Adding herbal extracts to silicone gel on post-sternotomy scar: a prospective randomised double-blind study.

OBJECTIVE: Silicone gel has been shown effective in improving healing post-sternotomy scars. It remains to be determined whether adding herbal extracts to the gel would augment the healing effect. METHOD: After median sternotomy, patients were randomised into two groups. Group 1: topical silicone gel plus herbal extract gel (Allium cepa, Centella Asiatica, Aloe vera and Paper Mulberry) and Group 2: silicone gel. Patients were treated for six months. The postoperative scars were assessed at three and six months by plastic surgeons using the Vancouver Scar Scale (VSS) and the patient assessment scar scale. RESULTS: Each group comprised 23 patients (n=46 in total). The VSS was significantly lower in Group 1 than in Group 2 (p=0.018 and p=0.051, respectively). In Group 1, the four differences from baseline were vascularity scores at three and six months (-0.391, p=0.025; -0.435, p=0.013, respectively), and pigmentation scores at three and six months (-0.391, p=0.019; -0.609, p=0.000, respectively). In Group 2, differences from baseline were the pigmentation and vascularity score at six months (-0.6609, p=0.000; -0.348, p=0.046, respectively). CONCLUSION: Our results suggest, post-sternotomy scars trend to have better vascularity and pigmentation when treated with silicone gel plus herbal extracts.

Empowering Volunteers at Tawanchai Centre for Patients with Cleft Lip and Palate.

BACKGROUND: Cleft lip and palate (CLP) congenital anomalies have a high prevalence in the Northeast of Thailand. A care team's understand of treatment plan would help to guide the family of patients with CLP to achieve the treatment. OBJECTIVE: To examine the impact of the empowering volunteer project, established in the northeast Thailand. MATERIAL AND METHOD: The Empowering Volunteer project was conducted in 2008 under the Tawanchai Royal Granted project. The patients and family's general information, treatment, the group brainstorming, and satisfaction with the project were analysed. RESULTS: Participants were 12 children with CLP their families and five volunteers with CLP; the participating patients were predominantly females and the mean age was 12.2 years. The treatment comprised of speech training, dental hygiene care, bone graft and orthodontic treatment. Four issues were addressed including: problems in taking care of breast feeding, instructions' needs for care at birth, difficulty in access information and society impact, and needs in having a network of volunteers. CONCLUSIONS: Empowering volunteer is important for holistic care of patients with CLP which provides easy access and multiple channels for patients and their families. It should be developed as part of the self-help and family support group, the development of community based team and comprehensive CLP care program.

Evaluation of Facial Appearance among Patients With Repaired Unilateral Cleft Lip and Palate: Comparison of Patient- and Clinician-Ratings of Satisfaction.

The objective of this study was to determine the levels of patient-satisfaction on facial and dental appearance compared with clinician ratings. Participants included 61 patients with repaired unilateral cleft lip and palate (UCLP), aged 14-25 years. Raters comprised three cleft team clinicians. A Likert scale was used to assess the levels of satisfaction of the patients themselves and the clinicians. The results revealed that the patients were moderately satisfied with their appearance. Nose was the least satisfactory feature, followed by lip appearance. When compared to the clinician ratings, the patients were less satisfied with their own nose and lip, but more satisfied with teeth. Concerning age, self-assessment did not differ between adolescents and young adults. Females were less likely to be satisfied compared to males, but the difference was not statistically significant. In conclusion, patients with repaired UCLP were moderately satisfied with their facial and dental appearance. Clinician- and patient-opinions were different in some aspects. This study highlights the importance of patient satisfaction as a meaningful treatment outcome assessment, which could lead to an improvement in cleft care to meet the patient expectations.

Oral health status and oral impacts on quality of life in early adolescent cleft patients.

OBJECTIVE: To determine the levels of dental caries, periodontal disease and oral health-related quality of life in children with cleft lip and/or cleft palate compared to non-cleft controls. MATERIAL AND METHOD: This cross-sectional study was conducted in Khon Kaen, Thailand. Subjects included 68 oral cleft and 118 non-cleft individuals aged 10-14 years, who were interviewed using the Child-Oral Impacts on Daily Pemformance (Child-OIDP) index and received oral examinations. RESULTS: Decayed, missing and filled teeth (DMFT) index in permanent teeth, plaque index (PI), and gingival index (GI) scores were significantly higher in the children with cleft than in the controls. However, there was no significant difference in caries prevalence and decayed, missing and filled teeth (dmnft) index inprimaly teeth between comparison groups. The prevalence of oral impacts on Speaking and Smiling was significantly higher in the cleft children than non-cleft controls. The mean impact score between both groups were not significantly different, but the cleft children with impacts had a significantly higher mean impact score (11.9) than did the controls (8.6). The impact score in the cleft children was high for speaking (4.5), emotion control (4.2), eating (3.4) and relaxing (3.4) activities. The main causes of these impacts included having oro-nasalftstula, having orthodontics appliance, position of teeth and deformity of mouth or face. CONCLUSION: The cleft children had higher levels ofdental caries and gingivitis, and poorer oral hygiene than the controls. They also had lower quality of life than the controls in most pelformances with different perceived causes.

Clinical outcomes of primary palatoplasty in pre-school-aged cleft palate children in Srinagarind hospital: quality of life.

BACKGROUND: Cleft lips and cleft palates are common congenital anomalies, which affects facial appearance, speech, hearing, teeth alignment and other structures. Craniofacial anomalies and speech disorders are crucial problems in the preschool-aged children (5-6 years old), when they start attending school and become more engaged in the community. This condition, which differentiates them from other students, can lead to teasing or mocking which can cause low-self esteem, an inferiority complex, andfoster bad relationships with friends. Missing class in order to receive treatment and other additional care can affect a student's learning, development and overall-quality of life. OBJECTIVE: The purpose of this research was to study the quality of life in preschool-aged cleftpalate children and satisfaction with their level of speech. MATERIAL AND METHOD: This was a retrospective, descriptive study. The data were collected by reviewing medical records of patients with cleft lip and cleft palate aged 5-6 years old who underwent operation and treatment with the Tawanchai Center at Srinagarind Hospital. There were 39patients in this study. Data collection was conducted for 5 months (June to October 2013). The research instruments were: (1) General Demographic Questionnaire, (2) Quality of Life Questionnaire with 5 Domains, and (3) the Satisfaction of Speech Questionnaire. The descriptive statistics, percentages and the standard deviation were analyzed in the present study. RESULTS: The findings revealedfamily information pertaining to CLP treatment and the impact it has on consumption, speech training, hearing test, development, dental treatment, communication skills, participation, referral treatment as well as the quality ofcoordinationfor advanced treatment. The present study revealed that all ofthe aforementioned criteria were met at a high level. Moreover the child's sickness had only a moderate impact on family life. In conclusion, the overall satisfaction was at a very high level. CONCLUSION: It was concluded that the collaboration of the Tawanchai Cleft Center and the government, as well as with private and non-governmental organizations was exceptional, particularly in regard to providing proper and continuous treatment for patients with cleft lips and/or cleft palate. The findings reflect a good quality of life in the pre-schooled children with cleft lip and cleft palate that received treatment from the Tawanchai Cleft Center at Srinagarind Hospital. Furthermore, the study showed that the problems associated with the condition, only affected the family's lives at a minimal level.

Growth modification in unilateral cleft lip and palate patients with face mask.

The intended aim of treatment in cleft lip and palate patients with growth modification is to improve the relation of jaws by advance the maxilla, restrict the mandible or combination of these. The appliances usually used are face mask or protraction headgear (Delaire and Petit types). Modification of growth is advocated to be applied before the end of adolescent growth spurt and long-term and permanent improvement cannot be guaranteed. Achieving the aim of growth modification is still controversial since most reported results of this treatment are dento-alveolar changes and backward rotation of the mandible that would not be considered to be growth modification.

Tawanchai Cleft Center quality of life outcomes: one of studies of patients with cleft lip and palate in Thailand and the Asia Pacific Region.

BACKGROUND: The needs and quality of life (QOL) of children with cleft lip and palate (CLP) after being processed through the healthcare system are important in order to understand how to improve the standards of care. The Tawanchai Cleft Center of Thailand in collaboration with Cleft Lip and Palate Care Center of the Asia Pacific Region, conducted a number of studies on various aspects of treatment outcomes as an indication of its performance. This paper presents the outcome effects on QOL. OBJECTIVE: To determine (a) the QOL of children with CLP in Northeast Thailand registered and followed-up at the Tawanchai Centre, (b) their ongoing care needs and (c) the mental health of their parents when the children reach 5 years of age. MATERIAL AND METHOD: Using the Need, Satisfaction, QOL and GHQ-12 questionnaires, the authors evaluated 36 five-year-old children with CLP, living in Northeast Thailand, registered at birth for treatment at the Tawanchai Cleft Center. RESULTS: The aspects most needing attention were: dental, speech therapy and local healthcare service. The QOL was low in the economic, child relationships and psychological domains. The parents need more training on how to raise children with CLP most appropriately. According to the GHQ-12, none of the families identified any mental problems. CONCLUSION: Children with CLP at five years of age under the care of the Tawanchai Cleft Center by their own self-assessment have satisfactory outcomes in most domains. Notwithstanding, there is need to improve parent training and access to dental care, speech therapy and local healthcare services.

The treatment of 4-5 year-old patients with cleft lip and cleft palate in Tawanchai Center: follow-up.

BACKGROUND: The highest incidence of cleft lip and cleft palate in Thailand occurs in the Northeast Region. Tawanchai Center was set up 10 years ago to be a specialized medical care center where an interdisciplinary team provides care for cleft lip and cleft palate patients. There has never previously been a study about 4-5 year old patients treated and followed-up by the multidisciplinary team. OBJECTIVE: To study the 4-5 year old patient's with cleft lip and cleft palate who received treatment and follow-up in Tawanchai Center, Srinagarind Hospital. MATERIAL AND METHOD: This retrospective study was conducted using data from every 4-5 years old cleft lip and cleft palate patients' medical record of the patients who had the continuous multidisciplinary treatment care at Tawanchai Center, Srinagarind Hospital, Faculty of Medicine and Faculty of Dentistry, Khon Kaen University. The 123 case samples were collected during the 3 months of April-June 2012. The research instrument was a form for general data record and follow-up data record and then the data were analyzed by statistic and percentage. RESULTS: From the 123 cases of the 4-5 years old patients with cleft lip and cleft palate who received treatment at Tawanchai Center Srinagarind Hospital, it was found that 120 cases or 97.56 percent had an operation, 20 cases (16.26 percent) were found where patients came from Khon Kaen Province, 10 cases of each male and female. For this treatment, the majority (108 cases) used government insurance cards. The patients with cleft lip and cleft palate were most common and found to be 74 cases consisted of 44 male and 30 female. The diagnosis and follow-up of cleft lip and cleft palate patients were classified into 18 age ranges, with a total of 2,269 follow-up visits. The most common follow-up was for the 2-3 year old patients, which consisted of 410 times or 18.07 percent which consisted of 220 male and 190 female. Regarding the age range of the patients for the first diagnosis, the highest amount was 38 cases or 30.89 percent of 0-1 month newborn which were 22 males and 16 females. Regarding examination rooms used, the highest number of patients attended the out-patient surgical examination room (969 times, 30.66 percent), of which 526 times were male and 443 times female. The second highest number of patients attended the ENT room, 706 times or 22.33 percent of which 411 times were male and 295 female. The 2 patients with the highest number of follow-up were 87 and 65 times respectively. CONCLUSION: 123 cases of the 4-5 years patients had been continuously treated by the multidisciplinary team at Tawanchai Center Srinagarind Hospital. The highest number of visits was 87 or more than once per month, so it was a good opportunity for such a team to improve the efficiency and for developing the follow-up system and the diagnosis process for a baby with cleft lip and cleft palate before birth by use of ultrasound checking during pregnancy. Such a development was helpful for providing counseling towards mothers and families' preparation in order to give the most suitable age related treatment and full co-operative support to the children with cleft lip-cleft palate and family.

Pierre Robin sequence: challenges in the evaluation, management and the role of early distraction osteogenesis.

BACKGROUND: The challenges for the management of Pierre Robin Sequence (PRS) are the evaluation and management of airway and feeding difficulty from glossoptosis and associated cleft palate. OBJECTIVE: To present the clinical findings, management, outcome and the role of early distraction osteogenesis in patients with PRS. MATERIAL AND METHOD: The medical records were reviewed of patients with PRS seen and managed by the authors at Srinagarind Hospital, Khon Kaen University between 2001 and 2011. RESULTS: Fifteen patients with PRS were seen and managed. The female-to male ratio was 1.8 to 1 (9 girls, 5 boys). All of the patients presented with a small mandible, retrodisplaced tongue and upper airway difficulty. One patient had cleft lip only and one patient had cleft lip with cleft palate. Patients were primarily from the provinces of Khon Kaen and Mahasarakham. Conservative management was successful in 12 patients while the 3 with tracheostomy required distraction osteogenesis and the tracheostomy was subsequently successfully decanualated. At the last follow-up, most of the patients had proper catch-up and mandibular growth. CONCLUSION: Primary management of airway insufficiency in patients with PRS can be managed in a prone position with or without nasopharyngeal airway, prolonged intubation, tongue-lip adhesion, mandibular distraction osteogenesis and tracheostomy. The present study confirmed that proper conservative management can be used to manage most of the patients with PRS. However, early mandibular distraction should be considered when (a) indicated in patients with respiratory insufficiency to avoid tracheostomies or (b) successfully decannulating tracheostomies. Interdisciplinary team management is needed to ensure proper evaluation, improve care and optimum outcome.

Craniofacial microsomia: goals of treatment, staged reconstruction and long-term outcome.

BACKGROUND: Craniofacial microsomia (CFM) is a complex congenital condition and includes a spectrum of malformations primarily involving structures derived from the first and second branchial arches. OBJECTIVE: to present a review of the clinical presentations, assessment, treatment and outcome of the patients with CFM who were treated by the authors in Srinagarind hospital, Khon Kaen University. MATERIAL AND METHOD: Medical records were reviewed of patients with CFM, seen and managed by the authors at Srinagarind Hospital between 1993 and 2011; for an analysis of the clinical and radiologic assessments, treatments and outcomes. RESULTS: There were 23 patients (14 males and 9 females), 4 of whom had bilateral deformities, 19 unilateral deformities, and 1 syndromic CFM. The clinical presentation ranged from microtia to more severe deformities involving the mandible, zygoma and maxilla. Surgical treatments included: correction of macrostomia, distraction osteogenesis, staged ear reconstruction, orbit-maxillary-mandibular surgery, soft tissue reconstruction with dermis fat graft, vascularized free tissue transfer, cleft lip-cleft lip nose repair and palatoplasty. Most of the patients were satisfied with the medical treatment and many patients were still in the growing skeletal age and had staged reconstruction planned. CONCLUSION: The goals of treatment for CFM are to (a) manage respiratory insufficiency and feeding problems (b) maximize hearing and communication (c) improve facial symmetry and proper facial growth and (d) optimize dental occlusion. These patients require staged reconstruction and coordinated care by an experienced multidisciplinary craniofacial team in order to ensure a thorough, comprehensive assessment of the nature and extent of the problems and to provide better treatment planning and long-term outcome adapted to the respective anatomic and functional deformities of each patient, and the needs of their family and other involved stakeholders.

Revision rates of alveolar bone grafting in unilateral cleft lip and palate patients with and without orthodontic preparation.

The main purpose of the present study was to compare the revision rates of alveolar bone grafting in cleft lip and palate (CLP) patients with and without orthodontic preparation. The dental record of 101 patients with unilateral cleft lip and palate were examined. Details were recorded of general characteristic, the need for revision, intraoral condition prior to surgery, surgical procedure and the cause of revision. The revision rates were 11.9% and 20.6% in orthodontic preparation and non-orthodontic preparation groups, respectively. The Fisher's exact test showed that there was no difference in the revision rate between both groups. Intraoral conditions prior to grafting and different surgical procedures did not affect the success of alveolar bone grafting.

Primary unilateral cleft lip-nose repair: the Tawanchai cleft center's integrated and functional reconstruction.

BACKGROUND: The challenges of previously described techniques in unilateral cleft lip repairs inadequately address all deformities of the primary palate, the problems of scar and secondary deformities and achievement of optimum outcome. OBJECTIVE: To propose the integrated and functional reconstruction of primary unilateral cleft lip-nose repair and to present the preliminary outcome and advantages of this technique. MATERIAL AND METHOD: The integrated concepts and functional reconstruction includes analysis of the deformities, interdisciplinary management and The Tawanchai Center's interdisciplinary protocol for cleft lip and palate care, pre-surgical orthopedic treatments, the integrated primary cleft lip-nose repair and post-operative management. This technique of repair includes modified rotation advancement technique for skin surgery, functional muscle reconstruction, the correction of nasal deformities, the reconstruction of vermillion and final skin closure. RESULTS: Between 2002 and 2010, this technique was performed and evaluated on 122 patients who received primary unilateral cleft lip-nose repair, including 72 complete and 50 incomplete, 81 males and 41 females. Six parameters (scar, Cupid's bow symmetry, vermillion border symmetry, philtrum anatomic fidelity, muscle function and nasal symmetry) were used for evaluating the results, based on 4 scales (0-3) by 2 plastic surgeons. Among the mean scores better rating scales were achieved in philtrum anatomic fidelity (0.25) and muscle function (0.36), while the mean of the those with less satisfactory rating scales were achieved found in scar (0.82) and nasal asymmetry (0.72). These preliminary outcomes showed satisfactory results. Secondary reconstruction is less difficult and may be performed at the age of 4-6 years if indicated. DISCUSSION AND CONCLUSION: The authors introduce The Tawanchai Center's integrated concepts and functional reconstruction technique for unilateral cleft lip-nose repair. The technique provides the advantages of integrated assessment of all deformities of the cleft of primary palate, the design of integrated techniques together with the proper perioperative care, presurgical orthodontic treatment and a holistic and well-coordinated interdisciplinary management. The good preliminary outcome has been demonstrated. More improvement in outcome can be achieved by continuing assessment of these groups of patients until they reach maturity, continuing refinement of technique, improvement of interdisciplinary care and benchmarking of the outcome.

Primary bilateral cleft lip-nose repair: the Tawanchai Cleft Center's integrated and functional reconstruction.

BACKGROUND: The repair of a bilateral cleft is more difficult than a unilateral repair because of numerous anatomical challenges, such as difficulty of repairing the skin and muscle overlying the protruded premaxilla and bilateral nasal reconstruction with shortening of the columella. An optimum outcome is achieved when all of the deformities of the primary cleft palate, the problems of scar and secondary deformities have been addressed. OBJECTIVES: To propose an integrated and functional reconstruction of the primary bilateral cleft lip-nose repair and to present the preliminary outcomes of this technique and its advantages. MATERIAL AND METHOD: An integrated, functional reconstruction process includes: 1) analysis of the bilateral cleft deformities; 2) interdisciplinary management and use of Tawanchai Center's protocol for cleft lip and palate care; 3) pre-surgical orthopedic treatments; and, 4) integrated primary cleft lip-nose repair and post-operative management. This approach to repair includes: 1) design of a prolabial flap and a modified, rotation advancement technique for skin surgery; 2) functional muscle reconstruction; 3) correction of nasal deformities and columella lengthening; 4) reconstruction of the vermillion; and, 5) final skin closure. RESULTS: Between 2002 and 2010, this technique was performed and evaluated on 42 patients who received primary bilateral cleft lip-nose repair, including 31complete, 6 incomplete and 5 right complete and left incomplete, 27 males and 15 females. Six parameters (scar, Cupid's bow symmetry, vermillion border symmetry, philtrum anatomic fidelity, muscle function and nasal symmetry) were used for evaluating the results, based on 4 scales (0-3) by 2 plastic surgeons. Among the mean scores better rating scales were achieved in philtrum anatomic fidelity (0.69) and Cupid' bow symmetry (0.76) while the mean of the less satisfactory rating scale was found in scar (1.13) and nasal asymmetry (0.96). These preliminary outcomes showed satisfactory results. Secondary reconstruction is less difficult and may be performed at the age of 4-6 years if indicated. DISCUSSION AND CONCLUSION: The authors introduced the Tawanchai Center's integrated concepts and functional reconstruction technique for bilateral cleft lip-nose repair. The technique offers the advantages of an integrated assessment for all of the deformities of the primary cleft palate, the design of an integrated technique together with proper peri-operative care, presurgical orthodontic treatment, and a well-coordinated, holistic, interdisciplinary management. A satisfactory preliminary outcome was demonstrated but more improvement of the outcome can be achieved by: 1) continuing assessment of this group of patients until they reach maturity; 2) refining techniques; 3) improving interdisciplinary care; and, 4) setting benchmarks for the outcome.