Fabrication of 3D-Printed Implant for Two-Stage Ear Reconstruction Surgery and Its Clinical Application

Purpose@#Ear reconstruction is one of the most difficult areas in the field of reconstructive surgery. Due to limitations of the current practice, a novel method of auricular reconstruction is needed. Major advancements in three-dimensional (3D) printing technique have rendered the process of ear reconstruction more favorable. Herein, we present our experience in designing and clinically using 3D implants in both 1st and 2nd stage ear reconstruction surgery. @*Materials and Methods@#After obtaining 3D CT data from each patient, a 3D geometric ear model was created using mirroring and segmentation processes. The 3D-printed implant design resembles but does not exactly match the normal ear shape, and can be inserted in harmony with the currently used surgical technique. The 2nd stage implant was designed to minimize dead space and support the posterior ear helix. The 3D implants were finally fabricated with a 3D printing system and used in ear reconstruction surgery in our institute. @*Results@#The 3D implants were manufactured for application to the currently used two-stage technique while maintaining the shape of the patient’s normal ear. The implants were successfully used for ear reconstruction surgery in microtia patients. A few months later, the 2nd stage implant was used in the 2nd stage operation. @*Conclusion@#The authors were able to design, fabricate, and apply patient-specific 3D-printed ear implants for 1st and 2nd stage ear reconstruction surgeries. This design, combined with 3D bioprinting technique, may be a future alternative for ear reconstruction.

Progressive Multifocal Leukoencephalopathy With Hyper-IgM Syndrome in a 6-Year-Old Boy

Hyper-immunoglobulin (Ig) M syndrome is a congenital immunodeficiency disorder characterized by increased serum IgM with low serum IgG, IgA, and IgE. We report the case of a 6-year-old boy with hyper-IgM syndrome as an underlying disease who showed progressive multifocal leukoencephalopathy findings on brain magnetic resonance imaging after visiting the hospital due to left upper extremity muscle weakness, gait disturbance, and speech impairment. At the time of hospitalization, he was treated with steroids and intravenous immunoglobulin, and his condition improved somewhat, but 6 months later, he visited the hospital with rapid deterioration.

The status of advanced cardiac life support performance by resident belonging to other department except for department of emergency medicine in in-hospital cardiac arrest

OBJECTIVE: This paper reports the status of the advanced cardiac life support (ACLS) according to the guidelines by residents belonging to other departments other than the department of emergency medicine. The differences in status between the junior group and senior group was also investigated according to grades of residents. METHODS: The ACLS performance for in-hospital cardiac arrest cases of one academic hospital, except for the cases occurring in intensive care unit between November 2015 and October 2017, were analyzed retrospectively. Data included the characteristics of residents, patients' outcomes, ACLS performance, and conventional treatment having discordance with the ACLS guidelines. Leaders during cardiopulmonary resuscitation (CPR) were divided into a junior group and senior group. RESULTS: A total of 152 cases were enrolled in this study. Of these, 131 cases (86.2%) showed at least one treatment with inconsistency from the guidelines and the incidence of discordant treatment was similar in the two groups (55 [85.9%] vs. 76 [88.4%], P=0.657). Implicit use of sodium bicarbonate was more frequent in the senior residents group (odds ratio [OR], 3.04; 95% confidence interval [CI], 1.36–6.81). On the other hand, no use of a defibrillator was less frequent in the senior residents group (OR, 0.14; 95% CI, 0.03–0.81). CONCLUSION: In both groups, the rate of discordance with the ACLS guidelines during CPR were high. The rate of implicit use of sodium bicarbonate and no use of defibrillator were significantly different in the two groups. A customized education strategy for ACLS is needed for each group.

Analysis of Herbal Medicine Prescriptions for Patients in An Academic Korean Medical Hospital: A Cross Sectional Study of Electronic Medical Records (2010-2013) / 中国结合医学杂志

<p><b>OBJECTIVE</b>To obtain fundamental information for the standardization of herbal medicine in Korea.</p><p><b>METHODS</b>We analyzed the herbal medicine prescription data of patients at the Pusan National University Korean Medicine Hospital from March 2010 to February 2013. We used the Dongui-Bogam (Dong Yi Bao Jian) to classify prescribed herbal medicines.</p><p><b>RESULTS</b>The study revealed that the most frequently prescribed herbal medicine was 'Liuwei Dihuang Pill (LWDHP, )' which was used for invigorating 'Shen (Kidndy)-yin'. 'LWDHP' was most frequently prescribed to male patients aged 50-59, 60-69, 70-79 and 80-89 years, and 'Xionggui Tiaoxue Decoction (XGTXD, )' was most frequently prescribed to female patients aged 30-39 and 40-49 years. According to the International Classification of Diseases (ICD) codes, 'Diseases of the musculoskeletal system and connective tissue' showed the highest prevalence. 'LWDHP' and 'XGTXD' was the most frequently prescribed in categories 5 and 3, respectively. Based on the percentage of prescriptions for each sex, 'Ziyin Jianghuo Decoction ()' was prescribed to mainly male patients, and 'XGTXD' with 'Guima Geban Decoction ()' were prescribed to mainly female patients.</p><p><b>CONCLUSION</b>This study analysis successfully determined the frequency of a variety of herbal medicines, and many restorative herbal medicines were identified and frequently administered.</p>

Phytochemical Constituents from the Rhizomes of Osmunda japonica Thunb and Their Anti-oxidant Activity

Eleven compounds (1–11) were isolated from the rhizomes of Osmunda japonica, and their structures were elucidated based on 1H, 13C-NMR and LC-IT-TOF MS data. Of these compounds, all compounds (1 – 11) have been previously reported, although five (6 – 9, 11) have not previously been isolated from this plant. The antioxidant activities of isolated compounds (1 – 11) were measured by DPPH and ABTS assays, and compound 10 showed the high antioxidant activity.

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.

Acute toxicity and cytotoxicity evaluation of Dendrobium moniliforme aqueous extract in vivo and in vitro / 한국실험동물학회지

Dendrobium moniliforme (L.) Sw., an herb of the Orchidaceae family, has long been used in traditional medicine to strengthen bones, nourish the stomach, and promote the production of bodily fluid. Recently, polysaccharides isolated from Dendrobium have been used in functional foods and nutraceutical products. A traditional method to process Dendrobium is to soak fresh stems in an ethanol solution, which is the most important factor to ensure high yields of aqueous-extractable polysaccharides. The present study was carried out to investigate the potential acute toxicity of D. moniliforme aqueous extract (DMAE), by a single oral dose in Sprague-Dawley rats. The test article was orally administered once by gavage to male and female rats at doses of 0, 2,500, and 5,000 mg/kg body weight (n=5 male and female rats for each dose). Throughout the study period, no treatment-related deaths were observed and no adverse effects were noted in clinical signs, body weight, food consumption, serum biochemistry, organ weight, or gross findings at any dose tested. The results show that a single oral administration of DMAE did not induce any toxic effects at a dose below 5,000 mg/kg in rats, and the minimal lethal dose was considered to be over 5,000 mg/kg body weight for both sexes. With respect to cytotoxicity, the cell viability of human embryonic kidney (HEK293) cells was less than 50% when the cells were treated with 10 mg/mL aqueous extract for 24 h.

Complications of Injectable Soft Tissue Filler

BACKGROUND: Soft tissue fillers have been used widely in recent years. As the use of filler increases, many complications have arisen. The complications should be prevented and if it occurs effective treatments are necessary to achieve a satisfying aesthetic result. In this article, we discuss the commonly used soft tissue filler and their complications. METHODS: We divided the soft tissue filler into three groups according to its origin. The possible complications and management according to the kind of filler were reviewed. RESULTS: Soft tissue fillers can be divided into autologous, biologic, and synthetic groups. Local reaction in the injection site is a common and minimal complication. Misplacement, allergic reaction, infection, and delayed granulomatous reaction can occur. Skin necrosis and visual impairment can occur. It is desirable to have proficiency of basic injection techniques such as aspiration before injection, injection with needle withdrawal, slow injection of small amount, using the blunt-tipped microcannula, pinching and tenting. CONCLUSIONS: Soft tissue filler is a simple and safe material to soft tissue augmentation. Clinicians should know about the property and complications of the commonly used fillers. Also clinicians should be well aware of preventing and treating the complications.

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.

Condylar Hyperplasia with Long-standing Temporomandibular Joint Dislocation

Pigmented villonodular synovitis of the temporomandibular joint - computed tomography and magnetic resonance findings: a case report

Pigmented villonodular synovitis (PVNS) is a benign but locally aggressive and destructive disease originating in the synovial membranes. It is a proliferative disorder of unknown etiology. Involvement of the temporomandibular joint (TMJ) is very rare. Computed tomography clearly reveals areas of lytic bone erosion and sclerosis, and also clearly defines the extent of the tumor which is the focal areas of hyperdensity within the soft-tissue mass. Magnetic resonance images invariably show profound hypointensity on both T1- and T2-weighted sequences due to hemosiderin pigmentation. Additionally, high signal intensity on T2-weighted images may indicate cystic loculation of the joint fluid. This case study describes a rare case of PVNS of the TMJ with bone destruction of the mandibular condyle. Complete surgical excision of the lesion was performed through a preauricular approach with temporal extension. During the 10-year follow-up, two more operations were performed due to local recurrence and the fracture of the reconstruction plate. Total joint reconstruction with Biomet was finally performed, and the absence of disease was confirmed with a biopsy report showing fibrosis with hyalinization and mild inflammation of the excised soft tissue from the old lesion.

Histomorphometric Analysis on Bone Formation Effect of Beta-tricalciumphosphate around Dental Implants in Rabbit Mandibular Body: Pilot Study

Tibial bone fractures occurring after medioproximal tibial bone grafts for oral and maxillofacial reconstruction

OBJECTIVES: Oral and maxillofacial defects often require bone grafts to restore missing tissues. Well-recognized donor sites include the anterior and posterior iliac crest, rib, and intercalvarial diploic bone. The proximal tibia has also been explored as an alternative donor site. The use of the tibia for bone graft has many benefits, such as procedural ease, adequate volume of cancellous and cortical bone, and minimal complications. Although patients rarely complain of pain, swelling, discomfort, or dysfunction, such as gait disturbance, both patients and surgeons should pay close attention to such after effects due to the possibility of tibial fracture. The purpose of this study is to analyze tibial fractures that occurring after osteotomy for a medioproximal tibial graft. MATERIALS AND METHODS: An analysis was intended for patients who underwent medioproximal tibial graft between March 2004 and December 2011 in Inha University Hospital. A total of 105 subjects, 30 females and 75 males, ranged in age from 17 to 78 years. We investigated the age, weight, circumstance, and graft timing in relation to tibial fracture. RESULTS: Tibial fractures occurred in four of 105 patients. There were no significant differences in graft region, shape, or scale between the fractured and non-fractured patients. CONCLUSION: Patients who undergo tibial grafts must be careful of excessive external force after the operation.

Assessment of the autogenous bone graft for sinus elevation

OBJECTIVES: The posterior maxillary region often provides a limited bone volume for dental implants. Maxillary sinus elevation via inserting a bone graft through a window opened in the lateral sinus wall has become the most common surgical procedure for increasing the alveolar bone height in place of dental implants in the posterior maxillary region. The purpose of this article is to assess the change of bone volume and the clinical effects of dental implant placement in sites with maxillary sinus floor elevation and autogenous bone graft through the lateral window approach. MATERIALS AND METHODS: In this article, the analysis data were collected from 64 dental implants that were placed in 24 patients with 29 lacks of the bone volume posterior maxillary region from June 2004 to April 2011, at the Department of Oral and Maxillofacial Surgery, Inha University Hospital. Panoramic views were taken before the surgery, after the surgery, 6 months after the surgery, and at the time of the final follow-up. The influence of the factors on the grafted bone material resorption rate was evaluated according to the patient characteristics (age and gender), graft material, implant installation stage, implant size, implant placement region, local infection, surgical complication, and residual alveolar bone height. RESULTS: The bone graft resorption rate of male patients at the final follow-up was significantly higher than the rate of female patients. The single autogenous bone-grafted site was significantly more resorbed than the autogenous bone combined with the Bio-Oss grafted site. The implant installation stage and residual alveolar height showed a significant correlation with the resorption rate of maxillary sinus bone graft material. The success rate and survival rate of the implant were 92.2% and 100%, respectively. CONCLUSION: Maxillary sinus elevation procedure with autogenous bone graft or autogenous bone in combination with Bio-Oss is a predictable treatment method for implant rehabilitation.

A Study on the Prediction of Hard and Soft Tissue Changes after Setback Genioplasty

The Differences of 2nd to 4th Digit Length Ratio between Schizophrenia Patients and Normal Controls / 신경정신의학

OBJECTIVES: The length ratio of the second to the fourth finger (2D : 4D) is a known indirect measure of prenatal sex hormone exposure. Sex hormones influence brain development through structural and epigenetic modifications of neurons. We examined the 2D : 4D in schizophrenia patients and normal controls to investigate the relationship between prenatal sex hormone exposure and the genesis of schizophrenia. METHODS: The participants were 187 schizophrenia patients (94 male, 93 female) and 190 normal controls (95 male, 95 female). We determined handedness via the Edinburgh Handedness Inventory and age of onset of schizophrenia via clinical records or directly questioning the patients. We measure digit length using vernier caliper and performed T-tests, ANOVA, and ANCOVA to analyze the data. RESULTS: There were no significant 2D : 4D differences between schizophrenic participants and normal controls. Also, there was no significant correlation between the 2D : 4D and the age of onset of schizophrenia. Among the controls, the 2D : 4D was significantly higher (more "feminized") in females than in males (F=4.937, p=.027). But, there were no significant 2D : 4D sex differences among the schizophrenia patients (F=3.429, p=.066). CONCLUSION: These results imply that sex hormone changes during fetal development might play some role in the development of schizophrenia.

Forehead Reconstruction with Hydroxyapatite Cement(Mimix(TM)) and the Check Framework

PURPOSE: The purpose of this study is to develop hydroxyapatite cement simplified procedures for reconstruction of craniofacial deformities. Due to its expense and characteristics of quick hardening time, it may be inappropriate for forehead reconstruction or augmentation. Therefore we hear by introduce a more precise, easy and cheap method. The authors report forehead reconstruction with hydroxyapatite cement for a patient who suffered from craniofacial deformity. METHODS: Case report and literature review. RESULTS: A 35 year old man came to us with forehead and temporal area depression. He had a history of brain operations due to traumatic epidural hematoma. A physical exam showed an evidence of right side forehead weakness sign. Authors made RP model of his skull and applied check framework with Kirschner's wires for measuring accurate volume and contour on the depressed right side forehead area on the RP model. After complete exposure of defect area by bicoronary insicion, absorbable plate which applied on skull area was removed. Using three Kirschner's wires, authors made check framework on the right forehead lively and fixed with 2-hole miniplates on the boundary of the defect. After checking asymmetry, hydroxyapatite was applied on check shape framework just above Kirschner's wire. After removing Kirschner's wire, we corrected minimal unbalance and contour with bur. CONCLUSION: Check framework with Kirschner's wire was very convenient and cost saving methods for forehead reconstruction with hydroxyapatite cement.

Effect of Fibrin Sealant in Extended Lattisimus Dorsi Flap Donor Site: Retrospective Study

PURPOSE: Donor site seroma is the most common complication of extended latissimus dorsi flap for breast reconstruction. One of preventive treatments is to use the fibrin sealant in donor site before closure. Experimentally, it has been used successfully in the prevention of latissimus donor site seroma, but its clinical efficacy and results were very controversial. Thus, the purpose of this study is to evaluate the clinical efficacy and to determine the optimal dose of fibrin sealant. METHODS: A retrospective study was done of patients operated under same surgical conditions by one operator with variable doses of fibrin sealant. The study group consisted of 60 consecutive patients who underwent breast reconstruction with extended latissimus flap reconstructions from January 2005 to December 2006. Patients were divided into 4 group by applied fibrin sealant amount(group 1=0mL, group 2=1mL, group 3=2mL, group 4=4mL). Retrospective data were obtained from total postoperative drainage amount, time from surgery to drain removal, and incidence and quantity of seroma formation in matched patients group. RESULTS: Total drainage amount decreased relative to the amount of fibrin sealant. The seroma formation rate of 30% in the study group 4 was significantly less than group 1 rate of 71%(p<0.05). It was an improvement over the rates of as much as 79% described previously in the literature. Also, time from surgery to drain removal was shortened significantly in group 4 patients (p<0.05). CONCLUSION: The use of fibrin sealant in the extended latissimus dorsi flap donor site appears effective in preventing seroma. However, important factors to obtain lower seroma formation rates are proper techniques and proper amounts such as the authors suggested amount: 0.01mL/cm2 with spray type fibrin sealant.