개및배농, 괴사조직제거를시행하였다. 수술직후좌측협부에피부괴사가발생하여다시괴사조직을제거하였다. 타조락탐, 훌그램, 하노마이신을복합투여하면서지속적으로괴사조직을제거하고환부세척술을시행하였다. 이후증상이호전되어술후 64일째절개를시행한악하부및측두부위를봉합하였으나좌측피부괴사부위는조직결손이심하여개방창이형성되었다. 개방창부위는피부이식술을위해타병원으로전원되었다. 고찰 : 괴사성근막염은조직강을통해빠르게퍼지는심함연조직감염이다. 괴사성근막염은병의진행이빠르고합병증유발의가능성이높으므로조기에배농및괴사조직의광범위한제거가요구된다. 다양한균주에의한혼합감염이흔하게나타나므로지속적인세균배양검사를통해적절한항생제치료가동반되어야한다. 본증례와같이괴사성근막염이의심되는환자의경우환자의전신질환에대해충분히파악하고적절한영양공급과전해질의균형조절과같은전신적보조요법을시행함으로써합병증을줄일수있다. Diagnosis and Treatment of Necrotizing Fasciitis in the Head and Neck : A Case Report SUN GYU CHOI *, JI HAE JUNG, JEHO CHO, SUNG HYUI HUA, SOO NAM YANG Department of Oral and maxillofacial surgery, CheongjuHankook hospital Introduction: Necrotizing fasciitis is an acute infectious disease that rapidly necrotizes subcutaneous tissue and fascia. It occurs infrequently in the head and neck area and can be life-threatening if not diagnosed and treated early. In particular, patients with diabetes, renal failure, malignant tumors, and steroid therapy are more prevalent and more profound in patients with weaker metastatic disease. In this case, we diagnosed necrotizing fasciitis in head and neck, treated surgically, and treated with active antibiotic therapy Case: A 74 - year - old female patient was admitted to our hospital with left facial pain and edema 3 days previously. At the time of admission, the left temporal region, isthmus, and lower abdomen were edema, fever, tenderness, limitation of opening, dysphagia, and dyspnea. The underlying disease was hypertension, blood biochemical tests showed elevated urea nitrogen levels and hypokalemia. In addition, food intake was poor and the system was in a state of weakened. Computed tomography revealed gas and abscesses in the temporal, interlobar, and hypotonic spaces. She was diagnosed with necrotizing fasciitis and underwent incision, drainage and necrotic tissue removal under general anesthesia on the day of admission. Immediately after surgery, skin necrosis occurred in the left isthmus and the necrotic tissue was removed again. The combination of ostreatolactam, hulgam, and hanomycin was repeatedly used to remove necrotic tissue and perform lavage lavage. The symptoms improved and the epigastric and epidural regions were sutured on the 64th postoperative day, but the left skin necrosis area was open due to severe tissue defect. The open window was delivered to another hospital for skin transplantation. discussion: Necrotizing fasciitis is a severe soft tissue infection that spreads rapidly through the tissue. Necrotizing fasciitis is rapidly progressed and the possibility of complication is high, so early elimination of drainage and necrotic tissue is required. Because of the frequent mixed infections with various strains, proper bacterial cultures should be accompanied by appropriate antibiotic treatment. In patients with suspected necrotizing fasciitis as in the present case, it may be possible to reduce the complications by fully understanding the patient's systemic disease and by providing systemic adjuvant therapy such as proper nutrition and electrolyte balance 182 대한악안면성형재건외과학회

183 PⅢ-36 비치성및치성상악동염의 MESS 후예후비교이최량, 호앙, 권익재, 서미현, 명훈, 김성민, 이종호서울대학교치과병원구강악안면외과상악동은 Schneiderian membrane (SM) 이라는섬모세포로이루어져있으며, 상악동내점액을섬모운동을통해상악동구로이동시키는과정, 즉Mucociliary Clearlance(MCC) 에의해상악동내의감염원및불순물을비인두및식도로배출함으로써상악동의생리학적활성을유지한다. 그러나, 상악동점막의섬모는감염이나알러지반응과같은염증성질환에취약하며, 이로인해 MCC 가제대로작용하지않게되고그결과상악동염과같은질환에이환될수있다. 상악동염은그원인에따라치성및비치성상악동염으로나뉠수있다. 치성및비치성상악동염을임상적증상으로명확히구분하기에는어려움이있으나, 이둘은병리생리학적, 생물학적소견에확연한차이가있으며따라서치료법에차별성을둬야한다. 상악동염의치료를위한 7상악동접근법으로대표적으로두가지방법이이용되고있다. 전통적인CLP(Caldwell Luc Procedure) 와현미경의발달에힘입어비강내로의접근을도모한 FESS (Functional endoscopic sinus surgery) 방법이다. 하지만이두방법은술후상악낭종 (POMC), 높은재발율및반흔조직의형성과같은잦은합병증을동반한다. 이를개선하기위해두가지기술, 협측의개창골을재고정시키는방법및비강내접근을통한상악동구의확장을차별점으로 MESS (Modified endoscopic-assisted sinus surgery) 기법이최근소개되었다. 본연구에서는 2011년 2월부터 2018년 6월까지서울대학교구강악안면외과에서한술자에의해 MESS를시행받은상악동염환자들을대상으로 3개월이상경과관찰을시행한 68명의환자를대상으로술후예후를분석하고자한다. A comparative study on the prognosis of MESS in odontogenic and non-odontogenic sinusitis Choi Ryang Lee, Thi Hoang Truc Nguyen, Ik Jae Kwon, Mi Hyun Seo, Hoon Myoung, Soung Min Kim, Jong Ho Lee, Department of Oral and Maxillofacial Surgery, School of Dentistry, Seoul national University Maxillary sinus is lined with Schneiderian membrane (SM) that produce mucous that moves to ostium by means of mucociliary clearance (MCC). Inhaled pollutants, allergens and pathogens are removed from nasal cavity to nasopharynx and esophagus, which maintain physiological activity of maxillary sinus. However, SM is vulnerable to inflammatory disease such as infection and allergic reaction. It causes mucociliary dysfunction which is important pathophysiological feature of patients with maxillary sinusitis. Depending on the cause, Maxillary sinusitis can be divided into odontogenic and non-odontogenic sinusitis. It is hard to differentiate whether it is odontogenic or non-odontogenic sinusitis by clinical symptoms. But odontogenic maxillary sinusitis differs in its pathophysiology, microbiology and treatment from non-odontogenic sinusitis. For the treatment of maxillary sinusitis, two main approaches have been used : CLP(Caldwell-Luc Procedure) and FESS through the osteo-meatal unit. However, several postoperative complications exists after CLP and FESS, such as postoperative maxillary cyst (POMC), high rate of recurrence and sinus scar tissue formation. So we introduced new technique, MESS (modified endoscopic-assisted sinus surgery) which overcomes the previous complications. MESS is differs in two techniques. One is buccal bony window repositioning and the other is maxillary ostium enlargement by an endonasal approach. The subjects included 68 patients with maxillary sinusitis who underwent MESS by a surgeon from Feb 2011 to June 2018 and checked post-operatively more than 3 months at department of oral and maxillofacial surgery, Seoul national university. 제 57 차종합학술대회및정기총회 183

184 PⅢ-37 좌측사골동, 접형동, 상악동을침범하는치성각화낭종 : 증례보고 장태환 *, 백진아전북대학교병원구강악안면외과 서론 : Phillipsen이 1956년에처음치성각화낭종에대해묘사한이후로, OKC는공격적이며침윤적인성향, 높은재발율, 특징적인조직학적소견으로많은관심을사왔다. 크기가큰치성각화낭종들은신경손상, 병적골절, 감각이상, 감염을초래한이런병소들은술후에재발의위험성또한증가한다. 따라서낭성병소의크기는치료방법과예후에중요한요소로작용하고, 치성각화낭종가같은침습적인병소에서더중요하다. 치성각화낭종의수술적치료전에시행하는조대술은낭종의크기를최소화하고수술의범위를줄이는역할을할수있다. OKC의치료법은단순한소파술부터절제술까지제시되었고, 치료법에따른재발률에관한문헌도있다. OKC의재발률은 2.5% % 로보고되었으며, 인접부절제술, Carnoy 용액적용, 냉동요법이포함된많은외과적기술이보고되었다우리는좌측사골동, 접형동, 상악동을침범하는광범위한 OKC에이환된 16세여자환자를 8개월동안의조대술을시행하고낭종제거술을통해치료한 case를발표하고자한다. Odontogenic KeratoCyst invading left ethmoidal, sphnoidal, maxillary sinus : a case Report Tae-Hwan Chang *, Jin-A Baek Department of Dentistry & Dental Research Institute, School of Dentistry, Chonbuk-National University, Chonju, Korea Since odontogenic keratocyst was first decribed by Phillipsen in 1956, the lesion has been particular interest because of its specific histopathologic features, high recurrence rate, and aggressive behavior. Large Odontogenic Keratocyst cause nerve damage, pathological fractures, sensory abnormalities, and infections. These lesions also increase the risk of recurrence after surgery. Therefore, the size of the cystic lesions is an important factor in the treatment and prognosis and is more important in invasive lesions such as keratocyst. Marsupialization prior to surgical treatment of the keratocyst can minimize the size of the cyst and reduce the extent of the operation. The treatment of OKC has been presented from simple curettage to resection, and there is literature on recurrence rate according to treatment method. The recurrence rate of OKC has been reported to vary from 2.5% , many surgical techniques, including resection of neighboring parts, application of Carnoy s solution, cryotherapy has been made. We present a case of 16-year-old female patient with extensive OKC (invading left ethmoidal sinus, sphenoidal sinus, maxillary sinus) treated with 8 months of marsupialization and cyst enucleation. 184 대한악안면성형재건외과학회

185 PⅢ-38 악골골수염환자에서부골적출술후즉시 rh BMP-2 를이용한골재생평가 안태웅 *1, 윤선웅1, 설가영1, 박철민1, 오민석1, 강나라 1, 유길화1 신동수2, 박영주2 선치과병원구강악안면외과1 선치과병원치주과2 Introduction: 악골골수염의치료는병원균의증식을중단시키고, 모든감염, 괴사조직을제거하고, 골조직과연조직을재건하는것으로이루어진다. 수술적처치는부골이완전히형성되었거나초기보존적방법이실패한만성골수염의경우, 병리적골절이일어난경우에시행하며, 4주이상의항생제치료, 즉각적인재건술등을요한다. 수술적치료의성공에중요한요소는부골적출술로생긴사강의처리방식에달려있다. 과거에는수술적치료후수술부위를개방성으로드레싱하다가치유양상에따라봉합을하거나골이식을하였지만, 최근에는수술부위를골유도능을가지고주위조직으로부터신생골형성을촉진할수있는BMP 등의골형성인자를운반체를이용해적용후일차봉합해서신생골형성을유도하고, 치유기간을단축시키는방식이이용되고있다. BMP는골형성단백질로골기질, 골육종조직, 상아질기질등에존재하며성장인자, 중간엽줄기세포를연골과골로분화시키는성질을가지고있고, 유전자재조합을이용해제조되어골재생에획기적인도움을주고있는물질이다. 그중 rh BMP-2는 BMP 그룹중가장높은골유도능력을가지고, 중간엽세포의전구체로부터조골세포로분화시키는초기단계에중요한역할을한다. 따라서골증대술이필요한경우에유용하게사용되고있으며, 골수염환자의수술적처치시동시에사용되어골형성을촉진시킨다. 하지만수용성단백질이고완충용액에서운반되며빠른분해가일어나기때문에불충분한생체이용률을가지며, 따라서 BMP만단독으로사용할경우즉시용해되면서골유도성효과를거의발휘하지못한다. 그러므로 BMP를임상에적용하기위해서는운반체역할을수행할수있는이상적인매개체가필수적이다. 이상적인매개체는성장인자나세포의방출을조절하면서분해와비활성화에대해보호하는역할을수행할수있어야하고, 생체적합성, 예측가능한생체분해성, 적절한염증반응의유도능력과같은조건을충족시켜야한다. 본원에서는이러한성질을고려하여흡수성콜라겐스펀지를매개체로이용하였다. Rh BMP-2와흡수성콜라겐복합사용의단점은짧은반감기를가지고, 방출을조절하지않는점이다. 따라서현재의연구는 성장인자의방출과활동력을조절하고국소화하는것을가능하게하는효과적인운반체의발견에초점이맞춰지고있다. 이에본연구에서는2016년부터 2018년까지본원에내원한골수염환자를 BMP를이용한수술적방식으로치료한예와그경과를보고하고, 후향적으로골재생의정도를정량적으로분석하였다. Material&Methods: 2016년부터 2018년까지본원에내원한 22명의골수염환자에서신선한출혈이관찰될때까지부골적출술과피질골박리술을시행한뒤, NOVOSIS(Bioalpha Inc., Seongnam, Korea) rh BMP-2를 Normal saline에수화시켜흡수성콜라겐스펀지 (Colladerm) 을매개체로하여골결손부위에적용하였고, 흡수성콜라겐스펀지의빠른용해를보완하기위해상방에 fibrin sealant인 Tisseel을도포하고, 콜라겐 sheet인 Remaix 또는 P-stop으로피개하였다. 수술부위는 3-0 Polysorb로일차봉합하였으며, 봉합부위가이차적으로결손되었을때이차치유를도모하였다. 수술후 2주, 2개월, 6개월째에파노라마, CT, 골스캔을촬영하여신생골질, 광화도, 골부피등을관찰하였다. 골부피는기존골에서신생골이형성된부피를가로x세로x높이로측정하여그비율을추산하였다. 약한달에서두달간항생요법을시행했고, 수술일로부터 10일후봉합사를제거하였다. 연령은 40대부터 80대까지로다양했고골수염의원인으로는급 / 만성골수염이 14례, 비스포스포네이트등의약물제제에의한악골괴사가 6례, 악골골절에의한골수염이 2례존재하였다. Results: X-ray 상본래의골과유사한구조를가지고, 향상된골밀도를갖는신생골형성이관찰되었다. 성공적인골재생을통해보철수복까지의기간이단축되었다. 신생골형성은 6개월의경과관찰기간동안수술후 2주째 8% 가, 2 개월째 26% 가, 6개월째 67% 가관찰되었다. Discussion: 골재생에영향을주는인자들로는봉합부위의안정성, 골이식재부피유지의안정성, 결손부위의골벽수, 이식재의생체친화도, 혈액장애, 영양장애등의전신적질환등을들수있다. 골수염은수술적처치가보존적처치와병행하여진행되어야하며, 수술적처치시괴사부위의철저한제거와확실한연조직피개가필수적이다. 골수염환자의수술적처치에있어서부골적출술후 rh BMP-2와콜라겐운반체를이용한즉시재건은더빠른시간에골이성숙되었고, 같은기간동안더많은양의신생골이형성되는것을관찰할수있었다. 골수염환자에서 BMP를사용해즉시재건함으로써양질의골재생효과를얻으며, 실질적인골이식없이보철수복이가능한장점이있는바, 추가적인연구를통해골수염환자의골재생에활발히사용될것이라사료된다. 제 57 차종합학술대회및정기총회 185

186 Evaluation of bone regeneration for treatment of osteomyelitis of jaw by sequesterectomy using rh BMP-2 Tae-Woong Ahn *1, Sun-Ung Yoon 1, Kil-Hwa Yoo 1, Ka-Young Seol 1, Chul-Min Park 1, Min-Seok Oh 1, Na-Ra Kang 1 Shin-Dong Soo 2, Ju-Young Park 2 1 Dept. of Oral and Maxillofacial surgery, Sun Dental Hospital 2Dept. of Periodontics, Sun Dental Hospital Introduction: Treatments of osteomyelitis of jaw are consisted of isolation of pathogens and debridment of all infective, necrotic tissues and reconstruction of hard and soft tissues. Successful surgical management requires adequate management of dead space created by debridement. In the past, after the debridement of sequestrum, stabilization of the bone, maintained the open wound. But nowadays, by using osteoinductive BMP and primary closure, new bone regeneration and shorten the healing period. BMP is bone morphogenic protein and axists in bone matrix, dentin matrix and makes it easy to new bone formation. Rh BMP- 2 has most effective osteoconductive property and plays an important role in differentiation from mesenchymal progenitor cell to osteoblasts. So it is used usefully for cases of bone augmentation and used for osteomyelitis. But it is water soluble protein and transported by buffer solution and degrades rapidly, so if it is used only, solved rapidly and has low osteoinductivity. So for use BMP clinically, ideal transporter is essential. In this study, we report osteomyelitis patients treated by surgical technique visited and analysed the quantity of bone regeneration retrospectively. Material&Methods: For 22 osteomyelitis patients visited our clinic from 2016 to 2018, sequesterectomy and dicortication were done. Novosis rh BMP-2 was wetted by normal saline and absorbable collagen spongy was applied to bone defect region. And for compensate of rapid solubility, Tisseel(fibrin sealant) and Remaix or P-stop were applied on them. Primary closure was done with 3-0 Polysorb and when the suture site was disrupted, secondary intention was done. Post operative of 2 weeks, 2 months and 6 months, panoramic view and CT and bone scan were taken and the quality of new bone, mineralization and quantitiy of bone were evaluated. The quantities of bone was measured by width, length and heights. Antibiotic treatment was done for one to two months. After 10 days of operation day, stitch out was done. Results: New bone that has similar bony structure with original bone and improved bone density was detected by x-ray. Through successful bone regeneration, the period to restoration was shortened. New bone formation was observed for 6 months and post operative 2 weeks 8%, 3 months 26%, 6 months 67% was detected. Discussion Factors related with bone generation are stability of suture site, walls of defected site, biocompatibility of graft materials, disorders of blood fluid and nutrition. In osteomyelitis, surgical treatments and conservative treatments should be done spontaneously and radical debridment of necrotic tissue is essential. In osteomyelitis patients, after the sequesterectomy, use of rh BMP-2 and absorbable collagen spongy spontaneously, bone maturation was progressed rapidly and more new bone generation was detected. 186 대한악안면성형재건외과학회

187 PⅢ-39 simvastatin / 베타 cyclodextrin HA 를 poly L-lactic acid/ 젤라틴섬유성 scaffold 에입혔을때의골재생능력 홍성옥 1, 이덕원 2 1 가톨릭관동대학교국제성모병원치과 ( 구강악안면외과 ) 2 경희대학교치과대학구강악안면외과학교실, 강동경희대학교 병원구강악안면외과 최근나노구조의재료를생체재료에활용하면서골대체물로서의가능성에대한연구가활발히이뤄지고있다. 이연구에서는 simvastatin (SIM) / 베타 cyclodextrin(βcd) HA 를 poly L-lactic acid/ 젤라틴섬유성 scaffold에입혔을골재생능력에대해살펴보았다. 이때 βcd 와 adamantine 의상호작용을이용하여분자를입힌다. SIM은골아세포의생합성및분화를촉진하는데, 이를남아있는 βcd 에로딩한다. Scanning electron microscopy(sem) 를이용하여특성을살펴본다. Scaffold 에서 SIM 의 release profile 도분석한다. In vitro 연구에서는 SIM/HAp coated PG composite scaffold에사람지방세포에서추출한 stem cell의골분화및증식능력은 alkaline phosphatase (ALP) activity, mineralization (Alizarin Red S staining), 그리고 real time Polymerase chain reaction (PCR) 을통해특정지을수있다. Scaffold 를토끼두개골결함에이식하여 4주, 8주후에각각 micro CT를이용하여골형성정도를분석한다. 결과적으로 control 보다는 SIM을로딩한 PLLA/gelatin/HAp-(β CD) scaffold 가더높은 ALP 활성, mineralization, 골분화 gene 발견, 골재생력을보였다. 결과적으로이재료는인체내골재생재료로써의가능성을보여준다. Poly (L -Lactic Acid)/Gelatin Fibrous Scaffold Loaded with Simvastatin/Beta-Cyclodextrin- Modified Hydroxyapatite Inclusion Complex for Bone Tissue Regeneration Sung ok Hong 1, Deok-Won Lee 2 1 Departmet of Dentistry (Oral and Maxillofacial Surgery), Catholic Kwandong University International St. Mary s Hospital, Incheon, Republic of Korea 2 Department of Oral and Maxillofacial Surgery, Kyung Hee University Dental Hospital at Gangdong, Kyung Hee University, Seoul 05278, Republic of Korea Recently, the application of nanostructured materials in the field of tissue engineering has garnered attention to mediate treatment and regeneration of bone defects. In this study, poly (L lactic acid) (PLLA)/gelatin (PG) fibrous scaffolds are fabricated and β-cyclodextrin (βcd) grafted nanohydroxyapatite (HAp) is coated onto the fibrous scaffold surface via an interaction between βcd and adamantane. Simvastatin (SIM), which is known to promote osteoblast viability and differentiation, is loaded into the remaining βcd. The specimen morphologies are characterized by scanning electron microscopy. The release profile of SIM from the drug loaded scaffold is also evaluated. In vitro proliferation and osteogenic differentiation of human adipose derived stem cells on SIM/HAp coated PG composite scaffolds is characterized by alkaline phosphatase (ALP) activity, mineralization (Alizarin Red S staining), and real time Polymerase chain reaction (PCR). The scaffolds are implanted into rabbit calvarial defects and analyzed by microcomputed tomography for bone formation after four and eight weeks. These results demonstrate that SIM loaded PLLA/gelatin/HAp-(βCD) scaffolds promote significantly higher ALP activity, mineralization, osteogenic gene expression, and bone regeneration than control scaffolds. This suggests the potential application of this material toward bone tissue engineering. This study was supported by a grant from the National Research Foundation of Korea (NRF-2014R1A1A and NRF-2016R1A2B ) This work was supported by the National Research Foundation of Korea (NRF) grant funded by the Korea government (MSIP; Ministry of Science, ICT & Future Planning)(No. NRF-2017R1C1B ) 제 57 차종합학술대회및정기총회 187

188

189 구강악안면외과외래진료보험청구 제 57 차대한악안면성형재건외과학회종합학술대회및정기총회

190 목차 총론 구강악안면외과보험진료 ( 외래 ) 총론마취료일반산정지침 ( 제6장 ) 치과처치 수술료일반산정지침 ( 제10장 ) 진료비의구성마취료, 절삭기류, 봉합사등의산정 각론 1. 발치 2. 수술후처치 3. 치조골성형수술 [1 치당 ] 4. 골융기절제술 5. 구강내소염수술 6. 치근단절제술 [1 치당 ] 7. 치근낭적출술 8. 치은판절제술 9. 협순소대성형술 10. 설소대성형술 11. 발치와재소파술 12. 구강내열상봉합술 13. 치아재식술 [1 치당 ] 14. 탈구치아정복술 [1 치당 ] 15. 치조골골절비관혈적정복술 16. 치간고정술 [1 악당 ] 17. 잠간고정술 [1 악당 ] 18. 악관절탈수비관혈적정복술 19. 치과임플란트제거술 (1 치당 ) 20. 낭종강감압장치술 [ 고무인상재를이용한경우 ] 21. 악관절강세척술 22. 절개생검 23. 구강상악동누공폐쇄술 24. 치은, 치조부병소또는종양절제술 [Epulis 포함 ] 25. 구강내종양적출술 26. 상고정장치술 190 대한악안면성형재건외과학회

191 총 론 구강악안면외과보험진료 ( 외래 ) 총론 항목 ( 분류번호 ) 코드 상대가치점수 ( 점 ) 유치 U 전치 U 구치 U 발치 ( 차-41) 난발치 U 단순매복치 U 복잡매복치 U 완전매복치 U 단순처치 U 수술후처치 대수술후처치 U ( 차-21) 수술후염증성처치, 배액관교환등 U 후출혈처치 U 발치와재소파술 ( 차-42) U 치조골성형수술 [1 치당 ] ( 차-43) U 치은농양, 치관주위농양 U 치조농양, 구개농양 U 구내소염술설또는구강저농양 ( 차-45) U [ 이하극, 설하극, 악하극농양등 ] 악골골염, 골수염등 U 치은, 구강전정, 협부 2.5cm 이하 U 구강내열상봉합술 치은, 구강전정, 협부 2.5cm 초과 U ( 차-47) 혀, 구강저, 구개부 2.5cm 이하 U 혀, 구강저, 구개부 2.5cm 초과 U 협순소대성형술 간단 U ( 차-50) 복잡 U 설소대성형술 간단 U ( 차-51) 복잡 U /2 치관크기이상 U 치근낭적출술 1 치관크기이상 U ( 차-56) 2 치관크기이상 U 치관크기이상 U4564 1, 제 57 차종합학술대회및정기총회 191

192 항목 ( 분류번호 ) 코드 상대가치점수 ( 점 ) 치근단절제술 전치 U ( 차-59) 구치 U 구강상악동누공폐쇄술 전진피판 U ( 차-62) 유경피판 U 치아재식술 [1 치당 ] ( 차-63) U 양성 Q2201 1, 양성 ( 구강저 ) Q2204 1, 구강내양성종양적출술 유두종등을간단하게제거 Q ( 자-220) 유두종등을간단하게제거 ( 구강저 ) Q 악성 [ 림프절청소포함 ] Q2203 7, 악성 [ 림프절청소포함 ] ( 구강저 ) Q2206 8, 치은판절제술 ( 차-66) U 치은, 치조부병소또는종양절제술 [Epulis 포함 ] ( 차-67) U 탈구치아정복술 [1 치당 ] ( 차-69) U 상고정장치술 [1 악당 ] ( 차-26) U 치간고정술 [1 악당 ] ( 차-33) U 잠간고정술 3 치이하 U ( 차-34) 4 치이상 U 골융기절제술 하악설측, 상악협측 U ( 차-73) 구개골 U 치과임플란트제거술 단순 U ( 차-98) 복잡 U 낭종강감압장치술 [ 고무인상제를이용한경우 ] ( 처-21) UX 악관절강세척술 ( 처-44) UX044 1, 절개생검 ( 나-853) 기타부위 C 치과침윤마취 [1/3 악당 ] ( 바-8) L 비구개신경블록 L 이신경블록 L 치과전달마취 ( 바-9) 후상치조신경블록 L 안와하신경블록 L 하치조신경블록 L 건강보험요양급여비용, 치과건강보험요양급여비용및급여기준참고 192 대한악안면성형재건외과학회

193 마취료일반산정지침 ( 제 6 장 ) 1. 마취약제주사시사용한 1 회용주사기및주사침등의재료대는마취료소정점수에포함되므로별도산정하지아니한다. 2. 신생아마취시에는마취료소정점수의 100% 를가산하며, 만 1 세미만의소아의경우에는마취료소정점수의 50% 를, 만 1 세이상만 6 세미만의소아또는만 70 세이상의노인의경우에는마취료소정점수의 30% 를가산한다. ( 산정코드첫번째자리에신생아는 1, 만 1 세미만은 A, 만 1 세이상 ~ 만 6 세미만은 B, 만 70 세이상은 4 로기재 ) 3. 장기이식수술마취, 심폐체외순환법마취, 일측폐환기법마취, 고빈도제트환기법마취, 개흉적심장수술마취, 뇌종양, 뇌혈관질환에대한개두술마취시에는마취료소정점수의 50% 를가산한다. ( 산정코드첫번째자리에각각 2, 5, 6, 7, 8, 9 로기재 ) 시 ~09 시또는공휴일에응급진료가불가피하여마취를행한경우에는소정점수의 50% 를가산한다. ( 산정코드두번째자리에 18 시 ~09 시는 1, 공휴일은 5 로기재 ) 이경우해당마취를시작한시각을기준으로산정한다. 5. 수술중에발생하는우발사고에대한처치 ( 산소흡입, 응급적인공호흡 ) 또는주사 ( 강심제 ) 등의비용은별도산정할수있으나, 그밖의경우에는산소흡입, 응급적인공호흡비용및 EKG monitoring 료는산정하지아니한다. 6. 동일목적을위하여 2 이상이마취를병용한경우또는마취중에다른마취법으로변경한경우에는주된마취의소정점수만산정한다. 7. 제 6 장에분류되지아니한표면마취, 침윤마취및간단한전달마취의비용은제 2 장, 제 9 장, 또는제 10 장에분류한소정시술료에포함되므로별도산정하지아니한다. 8. 마취통증의학과전문의초빙료를산정하는경우에는초빙된마취통증의학과전문의의면허종료, 면허번호를요양급여비용청구명세서에기재하고, 마취통증의학과전문의가서명또는날인한마취기록지를비치하여야한다. 마취료 = 행위료 ( 침윤, 전달마취등 ) + 약제료 ( 리도카인 ) + 의약품관리료앰플은사용한수만큼모두산정가능의약품관리료 : 병 의원에서보관하는약제에관하여관리비명목으로인정되는행위료이며치과에서주로사용하는리도카인, 주사제등을보관후사용한경우산정가능하고 1 일 1 회만인정산정단위 : 침윤마취 1/3 악당, 전달마취 1/2 악당 제 57 차종합학술대회및정기총회 193

194 치과처치 수술료일반산정지침 ( 제 10 장 ) 1. 본장에기재되지아니한치과진료영역의행위에대하여는제 2 부제 1 장내지제 9 장및제 16 장내지 19 장에의하여산정한다 시 ~09 시또는공휴일에응급진료가불가피하여처치및수술을행한경우에는소정점수의 50% 를가산한다. ( 산정코드두번째자리에 18 시 ~09 시는 1, 공휴일은 5 로기재 ) 이경우해당처치및수술을시작한시각을기준하여산정한다. 3. 본장및제 9 장에기재되지아니한간단한구강연조직질환의처치는기본진료료에포함되므로별도산정하지아니한다. 4. 동일피부절개하에 2 가지이상수술을동시에시술한경우주된수술을소정점수에의하여산정하고, 제 2 의수술부터는해당수술소정점수의 50%( 산정코드세번째자리에 1 로기재 ), 상급종합병원 종합병원 치과대학부속치과병원은해당수술소정점수의 70%( 산정코드세번째자리에 4 로기재 ) 를산정한다. 다만, 주된수술시에부수적으로동시에실시하는수술의경우에는주된수술의소정점수만산정한다. 5. 상 하악골악성종양절제술시행시경부의림프절청소술을병행한경우에는위 4 에도불구하고제 9 장제 1 절에기재된분류항목중경부림프절청소술 ( 자-211) 주 의소정점수를별도산정한다. 6. 각분류항목의처치및수술등에레이저를이용한경우에도각분류항목의소정점수만을산정한다. 7. 처치및수술에사용된약제및치료재료대는소정점수에포함되므로별도산정하지아니한다. 다만, 다음에열거하는약제및치료재료대는 약제및치료재료의비용에대한결정기준 에의하여별도산정하되, 본장에기재되니아니한약제및치료재료대는제 2 장내지제 9 장에의한다. ( 가 ) 충전재료 ( 글래스아이오노머시멘트, 아말감, 복합레진등 ) ( 나 ) 치간고정용재료 ( 금속선, 아취바등 ) ( 다 ) 체내고정용나사, 고정용금속핀, 고정용금속선, 고정용못 ( 라 ) 지속적주입, 지속적배액및지속적배기용도관 ( 체내유지 ) ( 마 ) 고정용신축성붕대 ( 바 ) 안면수술등장관이별도로정한처치및수술시사용된봉합사 ( 사 ) 인공관절 ( 아 ) 골, 관절의수복또는결손보철용인공재료 ( 체내유지 ) ( 자 ) 조직대용인조섬유포 ( 차 ) 기타장관이별도로인정한약제및치료재료 ( 인체조직포함 ) 8. ( 별표 ) 에열거한항목을상급종합병원 치과대학부속치과병원에서시행한경우에는해당항목소정점수의 30% 를가산하여산정한다. ( 산정코드첫번째자리에 1 기재 ) 해당분류항목 33 개 194 대한악안면성형재건외과학회

195 ( 별표 ) 분류번호및코드 U4415 단순매복치 차 -62 U4621 구강상악동누공폐쇄술 ( 전진피판 ) 차 -41 U4416 복잡매복치 U4622 구강상악동누공폐쇄술 ( 유경피판 ) U4417 완전매복치 차-63 U4630 치아재식술 차-43 U4430 치조골성형수술 차-67 U4670 치은, 치조부병소또는종양절제술 차-46 U4464 구강외소염수술 ( 표층 ) 차-69 U4690 탈구치아정복술 차-47 U4474 구강내열상봉합술 ( 치은, 구강전정, 협부 2.5cm 이하 ) 차-72 U4721 치조골골절관혈적정복술 (2치이하 ) 차-50 U4502 협순소대성형술 ( 복잡 ) U4731 골융기절제술 차-73 ( 하악설측또는상악협측 ) 차-51 U4512 설소대성형술 ( 복잡 ) U4732 구개골융기절제 U4551 법랑아세포종적출술 차-76 U4760 관상돌기절제술 ( 편측악골 1/3미만 ) 차-55 U4553 법랑아세포종적출술 ( 편측악골 1/2이상 ) 차-77 U4770 상악골골절비관혈적정복술 U4561 치근낭적출술 (½치관이상 ) 차-78-1 U4784 환관골궁현수고정술 차-56 U4562 치근낭적출술 (1치관이상 ) 차-78-2 U4785 두개안면현수고정술 U4563 치근낭적출술 (2치관이상 ) 차-90 U4900 악관절탈구비관혈적정복술 U4564 치근낭적출술 (3치관이상 ) 차-91 U4910 악관절탈구관혈적정복술 U4591 치근단절제술 ( 전치 ) 차-97 U4975 악골내고정용금속제거술 * 차-59 U4981 치과임플란트제거술 ( 단순 ) U4592 치근단절제술 ( 구치 ) 차-98 U4982 치과임플란트제거술 ( 복잡 ) * 골에삽입한금속핀이나금속정등을간단히제거한경우 제 57 차종합학술대회및정기총회 195

196 진료비의구성진찰료 + 행위료 + 약제료 + 재료대 + 가산율 = 총진료비 ( 본인부담금 + 청구액 ) 1) 진찰료의사의시진, 촉진, 문진등의행위를보상하는비용으로요양기관종별및초ㆍ재진여부에따라구분진찰료구분및상대가치점수 요양기관종별구분 초진 재진 1. 제3차의료급여기관으로지정된종합병원에설치된 치과대학부속치과병원 2. 제 1 호에해당되지아니하는치과대학부속치과병원, 제 1 호또는제 2 호에해당되지아니하는치과병원, 치과의원 치과건강보험요양급여비용및급여기준참고 2) 행위료각종진료행위의정해진수가 (Ex. 표준촬영, 발치등 ) 3) 약제료진료행위에사용된약제의수가 (Ex. 마취제, 주사제등 ) 4) 재료대진료행위에사용된치과재료의수가 (Ex. Burr/SAW, 봉합사등 ) 5) 진료행위별가산율 (= 요양기관종별가산율 ) 진료행위전체금액에대하여적용되는가산율약제료와재료대는가산이되지않는다. 요양기관종별구분 국민건강보험 의료급여 1. 제3차의료급여기관으로지정된종합병원에설치된 30% 22% 치과대학부속치과병원 2. 제 1 호에해당되지아니하는치과대학부속치과병원, 25% 18% 3. 제 1 호또는제 2 호에해당되지아니하는치과병원, 20% 15% 4. 치과의원 15% 11% 196 대한악안면성형재건외과학회

197 지금까지구강악안면외과 ( 외래 ) 요양급여관련항목, 요양급여에관련된일반적인원칙및진료비의구성요소에대해살펴보았습니다. 외래에서시행하는구강악안면외과진료의특성상요양급여청구와관련하여중요한요소는아무래도 마취, 진료행위 ( 발치, 치조골성형술등 ), 절삭기류, 그리고 봉합 과관련된내용이아닐까싶습니다. 본책자에서는다음장의표와같이각행위에대해 마취료 ( 행위 ), 마취료 ( 재료 ), 행위료 ( 술식 ), 절삭기류, 봉합사 의 5 개항목으로나누어청구가능여부를정리해보았습니다. 마취료 ( 행위 ) 는치과의사가하는국소마취행위에대한것이며, 마취료 ( 재료 ) 는마취시사용해는리도카인앰플과같은재료에대한것입니다. 앞의 진료비의구성 에서는각각 행위료 와 약제료 에해당하겠습니다. 행위료 ( 술식 ) 은발치, 치조골성형술등치과의사가하는진료행위에대한것입니다. 절삭기류 는진료시사용한 BURR/SAW 에대한것이며, 봉합사 는 suture material 에대한것입니다. 절삭기류 와 봉합사 모두 재료대 에해당됩니다. 이제각항목에대해구체적인산정기준및관련고시등을포함하여좀더구체적으로알아보도록하겠습니다, 그리고일부외래에서많이행해지는중요행위와관련하여서는청구프로그램 ( 두번에 ) 를활용하여설명을하도록하겠습니다. 사용하는프로그램에따라진료항목명칭, 국문상병명은다를수있습니다. 이경우코드를활용하시면되겠습니다. 요양급여청구와관련하여본책자에수록된내용은절대적인내용은아니므로참고적으로활용하시길바랍니다. 제 57 차종합학술대회및정기총회 197

198 < 마취료, 절삭기류, 봉합사등의산정 > 마취료 ( 행위 ) 마취료 ( 재료 ) 행위료 ( 술식 ) 절삭기류 봉합사 발치 유치 o o o x x 전치 o o o x x 구치 o o o x x 난발치 o o o o x 단순매복치 o o o o/x x 복잡매복치 o o o o x 완전매복치 o o o o x 치조골성형수술 o o o o o 골융기절제술 o o o o o 구강내소염수술 o o o - o 구강내열상봉합술 o o o - o 치근단절제술 o o o o x 치근낭적출술 o o o o x 치은판절제술 o o o - - 협순소대성형술 o o o - o 설소대성형술 o o o - o 발치와재소파술 o o o - - 악관절탈구비관혈적정복술 - - o - - 치과임플란트제거술 o o o o/x x 절개생검 x o o x 구강상악동누공폐쇄술 o o o - x 구강안면누공폐쇄술 o o o - o 구강내양성종양적출술 x o o - o 치은, 치조부병소또는종양적출술 o o o - o 198 대한악안면성형재건외과학회

199 각 론 1. 발치 Extraction ( 차 -41) 1) 단순발치 1 유치발치 (U4411), 전치발치 (U4412), 구치발치 (U4413) 2 방사선, 마취산정가능 3 상병명 : 치아우식 (K02.9), 만성치주염 (K05.39), 치근을포함한치관의파절 (S02.56) 등 2) 난발치 (U4414) 1 구치 ( 매복치제외 ), 전치또는유치가치근비대, 치근만곡또는골유착으로단순발치가곤란한경우산정 2 유치발치시후속영구치의손상의위험을방지하기위하여심부의유치잔근치를제거할목적으로치근분리술을시행한경우난발치로산정함. ( 고시제 호, 시행 ) 3 Bur, Saw 등절삭기류청구가능 ( 가. 발치, 치근, 치조골성형술등 ) 4 상병명 : 만곡치 (K00.44), 치아의강직증 3) 매복치 1 단순매복치 (U4415), 복잡매복치 (U4416), 완전매복치 (U4417) 발치시산정가. 단순매복치 복잡매복치또는완전매복치에해당하지않는경우나. 복잡매복치 치아분할술을실시한경우다. 완전매복치 치관이 2/3 이상치조골내에매복된치아의골절제와치아분할술을동시에시행한경우 2 Burr, Saw 등절삭기류청구가능 ( 가. 발치, 치근, 치조골성형술등 ) 3 상병명 : 매복치 (K01.19) 발치산정과관련된기준 (1) 발치시봉합사 (suture material) 은별도산정불가 ( 고시제 호, 시행 ) (2) 발치는치아의전부를발치한경우산정한다 : 발치도중중단한경우보통처치로산정 (3) 신경치료도중이나완료후에예후불량이나치아파절로발치한경우는치수치료와발치료각각 100% 산정가능 ( 단, 내역설명필수 ) (4) 발치나치주질환수술등당일에실시한창상봉합술수기료는해당소정수기료에포함되어별도산정할수없음. ( 고시제 호, 시행 ) 제 57 차종합학술대회및정기총회 199

200 (5) 영구치나유치의난발치및매복발치는 X-선촬영후치아상태등을확인하여실시하므로 X-선촬영없이일률적으로산정된난발치의경우는해당발치로, 매복발치는차 41 라. 난발치로산정함. ( 고시제 호, 시행 ) (6) 교정을목적으로시행한발치는비급여대상임. 다만교정치료과정중이라도질병의상태 ( 매복치, 치관주위염, 치아우식증등 ) 에서발치 ( 지치포함 ) 를하는경우에는요양급여대상으로함. ( 고시제 호, 시행 ) < 예시 1> - 하악제 3 대구치 ( 완전매복 ) 발치 * ** * 총진료비는초 재진, 진료시간, 환자나이및고시, 상대가치점수등에따라변동될수있으며, 절대적인금액은아님 ** 본인부담금은각의원급기준이며, 상급종합병원 종합병원 치과대학부속치과병원의경우금액이상이할수있음. 초진환자가내원한당일완전매복된제 3 대구치발치를하는상황을가정해보겠습니다. 환 자내원시통상적으로 x-ray 촬영 구강검사 마취 발치 봉합 의순서를거치게됩니다. 이를 단계별로살펴보겠습니다. 1. 검사 1) 파노라마촬영 2) Cone beam 전산화단층영상진단 일반 파노라마영상에서치근과하치조신경이근접한경우 cone beam 전산화단층영상촬영을시행 2. 마취 200 대한악안면성형재건외과학회

201 마취료 = 행위료 ( 침윤, 전달마취등 ) + 약제료 ( 리도카인 ) + 의약품관리료 1) 전달마취 ( 나 ) 하치조신경블록크 (L0905) 1 마취를하는 행위 에대한처방입니다. 2 부위에따라처방. 예를들어상악소 대구치발치를시행하는경우 후상치조신경블록 (L0903), 상악전치부매복과잉치발치의경우 비구개신경블록 (L0901) 을처방 3 하치조신경블록 (L0905) 처방후 침윤마취 (L0800) 추가처방불가하며그근거는다음과같습니다. ( 마취료일반산정지침 6 항 ) 동일목적을위하여 2 이상이마취를병용한경우또는마취중에다른마취법으로변경한경우에는주된마취의소정점수만산정한다. 4 산정단위 : 침윤마취 1/3 악당, 전달마취 1/2 악당 5 유치의경우후상치조신경전달마취는산정불가, 하지조신경전달마취는산정가능 2) 자이레스테신에이주 _(1.7mL): 1 사용한앰플에대한처방. ( 약제료 ) 2 앰플은사용한수만큼모두산정가능. 즉, 마취시행시 2 앰플을사용했다면회에 2 로처방 3) 의약품관리료 : 병 의원에서보관하는약제에관하여관리비명목으로인정되는행위료이며치과에서주로사용하는리도카인, 주사제등을보관후사용한경우산정가능하고 1 일 1 회만인정 3. 발치 1) 매복치발치 ( 골삭제, 분리 ) 1 발치 행위 에대한처방 2 완전매복치 (U4417) 발치에해당. 유치발치 (U4411), 전치발치 (U4412), 구치발치 (U4413), 난발치 (U4414), 매복치 (U4415), 복잡매복치 (U4416) 에해당하는경우각각을검색하여처방 2) 100:100 발치, 치근, 치조골성형술 BURR/SAW 절삭기류 : Burr, Saw 등절삭기류청구가능 ( 가. 발치, 치근, 치조골성형술등 ) 부록 1 참고 ( 단, 2 개이상의난발치또는매복발치를시행했더라도한번에 1 개의 bur 만청구가능 ) 4. 봉합 제 57 차종합학술대회및정기총회 201

202 봉합사는별도로산정불가능하며, 그근거는아래와같습니다. ( 고시제 호, 시행 ) 발치나치주질환수술등당일에실시한창상봉합술수기료는해당소정수기료에포함되어별도산정할수없음. Q) 치관절제술 (Coronectomy) 시행시처방은? A) 발치는치아전부를발치한경우산정합니다. 발치중치근첨이일부부러진경우가아니라 의도적으로치관만제거한경우원칙적으로는발치도중중단한경우에해당되므로보통처치로 산정하여야할것입니다. 또한치관분리술 (bicuspidization, 처 -102) 항목과는구분하여야합니다. < 예시 2> - 상악소구치난발치 _ 재진 * ** * 총진료비는초 재진, 진료시간, 환자나이및고시, 상대가치점수등에따라변동될수있으며, 절대적인금액은아님 ** 본인부담금은각의원급기준이며, 상급종합병원 종합병원 치과대학부속치과병원의경우금액이상이할수있음. 재진환자의치근만곡이심한상악소구치발치상황을가정해보겠습니다. 치근만곡이심하 므로상병명에 만곡치 [K00.44] 로입력하고 난발치 로산정합니다. 난발치 는아래와같은상황 에서산정합니다. ( 고시제 호, 시행 ) 202 대한악안면성형재건외과학회

203 구치 ( 매복치제외 ), 전치또는유치가치근비대, 치근만곡또는골유착으로단순발치가곤란한경우산정유치발치시후속영구치의손상의위험을방지하기위하여심부의유치잔근치를제거할목적으로치근분리술을시행한경우난발치로산정함. 재진상황이므로 x-ray 처방은없으며, 예시 1과마찬가지로 마취 [ 행위료 ( 전달마취 ( 가 ) 후상치조신경블록크 ) + 약제료 ( 자이레스테신에이주 _(1.7mL)) + 의약품관리료 ] 와 발치 [ 행위료 ( 난발치 ) + 재료비 (100:100발치, 치근, 치조골성형술 Burr/SAW 절삭기류 )] 산정하였음. 봉합사는별도산정불가항목임. Q) 소아에서사용한도포마취 ( 표면마취 ) 에대한비용산정은? A) 산정할수없음 마취료일반산정지침 7항 을보시면 제 6장에분류되지아니한표면마취, 침윤마취및간단한전달마취의비용은제 2장, 제9장, 또는제10장에분류한소정시술료에포함되므로별도산정하지아니한다. 는설명이있습니다. 제 6장에분류된마취중치과에해당하는부분은 치과침윤마취 [1/3악당] ( 바-8, L0800), 치과전달마취 ( 바-9, L0901~L0905) 로도포마취 ( 표면마취 ) 에대한비용은산정할수없습니다. 제 57 차종합학술대회및정기총회 203

204 ( 인터넷기사 capture 후재구성 ) 지난 8월의한인터넷신문기사입니다. 물론이기사는전신마취와관련된내용입니다. 하지만치과 ( 구강악안면외과 ) 외래에서빈번하게행해지는발치역시관혈적술식이며, 마취의정도와범위가다를뿐의료진과다른환자에게영향을미칠수있는교차감염의가능성은여전히있다고생각됩니다. ( 인터넷화면 capture) 또한환자자신도인지못하는감염성질환이나혈액응고장애, 백혈병등의가능성은있습니다. 이런차원에서특히발치와같은관혈적시술전관련된혈액검사또는검사 kit를통한검사시행을추천드립니다. ( 부록 2 참고 ) 204 대한악안면성형재건외과학회

205 2. 수술후처치 Postoperative Dressing ( 차 -21) 1) 단순처치 (U2211) 1 적응증 : 수술후익일부터시행하는간단한소독처치 2 발치또는외과수술후소독 (dressing), 발사 (stitch-out) 시산정하며, 구강전체를 1 단위로하여 1 일당산정 3 난발치와매복치발치후 수술후처치 가일률적으로없으면심사시조정되어질수있음. 4 유치발치시에는합병증이나전신장애가있는경우수술후처치와처방이가능 ( 단, 내역설명필요 ) 5 치은염, 지치주위염, 매복치등으로발치나수술전에행하여진 dressing 은기본진료로산정 6 동일악중 1/3 악또는동일악중에연결된 1/3 악범위내 ( 인정치 3~4 개이내범위 ) 에서치주치료또는치주치료후처치와수술후단순처치를시술한경우 7 발치전동통감소를목적으로시행한경우기본진료료에포함되어별도산정불가 2) 대수술후처치 (U2212) - 적응증 : 전신마취하에수술을시행받은환자에서수술후익일부터시행하는소독처치 3) 수술후염증성처치, 배액관교환 (dressing 포함 ) 등 (U2213) - 적응증 : 악안면영역에발생한다양한감염성병소의일차처치이후에시행하는소독처치, 비감염성외과시술후에생긴염증성창상처치 4) 후출혈처치 (U2214) - 적응증 : 발치를포함하여수술후에연조직에서나경조직에서출혈이발생하는경우의처치, 간질환을가진환자에서치주처치후에지속적인출혈 제 57 차종합학술대회및정기총회 205

206 3. 치조골성형수술 [1 치당 ] Alveoloplasty ( 차 -43, U4430) 1 적응증가. 발치후의치조골흡수부전이관찰되는경우-발치후치조정에예리한골면과팽융을남기고치유되면, 의치장착시동통을느끼고안정된장착을방해하기때문에적응증이됨나. 의치상에접한치조제의부분이이상돌출상태에있는경우-이상하게돌출한치조돌기, 하악융기, 구개융기, 상악결절부가돌출해있는경우, 기타의외골증과같은것이있는경우, 의치장착이곤란해지는경우가많기때문에그부분을평탄히할필요가있음다. 즉시의치를장착할경우-많은치아를연속해, 동시에발치해서즉시의치를장착할경우치조골이자연히평탄해지는것을기대할수없기때문에치조골성형술이필요라. 상, 하악에간격을만들필요가있을경우-상, 하악이긴밀히접촉해있기때문에의치상의삽입이곤란한경우치조정을삭제하고의치상또는인공치의배열이가능한간격을만들필요가있음 2 Burr, Saw 등절삭기류청구가능 ( 가. 발치, 치근, 치조골성형술등 ) 3 봉합사 (suture material) 별도청구가능 ( 단, 반드시구입후심평원에상한가와실구입가중낮은값으로등록후청구해야하며, 병원에서사용하는봉합사가 2 종류이상일경우 chart 에봉합사종류와수량기록하는것이필요함.) 4 상병명 : 불규칙한치조돌기 (K08.81) 발치와함께시행한경우발치의상병명그대로적용가능 5 무치악인경우해당부위의치식을표시 [( 적용상병 : 불규칙한치조돌기 [(K08.81)] 6 발치와동시에실시하는치조골성형수술은치아를발치한후반드시실시하는것이아니므로예리한치밀골의심한 under cut 이있거나, 발치시높은치료충격이있는경우에한하여산정하며, 주수술 (100%) + 부수술 (50%) 로산정함. 단, 상급종합병원 종합병원 치과대학부속치과병원의경우주수술 (100%) + 부수술 (70%) 로산정 ( 고시제 호, 시행 ) 7 발치후일정기간경과후치조골성형술시행시각각 100% 산정가능 206 대한악안면성형재건외과학회

207 < 예시 3> - 발치와동시에시행된치조골성형술 * ** * 총진료비는초 재진, 진료시간, 환자나이및고시, 상대가치점수등에따라변동될수있으며, 절대적인금액은아님 ** 본인부담금은각의원급기준이며, 상급종합병원 종합병원 치과대학부속치과병원의경우금액이상이할수있음. #24~26 을발치하면서치조골성형술이필요한환자에대한상황을가정해보겠습니다. 환자가 내원한당일발치 + 치조골성형술을한다고하겠습니다. 환자내원시 x-ray 촬영 구강검사 마 취 치조골성형술 봉합 의순서를거치게됩니다. 이를단계별로살펴보겠습니다. 1. 검사 : 파노라마촬영 시행 2. 마취 ( 상세내용은 1. 발치 - 예시 1 참고 ) 마취료 = 행위료 ( 침윤, 전달마취등 ) + 약제료 ( 리도카인 ) + 의약품관리료 1) 전달마취 ( 가 ) 후상치조신경블록크 (L0903) 2) 자이레스테신에이주 _(1.7mL): 3) 의약품관리료 : 병 의원에서보관하는약제에관하여관리비명목으로인정되는행위료이며치과에서주로사용하는리도카인, 주사제등을보관후사용한경우산정가능하고 1 일 1 회만인정 3. 치조골성형술 1) 치조골성형수술 제 57 차종합학술대회및정기총회 207

208 1 수술 행위 에대한처방 2 1 치당산정하므로 #24, 25, 26 에시행시 3 회로산정. 단, 무치악의경우해당부위에치식을표시 2) 100:100 발치, 치근, 치조골성형술 BURR/SAW 절삭기류 : Burr, Saw 등절삭기류청구가능 ( 가. 발치, 치근, 치조골성형술등 ) 부록 1 참고 3) 구치발치 (50% 산정 ): 고시제 호 에근거하여치조골성형수술은 100% ( 주수술 )+ 구치발치는 50% ( 부수술 ) 로산정 발치와동시에실시하는치조골성형수술은치아를발치한후반드시실시하는것이아니므로예리한치밀골의심한 under cut 이있거나, 발치시높은치료충격이있는경우에한하여산정하며, 주수술 (100%) + 부수술 (50%) 로산정함. 단, 상급종합병원 종합병원 치과대학부속치과병원의경우주수술 (100%) + 부수술 (70%) 로산정 ( 고시제 호, 시행 ) 4. 봉합 : 치조골성형술에서는봉합사를별도로산정할수있음. 208 대한악안면성형재건외과학회

209 4. 골융기절제술 Excision of Torus ( 차 -73) 1 상악구치부협측과하악설측부 (U4731) 및상악구개부 (U4732) 기저골에서발생된외종골을절제하는경우산정 2 적응증가. 상악구치부협측과하악설측부 (U4731) a. 하악설측및상하악의협측으로치조돌기의일부분혹은전체가돌출되어틀니의안착시에방해가되거나통증을유발하는경우. b. 돌출된부위가빈번한물리적자극으로통증의원인이되는경우나. 상악구개부 (U4732) a. 오래전부터있어왔던구개골융기를제거. b. 불편감을이유로제거를원하는경우 c. 골이식의공여부로이용되는경우 3 Bur, Saw 등절삭기류청구가능 ( 나. 절제, 적출, 골수염수술등 ) 4 구강당 1 일 1 회산정 좌 우동시에시행시에도한부위만인정됨. 5 상병명 : 하악융기 (K10.0), 구개융기 (K10.0) 지혈, 연조직압박또는창상보호등의목적으로상고정장치를제작한경우 25. 상고정장치술 참고. 제 57 차종합학술대회및정기총회 209

210 < 예시 4> - 하악설측골융기절제술 (Lingual torus removal) * ** * 총진료비는초 재진, 진료시간, 환자나이및고시, 상대가치점수등에따라변동될수있으며, 절대적인금액은아님 ** 본인부담금은각의원급기준이며, 상급종합병원 종합병원 치과대학부속치과병원의경우금액이상이할수있음. 하악좌측 lingual torus removal 상황을가정해보겠습니다. 앞선상황들과마찬가지로 마취 골 융기절제술 봉합 의과정으로진행됩니다. ( 상병명 : K10.0 악골발육성장애 ) 1. 마취 ( 상세내용은 1. 발치 - 예시 1 참고 ) 마취료 = 행위료 ( 침윤, 전달마취등 ) + 약제료 ( 리도카인 ) + 의약품관리료 1) 전달마취 ( 나 ) 하치조신경블록크 (L0905) 2) 자이레스테신에이주 _(1.7mL) 3) 의약품관리료 : 병 의원에서보관하는약제에관하여관리비명목으로인정되는행위료이며치과에서주로사용하는리도카인, 주사제등을보관후사용한경우산정가능하고 1 일 1 회만인정 2. 골융기절제술 1) 골융기절제술 1 수술 행위 에대한처방 2 이경우 상악구치부협측과하악설측부 (U4731) 에해당되며, palatal torus 제거시 상악구개부 (U4732) 를찾아서처방 2) 100:100 절제, 적출, 골수염수술 BURR/SAW 절삭기류 : Burr, Saw 등절삭기류청구가능 ( 나. 절제, 적출, 골수염수술등 ) 부록 1 참고 210 대한악안면성형재건외과학회

211 외래에서이루어지는다른진료와달리골융기절제술시사용한 BURR/SAW 절삭기류는 나. 절제, 적출, 골수염수술등 항목입니다. 3) 구강당 1 일 1 회산정 하루에좌 우양측의 torus removal 을모두시행하여도한부위만인정됨. 즉, 한쪽은행위료를청구할수없음. 3. 봉합 : 골융기절제술에서는봉합사를별도로산정할수있음. 제 57 차종합학술대회및정기총회 211

212 5. 구강내소염수술 Intraoral Antiphlogosis ( 차 -45) 1 치은농양, 치관주위농양절개등 (U4454), 치조농양또는구개농양의절개등 (U4455), 설또는구강저농양 [ 이하극, 설하극, 악하극농양등 ] (U4456), 악골골염, 악골골수염등 (U4457) 2 상명병 : 동이없는잇몸기원의치주농양 (K05.20), 동이없는근단주위농양 (K04.7), 입의연조직염및농양 (K12.2), 악하농양 (K12.2D) Fistula ( 농루, 동 ) 가있는경우에도 incision & drainage 시행시상병명은 동이없는 으로시행하는것을추천함. 3 적응증 가. 치은농양, 치관주위농양절개등 (U4454) a. 농양의형성및국소화가명백한경우-치은주변에서농이고여있는파동이촉진되거나시험천자 (aspiration test) 를통해농의위치가확인된경우 b. 화농성종창, 심한악취, 농이임상적으로구강내로관찰되는경우중구강내로접근이용이하다고판단되는경우 c. 지치 ( 사랑니 ) 주위치은 ( 잇몸 ) 과안면의심한종창으로절개및배농이필요한경우 d. 투약이나치은연하소파술로해결되지않는치은부의농양성병소 나. 치조농양또는구개농양의절개등 (U4455) a. 농양의형성및국소화가명백한경우-치조골주변의화농성종창, 심한악취, 농이관찰되는경우중구강내로접근이가능한경우 b. 구개점막의심한종창으로절개및배농이필요한경우 c. 농이고여있는파동 (fluctuation) 이촉진되거나, 시험천자 (aspiration test) 를통해농의위치가확인된경우 d. 투약이나근관치료등으로해결되지않는치조골부의농양성병소 다. 설또는구강저농양 [ 이하극, 설하극, 악하극농양등 ] (U4456) a. 농양의형성및국소화가명백한경우-구강저주변의화농성종창, 혀의편측변위, 심한악취, 농이관찰되는경우중구강내로접근이가능한경우 b. 구강저점막의심한종창으로절개및배농이필요한경우 c. 농이고여있는파동 (fluctuation) 이촉진되거나, 시험천자 (aspiration test) 를통해농의위치가확인된경우 d. 투약이나보존적치료로해결되지않는구강저부의농양성병소 라. 악골골염, 악골골수염등 (U4457) 212 대한악안면성형재건외과학회

213 a. 악골내에치성농양의형성및국소화가명백한경우-치은주변의화농성종창, 심한악취, 농이배출되는경우중구강내로접근이가능한경우 b. 지치주위치은의심한종창으로절개및배농이필요한경우 c. 농이고여있는파동 (fluctuation) 이촉진되거나, 시험천자 (aspiration test) 를통해농의위치가확인된경우 d. 투약이나치은연하소파술로해결되지않는치은부의농양성병소 e. 화농이골속으로확산되어극심한통증, 발열, 오한, 전율쇠약증등의전신증세가악화되는경우 f. 골수염진행기의후반, 즉골수화농기에이른병세가정지되지않을것으로추정되는경우 4 봉합사별도산정가능 5 당일에 2 부위이상동시시행시 ( 고시제 , 시행 ) 가. 상, 하, 좌, 우로구분하여주된부위 100% 나. 그이외의부위는 50% 로하여최대 200% 까지산정가능 6 동시시행시산정기준가. 응급근관처치와동시에시행 : 주수술 (100%) + 부수술 (50%) 나. 근관세척과동시에시행 : 주수술 (100%) + 부수술 (50%) ( 진료심사평가위원회 ) 다. 치석제거와동시시행 : 주수술 (100%) + 부수술 (50%) ( 진료심사평가위원회 ) 라. 발치와동시에시행시 : 발치료만 100% 인정 7 구강내소염술시행후 dressing 을시행하는경우수술후처치로산정하며, 마취및후처치등의연계처치가없을경우구강내소염술불인정 ( 진료심사평가위원회 ) 8 절개없이탐침이나큐렛으로배농한경우산정불가 제 57 차종합학술대회및정기총회 213

214 < 예시 5> - 치조농양절개및배농 * ** * 총진료비는초 재진, 진료시간, 환자나이및고시, 상대가치점수등에따라변동될수있으며, 절대적인금액은아님 ** 본인부담금은각의원급기준이며, 상급종합병원 종합병원 치과대학부속치과병원의경우금액이상이할수있음. 상악구치부협측전정 (buccal vestibule) 에파동성의종창이있는상태로병원에처음내원한환자를가정해보겠습니다. 진료는조금씩차이가있을수있겠으나 x-ray 촬영및구강검진 마취 구강내소염수술 drain 고정 의순서로이루어질것으로생각해보겠습니다. 1. 검사 : 파노라마촬영 시행, 필요시 치근단촬영 을시행 2. 마취 ( 상세내용은 1. 발치 - 예시 1 참고 ) 마취료 = 행위료 ( 침윤, 전달마취등 ) + 약제료 ( 리도카인 ) + 의약품관리료 1) 전달마취 ( 가 ) 후상치조신경블록크 (L0903) 2) 자이레스테신에이주 _(1.7mL): 3) 의약품관리료 : 병 의원에서보관하는약제에관하여관리비명목으로인정되는행위료이며치과에서주로사용하는리도카인, 주사제등을보관후사용한경우산정가능하고 1 일 1 회만인정 3. 구강내소염수술 1) 구강내소염수술 ( 치조농양또는구개농양의절개 ) 1 수술 행위 에대한처방 2 현재상황은 치조농양또는구개농양의절개 (U4455) 를가정한것이나부위및병의심도에따라 치관주위농양절개등 (U4454), 치조농양또는 214 대한악안면성형재건외과학회

215 구개농양의절개등 (U4455), 설또는구강저농양 [ 이하극, 설하극, 악하극농양등 ] (U4456), 악골골염, 악골골수염등 (U4457) 을찾아서처방 2) 당일에 2 부위이상동시시행시에는 상, 하, 좌, 우 로구분하여주된부위 100%, 그이외의부위는 50% 로하여최대 200% 까지산정가능. ( 고시제 , 시행 ) 상악우측, 상악좌측시행시한쪽은 100%, 반대쪽은 50% 로산정 3) 응급근관처치와동시에해당부위구강내소염수술진행시 주수술 (100%) + 부수술 (50%) 로처방 4) 근관세척과동시에해당부위구강내소염수술진행시 주수술 (100%) + 부수술 (50%) 로처방 ( 진료심사평가위원회 ) 5) 치석제거와동시에해당부위구강내소염수술진행시 주수술 (100%) + 부수술 (50%) 로처방 ( 진료심사평가위원회 ) 6) 발치와동시에해당부위구강내소염수술시행시에는발치료만 100% 인정 7) 구강내소염술시행후 dressing 을시행하는경우 수술후처치 로산정하며, 마취및후처치등의연계처치가없을경우구강내소염술불인정 ( 진료심사평가위원회 ) 8) 절개없이탐침이나큐렛으로배농한경우산정불가 즉, 마취없이 probe 나큐렛등으로찔러서배농하고 dressing 등의후처치가없을경우에는인정되지않음. 4. 봉합 : 구강내소염수술에서는봉합사를별도로산정할수있음. 제 57 차종합학술대회및정기총회 215

216 6. 치근단절제술 [1 치당 ] [ 치근단폐쇄비용포함 ] Apicoectomy ( 차 -59) 1 치근단병변이통상적인근관치료만으로해결되지않는경우치근의근첨을제거하고치근단조직을소파하는술식 2 전치 (Anterior tooth, U4591) 와구치 (Posterior Tooth, U4592) 로나누어산정됨. 3 근관수에관계없이 1 치당으로산정 4 Bur, Saw 등절삭기류청구가능 ( 가. 발치, 치근, 치조골성형술등 ) 5 상병멍 : 동이있는근단주위농양 (K04.62), 치근낭 (K04.80) 6 봉합사별도산정불가 7 역충전비용은별도산정불가 8 치근단폐쇄 ( 역충전 ) 시행여부와상관없이산정가능 ( 진료심사평가위원회 ) 9 치근낭적출술, 치근단절제술, 치조골결손부골이식술등을시행시골결손부에사용한골대체물질은자가골이식술없이사용하였을경우최대 3cc(2.5g) 범위내에서실사용량을인정함. ( 고시제 호, 시행 ) 216 대한악안면성형재건외과학회

217 < 예시 6> - 치근단절제술 * ** * 총진료비는초 재진, 진료시간, 환자나이및고시, 상대가치점수등에따라변동될수있으며, 절대적인금액은아님 ** 본인부담금은각의원급기준이며, 상급종합병원 종합병원 치과대학부속치과병원의경우금액이상이할수있음. 우측상악제 1 소구치치근단절제술이필요한경우를가정해보겠습니다. 1. 마취 ( 상세내용은 1. 발치 - 예시 1 참고 ) 마취료 = 행위료 ( 침윤, 전달마취등 ) + 약제료 ( 리도카인 ) + 의약품관리료 1) 전달마취 ( 가 ) 후상치조신경블록크 (L0903) 2) 자이레스테신에이주 _(1.7mL): 3) 의약품관리료 : 병 의원에서보관하는약제에관하여관리비명목으로인정되는행위료이며치과에서주로사용하는리도카인, 주사제등을보관후사용한경우산정가능하고 1 일 1 회만인정 2. 치근단절제술 1) 치근단절제술 1 수술 행위 에대한처방 2 전치부에서시행했다면 치근단절제술 ( 전치 ) (U4591) 을산정 2) 100:100 발치, 치근, 치조골성형술 BURR/SAW 절삭기류 : Burr, Saw 등절삭기류청구가능 ( 가. 발치, 치근, 치조골성형술등 ) 부록 1 참고 3) 역충전 (retrograde filling) 을시행하지않더라도관계없으며, 역충전을시행했다하더라도부가적으로산정할수없음. 제 57 차종합학술대회및정기총회 217