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