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12th Annual Meeting of Thai Cleft Lip-Palate and Craniofacial Association 2019

in conjunction with the 9th Asian Pacific Cleft Lip-Palate and Craniofacial Congress 2019

Theme

Regional & Global Partnership of Comprehensive Care in Cleft Lip-Palate and Craniofacial Deformities

Joint Organization

  • The Thai Cleft Lip-Palate and Craniofacial Association
  • Tawanchai Center of Excellence for Patients with Cleft Lip-Palate and Craniofacial Deformities
  • Faculty of Medicine, Khon Kaen University
  • Faculty of Dentistry, Khon Kaen University
  • Committee of the Asian Pacific Cleft Lip-Palate and Craniofacial Congress

Summary

The 12th Annual Meeting of Thai Cleft Lip-Palate and Craniofacial Association in conjunction with the 9th Asian Pacific Cleft Lip-Palate and Craniofacial Congress 2019 (APCLPC 2019) “Regional & Global Partnership of Comprehensive Care in Cleft Lip-Palate and Craniofacial Deformities” and had total 74 speakers. There were 479 participants from 25 countries consisting of Thailand, Lao PDR, Myanmar, Vietnam, Cambodia, Malaysia, Singapore, Philippine, Indonesia, China, Taiwan, Japan, South Korea, India, Bangladesh, Nepal, Uzbekistan, Jordan, Australia, United Kingdom, Belgium, Norway, United States of America, Canada, and Mexico. The Congress received high accomplishment with the support from Faculty of Medicine and Faculty of Dentistry, Khon Kaen University, Smile Train USA., Transforming Faces, Private and Government organizations, and collaborations from Thai Cleft Lip-Palate and Craniofacial Association and the interdisciplinary teams.

See more photos at our Facebook: day 1, day 2, gala dinner, sponsors

Overview

The Asian Pacific region is a home to thousands of the world’s ethnic group. While each region carefully harmonizes their cultures, primordial beliefs, economics, and environment through global transition, knowledge of people steps higher in parallel with external situation. With combination between eastern and western, traditional and modern, and developed and developing livings, Asian Pacific is considered as one of the most vibrant civilization in the world. Thus, when knowledge of medical care for cleft and craniofacial deformities was initially exchanged in 1985 at Monte Carlo, the forerunning CLP surgeons who participated Monte Carlo’s 5th International Cleft Lip Palate & Craniofacial meeting decided to establish the forum to open discussion and solution for cleft issues in Asian Pacific region, and that was the rise of the 1st Asian Pacific Cleft Congress in Singapore in 1988. Consequently, the 1st Asian Pacific Cleft Lip/Palate Congress was staged at Singapore in 1988, followed with the 2nd APCLP congress in 1991 which finally gave birth to the Asian-Pacific Cleft Lip and Palate/ Craniofacial Federation. Throughout three decades, the Congress travelled to Taiwan, New Zealand, Japan, South Korea, India, Australia, and Malaysia. In the year of 2019, Asian Pacific cleft professional shall reach the destination which is the homeland to many cleft people and have always circulated cleft care system – Khon Kaen, Thailand.

The congress focused on regional & global partnership of comprehensive care in cleft lip-palate and craniofacial deformities. Our key aspiration was to creat public space to exchange diverse experience in cleft care from past to present, and from the east to the west. This was not only to achieve the global knowledge on interdisciplinary cleft care but the most important target was to find the way to support cleft people in physical, psychological, social, and spiritual needs to become members of the society. This international conference in GMS enhanced collaboration work of comprehensive and interdisciplinary cleft care in this region. Since Khon Kaen is located at the center of Mekhong region, the problems of quality of life in cleft people was rendered, and it was fruitful to surgeons, anesthesiologists, pediatricians, speech-language pathologists, otolaryngologists, audiologists, orthodontists, pedodontists, geneticists, psychiatricians and psychologists, social workers, nurses and nurse coordinators, and other cleft professionals to see what was the real problem of marginal people.

We believe in that humanity have immeasurable capability, so this unification will synchronize wisdom across continents which finally brighten the future of cleft people and academic sphere.

Date & Venue

11-12 November 2019 at Pullman Raja Orchid Hotel, Khon Kaen, Thailand.

Participants

  • Faculty members of Asian Pacific Cleft Lip-Palate Association
  • Members of the Thai Cleft Lip-Palate and Craniofacial Association
  • Members of Medical and health care specialists who responsible for cleft lip-palate treatment in Asian Pacific region.
  • Interdisciplinary team and medical staffs from Khon Kaen University and any interest participants.

Activities

  1. Academic Conference
  2. Regional Partnership Panel Discussion
  3. Business Meetings
  4. Poster Presentation
  5. Booths and Exhibition
  6. Social Program

Program

Day 1

The first day of the conference starts with registration. The morning session is held at the Main Hall of Pullman Khon Kaen Raja Orchid Hotel. It comprises of opening ceremony and special lecture from the keynote speakers. Asst. Prof. Dr. Kornwipa Poonpon, the Master of Ceremony, greeted participants, briefly informed the program schedule, and conveyed all delegates and participants to the exclusive performance “Ponglang Dance” – the local artistic heritage of Khon Kaen province.

Opening Ceremony
Welcome Performance by a Cleft Patient
Welcome Performance by a Cleft Patient in the opening ceremony of the 12th Annual Meeting of the Thai Cleft Lip-Palate and Craniofacial Association
Miss. Rattiya Kerdpao, Tawanchai Center’s cleft patients, performed artistic heritage “Ponglang Dance” with her friends to welcome international delegates to Khon Kaen province.

This Ponglang Seanmuang Band comes from Nongrua Wittaya Secondary School located in Nongrua District at 45 kilometers from Khon Kaen City. This student band has national reputation when awarded the First Prize of Thailand Ponglang Performance Contest and the Gold Medal of Northeastern Thailand Cultural Performance Contest. At the latest contest, they were conferred the award by HRH Princess Sirindhorn. What is most remarkable is the cleft student who has undergone treatment with Tawanchai Center is one of the main dancers. Her name is Miss. Rattiya Kerdpao. Rattiya has proved that with comprehensive care and good environment, cleft patients can possess self-confidence, be able to express their beloved activities, and achieve success in both education and socialization as to normal people.

She had performed in the Band for years with honorary awards

Speech from honorary delegates

After the cultural performance which makes every participants highly impressed with their talents and the vibrant beuty of E-sarn culture, the MC invited four honorary delegates to deliver speech as a formal address to the participants.

Reporting Speech : Prof. Bowornsilp Chowchuen, the President of the 9th Asian Pacific Cleft Lip-Palate and Craniofacial Congress 2019
Welcome speech by Dr. Bowornsilp Chowchuen, the president of the congress in the opening ceremony of the 12th Annual Meeting of the Thai Cleft Lip-Palate and Craniofacial Association
Prof. Bowornsilp Chowchuen, the President of the 9th Asian Pacific Cleft Lip-Palate and Craniofacial Congress 2019, delivered a Reporting Speech which told the history of the APCLPC 2019

“On behalf of the President, I hereby convey my deepest contentment to welcome you to “The 9th Asian Pacific Cleft Lip-Palate & Craniofacial Congress” (APCLPC 2019) and “The 12th Annual Meeting of THAI CLEFT LIP-PALATE AND CRANIOFACIAL ASSOCIATION”. Since the first foundation of the Asian Pacific Cleft Lip-Palate and Craniofacial Association in 1988, the knowledge of cleft care was continually formed by the accumulation of invaluable wisdom of countless professionals around the world. Until today, cleft lip-palate and craniofacial deformities still present everywhere in the world, but what becomes greater is how humanity could optimize for the best quality of cleft patient’s life. This is the evidence of our effort, and that’s why the focal theme of the congress is “Regional & Global Partnership of Comprehensive Care in Cleft Lip-Palate and Craniofacial Deformities”.
Cleft lip-palate and craniofacial deformities are the congenital conditions that cause severe effect to the life of patient and family. While many children acquire innate rights to grow up happily, able to eat and drink whatever they want, hear whatever the sounds on earth say, engage with their preferable activities with confidence, there are millions of children with cleft who are facing feeding, hearing, and speech problems, including psychological stigma that block them from being normal-liked children. To recover their lives, interdisciplinary team care in global scale is required. It sounds like the world implies us that a sole expert cannot create the better world for these children and families. It is our unification, our collaboration, and our solidarity that evolve their world.
Passing eight countries across Asia and Australia continents, the 9th APCLPC 2019 gives big opportunity for Khon Kaen, Thailand to be a host for this precious conference. We are very proud that the city which serves as the melting pot of Asian history will becomes the forum of discussion, exchange, debate, and sharing of knowledge and experience on interdisciplinary cleft care. I have the faith that in this pot of wisdom, the atmosphere of compassion and humanness will combine with long-incubated experience, and transform into concrete practices; all will aim at the same target to brighten the life of children and families. In academic sphere, reciprocal talk between the seniors and the youngs, the east and the west, the teachers and learners will finally catalyze innovations that contribute to the best comprehensive cleft care and treatment in the future. With over 400 practitioners from over 20 countries in the field of plastic and reconstructive surgeons, neurosurgeons, pediatricians, pediatric dentists, orthodontists, anesthesiologists, speech pathologists, scrub nurses, nurse coordinators, social workers, and other public health personnel, I believe that the two days conference will surely benefit everyone from core to fragments of scholarship.
Thanks to the Thai Cleft Lip-Palate and Craniofacial Association (TCCA), Center of Cleft Lip-Cleft Palate and Craniofacial Deformities, Khon Kaen University under Tawanchai Royal Grant Project or “Tawanchai Center”, Faculty of Medicine and Faculty of Dentistry, Khon Kaen University, and the support from the Smile Train and others organizations. With these strong collaborations, we promise that all the participants shall reward with invaluable experience as well as noteworthy time in Khon Kaen.
All we have prepared is for your visiting, and all you have done is for the future of cleft patients.”

Welcoming Speech : Assoc.Prof. Nond Rojvachiranonda, the President of Thai Cleft Lip-Palate and Craniofacial Association (TCCA) and the Co-President of the 9th Asian Pacific Cleft Lip-Palate and Craniofacial Congress 2019
Welcome speech by Dr. Nond Rojvachiranonda, the President of Thai Cleft Lip-Palate and Craniofacial Association (TCCA) and the Co-President of the 9th Asian Pacific Cleft Lip-Palate and Craniofacial Congress 2019
Assoc.Prof. Nond Rojvachiranonda, the President of Thai Cleft Lip-Palate and Craniofacial Association (TCCA), welcomed the participants and exposed the role of TCCA

“As the co-president of the congress and the President of the Thai Cleft Lip-Palate and Craniofacial Association, I welcome you all to the academic sphere today.
Since the first foundation in 1988, the Asian Pacific Cleft Lip-Palate and Craniofacial Congress set its journey through the eight countries; Singapore, Taiwan, New Zealand, Japan, Korea, India, Australia, and Malaysia. Following the continent’s footstep, the Thai Cleft Lip-Palate and Craniofacial Association officially registered in September 2006 because we know that the unification of diverse disciplines will finally bring us knowledge which benefits cleft people and mankind.
Cleft lip-palate and craniofacial deformities are main challenges of healthcare in Thailand and countries in Asia Pacific region. It causes not only the disfiguration of the face, but it can also affect the feeding, hearing, speech, oral hygiene, dentition and psychosocial health of each patient. These problems are often dismissed, but thankfully for the unification and your concern. The conference today will bring the global knowledge together through the exchange of experience, skills and techniques among interdisciplinary teams. I believe that everybody here has jewellish wisdom, but as we delicately polish with the hands of surgeons, orthodontists, maxillofacial surgeons, anesthesiologists, nurses, speech therapists, and all medical professionals who have the heart of gold, the cleft knowledge will shine its brightest. That is the future of cleft people we want to see in the world.
Please hold on our “Regional & Global Partnership of Comprehensive Care in Cleft Lip-Palate and Craniofacial Deformities” and walk together. The Thai Cleft Lip Palate and Craniofacial Association will walk beside you. Thank you.”

Welcoming Speech : Dr. David Gillett, the Faculty of Asian Pacific Cleft Lip-Palate and Craniofacial Congress (APCLPC)
Welcome speech by Dr. Nond Rojvachiranonda, the President of Thai Cleft Lip-Palate and Craniofacial Association (TCCA) and the Co-President of the 9th Asian Pacific Cleft Lip-Palate and Craniofacial Congress 2019
Dr. David Gillett from Australia, one of the pioneers of the Asian Pacific Cleft Lip Palate and Craniofacial Association, announced the origin concept of “Team Care” and APCLPC’s unification

“On behalf of the Asian Pacific Cleft Lip-Palate and Craniofacial Congress, I would like to welcome you to our 9th Congress in Khon Kaen, Thailand.
The concept of "team care" for cleft patients was developed in the mid-1900s in Scandinavia. It has been proven that well-coordinated, protocol-based interdisciplinary care gives children born with a cleft the best possible life outcomes. The APCLPC was established after discussions at the 5th International Cleft Palate and Craniofacial meeting in Monte Carlo in 1985. The organization was created to promote team care and provide a venue for education and collaboration throughout the Asia Pacific region. The 1st APCLPC was held in Singapore in 1988 under the Chairmanship of Professor S T Lee. Meetings have been held every 4 years since that meeting to share our research and experiences with regional friends and neighbors. We have since had meetings in Taiwan, New Zealand, Japan, Korea, India, Australia, and Malaysia.
I would like to thank Professor Bowornsilp Chowchuen, Professor Nond Rojvachiranonda, The Thai Cleft Lip-Palate and Craniofacial Association and the conference organising committee for putting together fantastic scientific and social programs. I am certain we will all return home with new knowledge, new friends and heightened enthusiasm for improving the care we can provide to those patients entrusted to us.”

Opening Speech : Dr. Somsak Changtragul, the Governor of Khon Kaen Province
Mr. Somsak Changtragul, the Governor of Khon Kaen Province, gave an Opening Speech and hit the gong to formally open the APCLPC 2019
Mr. Somsak Changtragul, the Governor of Khon Kaen Province, gave an Opening Speech and hit the gong to formally open the APCLPC 2019.

“Ladies and Gentlemen,
I am delighted to be here in this wonderful day to welcome you to our province.
Many participants to this congress are here in Khon Kaen for the first time. For many from outside Mekhong sub-region, the name of “Khon Kaen” province might be unfamiliar to you. It is acceptable that Khon Kaen is a young city. We are not well-known comparing to Bangkok, Chiang Mai, or Phuket. But tracking back to the days before, the citizen here had shared their livings, folklores, languages, and knowledge with the neighbors in Mekhong regions as well as the visitors from Asia and outside. Thus, the presence of everybody recalls the origin of Khon Kaen. This is why I am overwhelmed when I see the guests from GMS countries like Lao PDR, Cambodia, Vietnam, and Myanmar to our South East Asian neighbors comprising of Malaysia, Singapore, Philippines, Indonesia including the far way guests from India, Nepal, Pakistan, Uzbekistan, Bangladesh, Jordan, Australia, South Korea, Taiwan, Japan, Germany, Belgium, United Kingdom, Mexico, and USA.
Today, Khon Kaen takes geographical advantages to accelerate transportation and communication such as establishment of double track railway along the East-West Corridor, the renovation of Khon Kaen airport to become international airport, and the trams project to solves environmental and traffic problems. This development gives benefits to the economic and helps us connecting to the global areas. Also, we are designated as MICE City – the perfect destination of meetings and seminars, and it is this “9th Asian Pacific Cleft Lip-Palate & Craniofacial Congress” and “The 12th Annual Meeting of THAI CLEFT LIP-PALATE AND CRANIOFACIAL ASSOCIATION” that addresses Khon Kaen’s modernization; not only because it captures the core situation of our region – cleft lip and palate and craniofacial deformities, but it unites the world-classed intellects together with the collaboration of our leading institution – Khon Kaen University.
This international congress focuses on “Regional & Global Partnership of Comprehensive Care in Cleft Lip-Palate and Craniofacial Deformities” which is the corridor that encapsulates the relationship of mankind. In the era where technology dissolves the border, to maximize the quality of people’s life cannot be done alone at all. It is by exchanging and sharing of diverse disciplines that could illuminates the new life to cleft patients. I wish the congress to substantially establish collaboration and serve as an area of wisdom.
I sincerely thank to all the keynote speakers, invited speakers and participants for your time and support. Tonight is the full moon night. As to the Buddhist calendar, it is the day we cherish the Mother of Rivers by praying and offering the banana leaf floating at the waterfronts. The Gala Dinner in the evening will take you to the terrain where Thai spirit is awaiting and will engrave your academic journey as the unforgettable one.”

The confetti was shot off as a sign of celebration by Prof. Bowornsilp Chowchuen, Assoc. Prof. Nond Rojvachiranonda, Dr. David Gillett, Assoc.Prof. Kamonwan Jenwitheesuk, and Assoc. Prof. Dr. Waranuch Pitiphat
The confetti was shot off as a sign of celebration by Prof. Bowornsilp Chowchuen, Assoc. Prof. Nond Rojvachiranonda, Dr. David Gillett, Assoc.Prof. Kamonwan Jenwitheesuk, and Assoc. Prof. Dr. Waranuch Pitiphat
Governor of Khon Kaen province, the honorary delegates, executives of Khon Kaen University and Smile Train organization, and Head of Sub-committee of APCLPC 2019 were taken group photos with over 300 participants in the Main Hall
Governor of Khon Kaen province, the honorary delegates, executives of Khon Kaen University and Smile Train organization, and Head of Sub-committee of APCLPC 2019 were taken group photos with over 300 participants in the Main Hall

The Governor hit the gong to formally open the 9th Asian Pacific Cleft Lip-Palate and Craniofacial Congress 2019. The resonance of the clear sound was a celebration of unity and auspiciousness. At the same time, the honorary delegates and executives from Khon Khon University comprising of Prof. Bowornsilp Chowchuen, Assoc. Prof. Nond Nond Rojvachiranonda, Dr. David Gillett, Assoc.Prof. Kamonwan Jenwitheesuk, Associate Dean for Academic Affair of Faculty of Medicine, and Assoc. Prof. Dr. Waranuch Pitiphat, Dean of Faculty of Dentistry, shot off the confetti together as a sign of celebration.

The scientific program focused on academic lectures which conducted at the Main Hall and 3 separated ballrooms. The latest was divided according to concentrative disciplines which were surgical management, orthodontics, and nurse, psychiatry, and speech therapy.

Main Hall

There were 6 topics of academic lectures in the Main Hall of Monday 11th November 2019. The first topic was “APCLPC as Regional & Global Partnership Role - Past, Present, and Future” delivered by Prof.Dr. Bowornsilp Chowchuen, the keynote speaker, and it was the highlight of the congress.

Ballroom 2 - Surgical Management

There were 5 topics of academic lectures in Ballroom 2 which focused topic is “Surgical Management” of Monday 11th November 2019. There were 8 speakers who delivered these 5 topics. The lecture ended at 17.15 hrs.

Ballroom 3 - Orthodontics & Others

There were 5 topics of academic lectures in Ballroom 3 which focused on “Orthodontics” and others relating issues such as maxillofacial surgery. There were 6 speakers who delivered these 5 topics. International speakers who delivered topics were from India, Singapore, and Nepal.

The lecture ended at 17.30 hrs.

Erawan Room - Nurse, Speech, Psychosocial, Social Workers & Others

The topics in Erawan room were varied, and most of the lecturers were knowledge and experience exchange. There were 7 topics delivered by 10 speakers. There was one international speaker from Sweden in this lecture room.

The lecture ended at 17.15 hrs.

Day 2

Ballroom 2 - Surgical Management

There were 6 topics of academic lectures in the Ballroom 2 on Tuesday 12th November 2019. There were 6 speakers; 4 of 6 were International speakers comprising of Germany, Taiwan, Myanmar, and Japan.

Ballroom 3 - Orthodontics and Others

There were 5 topics of academic lectures in Ballroom 3 which focused on “Orthodontics” and others relating issues such as maxillofacial surgery. There were 6 speakers who delivered these 5 topics. International speakers who delivered topics were from India, Taiwan, and Nepal.

Erawan Room - Nurse, Speech, Psychosocial, Social Workers & Others

There were 5 topics of academic lectures in Erawan Room. Two panel discussions were delivered to open opportunity for participants to talk and share experience in cleft care. There were totally 15 speakers in which 3 of them were international speakers from Australia, South Korea, and Mexico.

Main Hall

The last academic lectures were presented in the Main Hall of Tuesday 12th November 2019 by world-class speakers from Germany, Taiwan, Australia, and United Kingdom.

Poster Presentations

Chutimon Panyakham
The Princess Sirindhorn Craniofacial Center, King Chulalongkorn Memorial Hospital, The Thai Red Cross Society, Bangkok, Thailand

Introduction: The Princess Sirindhorn Craniofacial Center has provided high standard treatment for patients with craniofacial deformities for more than 30 years. It’some of the largest craniofacial centers in Southeast Asia. Our patients are treated by the multidisciplinary team care. The team uses the holistic approach to treat the patients not only physically but also psychologically and socially. The Princess Sirindhorn Craniofacial Center has attempted to develop the 3 aspects of service. That are considered as the heart of work with the goal of providing patients with access to the highest standard treatment as well as the international standards and accurate diagnosis with improvement of the quality of patients and families life.

Clinical Excellence: Every month has the craniofacial conference for all complicated cases to be discussed by the multidisciplinary team to provide the best treatment plan for the patients. It was found that most of the craniofacial patients were from rural areas and could not afford transportation expenses to the hospital. In an attempt to solve this problem, the mobile clinic of Princess Sirindhorn Craniofacial Center, King Chulalongkorn Memorial Hospital has been found. The first operation of the mobile clinic took place at Buriram Hospital. It’s call “Buriram Model”. Telemedicine it another channel for the patients to access to the basic diagnosis services.

Psychological Support: Assessing the stress in caregivers of all new patients and providing emotional and psychological support. Psychotherapy for those who have emotional problem or mental problem. Behavior modification for those who suffer from behavior problem. Such as ADHD, aggressive behavior. Intelligence and developmental assessment. In 2003, the “Life with Hope” project was established in order to provide mental support to the patients. This project consists of monthly support group in which members provide each other and being a center for mutual networks. In addition to monthly support group. The “Happy Family Day” event, which is held yearly, It’s the other way to increase social opportunities and promote a good relationship in families.

Social Support: For underprivileged patients with financial difficulty or patients who do not have healthcare coverage, our social workers will assist them and provide support throughout the treatment. No financial burden is placed on the patient or their families as we are capable of providing financial support for every patient without being restricted by any healthcare coverage. Our center has received a large amount of support and donations from communities and many organizations.

Conclusion: This is the evidence showing that these patients are not left behind in the society.In 2018, “Agriculture to fulfill the dream” projected was started in collaboration with “Agricultural Poverty Eradication , Mechai Viravaidya Foundation.

This presentation is disqualified due to scientific misconduct.

Hayley Benbow
Perth Children’s Hospital Cleft Lip and Palate Unit, Plastic and Reconstructive Surgery Department, Perth, Western Australia

Objective: Seven-year review of PRS patients including 1) associated syndromic conditions 2) comorbidity conditions 3) frequency/types of airway management and 4) frequency/types of feeding management.

Method: Retrospective case review of 36 consecutive PRS patients managed between 2012 - 2017 at neonatal/paediatric tertiary care units co-located at a tertiary teaching hospital. Review included demographic information, clinical findings, and multidisciplinary treatment interventions.

Results: M:F 10:26, av. gestation 37.97wks (31+3 - 41+1) and weight 3115.11g (1070 - 4510g). Av. LOS NICU 34.55 days (1-88). 11 babies have syndromes including Sticklers (5), XXX, cardiac, renal and talipes equinovarus (3). 7 mothers had gestational diabetes, 4 polyhydramnios, and one PIH. 7 babies required CPAP (1-83 hrs), 8 required oxygen support (1-572 hrs), 8 had NPA with extended paediatric hospitalisation (hospitalisation 39.5 days (1-152)).

Conservative management included prone positioning, 32 had sleep studies performed with 19 repeated sleep studies. 30 Babies were discharged with oxygen saturation monitoring, 11 with long-term NGT, 11 EBM, 20 formula fed and 5 mixed. 15 required further Hospital in the home nursing assistance. 30 had cleft palate repair at 11 months (8mth8day-19mt17d), av. weight 8.955kg (7.61-9.8kg), LOS 5.38 days (2-8 days).

Conclusion/Key Points: In the review, approximately a third of patients had syndromes, and one third of mothers had gestational diabetes and polyhydramnios. Conservative treatment of prone positioning contributed to length of hospitalisation, NPA management did not alter extended hospitalisation. Feeding difficulties contributed to faltering weights and lower weight at time of surgery, prolonged NGT feeding also delayed palate surgery timing.

Hayley Benbow
Perth Children’s Hospital Cleft Lip and Palate Unit, Plastic and Reconstructive Surgery Department, Perth, Western Australia

Objective: Four year review of patients with CLP to evaluate growth in the first year of life including 1) associated syndromic conditions 2) comorbidity conditions 3) frequency/types of feeding management and 4) treatment interventions.

Method: Retrospective case/chart review of CLP patients managed between 2012 - 2016 at neonatal/paediatric tertiary care units co-located at one tertiary teaching hospital. Review included demographic information, clinical findings, and treatment interventions. Results of both genders were compared to the data published by the World Health Organisation (WHO) regarding average growth parameters in children in the first year of life.

Results: The unit has 1000+ active patients, 50-60 new patients per year, and provides 70-90 primary repairs in the first year of life. Children with syndromic diagnosis were excluded from study. Review show average period of decrease from birth weight growth curves, and decrease in weights at time of lip repair and palate repairs using WHO/NCHS growth charts for males/females. Weight gain was delayed in both groups during the earlier months, and at the end of the first year of life was improving but not at levels of unaffected children.

Conclusion/Key Points: Children with cleft lip are more likely to have similar growth parameters to their unaffected counterparts, children with cleft lip and palate and palate only defects weigh less than children not affected during the first year of life. Factors that optimise growth parameters include specialist nursing assistance, individualised assessments and treatment planning, guidance and multidisciplinary integrated care.

Pongjai Virarat, Nirunrungreng P, Chatwongwan W, Thanai Subchanya, Kaviya Kanokpongsak, Nuntanaranont T
Maharat Nakhon Ratchasima Hospital, Nakhon Ratchasima, Thailand

Maxillary hypoplasia in unilateral cleft lip and palate deformities results from congenital reduction in midfacial growth and the effects of the surgical scar from surgical repair. Distraction osteogenesis (DO) is alternative surgical technique for generating new bone growth through the application of tensile stresses to a preexisting tissue lying between two bone ends. Rigid internal distractor has provided to treat severe midface hypoplasia with minimally invasive procedure, especially those secondary to orofacial clefting with the absence of maxillary and alveolar bone and the presence of scaring.

Thai female with left complete unilateral cleft lip and palate aged 16 years and 9 months with skeletal class III severe maxillary deficiency, Class III dental malocclusion with a negative overjet and concave facial profile. The operations involved a Le Fort I osteotomy (two pieces at cleft defect), palatal and intermediate stent placement and distractor insertion with screw fixation. Distraction of the maxilla was initiated after 7-day latency period. Postoperative cephalometric analysis showed maxillary advancement anteriorly and inferiorly, the total distraction treatment period was 8 days. The maxillary advancement was 7.5 mm on right side and 5 mm on left side, while the maxillary down grafting was 2 mm. The SNA angle increased from 69° to 78.5°. Moreover, the ANB angle changed from 6.5° to 3.5° and the occlusion changed from Class III to Class I occlusion. The profile of the face changed from concave to straight profile and a much better esthetic result was achieved.

Maxillary distraction osteogenesis is effective surgical procedure for the treatment of midfacial hypoplasia in cleft patient. Furthermore, it minimizes the risk of the surgical procedure and shortens the operating time.

Janella Christie1, Le Trung Chanh2, Nguyen Van Anh2, Andrew H.F. Tsang2
1Speech Pathology Service, Monash Children’s Monash Health, Melbourne, Australia
2National Hospital, Ho Chi Minh City, Vietnam

Introduction: Primary surgical repair of cleft lip and palate is well established in Vietnam, but an integrated multidisciplinary approach by surgical, dental, orthodontic and speech therapy specialists is in its infancy.
Objectives: This review provides an overview of the development of cleft services at the National Hospital of Odontostomatology and Maxillofacial Surgery (NHOS), Ho Chi Minh City and will outline the experiential challenges of a speech pathologist working within a philanthropic organisation at the hospital.
Methods: The NHOS’s involvement with local and international missions, humanitarian missions, specialist training programs and new cleft service development initiatives were identified. Speech pathology challenges were reflected upon and themes identified.

Results/ Discussion: The NHOS receives support from philanthropic organisations but also provides surgical support internationally. The identified challenges for the speech pathologist and the team include global partnerships and philanthropic missions, health policy and conceptualising local health systems, cultural and linguistic differences, methods of service delivery and development, socio economic issues, the accepted professional roles within a team, clinical practice, information management, outcome measurement and research.

Conclusion: Success within any partnership requires mutual learning and the ability to work within a different context to build capacity and ensure sustainability. Current status of the service must first be identified and then the barriers and opportunities discussed and agreed upon, for change to be considered.

Panida Panpon
Umphang Hospital, Tak, Thailand

Introduction: Umphang community hospital in collaboration with a surgical team of the Share the Love foundation began corrective surgeries for all cleft lip and cleft palate patients with no expense since 2014. In 2018, the primary supportive care system based on the holistic approach in dental unit, Umphang hospital was launched. The unit performed the primary care to the new born cleft lip and cleft palate patients using removable appliances in combination with nasal stent following Chiang Mai University – Nasoalveolar Molding (CMU-NAM) protocol.

Objective: Of this dental unit is to educate and prepare patients and their family to the upcoming treatment process in order to eliminate the facial defects and numbers of corrective surgery. Currently, the model originated in Umphang hospital is also applied to other community hospitals located along the boundary between Thailand and Myanmar. There are 21 cleft patients under this networking. Eleven of them were undergone a corrective surgery and had been enrolled in the follow up program. Unfortunately, ten patients were lost in this follow up program.

Conclusion: Primary supportive care system for cleft lip and cleft palate patients in community hospital is new for health system in Thailand. First hand aided by interdisciplinary team in community hospital is very important to provide safe and adequate feeding. The role of dentist is to provide feeding obtulator, presurgical orthodontics and case manager. This is not only help the newborn and their family in the very first feeding process but also improves quality of life of patients and their family significantly. Thus, developing of primary care personnel and networking of this system is encouraged because it will definitely improve the outcome of the treatment and reduce the congestion and/or delay of treatment at the general hospital.

Pinai Nirunrungreng, Pongjai Virarat, Klachoho S, Kaviya Kanokpongsak, Egaboot Lewchalermwongse
Maharat Nakhon Ratchasima Hospital, Nakhon Ratchasima, Thailand

Most of pre-surgical infant orthopedics did not address deformity of the nasal cartilage and columella tissue in infants with unilateral lip and palate cleft. The nasoalveolar molding (NAM) technique has been developed to reduce the severity of the initial cleft alveolar and nasal deformity which enables the surgeon and the patient to enjoy the benefits. Korat NAM I have been developed by Maharat NakhonRatchasima cleft lip and palate center to gain better nasal form before cheiloplasty. This appliance is designed to center tip of nose with two nasal acrylic bulbs, capable to adjust the nasal cleft side with coil activation, stabilize occlusion with physiological raise bite and assist bottle feeding with wire tag.

Thai newborn boy with left complete unilateral cleft lip and palate was referred. The clinical findings were 10-millimeters alveolar cleft width, deviated nose’s tip and flatted alar of nose. The treatment was started with active obturator to arrange the alveolar segments. After obtaining aligned alveolar ridge, the impression was taken to make the Korat NAM I (KN I). This appliance was used to mold the nasal form and maintain the alveolar ridge; its component is obturator, passive raise bite, active retention arm, passive retentive arm and two different size nasal acrylic bulbs. The patient had been inserted and activated KN I for six months, after that the cheiolplasty and primary repair nose was operated as one unit. The surgical operation, which consisted of Rotation Advancement cheiloplasty and Tajima alar repair, obtained good results. Therefore, Korat NAM I proved a reliable appliance in pre-surgical unilateral complete cleft lip and palate.

Thongchai Nuntanaranont1, Wipapun Ritthagol2
1Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Prince of Songkla University, Hatyai, Songkhla, Thailand
2Department of Preventive Dentistry, Faculty of Dentistry, Prince of Songkla University, Hatyai, Songkhla, Thailand

Introduction: Cleft patients often present with the severe maxillary deficiency condition. Distraction Osteogenesis (DO) is an optional surgical intervention which requires in these patients in order to improve the maxillary hypoplasia in all dimensions.

Method: Eighteen-year-old Thai male with previous repaired palate, presented with severe maxillary hypoplasia. Intra-oral examination revealed Class III malocclusion, severe crowding of anterior teeth, and crossbite of anterior teeth and premolars. The presurgical orthodontic treatment was performed followed by Lefort I osteotomy and intraoral maxillary distractor delivery. The distractor was activated 1mm/day until the appropriate maxilla position was achieved, 8 mm in total. The one-month consolidation was required before continuing the orthodontic treatment for seating the occlusion.

Results: The incidence of significant complication was not presented in this subject.

Conclusion: The intraoral maxillary DO was suitable treatment modality to protract maxilla in this cleft patient.

Supotjaman Kitchawee
Dental Department Pranangklao Hospital Nonthaburi Thailand 11000

Fundamental concern in treatment of newborns with orocleft includes breathing, feeding, sucking and swallowing for their safety and adequate milk intake. In term of feeding, use of an obturator is generally suggested. However, in more complicate condition such as dysphagia, appropriate management should be considered rather than the standard treatment to encourage oral feeding. That would avoid prolonged use of orogastric tube or gastrostomy or a long stay in hospital.

Abnormality of tongue is a crucial cause of dysphagia. Correction of its position, shape, muscle tone is necessary as well as stimulation of swallowing neuromuscular coordination. Understanding the etiology and proper approach is essential.

This presentation would introduce Phranangklao Cleft Center’s protocol to manage 5 cleft palate newborns with unusual complicate dysphagia in various degrees of severity. Use of Feeding-Facilitating Technique (FFT) and stimulation of the swallowing neuromuscular coordination will be reviewed. Success of the management resulted in safety and healthful babies like non-complicate cases.

Hayley Benbow
Perth Children’s Hospital Cleft Lip and Palate Unit, Plastic and Reconstructive Surgery Department, Perth, Western Australia

Objective: Review of national and international cleft lip and palate specialist nursing roles and involvement in the multidisciplinary team model of cleft lip and palate treatment.

Method: Literature review of national and international cleft lip and palate multidisciplinary models of care, clinical specialist nurse roles and quality of nursing care in the cleft lip and palate patient cohort.

Results: Presence of a clinical nurse specialist within the multidisciplinary cleft lip and palate team has become commonplace across many regions in the UK, Europe and America. The role of the clinical nurse specialist may commence in the antenatal period, progress through birth and infancy, and extend into childhood and early adulthood, to facilitate and promote health maintenance in conjunction with feeding, growth, psychosocial development and surgical protocols. The initial specialist nursing care focuses on establishment and support of early feeding management, review and support of growth parameters in the first year of life, psychosocial support of parents’ and child feelings and anxieties in relation to the cleft as they progress in childhood, ongoing operative support and management and transition to adult services.

Conclusion/Key Points: Role definition of the clinical nurse specialist in the cleft lip and palate multidisciplinary team supports the core functions of this essential discipline. Overarching specialised nursing aids to facilitate multiple discipline coordination and provides ongoing support in growth and development of the paediatric cleft cohort.

Hayley Benbow
Perth Children’s Hospital Cleft Lip and Palate Unit, Plastic and Reconstructive Surgery Department, Perth, Western Australia

Objective: Case review of 6 consecutive PRS patients with multidisciplinary management including 1) airway management, 2) feeding management and 3) early hospital discharge programme with specialist nursing/MDT support.

Method: Case review of 6 consecutive patients diagnosed with PRS 2017- 2018 at neonatal/paediatric tertiary care units co-located at a tertiary teaching hospital. Review included demographic information, clinical findings, treating disciplines and treatment interventions.

Results: M:F 5:1, 1 baby has syndromic comorbidities, represented with worsening respiratory symptoms, failed NPA attempt, and had mandibular distraction osteogenesis to assist airway compromise. Three babies had early NPA in NICU, parent education regarding airway and feeding support, and early discharge with Plastic Liaison nurse and MDT support in the outpatient setting. One patient represented with worsening airway compromise, admitted for NPA and early discharge programme. One baby represented with worsening airway issues and is under MDT review.

Conclusion/Key Points: Managing patients with Pierre Robin sequence is diagnostically and therapeutically challenging and is best managed with a multidisciplinary team. A comprehensive evaluation is important to detect patients who may have silent events during activities of early life, and may require feeding/post feed observations. Babies should have a complete assessment to anatomically define the site of airway obstruction and target management options, current protocol changes reflect the MDT management of airway and long term feeding challenges presented by this cohort. Early NPA management has assisted in reducing NICU LOS, airway support to aid feeding management and an early discharge/parent education programme for PRS patient management in the outpatient setting.

Ittiporn Suteepichetpun, Kiatanant Boonsiriseth
Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Mahidol University, Bangkok, Thailand

Premaxilla can be protruded or twisted in bilateral cleft lip and palate. Secondary bone grafting simultaneous to premaxillary repositioning is a well-known procedure for management of bilateral alveolar cleft. One of the indications to perform this procedure is to reduce either horizontal or vertical discrepancy. In this case, a 17-year-old patient had a problem of vertically discrepant positioned premaxillary segment. Osteotomized segment was superiorly positioned and iliac bone graft was performed. The segment was secured with orthodontic arch wire and stabilization splint. The bone graft was successful. Moreover, unintentional improvement of speech occurred. In vertical discrepancy of premaxilla with bilateral alveolar cleft, this procedure gave satisfactory result in patient requiring secondary bone graft.

Ting-Chen Lu
Chang Gung Memorial Hospital, Taipei, Taiwan

Secondary deformity of the cleft lip includes all kinds of deformities that include but not limit to the shifting of the lip, uneven Cupid’s bow, whistling deformity, asymmetry vermillion border and unsufficient tissue on the vermillion and lip. The secondary deformities of the cleft nose have even more problems. Such as short and deviated columella, attenuated lower lateral cartilage, underprojection of the nasal tip, asymmetric nostrils and downward displacement of the nasal alar base. Asian nose is especially flat that makes the appearance of the cleft patients more unsatisfactory.

In this series, we propose a treatment algorithm for the secondary deformities of the cleft patients.

The reconstruction of the facial profile should start from the midface advancement and occlusion setup by orthognathic surgery. The re-do rotation advancement decision should depends on the symmetrical lip height, the balanced alar base or the quality of the lip scar. If the appearance of the lip is acceptable, minimal revision can be done by fat grafting, fascia graft augmentation or vermillion border revision.

The Asian cleft nose should be treated as nose reconstruction. The deviated septum and attenuated lower lateral cartilage can be corrected by septoplasty and combined with spreader grafts and columellar grafts to establish a stronger nasal tip. The dorsum can be augmented with diced cartilage to achieve a stable and durable appearance. Rim graft can also be added on both sides to strengthen the alar rim.

We provide a durable and reasonable guideline for the treatment of secondary cleft lip and nose revision. It can be applied to most of the secondary cases.

Khamphai Phimphaphanh
Mahosot Hospital, Vientiane, Lao PDR
  • Laos is located in South East Asia, total area 280,000 km2
  • Population around 7 million people
  • For total birth rate is around 160,000- 180,000 per year
  • For incidence of cleft lip and cleft palate in Laos is quite a lot if compare to regional or in the world. around 1/600 of the birth rate, (the statistic are based on 4 central hospitals and 6 provincial hospital)

In practically we are unable to sufficiently help patients with incidence of cleft patients the reason are as following

  1. Human resources (plastic surgeons, Speech therapist, orthodontist, …)
  2. Equipment
  3. Budget, etc

However, we also have some cleft surgery in Laos supported by NGO funding from abroad such as

  1. Smile train (USA)
  2. Tawanchai, Twinpine (Thailand)
  3. Global Care (S. Korea)
  4. JAICA (Japan)
  5. From Philippine’s Military
  6. Association Breizh Lao (France)
  7. Community Health insurance

There are international help, but majority are mission. so the patient care is not continuously there are many things we still need to develop such as human resource especially plastic surgeon, Speech therapy, Orthodontic, ….

Although this work is hard, we still want to continue to work on it and make it better.

Lertchai Kaewpukdee1, Benjamas Prathanee2, Apisak Phatthanachak3
1Faculty of Education, Khon Kaen University, Khon Kaen, Thailand
2Department of Otolaryngology, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
3Department of Computer Science, Faculty of Science, Khon Kaen University, Khon Kaen, Thailand

Background: Communication technology and social media play an important role in daily life and child development. The purpose of this study was to review literature on the development of applications for stimulating language and speech development for toddlers with or without cleft lip and palate.

Methods: Searching for information from relevant websites using key words in the search are "babbling" or "prelinguistic" or "speech" or "language" and "therapy" or "intervention" or "stimulation" and "toddler" or "cleft palate", relevant information from databases on various websites, which have both positive and negative effects on the use of communication technology and social media for toddlers were summarized.

Results: The advantage of communication technology and social media online were the effective materials for stimulation language and speech in toddlers. The disadvantages was a negative result for social interaction and long duration of using the computer screen or communication technology might affect brain, eyesight, and other areas of learning skills.

Conclusion: In order to use communication technology and social media to facility to stimulate speech and language development for toddlers must be closely supervised by caregivers.

Kamonporn Nanekrungsan
Overbrook Hospital, Chiang Rai, Thailand

Cleft lip and palate are common birth defects. They are accompanied by various malformations, including disturbances in facial look, skeletal disorders and malocclusion. These may lead to psychological problem. Class III skeletal relationship with retrognathic maxilla is commonly found in cleft lip and palate patients. Growth modification by using protraction facemask before prepubertal growth spurt can improve facial profile by promoting forward, downward movement of maxilla and restrict the growth of mandible. This case report describes a nonsurgical approach for treating the 12 years old boy with right unilateral complete cleft lip and palate. He has class III skeletal relationship with ANB -9 degree, class III malocclusion with severe anterior crossbite. Rapid maxillary expansion followed by facemask and camouflaged treatment with fixed appliances can reduce class III skeletal discrepancy which yielded the successful result.

Frank Chun-Shin, Chang
Craniofacial Research Center, Department of Plastic & Reconstructive Surgery, Chang Gung Memorial Hospital, Tauyuan, Taiwan

There are three key points for unilateral cleft lip/nose repair: 1. Presurgical Nasoalveolar molding, 2. Surgical techniques and Post-operative care and maintenance.

In general, wider clefts tend to be associated with more significant nasolabial deformities, and reconstruction of the more severe nasolabial deformities tends to yield suboptimal outcomes. The presurgical NAM is used in an attempt to reduce cleft severity, narrowing cleft lip gap, improve nasal form in order to ease and improve the results of the primary operation.

The lip was repaired using a modified rotation advancement cheiloplasty with a Mohler incision. The incision for the advancement flap was along the cleft margin, with no horizontal incision on the nasal floor or perialar extension. An L flap was developed based on the alveolus on cleft margin. The incision was extended along the piriform aperture to mobilize the alar base on the cleft side. The nasal floor was reconstructed with the combination of an inferior turbinate flap, an L flap, and a CM flap on the noncleft side. The columella was lengthened with the C flap. The orbicularis muscle on both medial and lateral lips were adequately released and repositioned. The alar base on the cleft side was advanced medially and superiorly. The vermilion was reconstructed with Noordhoff’s vermilion flap. Semi-open rhinoplasty, via a Tajima inverse U incision on the cleft side and rim incision on the non-cleft side, was performed at the same time as primary cheiloplasty. The fibrofatty tissue was dissected off the alar cartilage and interdomal suture was placed with the cleft side cartilage slightly higher than the non-cleft side cartilage. The Tajima incision was used to resect nasal webbing at the soft triangle.

Post-Op care consisted with Nasal stents (Sunder Nasal Stent) were worn by all patients for six months. Parents or guardians were instructed how to place Micropore tapes across the upper lip wound and both cheeks to reduce wound tension caused by the adjacent risorius, zygomaticus major and zygomaticus minor muscles. Taping remained in place throughout the day and silicone sheeting or self-drying silicone gel was added during sleep.

The combination of pre-surgical NAM, current technique of cheiloplasty and rhinoplasty, post-op new nasal stent can achieve best outcome.

Apida Sakaew1, Benjamas Prathanee2, Apisak Phatthanachak3
1Faculty of Education, Khon Kaen University, Khon Kaen, Thailand
2Department of Otolaryngology, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
3Department of Computer Science, Faculty of Science, Khon Kaen University, Khon Kaen, Thailand

Introduction: Nowadays, the development of new technology be a medium for promoting various development of learning is a popular thing. As knowledge can be acquired at all times through social media and new technology. Using new technology in the development of vowel pronunciation of pre-school children, it is a new knowledge that is up-to-date.

Method: Finding information from relevant websites using relevant terms in the search includes "vowel" "babbling" or "prelinguistic" or "speech" or "language" and "therapy" or intervention "or stimulation." and "preschool" or "normal children" Find relevant information from databases on various websites.

Results: Found that the children will pronounce quickly or slowly, there are many factors. One thing that can help stimulate the development of children's speaking skills is the introduction of social media and new technology. To help improve pronunciation Language and speech but the use of these media should be under close supervision of the main care takers.

Conclusion: Social media and new technology There is a tendency that is beneficial to the language and speech development of normal children. It must also take into consideration the negative effects of using these media as well.

Dhave Setabutr1, 2, Thanakrit Sathavornmanee2, Polpatt Jitpakdee2, Songphon Nudchawong2, Penpak Krergmatukorn3
1Department of Otolaryngology, Queen Sirikit National Institutes of Health, Bangkok, Thailand
2Chulabhorn International College of Medicine, Thammasat University, Pathum Thani, Thailand
3Department of Plastic Surgery, Queen Sirikit National Institute of Children’s Health, Bangkok, Thailand

Objective: To investigate the trend in cleft care at a major children’s referral center in Bangkok, Thailand.

Study Design: Retrospective chart review.

Subjects and Methods: A review of one-hundred twenty-nine patients under 18 years of age who had underwent care by the Senior author for cleft treatment between January of 2015 to October of 2017 was done. The impact of varying factors on patient care was analyzed. We compare our demographics and treatment timeline to that of previously published literature in more developed countries.

Setting: Tertiary care medical center.

Results: One hundred and two patient charts were reviewed with 53% male patients. Most patients had both cleft lip and palate, 44%. Cleft lips most commonly were complete and occurred on the left side. 77.4 percent of cleft were non-syndromic. On average, primary cleft lip surgery was performed before three months of age (2 months, 24 days). Sixteen percent of patients were treated with an obturator, while 11 patients had NAM use. Hearing screenings occurred on average at around six months of age. Abnormal tympanograms were evident in 32 percent of individuals. There was no statistical significance in timing of surgery for patients who lived a distance greater than 30 kilometers from the hospital versus those from Bangkok. (p > 0.05)

Conclusion: Reviewing data from a high-volume referral center in Thailand reveals little variance with regards to cleft care timing compared to published literature from the developed world. Distance was found to not have an impact on delay to surgery for patients living outside of the city.

Moe Myat Noe Phyu1,2, Zayar Lin1, Kyaw Myo Tun3, Thiha Myint Wei1,4, Ko Ko Maung1,4
1New Look New Life Cleft Lip and Palate Center/ Smile Train Myanmar, Yangon, Myanmar
2Township Public Health Department, Mingalar Taung Nyunt Township, Yangon, Myanmar
3Department of Preventive and Social Medicine, Defense Services Medical Academy, Yangon, Myanmar
4Department of Oral and Maxillofacial Surgery, University of Dental Medicine

Background and objectives: Several studies suggested that stress during pregnancy can have serious adverse health outcomes on mother and increased risk of the orofacial cleft in many populations but none has been identified in Myanmar population. Socioeconomic status has been recognized as a strong predictor of stress among pregnant women. We sought to accesses the socioeconomic status among orofacial cleft families and to identify the causal factors of maternal stress during pregnancy.

Materials and method: A cross-sectional descriptive study was performed at New Look New Life Cleft Lip and Palate Center in two hospitals, Yangon, Myanmar from 2017 January to 2018 January. The study consists of 298 cleft-born mothers having age up to five years old cleft children. Research tools are questionnaires survey and face to face interviews with mothers. Socioeconomic status is measured by using Kuppuswamy’s Socioeconomic Scale. Maternal stress questions were adopted from Kaiser Permanente/California Department of Health Study of Pregnancy and Stress. Collected data were analyzed by SPSS version 22.0.

Result: Among the 298 cases, most of the household heads were farmers 126(42.28%) and their educational attainment was middle school passed 83(27.85%). More than half, 201(68%) of monthly family income were below 180,000 MyanmarKyats (approximately 120 USDollar). The majority of cleft families, 129(43.3%) belong to low socioeconomic class. 141(47%) of the mother had stressful life events during pregnancy and 106(60%) of stress reported mother answered financial related stress as the main cause. We found that socioeconomic status is statistically significant with maternal stress level (Chi-Square= 5.81, p value=0.01).

Conclusion: Most of the cleft families were a low socioeconomic condition and could give financially related stress to pregnant mothers. Further studies are needed for extending the results and to investigate whether socioeconomic status influence on maternal stress or not.

Hsiu-Hsia Lin1, Yi-Tan Hung1, Lun-Jou Lo2
1Image Lab and Craniofacial Research Center, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan, Taiwan
2Department of Plastic and Reconstructive Surgery and Craniofacial Research Center, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan, Taiwan
p>Objective: Genioplasty is a common procedure to improve facial and chin profile. An important precaution is to prevent injuring the mental nerve or the inferior alveolar nerve within the bone. A general principle suggests placing the osteotomy line at least 5 mm below the mental foramen in order to avoid nerve injury. Incidence of lip numbness was reported. This study evaluated the course of inferior alveolar nerve before exiting the mental foramen using 3-dimensional cone-beam computed tomography (CBCT) data, and a safe guideline is recommended to prevent nerve injury during genioplasty.

Methods: CBCT images from 366 young adult patients who received orthodontic treatment and/or surgical correction for dentofacial problems were retrospectively collected and analyzed. Vertical distance from the inferior margin of mental foramen to the lowest point in the inferior alveolar neurovascular canal was measured.

Results: In the 732 hemi-mandibles, the mean ± SD of the vertical distance was 4.80 ± 1.53 mm, ranging from 0.3 to 10.0 mm. Only 42.90% of the vertical distances were up to 5mm, whilst it was up to 6mm in 79.91%, 7mm in 93.56%, 8mm in 97.79%, and 9mm in 99.57%.

Conclusions: A wide range of vertical distances from the lower margin of mental foramen to the lower border of inferior alveolar nerve was found. CBCT provides useful nerve information before sliding genioplasty. Otherwise, it is recommended to perform the osteotomy at least 8 mm below the inferior margin of the mental foramen in order to avoid the nerve.

Teruo Sakamoto1, Mari Okayasu2, Au Sasaki3, Takashi Tsuchimochi4, Ryo Nagahama5, Suguru Kondou6, Yuri Yamamoto Oonishi7, Hiroki Mori8, Tadashi Morishita9, Issei Takahashi10, Takenobu Ishii1, Haruyo Miyazaki1, Naoto Suda2, Takafumi Susami11, Isao Saito12
1Department of Orthodontics, Tokyo Dental College, Tokyo, Japan
2Department of Oral-Maxillofacial Surgery, Dentistry and Orthodontics, University of Tokyo Hospital, Tokyo, Japan
3Division of Orthodontics, Department of Human Development and Fostering, Meikai University School of Dentistry, Saitama, Japan
4Nippon Dental University Hospital,

Introduction: Hemifacial microsomia (HFM) is a congenital anomaly characterized by facial asymmetry and treatment requires interdisciplinary approach. The current situation on the treatment of HFM patients is unclear, therefore, a multi-institutional research was carried out by orthodontists to determine status and treatment of HFM patients.

Methods: A total of 19 facilities in Japan participated in the survey. Survey items of patients included the following: affected side, Pruzansky classification, complications, and history of orthodontic and surgical treatment.

Results and Discussion: Data from 584 cases were collected. Affected sides were 45.9% on the right, 45.0% on the left, and 9.1% on both. As for Pruzansky classification, 37.5% were Grade I, 52.1% were Grade II, and 9.2% were Grade III, and 1.2% were unknown. Complications included microtia in 66.1%, cleft lip and palate in 9.8%, transverse facial cleft in 25.9%, and epibulbar dermoid in 12.8% of cases. Phase 1 orthodontic treatment was initiated mostly between the ages of 4 and 9. The objectives of treatment were to improve cant of the occlusal plane and facial asymmetry and guide the growth of the mandible. So, FKO and bite plates were used. Orthodontic treatment was seen in 7.2% of cases for intraoperative and postoperative occlusal management such as distraction osteogenesis. During phase 2 treatment, surgical orthodontic treatment was seen in 41.9%. Distraction osteogenesis during the patients’ growth phase was performed in 19.6% (82 cases) at the average age of 7.9 years. After the completion of growth, 28 cases were re-operated, 18 cases did not require surgery, 25 cases required surgery but were not desired by patients, and 11 cases remained undecided.

Conclusion: The current situation of team care for HFM patients was clarified and the information was considered useful for standard treatment.

Siti Nur Nabihah Bte Zainul Abidin, Siti Mazlipah Ismail
Department of Oro-Maxillofacial Surgical & Medical Sciences, Faculty of Dentistry, University of Malaya, Kuala Lumpur, Malaysia

Objective: Aim of this study is to assess perceptual intelligibility of speech and proficiency of Quran recitations in Malay cleft palate patients and to compare if there any differences between the two

Method: 30 patients with repaired cleft palate were recruited from at Combined Cleft Clinic, Faculty of Dentistry, University of Malaya. Simple interview and oral examination were done after consent taking. Audio recordings were made of these patients reading a Malay passage and reciting Arabic letter and Chapter 1 Surah A-Fatihah from Holy Quran in a quiet room. The speech intelligibility was judged by author through perceptual assessment adapted from Cleft Audit Protocol for Speech – Augmented assessment form. The proficiency of Quran recitations was assessed by a Quranic expert, who are academician. Quranic Assessment Form Adapted j-QAF (Ukuran Tahap Pencapaian Bacaan Al-Quran).

Result: Intra-rater reliability were calculated using intra-class correlation coefficients and the levels of agreement were found to be excellent for both assessors. The assessment of speech intelligibility showed a good result however the proficiency of Quranic recitation in this study showed a moderate result. It is noted that difference between speech intelligibility and proficiency of Quranic recitation is statistically significant with 95% confident level.

Conclusion: Good speech intelligibility is noted among this group of patients. However, they did not show similar abilities in proficiency of Quranic recitation. It is noted that difference between speech intelligibility and proficiency of Quranic recitation is statistically significant.

Suteera Pradubwong, Yupin Puggasung, Bowornsilp Chowchuen
Tawanchai Cleft Center, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand

Background: Cleft lip and palate are congenital deformities which require interdisciplinary team care and appropriate treatment to achieve best outcomes. Nurse coordinator and Nurse specialist has significant role for patients care and coordination for treatment.

Objective: To report the roles and outcomes of nurse coordinator and nurse specialist in cleft care team.

Method: The descriptive study of the roles and outcomes of nurse coordinator and nurse specialist in cleft care team was done by collecting key performance indexes (KPI) from treatment protocol of Tawanchai center total 16 items in 2018 include 7 items satisfactions and 8 items clinical outcomes. Percentage and means analysis were determined from these data.

Results: Nurse Coordinator and Nurse Specialist take the roles in providing continuous care starting from pregnancy until birth to adulthood and from the hospital to patient’s home, offering various ways for patients to access the services, working and using a referral of care among the interdisciplinary team, developing a patient database, supporting patients and families, conducting researches and publications, exchanging knowledge, trainings and improving quality of the patients. The satisfaction outcomes were showed in the following aspects: quality of life, image, speech and communications, teeth alignments and occlusion, obtaining the pre-surgery information, and the treatment protocol (x + SD= 4.22 + 0.78; x + SD = 4.00+0.66; x + SD = 4.11+0.73; x + SD = 3.55+0.83; x + SD = 4.22 + 0.62; x + SD = 4.44+0.49, respectively). The clinical outcomes revealed that there were cheiloplasty in 3 to 6 months old, palatoplasty in 10 to 18 months old; in obtaining the pre-surgery information and follow-up with multidisciplinary team they showed 94.95, 96.96, 84, and 92.31%, respectively.

Conclusion: Nurse coordinator and Nurse specialist is important for patients and cleft care team. The overall outcomes of care concretely benefit the patients and families and interdisciplinary team. Therefore, nurse coordinator and nurse specialist is necessary for Cleft Center to achieve holistic care.

Jin-Han Yong, Chuan-Fong Yao, Ying-An Chen, Chiung-Shing Huang, Yu-Ray Chen, Pang-Yun Chou, Yi-Yu Lin
Craniofacial Center, Department of Plastic Surgery, Chang Gung Memorial Hospital, Taoyuan, Taiwan

Objective: An upward nasal rotation with increased nostril show is a main concern in Asian culture as it is considered not only as an unpleasant look appearance but also a potential psychosocial-related problem. Piggy nose is indicated for this situation, however it is not exactly defined. This 3D imaging-based study evaluated the definition of piggy nose by the nasal tip rotation from clinicians and observers for a reference to mutual consensus.

Material and Methods: This study enrolled consecutive patients who underwent two-jaw orthognathic surgery (n=107). Pre-operative 3dMD photos and cone beam CT were collected to measure the nasal tip rotation. This angle was defined by the intersection point of two planes, the standard Frankfort horizontal plane and the nasal tip plane from sn to the most slop of columella. Four groups of nasal tip rotation angle were divided according to the average range of the angular gap, group I to IV: 6 to 15 degree, 15 to 24 degree, 24 to 33 degree and 33 to 42 degree. A video was produced consisting of random 5 subjects in each group for appraising by the clinicians and observers to define the piggy nose. Statistically, significance is P<0.05.

Results: IRB was approved in the study. Total 20 craniofacial doctors and 40 laypersons were collected to appraise the video. In group I, the recognition rate of piggy nose is 13% in observers, and 9% in clinicians; in group II, 27% in observers vs 14% in clinicians; in group III, 54% vs 53; in group IV, 62% vs 77%. The inter-rater reliability is good (>0.8) in the study.

Conclusions: More than half of the clinicians and observers, piggy nose is defined when nasal tip rotation angle more than 24 degree.

Rafael Denadai1, Pang-Yun Chou1, Hyung Joon Seo1, Daniel Lonic1, Hsiu-Hsia Lin2, Betty CJ Pai3, Lun-Jou Lo1
1Department of Plastic and Reconstructive Surgery and Craniofacial Research Center, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan, Taiwan
2Image Lab and Craniofacial Research Center, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan, Taiwan
3Department of Craniofacial Orthodontics and Craniofacial Research Center, Chang Gung Memo

Background: Patient satisfaction with the shape and appearance of their nose after orthognathic surgery-based skeletofacial reconstruction is an important, but often overlooked, outcome. We assessed the nose-related outcomes through a recently developed patient-reported outcome instrument and a widely adopted 3D computer-based objective outcome instrument, to verify any correlation in the results produced by these tools.

Methods: We collected FACE-Q nose appearance reports (2 scales) and 3D nasal morphometry (10 parameters) from patients with class III skeletal pattern and congenital cleft lip palate deformity (n=23) or developmental dentofacial deformity (n=23) after (>12 months) skeletofacial reconstruction. Normal age-, gender-, and ethnicity-matched subjects (n=107) were enrolled for comparative analyses. The Wilcoxon signed-rank, Kruskal–Wallis, and Spearman’s correlation tests were used for the comparative and correlation analyses.

Results: The cleft and dentofacial cohorts demonstrated significantly (p<0.001) poorer satisfaction scores with regard to the FACE-Q nostrils scale than the normal cohort, without any significant difference in FACE-Q nose scale. The cleft cohort had significantly (p<0.001) smaller nasal length, nasal tip projection, and columellar angle and greater nasal protrusion, alar width, and columellar–labial angle values than the dentofacial and normal cohorts; however, there were no significant differences between the dentofacial versus normal cohorts. The FACE-Q nose and nostrils scales were significantly (p<0.001; r<0.30) correlated to the results of the 3D morphometric analysis, with regard to nasal length, alar width, columella angle, and columellar–labial angle parameters.

Conclusion: This study revealed differences in satisfaction with the appearance of the nose according to the type of underlying deformity, and demonstrated a significant correlation between the patient-reports and 3D image-based outcome measure tools, which has implications for multidisciplinary-centered research, auditing, and clinical care.

Natthaphon Piyasatukit1, Bowornsilp Chowchuen1, Benjamas Prathanee2, Ueamporn Summart3
1Division of Plastic Surgery, Department of Surgery, Khon Kaen University, Khon Kaen, Thailand
2Department of Otolaryngology, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
3Data Management and Statistical Analysis Center (DAMASAC) Doctoral student Faculty of Public Health, Khon Kaen University, Thailand

Background: The purpose of this study was analyzed the speech and language outcomes of cleft palate surgery including nasality, nasal emission, facial grimace, phonatory characteristics, compensatory misarticulations, intelligibility and rate of velopharyngeal insufficiency(VPI) by the Pittsburgh Weighted Speech Scale(PWSS) in the 8-12 years-old children with non-syndromic cleft palate with or without cleft lip and evaluated the factor that affected of the rate of VPI

Materials and Methods: A Cross-sectional study of 83 consecutive non-syndromic cleft palates with/or without cleft lips, born between January 2004 to December 2008, whom underwent the primary palatoplasty according to protocol of Tawanchai center, Srinagarind Hospital, Thailand. They were selected by systematic simple random sampling. Demographic datas were recorded the patients with cleft types, age at palatoplasty, operating surgeons, surgical techniques, otitis media and had oronasal fistula. The assessment protocol was recorded history taking, intraoral examinations, speech and language assessment. We use Thai universal parameters of speech outcomes to evaluate the THAICLET 10 year-index speech and language outcomes and the Pittsburgh weighted speech scale(PWSS) for correlation the outcomes. In the multivariate analysis occurrence VPI by PWSS and other covariate factors were performed by using estimation methods based on an exact binomial distribution. Magnitude of this study was expressed both adjusted risk difference and its 95% CI. All analysis was performed using Stata 13(Stata Corp, College Station, TX Significance level was set as P<0.05)

Results: The findings revealed that children with clefts had speech and language delay, abnormal understandability, resonance abnormality, voice disturbance and articulation defects that were 7(8.4%), 13(15%), 35 (42%), 10(12%) and 28(33.7%). For significant resonance abnormality the rate of moderate hypernasality was 15.6% and severe hypernasality was 3%. 14(21.69%) patients with persistent VPI following cleft palate repair and had a complete perceptual speech assessment on Thai universal speech parameter and nasoendoscopy(NAS). Diagnosis of VPI was determined by the patients’ score on the PWSS average 3.6(0-20), whereas score 0 indicates likely velopharyngeal competence were 30(36.14%) patients, 1–2 borderline competence were 5(6%) patients, 3–6 borderline incompetence were 23(27.7%) and ≥ 7 velopharyngeal incompetence were 18(21.6%) patients. After adjusting for multiple variables including age at primary palatoplasty, sex, cleft type, operating surgeon, otitis media, had oronasal fistula, amount procedure of oronasal fistula closure and VPI surgery through logistic regression, the results showed no statistically significant differences between VPI diagnosis by PWSS and any of these variable formations.

Conclusion: Articulation disorders are generally the most common speech problems for children with clefts. The overall rates of VPI by PWSS, corroborating with previous studies show the good outcomes using a similar definition for VPI in cleft palate patients whom underwent primary palatoplasty during previous rounds of our management protocol. The speech and language outcomes at 10 years-old with cleft palate is necessary for further management and treatment planning to support adaptation in school and feedback for reviewing the treatment protocols to improve clinical outcomes. However, the value of perceptual speech assessment, the standard national investigation of speech and language results should be concern for comparison of published results possible.

Krisadi Phannarus1, Sajjaporn Pakanant2, Chontira Saetang3, Waranee Linlawan4, Pornnapas Vongvanichvatthana5
1Dental Department, Queen Sirikit National Institute of Child Health, Bangkok, Thailand
2Dental Department, Phra Nakhon Si Ayutthaya Hospital, Phra Nakhon Si Ayutthaya, Thailand
3Dental Department, Pathumthani Hospital, Pathumthani, Thailand
4Dental Department, Samutsakhon Hosptial, Samutsakhon, Thailand
5Dental Department,

Background: Unilateral cleft lip and palate (UCLP) is one of the most common craniofacial anomalies with an incidence of 1-2 cases per 1,000 live births in Thailand. Initial cleft severity in patients with UCLP varies and the initial cleft size could impact maxillofacial growth potential and surgical outcome. The anthropometric measurements could provide valuable information for surgical correction and rehabilitation in the patients. However, study of initial maxillary arch dimensions in Thai neonates with UCLP remains limited.

Objective: The aim of this study was to evaluate the maxillary arch dimensions of neonates with non-syndromic complete UCLP in Thailand.

Material and method: Thirty-seven full-term neonates with non-syndromic complete UCLP born between 2016 and 2019 from 5 hospitals in Thailand were included in this study. The dental casts were obtained before applying a presurgical orthopedic appliance. Conventional landmarks were identified on the study casts to measure anterior cleft width (ACW), middle cleft width (MCW), posterior cleft width (PCW), anterior arch width (AAW), posterior arch width (PAW), arch length (AL), and arch circumference (AC) with a digital sliding caliper. Data were analyzed using descriptive statistics. Means and medians were compared using unpaired t-test and Mann-Whiney U statistic, respectively.

Result: Of 37 patients with UCLP, 17/37 (46%) were boys. Mean age was 8.14+8.18 days with no statistically significant difference between boys and girls (p= 0.6). The mean of ACW was 10.78+2.37 mm, MCW was 15.49+2.05 mm, PCW was 19.17+2.19 mm, AAW was 28.08+3.39 mm, PAW was 34.33+2.33 mm, AL was 22.27+2.0 mm, and AC was 50.45+4.69 mm. There were no statistically significant differences of the parameters between boys and girls (p>0.05).

Conclusion: The study showed initial pre-surgical cleft size in full-term Thai neonates with non-syndromic complete UCLP. There were no statistically significant differences between sexes in all parameters.

Yi-Yu Lin, Pang-Yun Chou, Po-Fang Wang, Chuan-Fong Yao, Ying-An Chen, Cheng-Hui Lin, Chiung-Shing Huang, Yu-Ray Chen
Craniofacial Center, Department of Plastic Surgery, Chang Gung Memorial Hospital, Taoyuan, Taiwan

Objective: Postoperative nasal morphology in orthognathic surgery (OGS) is a dominant esthetic concern. In this study, we aimed to evaluate the nasal morphologic difference in four-quadranted movements, even in the vertical and horizontal movements of Le Fort I osteotomy.

Material and Methods: From 2015 to 2017, the patients receiving OGS by one surgeon with routinely cinch suture were enrolled in our center. The cone beam computed tomography (CBCT) scans were completely collected preoperatively (T0), one-week (T1), and one-half year (T2) postoperatively. Subjects were divided into four groups based on quadrantal movement of maxilla in CBCT. Multivariate analyses were conducted at T0, T1, and T2, including the maximum lateral convexity of the alae of the nose (AL), the lateral extremity of the alar base curvature at the alar groove (AC), etc. Statistics was applied with significance P<0.05.

Results: IRB approval was obtained in Chang Gung Memorial Hospital. Total 107 patients (male= 32, female= 75, age= 24.4±5.3) were enrolled in this study. In the aspect of nasal morphologic change between pre- and post-operation (T2-T0), AC (mean= I:1.42, II:0.52, III:0.25, IV:2.26 mm) and nostril angle (mean= I:3.88, II:1.59, III:1.86, IV:4.04 degree) showed statistically significance in the four groups. Real move distance was not related to all measurements in the four groups. While comparing horizontal movement of LFI osteotomy, no significant difference of all peri-operative nasal morphologic change (T2-T0) was found. However, while comparing vertical movement, upward group had significantly more increased AL (mean= 1.28 vs 0.76 mm), AC (mean= 1.59 vs 0.46 mm), nostril angle(mean= 3.91 vs 1.66 degree) and less increased nasal height(mean= -0.09 vs 0.52 mm) than downward group. The resulting correlation coefficient turned out to be very good (all ICC > 0.8).

Conclusions: This study shows that the impact on the nasal morphology varies distinctly depending on the type of Le Fort I maxillary surgical movement.

Hattakorn Samretdee, Chanatiporn Chonprai, Niramol Patjanasoontorn
Hattakorn Samretdee, Chanatiporn Chonprai, Niramol Patjanasoontorn Department of Psychiatry, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand

Background: Physical self-perceptions are sense of physical satisfaction, appearance, and healthy or illness, Persons will assess physical self-perceptions in positive or negative ways that can reflexing personal sense of wellbeing. Adolescence is a period of body identification and vulnerable to self-appearance. The adolescences with repaired cleft lips and palates may be dissatisfaction with their physical self-perceptions or may not.

Objective: To assess the Physical Self-concept score of the Adolescences with repaired cleft lip and palate age 12-18 years old.

Materiel and method: A cross-sectional study design, Participants were 42 adolescences age 12-18 years old with repaired cleft lip and palate joined the 7th Comprehensive Care for Patients with Cleft Lip-Palate and Craniofacial Deformities in Khon Kaen Province by Tawanchai Royal Granted Project on 27th June 2019 answer the Tennessee Self Concept Scale (Thai-version, physical part), in 1-5 Likert Scale. The range of mean score is 2.50 - 3.49.

Result: Physical Self-concept scale of the adolescences age 12-18 years old with repaired cleft lip and palate was 3.64 (SD=0.39) more than 3.5 (p-value=0.0336, 95%CI=3.49-3.79).

Conclusion: Physical Self-concept scale of the adolescences age 12-18 years old with repaired cleft lip and palate was higher than mean score.

Lien-Shin Niu1, Hsiu-Hsia Lin2, Lun-Jou Lo3
1Craniofacial Research Center, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan, Taiwan
2Image Lab and Craniofacial Research Center, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan, Taiwan
3Department of Plastic and Reconstructive Surgery and Craniofacial Research Center, Chang Gung Memorial Hospital, Chang Gung University, Taoyua

Objective: The purpose of this prospective study was to present a new method of computer-aided design and manufacture (CAD/CAM) final (single) occlusal splint for orthognathic surgery, and the experience and validation of our method was provided and discussed.

Method: A total of twelve patients were enrolled. Cone-beam computed tomography (CBCT) was taken preoperatively and postoperatively. The digital occlusal splint with crossbar and some auxiliary markers was designed on the basis of the surgical simulation. The crossbar contained two horizontal and vertical cylinders and was used for evaluation of dental midline, skeletal midline, occlusal plane, upper tooth show, facial skin midline with the mouth closed, facial proportion, and symmetry during surgery. The vertical cylinders were perpendicular to Frankfort horizontal (FH) plane and especially used to control the head pose pitch direction. To ensure the accuracy of interoccusal relations of our design, the digital occlusal splint was compared with the traditional laboratory-made occlusal splint using a surface superimposition technique. For validation of surgical outcome, the virtual plan and postoperative surgical CBCT images were superimposed using surface-based registration to quantify the difference between the images. The data were presented in root-mean-square difference (RMSD) values between the images. Errors from localizing 3D superimpositions were controlled by repeated tests to ensure the intra-observer reproducibility and inter-observer reliability.

Results: The experimental results showed that RMSD values between the images ranged from 0.08 to 0.17 mm in the occlusal splint, 0.22 to 0.36 mm in the maxilla and from 0.95 to 1.83 mm in the mandible. The patients were follow-up for 6 months or more and all of them were satisfied with the results.

Conclusion: This study showed that the proposed approach is clinical feasible, reliable, simple designing, low-cost fabricating, and particularly easy and fast for intraoperative visual inspection of the postoperative facial appearance with or without face bow during surgery.

Muhammad Jailani1, Muhammad Taufik2
1Plastic Surgeon at Smile Train Organizations, Malahayati Hospital, Banda Aceh, Indonesia
2An intern at Plastic Surgery Departement. Smile Train Organization, Malahayati Hospital, Banda Aceh, Indonesia

Introduction: Cleft Lip and Palate (CLP) is a congenital abnormality in the form of gaps in the lips, gums and palate. This disorder occurs due to a disruption in the first trimester of pregnancy that causes disruption of the process of fetal growth and development. Surgical techniques for reconstructive surgery vary greatly, but labioplasty using a modified millard technique with premaxillary shortening is a technique that we used in this study with the aim of premaxilla shortening to reduce the tension of the suture wound and will reduce the scar formed in Bilateral labioplasty after surgery.

Method: This research is a cohort with a retrospective approach conducted on labioplasty patients at Malahayati Hospital in Banda Aceh, which was handled in the period of 2016 - 2019. The sample amounted to 23 respondents who will be analyzed using the frequency distribution table.

Results: From the results of the study found male sex as much as 60.9%, the age of patients in the age group 2 years and over as much as 69.6%, 6-9 months evaluation time as much as 87.0%, the diagnosis of complete bilateral labioplasty as much as 65.2% and good outcome in bilateral labioplasty using modified millard technique with premaxilla shortening as much as 73.9%

Conclusion: From the overall it can be concluded that the majority of male sex is the most, the highest in the age group 2 years and above, the most evaluation time is 6-9 months, the most common diagnosis is complete bilateral labiolasty and the most results on bilateral labioplasty using modified millard techniques with premaxillary shortening is good outcome.

Oanh H. Nguyen1, Janella Christie2
1Danang University of Medical Technology and Pharmacy, Ha Noi, Vietnam
2Speech Pathology Service, Monash Children’s Monash Health, Melbourne, Australia

Introduction: Cleft speech patterns have not yet been identified in Vietnamese speaking children and adults following cleft repair. Although cleft speech characteristics are considered universal, only informal data has so far been collected in Vietnam. Objective: This paper presents preliminary data outlining cleft speech characteristics of Vietnamese children’s speech.

Method: The study was cross-sectional in design. The subjects consisted of 60 children aged between 4 years and 7 years with complete unilateral cleft lip-palate from 2016 to 2019, who had received surgical treatment at National Hospital of Odonto – Stomatology. Initial consonant production at a word level was evaluated using a list of 18 words representing the consonant table of the Northern dialect of Vietnam (including: mouse/chuột, to draw/vẽ, tree/cây, monkey/khỉ, red/đỏ, teacher/thầy, flower/hoa, movie/phim, to sleep/ngủ, lid/nắp, book/sách, class/lớp, bed/giường, bear/gấu, grape/nho, kitchen/bếp, cat/mèo, ear/tai, battery/pin). Articulation errors were analyzed according to Vietnamese IPA chart and phoneme sequence of Tang and Barlow (2006).

Results: All children in the study produced errors in the initial position in words. These errors related to nasalization, initial consonant deletion, phoneme substitution and weak production. In terms of positioning: 30% had fronting, 45% had sounds produced mid palate and 30% had backing errors.

Conclusions: Most children with cleft lip and palate in the study have initial consonant errors. Speech therapy for these children is extremely important to improve their speech intelligibility to enable effective communication and participation within their family, school and social environments.

Thi Ha Myint Wei1
Department of Oral and Maxillofacial Surgery, University of Dental Medicine, Mandalay, Myanmar

Objective: The purpose of this study was to study the changes of nostrils sill height and upper lip height after secondary alveolar bone grafting (secondary ABG) in patients with repaired unilateral complete cleft lip and palate.

Method: In this study, secondary ABG was done to 30 patients of age between 7 to 15 years of age with alveolar cleft of operated unilateral cleft lip and palate patients. The changes of nostril sill height and upper lip height after secondary ABG were done at postoperative two weeks and determination of postoperative infection and fistulas at bone graft site on postoperative 1st week, 2nd week and 12th week. Success rate of bone graft was assessed by taking periapical, standard occlusal and orthopantomogram X-rays and assess by using modified Bergland Scale and Chelsea Scale on postoperative 12th weeks. All data was collected and imported into a paired t-test with STATA 15.0 statistical software for determination of significant differences.

Results: A total of 30 patients age between 7 to 15 years were included in this study. Measurement of all the proportion indices of nasal sill height and upper lip height were statistically significant (p<0.0001) and significantly elevated. All the bone grafts present in the study were successful according to the Modified Bergland Scale and Chelsea scale. There was no cases of postoperative complication of wound dehiscence, wound infection and fistula at grafted site within postoperative 1st week, 2nd week and 12th weeks.

Conclusion: Successful secondary alveolar bone grafting could significantly elevate the nostril sill height and the upper lip height without any complication in patients with repaired unilateral complete cleft lip and palate

Chikayoshi Narita, Keisuke Imai, Takeshi Masuoka, Daisuke Sakahara
Department of Plastic and Reconstructive Surgery, Osaka City General Hospital, Osaka, Japan

Objective: The absorbable plate would be retained for only 1 year during the period of rapid cranial growth and then would be absorbed, allowing for delayed bone formation. Bone formation in the early phase could be prevented by this reaction. The efficacy of our developed suturectomy using absorbable plates was examined.

Method: The primary study subjects were patients with scaphocephaly or plagiocephaly younger than 3 months of age who had been indicated for suturectomy followed by helmet-therapy, were indicated for our technique, suturectomy with absorbable plates. Patients presenting with a history of cranial or intracranial surgery were excluded. Preoperatively and postoperatively, radiography and computed tomography (CT) were used to evaluate the cranial shapes. The cranial shapes were evaluated by using three-dimensional CT and clinical photos. The cephalic index (CI) of the patients were compared, and the standard range of forehead measurements, which we reported in 1991, was used for those with frontal plagiocephaly. The patients underwent surgery between 2011 and 2019, and were followed up for at least 6 months postoperatively.

Results: In total, 10 cases were reviewed (plagiocephaly: 4, scaphocephaly: 6). Those patients demonstrated either a normal cephalic index or symmetric forehead, and did not require secondary surgery. Furthermore, the amount of blood loss was lesser and operative time was shorter with this approach than with conventional cranial reconstruction and distraction osteogenesis.

Conclusion: Placement of absorbable plates during suturectomy has prevented undesirably rapid bone formation during the early postoperative period, and yet also promoted positive bone formation after plate absorption in patients with plagiocephaly and scaphocephaly. Positive outcomes were obtained without adjunctive therapy (e.g., helmet therapy). We believe that our novel procedure is less invasive and it is expected to be highly effective.

Kaviya Kanokpongsak
Cleft Lip and Palate Center, Maharat Nakhon Ratchasima Hospital, Nakhon Ratchasima, Thailand

Maxillary hypoplasia in unilateral cleft lip and palate deformities results from congenital reduction in midfacial growth and the effects of the surgical scar from surgical repair. Distraction osteogenesis (DO) is alternative surgical technique for generating new bone growth through the application of tensile stresses to a preexisting tissue lying between two bone ends. Rigid internal distractor has provided to treat severe midface hypoplasia with minimally invasive procedure, especially those secondary to orofacial clefting with the absence of maxillary and alveolar bone and the presence of scaring.

Thai female with left complete unilateral cleft lip and palate aged 16 years and 9 months with skeletal class III severe maxillary deficiency, Class III dental malocclusion with a negative overjet and concave facial profile. The operations involved a Le Fort I osteotomy (two pieces at cleft defect), palatal and intermediate stent placement and distractor insertion with screw fixation. Distraction of the maxilla was initiated after 7-day latency period. Postoperative cephalometric analysis showed maxillary advancement anteriorly and inferiorly, the total distraction treatment period was 8 days. The maxillary advancement was 7.5 mm on right side and 5 mm on left side, while the maxillary down grafting was 2 mm. The SNA angle increased from 69° to 78.5°. Moreover, the ANB angle changed from −6.5° to 3.5° and the occlusion changed from Class III to Class I occlusion. The profile of the face changed from concave to straight profile and a much better esthetic result was achieved.

Maxillary distraction osteogenesis is effective surgical procedure for the treatment of midfacial hypoplasia in cleft patient. Furthermore, it minimizes the risk of the surgical procedure and shortens the operating time.

Warutta Kasemsarn, Kiatanant Boonsiriseth
Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Mahidol University, Bangkok, Thailand

Cleft lip-nose is a unique deformity that may affect aesthetic and function of air flow via nostrils. Wide nostril, flaring alar and short columella are notable characters in bilateral cleft lip-nose deformity. Our case was 29 year-old Thai male with bilateral cleft lip and palate. He had been operated according to cleft sequence; lip repair, palate repair, alveolar bone graft and orthognathic surgery. He had a main feature of bilateral cleft lip-nose deformity including bend nasal tip and obvious scar at philtrum. Open septorhinoplasty and scar revision were planed, forked-flap was designed as trans- columella incision, septal cartilage was harvested for creating strut and cap graft, diced ear cartilage was augmented on nasal dorsum. Post-operation, left side of forked-flap had flap compromise but it was improved spontaneously. The result shows lengthening columella with increasing of tip projection and narrowing philtrum.

Sayuri Taniguchi, Keisuke Imai
Department of Pediatric Plastic Surgery, Osaka City General Hospital, Osaka, Japan

Introduction: We have been performing a modified Tajima’s Technique (=NANIWA) on infants at about three months of age. To evaluate the results, the effect of growth of the lip and nose should be measured and assessed for more than 10years postoperatively.

Method: The basic designs are the rotation advancement with a small quadrangular flap. The important points of our method are: The muscle should not be dissected from the skin. The optimum length of the small quadrangular flap is 1.5 mm. This study was performed to measure red lip and white lip growth, as well as nostril floor length growth from photos taken at six months (T1), one year (T2), four years of age (T3) and last follow-up over ten years (T4). To compare changes over time, as ratios of cleft / non-cleft side, the base of the alar (=BAR), vertical white lip length (=WLR) and horizontal red lip length (=RLR) were evaluated.

Results: Of the 47 patients, 19 had incomplete cleft lip and 28 had complete cleft lip. In the complete cleft group, at T1, the average NBR;1.27, the average WLR;0.97 and the average RLR;0.95. At T4, the average NBR;1.17, the average WLR; 0.96 and the average RLR: 1.02. RLR(T3) <1.00, RLR(T4) increased to equal. In the incomplete cleft group, at T1, the average NBR; 1.18, the average WLR; 1.02 and the average RLR;0.92. At T4, the average NBR; 1.09, the average WLR; 1.02 and the average RLR; 1.00. RLR(T3) <1.00, RLR(T4) increased to equal.

Conclusion: The present study demonstrated that white lips and red lips gain symmetry over the years, and laterality of the nostril floor could be decreased with postoperative growth for 10 years. It is believed that our method corrected laterality of the white lip in incomplete cleft lip, but not in complete cleft lip.

Kaweesak Saothonglang, Pattama Punyavong, Kengkart Winaikosol
Division of Plastic and Reconstructive Surgery, Department of Surgery and Department of Pathology, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand

Background: Oronasal fistula (ONF) is a common complication following cleft palate surgery. Its incidence varies widely. Also, various factors have been proposed for the development of ONF after cleft palate surgery.

Objective: To investigate prevalence of oronasal fistula and identify factors contributing to oronasal fistula following primary palatoplasty.

Material and Methods: A cross sectional study was performed. A total number of 234 cleft patients whom underwent primary palatoplasty during 1st January 2012 - 31st December 2016 at our center whom met the inclusion criteria were enrolled. Data collection was accomplished through reviewing electronic medical records and photographic measurement records during 2-year postoperative follow ups.

Results: Oronasal fistula developed in 26.1% of cases. There was a significant association between Veau classification and the development of ONF (P< 0.01), with ONF occurrence most prevalent in patients with Veau type IV and III respectively. Also, fistula rate was significantly higher among patients with congenital organ anomaly (P<0.01) and non-pre-operative nasoalveolar molding (non PNAM) (P<0.05) and positively correlated with the width of the cleft when it exceeded >11.5 mm (P<0.05)

Conclusion: Patient with more cleft severity in Veau class III or IV and cleft width >11.5 mm are more likely to be at risk of fistula formation. Besides the severity of cleft palate, cleft patients with congenital organ anomaly also has higher fistula occurrence. Preoperative nasoalveolar molding is likely to help in lowering rate of ONF in wide cleft patients.

Closing Ceremony

Paper competition announcement

In the 9th Asian Pacific Cleft Lip-Palate and Craniofacial Deformities Congress (APCLPC 2019), Poster presentation awards are given for the best poster presentations. Posters are judged by members of the Thai Cleft Lip-Palate and Craniofacial Association (TCCA) at 1.30-2.00 PM. of Monday 11 November 2019. Consideration is given to scientific impact, research rigours, and overall presentation of the contents. The posters selected for the Best Poster Awards are officially announced as follows;

Research Poster Presentation

The 1st Place Prize - Long-Term Follow-Up of the Shape and Length of the Lip and Nose after Unilateral Cleft Lip Repair with A Modified Tajima’s Technique (=Naniwa) by Sayuri Taniguchi, Keisuke Imai

The 2nd Place Prize - A Comparative Study of the Nose-Related Outcomes after Skeletofacial Reconstruction in Cleft and Dentofacial Deformities: Patient-Perceived Appearance and 3D Morphometric Analysis by Rafael Denadai, Pang-Yun Chou, Hyung Joon Seo, et al. AND
Efficacy of Suturectomy Using Absorbable Plates in Early Surgery for Plagiocephaly and Scaphocephaly by Chikayoshi Narita, Keisuke Imai, Takeshi Masuoka, et al.

Case Reports and Others Posters

The 1st Place Prize - Simultaneous Premaxilla Repositioning with Iliac Bone Graft in Bilateral Alveolar Cleft by Ittiporn Suteepichetpun, Kiatanant Boonsiriseth

The 2nd Place Prize - Korat NAM I in Presurgical Unilateral Cleft Lip and Palate Treatment by Nirunrungreng P, Virarat P, Klachoho S, et al.

The 3rd Place Prize - Peirre Robin Sequence (PRS) Management: A Retrospective Review of 36 Consecutive Patients at Princess Margaret Hospital by Hayley Benbow

The Host of the 10th APCLPC 2023
Prof. Lun-Jou Lo from Chang Gung University, Taiwan received consensus agreement to be the host of the 10th APCLPC 2023
Prof. Lun-Jou Lo from Chang Gung University, Taiwan received consensus agreement to be the host of the 10th APCLPC 2023

In accordance with the Faculty Meeting on 11th November 2019, 23 committee members of the Asian Pacific Cleft Lip-Palate and Craniofacial Congress (APCLPC) had consensus agreement with Prof. Lun-Jou Lo to be the host of the 10th APCLPC 2023. The Congress will be held at Taiwan in 2023. In this occasion, Dr. David Gillett, in regards of APCLPC Congress, presided over to give the flag of the hosting country to Prof. Lun-Jou Lo.

Adjourn

Prof. Bowornsilp Chowchuen, the president of the organizing committee, expressed sincere thanks to the invited speakers, delegates, and participants for being together until the last day of the congress. “The 9th Asian Pacific Cleft Lip-Palate and Craniofacial Congress achieves wonderful success, but it will be impossible without everybody. We see the linkage between regional and global professionals which ensure the good future of patients with cleft lip-palate and craniofacial deformities. Thank you for your dedication and your time for joining us, and see you again in Taiwan in 2023!”, Prof. Bowornsilp embedded the good bye.