The Pros and Cons of Computer-Aided Surgery for Segmental Mandibular Reconstruction after Oncological Surgery

Computer-aided surgery (CAS) started being used for head and neck reconstruction in the late 2000s. Its use represented a paradigm shift, changing the concept of head and neck reconstruction as well as mandible reconstruction. Reconstruction using CAS proceeds through 4 phases: planning, modeling, surgery, and evaluation. Thus, it can overcome a number of trial-and-error issues which may occur in the operative field and reduce surgical time. However, if it is used for oncologic surgery, it is difficult to evaluate tumor margins during tumor surgery, thereby restricting pre-surgical planning. Therefore, it is dangerous to predetermine the resection margins during the pre-surgical phase and the variability of the resection margins must be taken into consideration. However, it allows for the preparation of a prebending plate and planning of an osteotomy site before an operation, which are of great help. If the current problems are resolved, its applications can be greatly extended.

A Novel Surgical Method Using Two Triangular Flaps for Accessory Tragus

BACKGROUND: Accessory tragus is an abnormal ear structure that has the shape of a nodule or a papule. The existing surgical method is very simple, wherein an elliptical incision is made around the lesion and the underlying cartilage is removed. However, this method may leave a depressed or dimpled scar and may cause chondrodermatitis. METHODS: We corrected the accessory tragus by a new method using triangular flaps, and the procedure was performed in eight patients. Out of the four triangular flaps, which were created by drawing lines that connected the left and the right sides and the superior and inferior surfaces of the accessory tragus and quartering them, two flaps that faced each other were excised. Once the cartilaginous tissue inside was verified and removed up to the base to the greatest extent possible, the remaining two triangular flaps were sutured and the remaining skin margin of the flap was trimmed. RESULTS: None of the patients had any wound problems related to the surgery, and none of them complained of chondrodermatitis up to 6 months postoperatively. No depression or dimple was observed externally up to 6 months after the operation, and the z-shaped scar, which was created by the crossing over of the triangular flaps, was not as visible as a linear scar. CONCLUSIONS: Correction of an accessory tragus by using the triangular flaps introduced in this study provides a wider operative view through a smaller incision, while preventing the formation of dimples or a depression after the operation.

Comparative anatomical characteristics of cardiac valves in animals / 동물의과학연구지

Although various animals have been used as models of cardiac valvular diseases in humans, the structural characteristics of cardiac valves in animals remain unclear. In this study, we investigated cardiac valves in representative animal models for the purpose of comparative anatomy. Adult hearts from three dogs, four goats, six rabbits, and six fowls were fixed with 10% neutral-buffered formalin and analyzed gross-anatomically. Cardiac appearance was spherical or oval in dogs, goats, and rabbits, whereas it had a long conical shape in fowls. Left atrioventricular (AV) valve was composed of membranous septal and parietal cusps connected to two papillary muscles in all animals. The right AV valve was composed of membranous septal, parietal, and angular cusps with three papillary muscles in dogs and goats, membranous septal and parietal cusps attached to four papillary muscles in rabbits, and a single muscular plate without any papillary muscles and chorda tendinae in fowls. Aortic valves with thin membranous right, left, and septal semilunar cusps in dogs, goats, and rabbits had a thick membrane with a bended free border in fowls. Pulmonary valve (PV) with membranous right, left, and intermediate semilunar cusps made a large central hole by being closely attached to the surrounding wall in dogs, goats, and rabbits, whereas it protruded into half of the lumen as a thick membrane in fowls. The membranous cusp of the PV was composed of several layers in dogs and goats but was a single layer in rabbits and fowls. These findings indicate that even if animals have two completely separated atria and ventricles each, cardiac valves have species-specific morphological characteristics, especially between mammals and fowls.

Early congenital syphilis presenting with skin eruption alone: a case report / 소아과

Congenital syphilis is one of the most well-known congenital infections, yet it remains a worldwide public health problem. Congenital syphilis can involve any organ system and present with various symptoms. However, early diagnosis of congenital syphilis is difficult because more than half of the affected infants are asymptomatic, and the signs in symptomatic infants may be subtle and nonspecific. Here, we report a case of congenital syphilis with only a skin rash, which led to a delay in diagnosis. This case indicates that congenital syphilis should be considered throughout early childhood.

An Experimental Study for The Biomechanical Properties and Histologic Reactions of Carbon Fiber Reinforced Epoxies(CFRE) * Implant / 대한정형외과학회잡지

Histologic reactions of bone and soft tissue to CFRE were explored, and biomechanical properties of both CFRE plate and stainless steel plate were tested and compared. Six achilles tendons of albino rabbits were replaced with CFRE implant after artificial rupture and serial histologic examination of neotendon and histologic response in vivo were done during 8 weeks. Proximal tibia of twelve albino rabbit was selected, subjected the tibia a single osteotomy and internal fixation with CFRE plate in six cases, and stainless steel plate in the others. And then, consequent radiographic and histologic change was observed during 8 weeks. Objectives in this paper is to provide basic data of CFRE in its biomechanical and biologic response in vivo. The results were as follows :1. Foreign body reaction and fibroblast were decreased at 7-8 weeks after operation. Early formation of collagen, which is similar to that found in the normal side, was shown. So, CFRE seems to be ideal material in the aspect of tissue tolerance among biocomaptibility factors. 2. In biomechanical test, CFRE plate is lower than stainless steel plate in flexural strength and flexural modulus. This means that CFRE plate is semirigid in nature. 3. While external callus formation is marked after fixation of CFRE, internal callus for mation is marked after fixation of stainless steel plate. In CFRE plated tibia, the resorption-cavity is much smaller than stainless steel plated, and there is some formation of woven bone beneath the plate. In conclusion, CFRE is ideal material in the aspect of its biomechanical compatibility and tissue tolerance. Further efforts on production and varying design of CFRE make it to use widely in clinical application, Such as internal fixator of fracture and temporary replacement of tendon or ligament.

Lumbar Epidural Venography in the Diagnosis of Lumbar Disc Herniation / 대한정형외과학회잡지

Epidural venography is a relatively simple and highly accurate method in the diagnosis of lumbar disc herniation. Angiographic visualization of the epidural vein has been tried and investigated by intraosseus injection of contrast agent into lumbar spinous process and intravascular injection into iliac vein since first report in 1954. Recently, lumbar epidural venography is instituted by selective catheterization of ascending lumbar vein or internal iliac vein. Lumbar epidural venography is valuable for the diagnosis of herniated lumbar disc, not demonstrated by myelography. Especially, lumbar epidural venography is more accurate than myelography in the diagnosis of L5-Sl disc herniation and in the case of extreme lateral herniation. Other advantages of epidural venography are low incidence of complication and ease of performance. Epidural venography may be recommended as an alternative rnethod rather than as adjunctive to myelography. We report 20 cases of epidural venography, compared with myelographic and operative findings.

Appendiceal Tuberculosis of Spine / 대한정형외과학회잡지

The appendiceal tuberculosis is a rare from of skeletal tuberculosis in child and adults, arising from a focus or foci in posterior compartment of spine. This from may be unilateral and may be isolated or present at multiple levels, characterieed by slight change of the disk space and deformity, but large psravertebral abscess are invariable. Extradural extension may lead to the development of paraplegia. We had experienced one case of appendiceal tuberculosis at L1 and treated with antituberculosis medication and radical curettage, followed with body jacket cast.

Osteopetrosis / 대한정형외과학회잡지

Osteopetrosis is a rare familial disease, characterized roentgenographically by a marked increase in the radiodensity of bone and by abnormality in the shape of the long bone, especially the metaphysis. It was discovered fist by Albers-Schonberg in 1904 during an X-ray examination of a patient and is known as Albers-Schonberg disease, marble bone or osteosclerosis fragilis generalisata. We experienced a case of osteopetrosis in adult.

Comparative study between myelograpic and operative finding on 150 cases of lumbar H.I.V.D / 대한정형외과학회잡지

During January 1975 to December 1979, myelographic studies followed by operation was carried out on 150 cases of lumbar H.I.V.D. at Chung Nam National University Hospital. As to the myelographic findings, mode, level of indentation, and positive and negative finding were analyzed in comparison with operative findings. The followings results were obtained: 1. Plain radiography has a Iittle value In diagnosis of Iumbar H.I.V.D. about one third of 150 cases show significant sign in plain film study. 2. The major discrepancies between myelographic and operative findings were found in 11.3%, while the minor discrepancies were 4%, so giving an accuracy of 84.7%. 3. Positive myelographic finding(120 cases) consisted of smooth round defect in 83 cases (48.8%), unilateral wedge defect In 45 cases (26.4%), block defect In 18 cases (10.5%), bilateral wedge defect in 13 cases (7.6%), and hourglassdefect In 11 cases (6.4%), respectively. 4. Operative findings revealed the protruded disc: 74.5%, bulging: 11.1%, extruded: 22%, and mlgrated: 1.7%. 5. The myelographic finding of bulging type disc usually showed smooth round filling defect and those of protruded were smooth round filling defect, wedge shape and block filling defect, while the extruded type revealed smooth round filling defect In the most cases. 6. The myelography can be a valuable aid in the determination of the level and degree of H.I.V.D. and very helpful ln differential diagnosis.

Disseminated Bone Tuberculosis / 대한정형외과학회잡지

Disseminated bone tuberculosis is a rare manifestation of skeletal tuberculosis in adults in which cystlike lesions occur in the axial skeleton, shoulder, and pelvic girdles. Varied nomenclature applied to the entity of multiple cystic bone lesions in bone tuberculosis have been described in the literature. We experienced 2 cases of disseminated bone tuberculosis in adult.