Reconstruction of extensive jaw defects induced by keratocystic odontogenic tumor via patient-customized devices / 대한악안면성형재건외과학회지

Keratocystic odontogenic tumors can occur in any area of the maxilla or mandible. According to their size, location, and relations with surrounding structures, they are treated by cyst enucleation or enucleation after either marsupialization or decompression. Enucleation is performed when cysts are not large and when only minor damage to adjacent anatomical structures is expected. Although marsupialization and decompression follow the same basic bone-regeneration principle, which is to say, by reducing the pressure within the cyst, the former leaves a large defect after healing due to the large fistula necessary to induce the conversion of the cyst-lining epithelia to oral epithelia; the latter leaves only a relatively small defect, because of the continuous washing carried out by means of a tube inserted into a small hole in the cyst. In the latter case too, a decompressor appropriate for the focal position is required, owing to the importance of maintaining the device and controlling for oral hygiene. We report herein decompression treatment with a patient-customized device for an extensive cyst in the anterior region of the mandible.

Treatment Results of the New Microsurgery in Hemifacial Spasm

Hemifacial spasm is painless uncommon disorder characterized by involuntary paroxysmal movement of one side of face. Microvascular decompression at root exit zone of the facial nerve has become the standard treatment for hemifacial spasm. An alternative hypothesis, proposed for the relieve of hemifacial spasm with microvascular decompression, actually result from minor trauma or circumferential fibrosis to a sensitive zone of the facial nerve. Upon the base of this hypothesis, author have treated patient with hemifacial spasm with surgical manipulation in addition to microvascular decompression. During last fifteen years, 250 patients with hemifacial spasm underwent this operation. The age at operation ranged from 18 to 71 years, with mean over 45.7 years and the duration of symptoms averaged 5.8 years. The spasms occurred predominantly right side, 5 cases were bilateral. The common offending vessels were AICA in 127 cases(50.8%) and PICA in 50 cases(20%). The remainder were 17 cases in vertebral artery, 9 cases in labyrin-thine artery(3.6%) and multiple offending vessels were found in 29 cases(11.6%). In two hundred fifteen cases, the spasm was completely relieved within 5 days after operation. Among 25 cases whose spasm unrelieved initially after surgery, 19 cases was relieved within 3 weeks and 6 cases within 3 months. Complications following surgery is approximately 22.8%: the most commonly encountered deficit is facial weakness(16 cases) followed by CSF leak (12 cases), and some degree of hearing loss(12 cases). Other complications include wound infection, ataxia, pneumocephalus and focal hemorrhage. Surgical manipulation in addition to microvascular decompression for hemifacial spasm(a new combined approach) produces better results of improvement approximately up to 96%.

Regional Cerebral Blood Flow in Intracranial Tumors

Reginal cerebral blood flow was measured in 40 patients with intracranial tumors using 133 Xe-inhalation method ; 15 metastatic brain tumors, 11 meningiomas, 14 glioblastoma multiformes. While superficially located meningiomas usually revealed high cortical flow in the tumor area, metastatic brain tumors and glioblastoma multiformes showed low cortical flow. High flow in meningiomas may be related to the vascular proliferation on the tumor surface, low flow in metastatic brain tumors and glioblastoma multiformes may be result from surrounding brain edema. Measurement of rCBF can afford differential diagnostic information in meningiomas, but study is needed further in differenting between metastatic brain tumors and glioblastoma multiformes.