Analysis of proper chest compression position according to abdominal distension using multi-detector computed tomography

Objective@#The purpose of this study was to analyze the effect of abdominal distension on proper chest compression position selection during the use of multi-detector computed tomography (MDCT). @*Methods@#Fifty-eight patients who underwent thoraco-abdominal MDCT for the diagnosis of aortic dissection from January 2013 to August 2018 were included in the study. Abdominal distension was defined as a condition in which the area around the navel in the supine position was higher than the lower half of the sternum. The left ventricle maximal diameter (LVMD) level was scored based on the vertebral body using MDCT. The distance from the end of the sternum (Se), the middle of the lower half of the sternum (Sm), and the upper edge of the liver (Lu) to the LVMD were measured and analyzed. @*Results@#The LVMD level was significantly higher in the abdominal distension group than in the non-abdominal distension group (1.74±1.39 vs. 2.77±1.33, P=0.007). The difference was about 1/2 of the height of a vertebral body, i.e. 1.2 cm. In the abdominal distension group, Lu was higher (19.6±18.0 vs. 29.2±13.1, P=0.034) and the distance from LVMD to Sm was shorter than in the non-abdominal distension group (36.3±17.5 vs. 45.8±11.5, P=0.027). @*Conclusion@#Abdominal distension alters the position of the heart through the elevation of the diaphragm. Therefore, when performing chest compressions in patients with cardiac arrest, it is necessary to select a chest compression location based on the presence or absence of abdominal distension.

Analysis of the treatment-time reduction of ST elevation myocardial infarction patients transferred by helicopter-based emergency medical services in Korea

Objective@#ST-elevation myocardial infarction (STEMI) requires timely reperfusion therapy, and the first medical contact (FMC) to percutaneous coronary intervention (PCI) time within 120 minutes is recommended. Therefore, early recognition and rapid transportation of STEMI patients to the PCI-capable hospital are important. This study analyzed the time reduction effect of STEMI patients who were transferred by a helicopter. @*Methods@#This was a retrospective, single-center study. The study period was from 2016 to 2017. An air ambulance was available based on the 24-hour PCI capable hospital. This study selected STEMI patients who were transferred from other hospitals in six regions. The transfer distances, time factors, and treatment outcomes in those transferred by helicopter and those transferred by ambulance were compared. @*Results@#Among 88 STEMI patients from six regions, 38 (43.2%) and 50 (56.8%) were transferred by helicopter and ambulance, respectively. The average transfer distances were longer in the helicopter-transfer group (92.7 km vs. 82.4 km, P=0.004). The transfer time, call-to-lab time, door-to-balloon time, and FMC-to-PCI time were shorter in the helicopter-transfer group. The proportion of FMC-to-PCI within 120 minutes was higher in the helicopter-transfer group (40.5% vs. 11.4%, P=0.002). @*Conclusion@#Helicopter-transfer reduced the FMC-to-PCI time, including the transfer time and call-to-lab time. Therefore, a higher proportion of time-targeted treatment was achieved.

Experiences of disaster medical assistance activities in a fire accident at the Ramada Encore Hotel, Cheonan

Objective@#This study examined the disaster medical assistance activities at the fire accident scenes at the Ramada Encore Hotel, Cheonan, on January 14, 2019. @*Methods@#This study reviewed the disaster response timelines and patients’medical records retrospectively during the disaster medical assistance activities. The results of field and hospital triage of patients and the medical records of patients who visited the emergency department on the day of the fire accident were analyzed. @*Results@#The disaster medical assistance team arrived at the fire scene 59 minutes after the first emergency medical services (EMS, 119) call. Forty-nine patients were enrolled in this study. Four patients were classified as the ‘Emergency’ group; 44 patients were in the ‘Non-emergency’ group, and one patient was triaged as dead on arrival. Thirty-four out of 49 patients finally visited the nearest hospital. Twenty patients were transported by the EMS who were triaged as 12 patients to ‘minimal (green)’, four patients to ‘delayed (yellow)’, three patients ‘immediate (red)’, and one patient to ‘expectant (black).’ @*Conclusion@#Several mismatches could be observed between disaster preparedness and the real scene activities performed by multi-agencies disaster medical assistance activities in this study. A reassessment of disaster planning and the proper training program for disaster medical assistance activities should be needed.

Analysis of the treatment-time reduction of ST elevation myocardial infarction patients transferred by helicopter-based emergency medical services in Korea

Objective@#ST-elevation myocardial infarction (STEMI) requires timely reperfusion therapy, and the first medical contact (FMC) to percutaneous coronary intervention (PCI) time within 120 minutes is recommended. Therefore, early recognition and rapid transportation of STEMI patients to the PCI-capable hospital are important. This study analyzed the time reduction effect of STEMI patients who were transferred by a helicopter. @*Methods@#This was a retrospective, single-center study. The study period was from 2016 to 2017. An air ambulance was available based on the 24-hour PCI capable hospital. This study selected STEMI patients who were transferred from other hospitals in six regions. The transfer distances, time factors, and treatment outcomes in those transferred by helicopter and those transferred by ambulance were compared. @*Results@#Among 88 STEMI patients from six regions, 38 (43.2%) and 50 (56.8%) were transferred by helicopter and ambulance, respectively. The average transfer distances were longer in the helicopter-transfer group (92.7 km vs. 82.4 km, P=0.004). The transfer time, call-to-lab time, door-to-balloon time, and FMC-to-PCI time were shorter in the helicopter-transfer group. The proportion of FMC-to-PCI within 120 minutes was higher in the helicopter-transfer group (40.5% vs. 11.4%, P=0.002). @*Conclusion@#Helicopter-transfer reduced the FMC-to-PCI time, including the transfer time and call-to-lab time. Therefore, a higher proportion of time-targeted treatment was achieved.

Experiences of disaster medical assistance activities in a fire accident at the Ramada Encore Hotel, Cheonan

Objective@#This study examined the disaster medical assistance activities at the fire accident scenes at the Ramada Encore Hotel, Cheonan, on January 14, 2019. @*Methods@#This study reviewed the disaster response timelines and patients’medical records retrospectively during the disaster medical assistance activities. The results of field and hospital triage of patients and the medical records of patients who visited the emergency department on the day of the fire accident were analyzed. @*Results@#The disaster medical assistance team arrived at the fire scene 59 minutes after the first emergency medical services (EMS, 119) call. Forty-nine patients were enrolled in this study. Four patients were classified as the ‘Emergency’ group; 44 patients were in the ‘Non-emergency’ group, and one patient was triaged as dead on arrival. Thirty-four out of 49 patients finally visited the nearest hospital. Twenty patients were transported by the EMS who were triaged as 12 patients to ‘minimal (green)’, four patients to ‘delayed (yellow)’, three patients ‘immediate (red)’, and one patient to ‘expectant (black).’ @*Conclusion@#Several mismatches could be observed between disaster preparedness and the real scene activities performed by multi-agencies disaster medical assistance activities in this study. A reassessment of disaster planning and the proper training program for disaster medical assistance activities should be needed.

Is hyperbaric oxygen therapy more effective than normobaric oxygen therapy for improving acute neuropsychologic status due to carbon monoxide poisoning?

OBJECTIVE: The evidence that hyperbaric oxygen (HBO) therapy is more effective for improving the acute neuropsychological status (ANS) of carbon monoxide poisoning than normobaric oxygen (NBO) therapy is not convincing. This is because the levels of carboxyhemoglobin (COHb) do not correlate with the clinical severity of carbon monoxide poisoning and there is no universally accepted severity scale of carbon monoxide poisoning. This paper suggests a new scale for the clinical and neurological severity of carbon monoxide poisoning, called the ANS, and assesses the effect of HBO therapy for each level of ANS compared to NBO therapy. METHODS: A total of 217 patients who had been hospitalized because of carbon monoxide poisoning from January 2009 to July 2013 were studied. ANS was suggested as a new severity scale of carbon monoxide poisoning considered in the Glasgow Coma Scale, acute neuro-psychologic signs and symptoms, or cardiac ischemia on the initial medical contact. HBO therapy is indicated in those who have a loss of consciousness, seizure, coma, abnormal findings on a neurological examination, pregnancy, persistent cardiac ischemia, level of COHb >25%, or severe metabolic acidosis (pH < 7.2). The end point is the day of discharge, and recovery is defined as a normal neuro-psychological status without any sequelae. RESULTS: The levels of troponin T and creatinine increased significantly with increasing ANS score. In the moderate to severe group (ANS 2 and 3), the recovery rate was significantly higher when treated with HBO therapy than with NBO therapy (P=0.030). On the other hand, the development of delayed neuro-psychological sequelae (DNS) did not correlate with any level of ANS, type of oxygen therapy, or recovery on discharge. CONCLUSION: In the moderate to severe poisoned group, HBO therapy is more effective for improving the ANS from carbon monoxide poisoning than NBO therapy. On the other hand, the development of DNS of HBO therapy is no more preventable than with NBO therapy. Although the level of ANS is low, the patient needs to be provided with sufficient information and a follow-up visit is recommended for any abnormal symptoms because the ANS does not correlate with the development and degree of DNS.

Effect of herbal extracts on bone regeneration in a rat calvaria defect model and screening system

OBJECTIVES: The aim of this study was to evaluate the effects of herbal extracts on bone regeneration. Two known samples were screened. MATERIALS AND METHODS: We previously established a rat calvaria defect model using a combination of collagen scaffold and herbal extracts. An 8 mm diameter trephine bur with a low-speed dental hand piece was used to create a circular calvaria defect. The experimental group was divided into 4 classifications: control, collagen matrix, Danshen with collagen, and Ge Gan with collagen. Animals in each group were sacrificed at 4, 6, 8, and 10 weeks after surgery, and bone regeneration ability was evaluated by histological examination. RESULTS: Results revealed that both Danshen and Ge Gan extracts increased bone formation activity when used with collagen matrix. All groups showed almost the same histological findings until 6 weeks. However, after 6 weeks, bone formation activity proceeded differently in each group. In the experimental groups, new bone formation activity was found continuously up to 10 weeks. In the Danshen and Ge Gan groups, grafted materials were still present until 10 weeks after treatment, as evidenced by foreign body reactions showing multinucleated giant cells in chronic inflammatory vascular connective tissue. CONCLUSION: Histological analyses showed that Danshen and Ge Gan extractions increased bone formation activity when used in conjunction with collagen matrix.

A Case of Delayed Tracheo-esophageal Fistula Complicating Acute Intoxication of Hydrogen Peroxide

Hydrogen peroxide is a commonly used oxidizing agent. If injected, it may result in morbidity via direct caustic injury, oxygen gas formation, and lipid peroxidation. We report a 40-year-old male patient who accidentally swallowed undiluted hydrogen peroxide (35%). The initial chest computed tomography scan showed no active lesions. He was admitted to the intensive care unit for conservative treatment. Fourteen days after treatment, uncontrolled fever and foul oder sputum occurred, which was not alleviated despite empirical antibiotics therapy. Findings on a chest computed tomography showed tracheo-esophageal fistula at the lower trachea and left main bronchus. He underwent surgical replacement surgery and was discharged without complication after 52 days of admission.

Intramuscular hemangiomas on the masseter muscle and orbicularis oris muscle: a report of two cases

Intramuscular hemangioma (IMH) is a rare vascular disease involving skeletal muscle, comprising only 0.8% of hemangiomas. About 10% to 15% of IMHs occur in the head and neck region, mostly involving the masseter muscle. IMH occurs mostly in childhood, but is often not found until unexpected enlargement, pain, or cosmetic asymmetry occurs in adulthood. Several non-surgical treatments including cryotherapy, sclerosant injection, and arterial ligature have been described, but complete surgical resection is the curative intervention. In this report, we present two rare cases of IMH. One IMH case in a 48-year-old male occurred in the masseter muscle feeding from the transverse facial artery. Embolization of the distal branch of the facial artery was first conducted, and then the buccal mass was removed surgically via the intraoral approach. A second IMH case in a 58-year-old female occurred in the orbicularis oris muscle feeding from the superior labial artery, and the mass was excised surgically without embolization.

Intracorporeal reduction of condylar fracture using both pedicled condylar and seperated ramal fragments after vertical ramal osteotomy

The aim of this study is to introduce a surgical technique that can maintain blood supply to prevent condylar resorption in the extracorporeal reduction of condylar fracture. Neither the medial pterygoid muscle on the ramal bone nor the lateral pterygoid muscle on the condylar fragment was detached after vertical ramal osteotomy. Thus, reduction was performed in the intracorporeal state. Therefore, blood supply was expected to be maintained to the fragments of both the condylar and ramal bones. On postoperative radiographs, the anatomical outline of the fractured condyle was well restored, and the occlusion was stable. In the unilateral case, there were no signs of mandibular condylar resorption until postoperative 3 weeks. In the 2 bilateral cases, condylar displacements with plate fractures and screw loosening were observed at postoperative 1 month or 5 months, but radiodensity at the displaced fracture site increased during the follow-up period. Finally, complete remodeling of the condylar fragments with restored anatomic appearance was observed on 8-month or 2-year follow-up radiographs. All cases exhibited good healing aspects with no signs or symptoms of mandibular condylar dysfunction during the postoperative remodeling period after intracorporeal reduction of condylar fracture.

Intracorporeal reduction of condylar fracture using both pedicled condylar and seperated ramal fragments after vertical ramal osteotomy

The aim of this study is to introduce a surgical technique that can maintain blood supply to prevent condylar resorption in the extracorporeal reduction of condylar fracture. Neither the medial pterygoid muscle on the ramal bone nor the lateral pterygoid muscle on the condylar fragment was detached after vertical ramal osteotomy. Thus, reduction was performed in the intracorporeal state. Therefore, blood supply was expected to be maintained to the fragments of both the condylar and ramal bones. On postoperative radiographs, the anatomical outline of the fractured condyle was well restored, and the occlusion was stable. In the unilateral case, there were no signs of mandibular condylar resorption until postoperative 3 weeks. In the 2 bilateral cases, condylar displacements with plate fractures and screw loosening were observed at postoperative 1 month or 5 months, but radiodensity at the displaced fracture site increased during the follow-up period. Finally, complete remodeling of the condylar fragments with restored anatomic appearance was observed on 8-month or 2-year follow-up radiographs. All cases exhibited good healing aspects with no signs or symptoms of mandibular condylar dysfunction during the postoperative remodeling period after intracorporeal reduction of condylar fracture.

Multi-Detector Computed Tomography Coronal View for Deciding Optimal Incision Site in Acute Appendicitis

PURPOSE: This study identifies the optimal incision site by describing the relationship between McBurney's point and the base of appendix using the coronal view of abdominal multi-detector computed tomography (MDCT) in patients with acute appendicitis. METHODS: We reviewed the records of 206 patients with positive MDCT findings who were histologically diagnosed with acute appendicitis after appendectomy between January 2014 and September 2015. The outer 1/3 point between two points, the umbilicus and the right anterior superior iliac spine, was marked as McBurney's point on the coronal view. The superoinferior, mediolateral and radial distances between the base of appendix and McBurney's point were measured and recorded. RESULTS: The average age was 35.1±20.3 years. There were 34 patients below the age of 15-years-old (children), and 172 patients over 15-years-old (adults). In 35.4% of patients, the base of appendix was located within a radius of 2 cm from the McBurney's point, in 39.8% it was within 2~4 cm, and in 24.8% was over 4 cm. The average center coordinate of the base of inflamed appendix in our patients is 9.32 mm, 8.31 mm and the distance between two points is 12.5 mm. CONCLUSION: The location of appendix has wide individual variability; therefore the McBurney's point has limitations as an anatomic landmark. If we choose to customize appendectomy incisions considering the base of appendix by using an abdominal MDCT coronal view, additional incision site extension can be reduced.

The Prevalence and Significance of Overt Disseminated Intravascular Coagulation in Patients with Septic Shock in the Emergency Department According to the Third International Consensus Definition / 대한중환자의학회지

BACKGROUND: The prevalence and prognostic value of overt disseminated intravascular coagulation (DIC) in patients with septic shock presenting to emergency departments (EDs) is poorly understood, particularly following the release of a new definition of septic shock. The purpose of this study was to investigate the prevalence and prognostic value of DIC in septic shock. METHODS: We performed retrospective review of 391 consecutive patients with septic shock admitting to the ED of tertiary care, university-affiliated hospital during a 16-month. Septic shock was defined as fluid-unresponsive hypotension requiring vasopressor to maintain a mean arterial pressure of 65 mmHg or greater, and serum lactate level ≥ 2 mmol/L. Overt DIC was defined as an International Society on Thrombosis and Hemostasis (ISTH) score ≥ 5 points. The primary endpoint was 28-day mortality. RESULTS: Of 391 patients with septic shock, 290 were included in the present study. The mean age was 65.6 years, the 28-day mortality rate was 26.9%, and the prevalence of overt DIC was 17.6% (n = 51) according to the ISTH score. The median DIC score was higher in non-survivors than in survivors (5.0 vs. 2.0, p = 0.001). Significant higher risk of mortality was observed in overt DIC patients compared to those without (28.2% vs. 13.7%, p = 0.005). Multivariable logistic regression analysis identified DIC to be independently associated with 28-day mortality (odds ratio, 2.689 [95% confidence interval, 1.390-5.201]). CONCLUSIONS: Using the ISTH criteria of DIC, overt DIC in septic shock was found to be common among patients admitting to the ED and to be associated with higher mortality when it is accompanied with septic shock. Efforts are required to identify presence of overt DIC during the initial treatment of septic shock in patients presenting the the ED.

Prostate adenocarcinoma mandibular metastasis associated with numb chin syndrome: a case report

The purpose of this study is to report a rare case of mandibular adenocarcinoma that was diagnosed due to metastasis from the prostate. Numb chin syndrome (NCS), which was associated with this case, is also discussed. Computed tomography (CT) and an intraoral incisional biopsy of the left mandibular area were performed. Urology consultation, hormone therapy, chemotherapy and follow-up radiographic images were administered. Histological examination of the incised specimen revealed moderately differentiated adenocarcinoma. The Gleason score was 8 (primary 4/secondary 4). Immunohistochemical features and radiographic results confirmed the diagnosis of metastasis from prostate adenocarcinoma, moderately differentiated. The patient's prostate-specific antigen (PSA) level was very high. After hormone treatment, the patient's PSA levels dropped gradually. Seventeen months later, in May 2015, the PSA level was elevated. The 18-month follow-up CT image indicated that the patient's condition was aggravated. Docetaxel chemotherapy was started in June 2015 (18 months later), and the sixth cycle of the therapy is in progress. Oral metastases that originate from prostate adenocarcinoma are rare and can induce various periosteal reactions. Hormone therapy, chemotherapy and close follow-up could be additional, appropriate treatment, and were applied in this case. Finally, NCS is a valuable indicator of metastatic disease in the mandible.

Retiform hemangioendothelioma in the infratemporal fossa and buccal area: a case report and literature review

We report a case of retiform hemangioendothelioma (RH) located in the infratemporal fossa and buccal area in a 13-year-old Korean boy. The tumor originated from the sphenoid bone of the infratemporal fossa area and spread into the cavernous sinus, orbital apex, and retro-nasal area with bone destruction of the pterygoid process. Tumor resection was conducted via Le Fort I osteotomy and partial maxillectomy to approach the infratemporal fossa and retro-nasal area. The diagnosis of RH was confirmed after surgery. In the presented patient, surgical excision was incomplete, and close follow-up was performed. There was no evidence of expansion or metastasis of the residual tumor in the 8 years after surgery. In cases of residual RH with low likelihood of expansion and metastasis, even though RH is an intermediate malignancy, close follow-up can be the appropriate treatment choice over additional aggressive therapy. To date, 29 papers and 48 RH cases have been reported, including this case. This case is the second reported RH case presenting as primary bone tumor and the first case originating in the oromaxillofacial area.

The healing effect of platelet-rich plasma on xenograft in peri-implant bone defects in rabbits / 대한악안면성형재건외과학회지

BACKGROUND: The association of biomaterial combined with repair factor-like platelet-rich plasma (PRP) has prospective values. Bovine-derived xenograft has been identified as an osteoconductive and biocompatible grafting material that provides osseointegration ability. PRP has become a valuable adjunctive agent to promote healing in a lot of dental and oral surgery procedures. However, there are controversies with respect to the regenerative capacity of PRP and the real benefits of its use in bone grafts. The purpose of this study was to assess the influence of PRP combined with xenograft for the repair of peri-implant bone defects. METHODS: Twelve rabbits were used in this study, and the experimental surgery with implant installation was performed simultaneously. Autologous PRP was prepared before the surgical procedure. An intrabony defect (7.0 mm in diameter and 3.0 mm deep) was created in the tibia of each rabbit; then, 24 titanium dental implants (3.0 mm in diameter and 8.5 mm long) were inserted into these osteotomy sites. Thus, a standardized gap (4.0 mm) was established between the surrounding bony walls and the implant surface. The gaps were treated with either xenograft alone (control group) or xenograft combined with PRP (experimental group). After healing for 1, 2, 3, 4, 5, and 6 weeks, the rabbits were sacrificed with an overdose of KCl solution. Two rabbits were killed at each time, and the samples including dental implants and surrounding bone were collected and processed for histological analysis. RESULTS: More newly formed bone and a better bone healing process were observed in control group. The histomorphometric analysis revealed that the mean percentage of bone-to-implant contact in the control group was significantly higher than that of the experimental group (25.23 vs. 8.16 %; P < 0.05, independent-simple t test, analysis of variance [ANOVA]). CONCLUSIONS: The results indicate that in the addition of PRP to bovine-derived xenograft in the repair of bone defects around the implant, PRP may delay peri-implant bone healing.

The Prevalence and Significance of Overt Disseminated Intravascular Coagulation in Patients with Septic Shock in the Emergency Department According to the Third International Consensus Definition / 대한구급학회지

BACKGROUND: The prevalence and prognostic value of overt disseminated intravascular coagulation (DIC) in patients with septic shock presenting to emergency departments (EDs) is poorly understood, particularly following the release of a new definition of septic shock. The purpose of this study was to investigate the prevalence and prognostic value of DIC in septic shock. METHODS: We performed retrospective review of 391 consecutive patients with septic shock admitting to the ED of tertiary care, university-affiliated hospital during a 16-month. Septic shock was defined as fluid-unresponsive hypotension requiring vasopressor to maintain a mean arterial pressure of 65 mmHg or greater, and serum lactate level ≥ 2 mmol/L. Overt DIC was defined as an International Society on Thrombosis and Hemostasis (ISTH) score ≥ 5 points. The primary endpoint was 28-day mortality. RESULTS: Of 391 patients with septic shock, 290 were included in the present study. The mean age was 65.6 years, the 28-day mortality rate was 26.9%, and the prevalence of overt DIC was 17.6% (n = 51) according to the ISTH score. The median DIC score was higher in non-survivors than in survivors (5.0 vs. 2.0, p = 0.001). Significant higher risk of mortality was observed in overt DIC patients compared to those without (28.2% vs. 13.7%, p = 0.005). Multivariable logistic regression analysis identified DIC to be independently associated with 28-day mortality (odds ratio, 2.689 [95% confidence interval, 1.390-5.201]). CONCLUSIONS: Using the ISTH criteria of DIC, overt DIC in septic shock was found to be common among patients admitting to the ED and to be associated with higher mortality when it is accompanied with septic shock. Efforts are required to identify presence of overt DIC during the initial treatment of septic shock in patients presenting the the ED.

Odontogenic carcinosarcoma of the mandible: a case report and review

Odontogenic carcinosarcoma is an extremely rare malignant odontogenic tumor with only a few reported cases. It is characterized by a true mixed tumor showing malignant cytology of both epithelial and mesenchymal components. It has been assumed to arise from pre-existing lesions such as ameloblastoma, ameloblastic fibroma, and ameloblastic fibrosarcoma. To date, the reported cases have exhibited considerably aggressive clinical behavior. The case of an odontogenic carcinosarcoma in the mandible of a 61-year-old male is described herein. The tumor destroyed the cortex of the mandible and invaded the adjacent tissues. Treatment was performed by surgical resection and reconstruction. The purposes of this article are to introduce odontogenic carcinosarcoma through this case study, to distinguish it from related diseases and to discuss features of the tumor in the existing literature.

Retrospective study of changes in pharyngeal airway space and position of hyoid bone after mandibular setback surgery by cephalometric analysis / 대한악안면성형재건외과학회지

BACKGROUND: The posterior movement of mandible was known as the main cause of the changes in the pharyngeal airway space (PAS) and the postoperative obstructive sleep apnea (OSA). The purpose of this study was to know the changes of PAS and position of hyoid bone. METHODS: Lateral cephalographies of 13 patients who had undergone sagittal split ramus osteotomy (SSRO) setback surgery were taken preoperatively (T1), postoperatively within 2 months (T2), and follow-up after 6 months or more (T3). On the basis of F-H plane, diameters of nasopharynx, oropharynx, and hypopharynx were measured. The movements of the soft palate, tongue, and hyoid bone were also measured. RESULTS: The amount of mandible setback was 7.5 +/- 3.8 mm. In the measurements of PAS, there was a statistically significant decrease of 2.8 +/- 2.5 mm in nasopharynx (P < 0.01), and 1.7 +/- 2.4 mm in oropharynx (P < 0.01) were observed after surgery. The hypopharynx decreased 1.0 +/- 2.1 mm after surgery and continuously decreased 1.0 +/- 2.8 mm at follow-up. The changes in hyoid bone position showed the posterior movement only after surgery and posteroinferior movement at follow-up. CONCLUSIONS: The PAS such as nasopharynx, oropharynx, and hypopharynx showed relatively high correlation with the amount of mandibular setback. The change of resistance in upper airway may be important for the prevention of OSA after mandibular setback surgery.

Facelift incision and superficial musculoaponeurotic system advancement in parotidectomy: case reports / 대한악안면성형재건외과학회지

Surgical procedures for parotidectomy had been developed to gain adequate approach, prevent morbidity of nerve, and give esthetic satisfaction. We performed two cases of parotidectomy through facelift incision. One case was reconstructed with superficial musculoaponeurotic system (SMAS) flap and sternocleidomastoid (SCM) muscle rotated flap at the parotid bed. In second case, same procedures were performed, but collagen membrane was additionally implanted for prevention of Frey's syndrome. After surgery, two cases showed esthetic results without neck scar and hollow defect on parotid bed area.