Mandibular distraction osteogenesis in unilateral craniofacial microsomia: preliminary report.

At present, Ilizarov's distraction principle becomes applicable in craniofacial surgery. We would like to present a report of mandibular lengthening by distraction osteogenesis that has been performed in 4 Thai children with unilateral craniofacial microsomia in King Chulalongkorn Memorial hospital from 1996 to 1997. The distraction process was composed of latency, distraction, and consolidation phases. After the latency period, the distraction was performed by a patient's family member at home at the rate of 1 millimeter per day. Facial asymmetry and malocclusion were improved in all cases after the process was completed. No complication was experienced. No relapse or complication was detected after a mean follow-up period of 99.5 weeks. However, more cases and longer follow-up are needed before any conclusion can be made.

Outcome of treatment of rectal cancer.

To demonstrate the trend and treatment outcome of rectal cancer after the advent of adjuvant therapy, all case notes of rectal cancer patients admitted to Chulalongkorn Hospital from 1985-1994 were reviewed and cases were followed until 1996. Mean follow-up period was 685.3 days (8-3, 193 days). Most rectal tumors were Dukes' C (43.8%), well-differentiated (54.1%) and at the distal third (53.4%). AP resection remained the most common procedure before and after the advent of adjuvant therapeutic options (62.3%). Of 146 patients treated by curative operations, 60 had adjuvant therapies of which radical radiotherapy with or without chemotherapy was the most common. However, chemotherapy was increasingly employed as the neoadjuvant and as combined chemoradiotherapy. There was a preferential selection of less well-differentiated, more distal, more Dukes' C disease and younger patients for the adjuvant therapy (p < 0.05). Recurrence rate in the adjuvant group was not different from the surgery group despite significant poorer prognostic indicators (17.4% & 21.7%, p = 0.53). Mortality was higher in Dukes' B + C patients in adjuvant group (17.3% & 3.4%, p = 0.02). The outcomes were not different among Dukes' A patients. The complications; i.e. wound problems, gut obstruction; did not increase with the adjuvant treatment. No adverse effect was observed on the healing of colorectal or coloanal anastomoses in the adjuvant group.