양측성 구순/구개열을 가진 이란성 쌍둥이를 대상으로 한 술전 비치조정형술: 증례보고

김진선,김영진,남순현,김현정 大韓小兒齒科學會 2014 大韓小兒齒科學會誌 Vol.41 No.1

Cleft lip and palate(CLP) is one of the most common craniofacial deformities that requires systemic managementinvolving a multidisciplinary team approach. Although there has been great improvement in the field of cleftsurgery, surgical approach alone cannot resolve the various problems in treating cleft lip and palate. Hence theneed for presurgical treatment was appreciated and especially, the concept of presurgical nasoalveolar moldingwas applied to treat unilateral and bilateral cleft lip and palate patients. Presurgical nasoalveolar molding(PNAM) of unilateral cleft mainly aims to recover nasal symmetry while theobjectives of pre-surgical nasoalveolar molding in the bilateral cleft are to elongate the columella, to erect the tipof nose, and to reposition the forward displaced premaxillary region. This report covers the case of fraternal twins diagnosed with bilateral cleft. Retraction of the premaxillaryregion and nasoalveolar molding were conducted for 70 days until cheiloplasty, using elastic bands andnasoalveolar molding appliances. After cheiloplasty, there had been improvements in the length of columella andthe position of forward-displaced premaxilla for both patients compared to their initial states. The esthetics wasalso satisfactory for both the surgery and the parents. In order to maximize the efficacy of the appliance, threecomponents should be in balance; patients’adaptation to the appliance, parents’cooperation and proper selectionand careful adjustment of the appliance by the dentist. 구순구개열은 선천성 악안면 기형 중 발생률이 가장 높은 질환으로 관련된 여러 분야의 협진(team approach)을 통한 조직적인 관리를 필요로 한다. 치료에 있어 수술분야의 많은 발전이 있어 왔으나 수술만으로는 다양한 문제점을 해결하기 어려웠다. 이에 따라 술 전 처치의 필요성을 인식하여 술전 비치조 정형의 개념이 개발되었으며 편측성 및 양측성 구순구개열 환자에게 적용되고 있다. 편측성 구순구개열에서 술전 비치조정형의 목적을 코의 대칭성을 회복시키는데에 중점을 두었다면 양측성 구순구개열에서는 짧은 비소주를 신장시키고, 낮아진 코끝을 세우고, 전방으로 변위된 전상악부를 재위치 시키는 것이 목적이라 할 수 있다. 본 증례에서는 양측성 구순/구개열로 진단받은 이란성 쌍둥이에게 술전 탄성밴드와 비치조정형 장치를 이용하여 첫 번째입술수술 전까지인 약 70일간 전상악부의 후방 견인 및 술전 비치조정형을 시행하였다. 두 환아 모두 초기에 비해 비소주가길어지고 전방 변위된 전상악부가 제 위치로 많이 회복된 것을 관찰할 수 있었다. 그리고 입술 수술 후 술자와 보호자가 모두만족할만한 심미적인 결과를 얻을 수 있었다. 장치의 효과를 극대화하기 위해서 환자의 적응력, 보호자의 협조도 및 술자의적절한 장치물의 선택과 세심한 조정, 이 3가지 요소가 조화를 이루어야 할 것이다.

Effect of Presurgical Nasoalveolar Molding in Unilateral Cleft Lip and Palate Infants

Jin-Sun Kim,Young-Jin Kim,Soon-Hyeun Nam,Hyun-Jung Kim 大韓小兒齒科學會 2013 大韓小兒齒科學會誌 Vol.40 No.3

Cleft lip and palate, the most common craniofacial anomalies, are severe congenital defects that have an incidence of 0.28 to 3.74 per 1000 live births. Although there has been great improvement in the field of cleft surgery, surgical approach cannot be the single solution to resolve the various problems encountered in patients with cleft lip and palate. The concept of presurgical infant orthopedics (PSIO) for gradual closure of the cleft gap and simplified surgical performance was first introduced by McNeil in 1950. Recently, there are many attempts not only to approximate the alveolar segments but also to reshape the nasal cartilage. Three infants with unilateral cleft lip and palate were referred from the department of Plastic Surgery for presurgical nasoalveolar molding (PNAM). Maxillary appliances using resin with orthodontic wire were fabricated. Then these appliance was applied until patients underwent lip surgery. In all cases, the patients could wear the appliance all day since they were able to eat even with the appliance on, This resulted in significant improvements in the nasal symmetry were found. Our appliance, namely K-NAM, extends the wearing time within the limited period and as a result it is expected to maximize the treatment effects. Used properly, this appliance would play a major role in enhancing nasal symmetry with satisfactory results. 구순구개열은 얼굴에 발생하는 다양한 종류의 기형 중 빈번히 발생하는 기형으로, 발생 빈도는 일반적으로 1000명당0.28~3.74명으로 알려져 있으나 파열의 종류, 인종 및 성별에 따라 큰 차이를 보인다. 구순구개열의 치료는 수술영역에서 많은 발전이 있었지만 수술만으로는 문제점을 해결하기는 어렵다. 파열부 간격을 줄이고 구순열 수술을 용이하게 하기 위한 술전 신생아 정형술의 개념이 1950년 McNeil에 의해 개발되었으며, 최근에는 술전비치조 정형장치(presurgical nasoalveolar molding appliance, PNAM)를 사용하여 치조골뿐만 아니라 코의 모양을 정상화하려는 시도가 이루어지고 있다. 세 명의 환자가 편측성 구순구개열로 진단받은 후 술전비치조정형장치 장착을 위해 의뢰되었다. 레진과 교정용와이어를 이용하여 제작한 K-NAM 장치물을 입술 성형 수술을 시행하기 전까지 장착하였다. 첫 내원시와 nasal molding을 시행하여입술 성형 수술을 하기 직전, 입술 성형 수술 이후 콧구멍의 높이, 너비, 비주의 각도를 측정하여 비교한 결과 세 증례에서 모두 코의 대칭성이 증가하며 술 후 심미개선에 효과적임을 알 수 있었다. K-NAM 장치물은 장치의 장착, 유지, 조절이 용이하고 장착한 상태에서 수유가 가능하기 때문에 장착시간을 증가시킬 수 있다. 따라서 nasal molding이 가능한 한정된 기간안에 최대의 효과를 기대할 수 있다. 그리고 젖병을 빠는 행위가 가능해짐으로써 동시에 구강조직의 발달에도 도움을 줄 수있을 것이라 생각한다.

편측성 완전 구순열에서 악정형 장치로서 Latham 장치와 PNAM 장치의 순차적 이용- 증례보고

임재석,박진후,정휘동,정영수 대한구순구개열학회 2017 대한구순구개열학회지 Vol.20 No.1

Severe cleft forms are associated with severe nasolabial deformities, and present a significant surgical challenge in order to achieve functional and aesthetic outcome. The aim of presurgical infant orthopedics (PSIO) is to reduce the severity of the cleft (e.g., nasal deformity, cleft size), thereby improving surgical results, reducing the need for lip and nose revisions. Since the concept of Presurgical infant orthopedics (PSIO) was first introduced by McNeil in 1950, various forms of orthopedic devices with different mechanics have been developed. The Latham device applies active force which align the maxillary segments and reduce the cleft size prior to definitive surgery. The Presurgical Nasoalveolar Molding (PNAM) device corrects the position of the nasal tip, alar base, philtrum, and columella improving nasal appearance, which can minimize the need for secondary nasal surgery. In this article we report sequential use of Latham device and Presurgical nasoalveolar molding (PNAM) device in unilateral complete cleft lip and palate patient

완전 편측성 구순열 및 불완전 구개열 신생아에서 술전 비치조 정형장치를 이용한 치료 - 증례보고

홍석환,이용빈,정휘동,정영수 대한구순구개열학회 2016 대한구순구개열학회지 Vol.19 No.2

Cleft lip and palate are the most common congenital facial deformities. Surgical approach alone cannot resolve all the various problems in patients with cleft lip and palate. The concept of presurgical infant orthopedics (PSIO) was first introduced by McNeil to reduce the interval of the cleft and to facilitate surgery. In addition to the traditional PSIO concept, Grayson et al. also reported that a presurgical nasoalveolar molding appliance (PNAM), capable of non-surgically expanding short columella and correcting nasal tip cartilage deformities. The newborn with unilateral cleft lip and palate was referred from the department of Neonatology to the department of Oral & Maxillofacial Surgery(OMFS) for evaluation & treatment. The PNAM was applied 19 days after birth. Then the PNAM was applied for 99 days before the operation and the primary lip and nose repair was performed at 118 days after birth. From the result of this case, we could see that preoperative application of PNAM may provide improvement in the esthetics of nasolabial complex and can minimize the scar tissue after surgery by reducing tension on the surgical area. It can also be helpful to normalize the shape of the nose through correcting of the nasal cartilage and extension of columella.

Three-dimensional evaluation of alveolar changes induced by nasoalveolar molding in infants with unilateral cleft lip and palate: A case-control study

Merve Altay Burgaz,Derya Germec Cakan,R. Burcu Nur Yılmaz 대한치과교정학회 2019 대한치과교정학회지 Vol.49 No.5

Objective: The objectives of this study were to evaluate linear and volumetric alveolar changes induced by nasoalveolar molding (NAM) in infants with complete unilateral cleft lip and palate (UCLP) and compare the maxillary dimensions after NAM with the normal dimensions in infants without clefts. Methods: A total of 26 infants with UCLP treated by NAM (mean age before and after NAM: 14.20 ± 8.09 days and 118.16 ± 10.06 days, respectively) comprised the treatment group, while 26 infants without clefts (mean age: 115.81 ± 8.71 days) comprised the control group. Changes in the maxillary dimensions following NAM were measured on three-dimensional models using Mimics software, version 17.0. Results: During NAM, there was a decrease in the cleft widths, maxillary arch depths, and rotation of the greater segment. While the anterior alveolar arch width exhibited a significant decrease, the posterior arch width was mostly maintained. There were no changes in the anterior vertical deviations of the alveolar segments. The alveolar crest lengths, arch circumference, and bilateral posterior volumetric measures exhibited an increase. After NAM, the anterior arch width was comparable between the treatment and control groups, whereas the posterior arch width and anterior vertical deviations were greater in the treatment group than in the control group. The maxillary arch depths, alveolar crest lengths, and maxillary volumes were smaller in the NAM group than in the control group. Conclusions: During NAM in infants with UCLP, the cleft width and anteroposterior and transverse alveolar dimensions exhibited a decrease while the vertical dimensions were maintained. Compared with infants without clefts, those with UCLP treated by NAM exhibited sagittal and vertical alveolar growth deficiencies and tissue insufficiency.

술자가 제작한 술전 비치조교정기를 이용한 일측성 구순열의 교정

양정열,조인영,천지선 大韓成形外科學會 2004 Archives of Plastic Surgery Vol.31 No.1

완전 편측성 순구개열 신생아 환자의 술전 비치조 정형장치와 구순열 수술이 치조골 정형에 미치는 효과

김나영,이신재,백승학 대한치과교정학회 2003 대한치과교정학회지 Vol.33 No.4

본 연구의 목적은 술전 비치조 정형장치 (PNAM) 와 구순열 수술이 치조골 정형에 미치는 효과를 평가하는 것이다. 연구 대상은 장기간 추적검사가 가능했던 16명의 완전 편측성 순구개열 환자 (남자 10명. 여자 (6명, 평균 파열부 최단거리: 10.46mm) 이었으며 서울대학교 치과병원 교정과에서 동일 교정의에게서 술전 비치조 정형장치로 치료받은 후 동일 외과의에 의해서 회전-전진법을 사용한 구순열 수술을 받았다. 평균 치조 정형기간은 13.10주였으며 구순열 수술후 내원시까지 기간은 평균 8.31주였다. 초진시 (T0, 평균연령 : 37.0±27.89일), 치조골 정형술 후(T1, 평균연령 : 119.25±40.18일), 구순열 수술 후 (T2, 평균연령 : 190.81±42.78일)에 환자들의 상악모형을 각각 채득하였고 1 : 1 비율로 사진을 찍은 후 컴퓨터 프로그램을 이용하여 7개의 선, 5개의 각도 계측항목을 측정하였고 paired t-test를 사용하여 통계학적 분석을 시행하였다. 1. 치조 분절의 후방부위는 치조골 정형술과 구순열 수술의 영향을 받지 않는 안정적인 구조였다. 2. 치조골 정형술에 의한 파열부 간격의 폐쇄는 주로 대분절 전체의 후방 굴곡으로 이루어졌다 3. 치조골 정형술 기간 동안 대분절의 전방 성장이 억제되었으나 구순열 수술 후에는 전방성장이 회복되었다 4. 구순열 수술 후 전방부 분절간 각도가 증가한 이유는 구순열 수술 이후 형성된 구순 반흔조직의 압력 에 의하여 치조골 정형술 효과가 나타난 것이다. The goal of the present study was to evaluate the effects of PNAM appliance and cheiloplasty on alveolar molding. Samples consisted of 16 unilateral cleft lip and palate infants (10 males and 6 female, mean age=37.0 days after birth, average alveolar cleft gap=10.46 mm), who were treated with PNAM appliances by one orthodontist and rotation advancement cheiloplasty by one surgeon in Seoul National University Hospital. Average duration of alveolar molding treatment was 13.10 weeks and these patients were recalled at average 8.31 weeks after cheiloplasty. These patients' models were obtained at initial visit (T0, mean age : 37.0 ±27.89 days after birth), after successful alveolar molding (T1, mean age : 119.25±40.18 days after birth), and after cheilopasty (T2, mean age : 190.81±42.78 days after birth). Seven linear and five angular variables were measured using 1 : 1 photometry and soft ware program(V ceph. Cybermed, Seoul, Korea). Paired t-test was performed to investigate statistical significance at p<0.05 level. 1. The posterior parts of alveolar segments were the stable structures during alveolar molding treatment period and after cheiloplasty in infants. 2. The closure of cleft gap during alveolar molding was usually due to backward bending of the whole part of the greater segment. 3. Although forward growth of the greater segment was hindered by alveolar molding, it resumed after cheiloplasty. 4. Increase of anterior inter-segment angle after cheiloplasty was due to the molding effect of the lip scar pressure.

The Severity of Cleft Lip and Palate and Postsurgical Outcome in Non-syndromic Complete Unilateral Cleft Lip and Palate: A Pilot Study Based on Surgeon’s Perception

Pollyana Marques de Moura(Pollyana Marques de Moura),James Seaward(Seaward James),Alex Kane(Alex Kane),Yong Jong Park(Yong Jong Park) 대한구순구개열학회 2023 대한구순구개열학회지 Vol.26 No.1

Objective: The aim of this study was to assess the pre-operative and post-operative aesthetic outcome of patients following primary lip repair to investigate the association of the severity of the cleft deformity after NAM therapy and final surgical outcome. Materials and Methods: To assess the correlation between severity of the cleft and the primary surgery outcome, four pediatric craniofacial surgeons from the affiliated teaching hospital were asked to independently rate 156 randomized sets of photographs from 39 case of non-syndromic patients with complete unilateral cleft lip and palate who received NAM treatment.by mean of visual analogue scale. The photographs were acquired in four different time points: (T1) Pre NAM therapy, (T2) Post NAM therapy, (T3) Immediate post-operative, (T4) Late post-operative. Results: The mean of VAS score for lip and nose improved significantly after NAM therapy. There was significant correlation between NAM treatment (T2) outcome and immediate post-operative outcome (T3) for nose. There was no significant correlation between NAM treatment outcome (T2) and immediate postoperative outcome (T3) or late postoperative outcome for lip. Conclusion: Cleft deformity improved significantly after NAM therapy and this improvement led to better nasal esthetics immediate post operatively.

비순낭종의 치험례

김일규,조현영,백민규,장금수,박승훈,박종원,Kim, Il-Kyu,Cho, Hyun-Young,Baek, Min-Kyu,Chang, Keum-Soo,Park, Seung-Hoon,Park, Jon-Won 대한악안면성형재건외과학회 2008 Maxillofacial Plastic Reconstructive Surgery Vol.30 No.2

Nasolabial cyst is a rare non-odonotogenic, soft-tissue, developmental cyst arising inferior to the nasoalar region of the face. The most common clinical finding of the nasolabial cyst is that of a slowly enlarging asymptomatic swelling typically without radiographic abnormalities. This case report describes a 25-year-old man in which the clinicopathologic findings and an erosive finding on the computed tomographic scan on maxilla were consistent with nasolabial cyst. The histopathologic features, differential diagnosis, treatment and prognosis are discussed. 비순낭은 비루관의 상피 잔사에 의해 발생하는 드문 발육성 낭종으로 상순의 종창과 비익부의 음기를 야기시킨다. 치료 방법으로는 구내접근법에 의한 낭종의 완전 절제술로 재발율은 거의 없다. 25세 남환으로 상악골의 흡수를 야기시킨 좌측부 비순낭종을 외과적 완전 절제술로 치료하고 양호한 결과를 얻어 문헌 고찰과 함께 보고하는 바이다.

Biocreative Alveolar Molding Plate Treatment (BioAMP)for neonatal unilateral cleft lip and palate with excessively wide alveolar cleft and maxillary arch width

HyeRan Choo,HyoWon Ahn 대한치과교정학회 2024 대한치과교정학회지 Vol.54 No.1

Since its inception in Europe in the 1950s, alveolar molding treatment for neonates with complete cleft lip and palate has undergone significant evolution in both design and application methodology, demonstrating effectiveness in normalizing the alveolar cleft and nasal shape. However, excessively wide alveolar clefts accompanied by disproportionately wide total maxillary arch pose significant challenges when utilizing conventional alveolar molding methods involving cyclical adding and grinding of acrylic on molding plates. The current report introduces a novel alveolar molding method named Biocreative Alveolar Molding Plate Treatment (BioAMP), which can normalize the maxillary alveolar cleft and arch shape without laborious conventional acrylic procedures. BioAMP sets the target arch form and provides unrestricted space for natural growth of the maxillary alveolar bones while systematically reducing the total maxillary arch width in precise increments. Two exemplary cases are presented as proof-of-concept, showcasing the clinical innovation of BioAMP.