Bowornsilp Chowchuen

Development of a network system for the care of patients with cleft lip and palate in Thailand

Cleft lip and palate are major public health concerns in Thailand, particularly in the north‐east. The challenge for a developing country is to adapt to its unique environment the form of multidisciplinary care of patients with clefts in industrialised nations. An epidemiological study of the incidence of clefts was made by reviewing previous studies conducted in Thailand as a guide to development of a prospective multicentre study. As a result, a system for the care of patients with clefts has been developed by the Cleft Center in Khon Kaen University. The new aims of cleft care in Thailand are to establish and develop specialised cleft centres and supportive systems for interdisciplinary management, adopt protocols for long‐term guidelines, provide education programmes about clefts, develop a database, and conduct relevant research projects. Other key factors in its success are the multicentre project, collaboration, fund raising, and good public relations.

Micronutrients and Oral Clefts: A Case-Control Study

Little is known about oral clefts in developing countries. We aimed to identify micronutrient-related and environmental risk factors for oral clefts in Thailand. We tested hypotheses that maternal exposure during the periconceptional period to multivitamins or liver consumption would decrease cleft lip with or without cleft palate (CL ± P) risk and that menstrual regulation supplements would increase CL ± P risk. We conducted a multisite hospital-based case-control study in Thailand. We enrolled cases with CL ± P and 2 live births as controls at birth from the same hospital. Mothers completed a questionnaire. Conditional logistic regression was used to estimate odds ratios (ORs) and 95% confidence intervals (CIs). Eighty-six cases and 172 controls were enrolled. Mothers who took a vitamin (adjusted OR, 0.39; 95% CI: 0.16, 0.94) or ate liver (adjusted OR, 0.26; 95% CI: 0.12, 0.57) were less likely than those who did not to have an affected child. Mothers who took a menstrual regulation supplement were more likely than mothers who did not to have an affected child. Findings did not differ for infants with a family history of other anomalies or with isolated CL ± P. If replicated, our finding that liver decreases CL ± P risk could offer a low-cost primary prevention strategy.

Modified bilateral neurovascular cheek flaps: a new technique for reconstruction of extensive upper lip defects.

The authors present a modified bilateral neurovascular cheek flap as a new technique for extensive upper lip reconstruction. The technique is modified from the bilateral neurovascular cheek flap for lower lip reconstruction described by Vatanasapt and colleagues in 1987 by designing rectangular and triangular flaps in the cheek tissues lateral to the lip defect on both the skin and the mucosal sides. This method has the advantage of preserving neurovascular structures as well as the original position of the oral commissure. Five patients are presented with acceptable surgical results. The technique is a good choice for functional reconstruction of near-total or total upper lip defects.

Case–control study of nutritional and environmental factors and the risk of oral clefts in Thailand

BACKGROUND One infant in 700 is born with an oral cleft. Prior studies suggest low micronutrient status is associated with an increased risk of oral clefts. Environmental factors such as passive smoke exposure or supplement use may also affect oral cleft risk. We examined nutrition and environmental related risk factors for oral clefts. METHODS We conducted a case-control study in Northeast Thailand in 2012 to 2013. We enrolled 95 cases and 95 controls. We recruited cases with a nonsyndromic cleft lip with or without a cleft palate (CL±P) less than 24 months old. Cases were matched to controls on age and place of conception. We collected survey data, a food frequency questionnaire, and measured zinc concentrations in toenail trimmings. We calculated descriptive statistics by case and control status. We used conditional logistic regression to estimate unadjusted and adjusted associations, 95% confidence intervals (CIs), and p-values. RESULTS Any liver intake (adjusted OR [aOR] for ≥1/week versus none), 10.58; 95%CI, 1.74-64.37, overall p = 0.02) and the presence of food insecurity (aOR, 9.62; 95% CI, 1.52-61.05; p = 0.02) in the periconceptional period increased CL±P risk. Passive smoke exposure increased the risk of CL±P (aOR, 6.52; 95% CI, 1.98-21.44; p < 0.01). Toenail zinc concentrations were not associated with CL±P risk. CONCLUSION Our findings add to a growing body of knowledge of environmental risk factors for oral clefts from low- and middle-income countries. Our findings on liver are contradictory to prior results. Large multisite studies are needed to identify environmental and genetic risk factors for oral clefts. Birth Defects Research (Part A) 106:624-632, 2016.

Modified Bilateral Neurovascular Cheek Flap: Functional Reconstruction of Extensive Lower Lip Defects.

Background: Reconstruction of extensive lower lip defects is challenging, and functional outcomes are difficult to achieve. Methods: A modified bilateral neurovascular cheek (MBNC) flap has been described. The data of patients with cancer of the lower lip treated with wide excision and reconstructed with the MBNC flap in the Plastic Surgery Unit, Srinagarind Hospital, Khon Kaen University, from 1966 to 2012 were reviewed. Results: Of the total of 143 patients included, 90.91% were women, and their age ranged from 32 to 100 years. All defects involved 70% or greater of the lower lip, which included oral commissure, buccal mucosa, or cheek skin and upper lip. All 20 patients who were followed up demonstrated good outcomes of intercommissural distance, interlabial distance, sulcus depth, and 2-point discrimination compared with normal lip parameters according to age group and satisfaction with treatment. Conclusions: Reconstruction of extensive lower lip defects with the MBNC flap provided good oral competence and functional outcomes. The flap provided adequate lip height and width, with proper position of oral commissure and vermilion reconstruction. The awareness about neurovascular anatomy of the lip and cheek and gentle dissection preserve the lip function. The flap overcomes the drawbacks of Karapandzic technique, which is microstomia, and of Bernard technique, which is a tight adynamic lower lip. It can be used in defects of more than two-thirds of the lip, extending to the cheek, commissural reconstruction, and secondary reconstruction.

A Prospective Randomized, Controlled, Double-Blind Trial of the Efficacy Using Centella Cream for Scar Improvement

Objective This study was performed to evaluate the efficacy of Centella asiatica extract in cream, a preparation for the prevention of scar development of the split-thickness skin graft (STSG) donor site. Methods A prospective randomized, double-blind control study was performed to evaluate the efficacy of Centella cream in 30 patients who underwent a STSG operation. Both Centella cream and placebo were applied equally to the donor site at least 2 weeks after epithelialization was completed. A scar assessment using the Vancouver Scar Scale (VSS) was taken at 4, 8, and 12 weeks. Results Of the original 30 patients, 23 patients completed evaluation. There were significant differences in pigmentation parameter of VSS and comparative total VSS scores between 4 and 12 weeks in Centella cream group. Conclusion The effect of Centella cream on scar development of a STSG operation may be attainable in terms of better pigmentation. By means of objective measurements and longer follow-up times, Centella cream may prove to be an alternative product for hypertrophic scar amelioration.

Degree of improvement after hyperbaric oxygen therapy for compromised flap and graft: A case series

Objective: To determine the treatment outcome of hyperbaric oxygen therapy (HBOT) in compromised graft/flap. Method: A retrospective study was conducted to identify patients who had undergone ischemic compromised graft and flap and received hyperbaric oxygen therapy at Srinagarind Hospital, Faculty of Medicine, Khon Kaen University, Thailand, between 2012 and 2017. Wound improvement was the primary outcome. Results: Eleven patients with ischemic graft/flaps were enrolled in the study (9 adults; 2 children). The results showed that the treatment outcome for all patients undergoing skin flap/graft was improved. Patients classified as grade 3 and 4 (7 flaps in total) had improved wound healing without other adjunctive therapies whereas 4 patients-classified as grades 1 and 2-experienced partial wound healing and required surgical debridement with skin graft or flap reconstruction. Conclusion: In flap or graft ischemia, HBOT represented an additional medical treatment that can enhance wound healing resulting in a satisfactory treatment outcome.

Efficacy of Adjunctive Hyperbaric Oxygen Therapy in Osteoradionecrosis

Abstract Osteoradionecrosis (ORN) is a common consequence resulting from radiation in patients with cancer. Presently, hyperbaric oxygen therapy (HBOT) is proposed to have a role in improving wound healing in ORN patients. There is no strong scientific evidence to confirm the benefits of HBOT for treatment of ORN as an adjunctive treatment. This study aimed to determine the benefits of adjunctive treatment of HBOT in ORN. A retrospective study was conducted at the Srinagarind Hospital, the Faculty of Medicine, Khon Kaen University, Thailand, between 2011 and 2017. The patients diagnosed with ORN, who received adjunctive HBOT before the operation, were enrolled. Complete healing of wounds was the primary outcome. There were 84 ORN patients with a mean age of 58.78 years; 54.76% were male and 45.24% were female. HBOT had a role significant in improving wound healing of ORN patients with stages 1 and 2. Poisson regression analysis showed that stage 3 of ORN negatively correlated with the number of HBOT dives (p = 0.001, incidence rates ratio = 0.85). In conclusion, HBOT improved wound healing of ORN patients with stages 1 and 2. In addition, stage 2 of ORN patients significantly required the highest number of HBOT dives compared to other types of ORN to promote wound healing, whereas stage 3 patients, who underwent bone debridement combined with HBOT, initiated to success of treatment process and required a smaller number of dives.

A Multisite Study of Oral Clefts and Associated Abnormalities in Thailand: The Epidemiologic Data.

Background: This study aimed to obtain epidemiological data of birth incidences of cleft lips and/or cleft palates (CLP) in the Thai population with associated risk factors. Methods: The data were collected for a period of 12 months between 2003 and 2004 for infants’ deliveries with CLP and associated risk factors in all hospitals of 6 provinces from 4 regions of Thailand. The birth incidence, related factors with cleft birth, and linkage with geographical area were analyzed by the geographic information system. Results: Phitsanulok, Saraburi, and Khon Kaen had higher birth incidences for CLP of 2.01, 1.69, and 1.66 per 1000 live births, respectively, and the overall birth incidence was 1.51 per 1000 live births. There were a total of 112 cleft births (61 males and 51 females) with 43 cleft lips, 18 cleft palates, and 51 cleft lips + cleft palates. The northeast region had infants with different gestational ages at birth and mothers with higher intakes of vitamins and a use of vitamin A supplement or retinoic acid than others. A use of folic acid supplement was low in all 4 regions. Conclusions: The varied incidence of CLP may reflect the incomplete accuracy of case ascertainment. A number of challenges were addressed. The geographic information system was helpful for more background investigation and planning of cleft care management. Our study enables future studies of etiological factors and future birth registries.