Evaluation of nasolabial esthetics in 8- to 12-year-old patients with cleft lip and palate by healthcare professionals in Northeast Thailand.

Objective: To assess the aesthetics of the nasolabial appearance of patients with cleft lip and palate aged 8-12 years by experienced and inexperienced professionals. Methods: A cross-sectional study was conducted on 32 patients with cleft lip and palate, who underwent surgery and follow-up treatment at the Cleft Center. The research tools included a parent-completed survey providing GO graphic data and two-dimensional frontal view photographs of patients from both left and right sides. The aesthetic of the lip, nose, and nasolabial region was evaluated by an experienced and inexperienced medical professional team in groups of four individuals. In addition, data analysis was performed using descriptive statistics, mean values, standard deviations, Cronbach's alpha reliability coefficient, and the Wilcoxon signed-rank test. Results: The average age of patients was 10.32 years, mainly male (65.63%), had unilateral cleft lip and palate (62.50%), and underwent bone grafting (96.88%). Regarding the assessment in three aspects, the aesthetic score assessed by experienced evaluators is fair level (2.64 ± 1.09) with an acceptable value of 0.73. In contrast, the inexperienced evaluator showed a high level (2.43 ± 0.83) with a high inter-rater reliability acceptable value of 0.60. Inexperienced evaluators showed higher scores for the lip and nasolabial region than experienced evaluators, which was statistically significant (p-values < 0.01). Conclusions: The inexperienced evaluators showed significantly higher scores for appearance than experienced evaluators. This result can improve surgical techniques in future procedures to meet the needs of patients seeking lip and nasolabial appearance corrections across different age groups.

En bloc groin node resection reconstructed with external oblique flap for solitary metastatic cholangiocarcinoma: a case report.

Cholangiocarcinoma requires complete surgical resection for cure. Even so, the recurrence and metastasis rates are high, and further treatment is typically through palliative systemic chemotherapy. Curative-intent resection of metastatic site may provide survival benefit in selected cases. However, there were no previous reports of groin node dissection in cholangiocarcinoma. We have reported the first case of intrahepatic mass-forming cholangiocarcinoma with isolated synchronous groin node metastasis, successfully treated with   resection of the liver mass followed by groin node resection, reconstructed with musculofascial flap. A 73-year-old man presented with right upper quadrant abdominal pain radiating to the right groin for two months. Magnetic resonance cholangiopancreatography revealed a 3.1 × 1.2 cm enhancing mass between hepatic segment 4 and the anterior peritoneum, invading the abdominal wall. Computed tomography of the abdomen revealed a 2.4 × 2.2 cm focal enhancing mass at the anterior aspect of the right lower abdominal wall, just anterior to the right inguinal ligament and iliac vessel. He underwent en bloc resection of hepatic segment 4, gallbladder, and anterior abdominal wall, and the histology result is cholangiocarcinoma. After systemic chemotherapy, he underwent en bloc resection of the right groin mass, reconstructed with external oblique musculofascial flap. The patient was able to achieve a 20-month recurrence free survival after the final operation. This case has demonstrated that in a carefully selected case, resection of distant metastasis cholangiocarcinoma can provide survival benefits, even in the rare site of metastasis.

The perspectives of learners at a public medical school on the evaluation of an online learning management system for degree and non-degree courses.

BACKGROUND: There has been a rapid development and adoption of online learning in medical education. However, it is difficult to adopt the currently available online learning management systems (LMS). This study aimed to examine learners' perspectives on the evaluation of online LMS. METHODS: An online LMS was developed based on the evidence-based guidelines. Two cross-sectional studies were conducted. A short survey was conducted with 716 learners registered on the LMS to obtain their perspectives on the online participation. A satisfaction survey was conducted with 255 learners enrolled in the courses taught solely online. Data from the LMS monitoring system was used to report the uptake of online courses. Data were analyzed using descriptive statistics. RESULTS: Participants reported that the major factor influencing LMS uptake was the ability to be accessed anytime and anywhere (n = 556, 77.7%). The participants had good experience in using the LMS and were satisfied with it (n = 255, mean = 4.53, SD = 0.62). For online degree courses, the course had a high completion rate of 90% provided that a mark was assigned for course attendance. For non-degree courses, irrespective of whether they were free, paid, exam-based, or participation only, the completion rate was considered low (range 4.3-36.7%). CONCLUSION: Under a limited budget, a medical school in a low- to middle-income country could develop an effective online LMS to meet learners' needs. Our newly developed online LMS is relevant, accepted and to the satisfaction of the learners. Medical schools in the same context are encouraged to develop their own online LMS that serve and support learning in both degree and non-degree courses.

The Effect of Presurgical Nasoalveolar Molding on Oronasal Fistula Following Primary Palatoplasty.

OBJECTIVE: Presurgical nasoalveolar molding (PNAM) is widely used in cleft care protocol. This study investigated the correlation between PNAM and oronasal fistula after primary palatoplasty. METHODS: A case-controlled study of 80 unilateral and bilateral complete cleft palate patients who underwent cleft palate repair were enrolled. Patients were divided into 2 groups: (1) no PNAM use and (2) PNAM use. The incidence of oronasal fistula and postoperative complications were compared between groups. RESULTS: Forty patients in each group demonstrated the same baseline characteristics. The PNAM group showed a significantly lower postoperative oronasal fistula rate (15% versus 50%, P=0.003). Palatal cleft width wider than 12.5 mm increases the odds ratio of fistula formation by 1.19-fold (P=0.037), and the PNAM protected against postoperative palatal fistula formation (odds ratio 0.20, P=0.003). CONCLUSION: Presurgical nasoalveolar molding can reduce postoperative oronasal fistula in wide-gap Veau type III and IV cleft palate.

Predictive MERRA-2 aerosol diagnostic model for oral, oropharyngeal and laryngeal cancer caused by air pollution in Thai population.

Introduction: Head and neck cancers were generally characterized with many possible causes. Exposure to outdoor particulate matter affected to multiple organ systems but it was unknown whether which species in PM was an association with cancer incidence. Objectives: The study aimed to examine the oral- oropharyngeal- laryngeal cancer incidence and accumulated air pollution-related cancers in the spatial patterns. Methods: Observational study was conducted, and the Poisson log-linear models were used which were analyzed on subgroups-specific incidence rates by national references of Thailand and NASA's database of aerosol diagnostics model (MERRA-2). Results: With a significant influence on increasing of 1 µg/m3 black carbon, organic carbon, Dust-PM2.5, and SO4 were associated with increased cancer risk in 1.433 times (95%CI: 1.215-1.690), 1.272 times (95%CI: 1.139-1.420), 3.640 times (95%CI: 2.011-6.589), and 1.704 times (95%CI: 1.334-2.177), respectively. Conclusion: This study indicated that oral-oropharyngeal-laryngeal cancer incidence could worsen because of adverse air pollution conditions. These issues should be addressed and the importance of the monitoring procedure for dust-PM2.5, sulfate, black carbon, and organic carbon should be emphasized.

Buccal Fat Pad: Adjunctive Procedure for Lateral Defect Coverage following Primary Palatoplasty.

BACKGROUND: The buccal fat flap is an encapsulated mass originating from a specific fat tissue that is easily accessed and richly vascularized. The aim of this study was to report the effect of using the buccal fat flap on the oronasal fistula rate in primary palatoplasty. METHODS: A case-controlled study of 94 patients who underwent primary cleft palate repair. Patients were divided into two groups: (1) two-flap palatoplasty with buccal fat flap for coverage of lateral hard palate defect and (2) conventional two-flap palatoplasty. The incidence of oronasal fistula and postoperative complications were compared between groups. Multivariate analysis was performed to determine the risk factors of oronasal fistula development. RESULT: Forty-seven patients in each group demonstrated the same baseline characteristics. The buccal fat group showed a significant lower postoperative oronasal fistula rate (2.13 percent versus 21.28 percent, p = 0.008) and smaller fistula size (2 mm versus 4 mm, p = 0.049). A cleft width wider than 11.5 mm increased the odds ratio of fistula formation by 8.44-fold (p = 0.047), and the use of buccal fat protected against postoperative palatal fistula formation (OR, 0.08, p = 0.019). CONCLUSION: The use of buccal fat flaps for lateral hard palatal defect coverage in primary palatoplasty can reduce the rate of postoperative palatal fistula, especially in cases of wide palatal cleft. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, III.

The effects of a newly established online learning management system: the perspectives of Thai medical students in a public medical school.

BACKGROUND: There are obstacles for medical schools in low- and middle-income countries (LMIC) to implement an online learning management system (LMS) during the pandemic of coronavirus disease 2019. Our medical school has developed and implemented tailored LMS for medical students and examine the acceptance and effects of this LMS on the medical students' learning outcomes and identify factors influencing their adoption of online learning. METHODS: This was a mixed-methods study using an online questionnaire and online semi-structured interviews with first-year medical students at one medical school in Thailand. The platform's monitoring system and questionnaire data were analysed using descriptive statistics and binary logistic regression. RESULTS: The response rate was 55.5% (157/283). Most of the respondents agreed on the advantages and were very satisfied with their learning experience. The logistic regression showed that content quality (adjusted odds ratio (AOR) = 2.43; 95% CI = 1.11-5.31) and perceived usefulness (AOR = 2.75; 95% CI = 1.02-7.39) were significantly associated with the acceptance of online learning among medical students. There was no association between the test scores and time spent in the course. CONCLUSION: Despite limited evidence of LMS effectiveness in medical schools in LMIC, learning on a customised LMS appeared to be accepted, useful, user-friendly, and effective among medical students. The perceived usefulness and the content quality are associated with the acceptance of online learning. Medical schools in LMIC can develop their own LMS to ensure that it meets their learners' and faculties' needs. This study is a single-institution study, further large-scale studies are needed to ensure generalisability.

Significant Prognostic Factors Influencing the Survival Difference of Oral Tongue Squamous Cell Carcinoma.

BACKGROUND: Oral tongue squamous cell carcinoma is the most common malignancy in the oral cavity. Overall survival varies across many countries, and poor prognosis is prevalent in developing countries, including Thailand. Our study aimed to identify prognostic factors that affected survival for oral tongue cancer in Thailand. METHODS: We performed a retrospective study of 183 patients diagnosed with oral tongue squamous cell carcinoma between January 2012 and December 2016 and who underwent multidisciplinary treatment. The disease stage was classified by tumor-nodes-metastasis (TNM) staging system. The survival outcome was calculated and represented in median survival time. Univariate and multivariate Cox proportional hazards models were used to identify factors that impacted survival outcomes. RESULTS: A clear margin was achieved in 88.8% of the 125 operated patients. Radiotherapy was given to 115 patients (62.84%). The survival shown in Kaplan-Meier curves was significantly lower according to advanced TNM stage, poor histologic grade, nonsurgical treatment, and patients treated with radical neck dissection. Radiotherapy was a good prognostic factor [hazard ratio (HR) 0.25, P = 0.022]. Poor prognostic factors were body mass index less than 18.5 kg per m2 (HR 3.03), vertical tumor dimension 20 mm or more (HR 5.84), non-well-differentiated grade tumor (HR 3.09), and operated cases with radical neck dissection (HR 4.29). CONCLUSIONS: Surgical treatment can improve the survival outcome, whereas advanced stage and poor histological grading can worsen the overall survival. For oral tongue squamous cell carcinoma, radiotherapy was a good prognostic factor. On the contrary, a tumor with large vertical size, closed surgical margin, poor histologic grade, and radical neck dissection in the operated group were poor prognostic factors.

Indocyanine Green Angiography Precise Marking for Indeterminate Burn Excision: A Prospective, Multi-centered, Double-blinded Study.

BACKGROUND: During burn excision, the clinical judgment whether to excise or not excise the area with indeterminate burn depth is difficult. Indocyanine green angiography (ICGA) has been reported to provide high accuracy in diagnosing indeterminate burns. This study aims to evaluate the complete wound closures in both short-term and long-term outcomes after using ICGA precise marking to guide indeterminate burn excision. METHODS: This was a prospective, multi-centered, double-blinded, experimental study. The participants were admitted to the hospital with indeterminate burn wounds. ICGA precise marking was performed. The deep second-degree burn was painted, excised, and subsequently covered with skin grafts and measured on day 5. The superficial burns were measured on day 21. All wounds were followed-up at two months. RESULTS: Thirty indeterminate burn sites were included in this study. Using ICGA precise marking, the overall rate of short-term complete wound closure, which combined superficial and deep burns, was found to be as high as 96.7% (29/30). The long-term complete wound closures at two months confirmed the short-term result and yielded 100.0% of complete wound closure. The complete wound closures between the short-term and long-term measurements were not significantly different (P > 0.999). CONCLUSIONS: Using ICGA precise marking to guide indeterminate burn excision resulted in an excellent rate of complete wound closure and an insignificant difference between short-term and long-term wound outcomes. ICGA is a competent method to aid decision-making in burn surgery of the indeterminate area.

An Inconvenient Truth of Clinical Assessment and Indocyanine Green Angiography Precise Marking for Indeterminate Burn Excision.

The clinical assessment of indeterminate burn wounds has relatively poor accuracy. Indocyanine green angiography (ICGA) has high accuracy and can be used to mark wounds precisely so as to guide burn excision. This study aimed to assess the differences between ICGA and clinical assessment marking and compare the marking result with the long-term wound outcome. METHODS: This was a prospective, multicentered, triple-blinded, experimental study. Indeterminate burn wounds were clinically assessed, and the area to be excised was firstly marked by the attending surgeon. ICGA marking was then performed by a second surgeon. Measurement of the marked area was conducted by a third surgeon. Three surgeons were each blinded to the others' processes. The wounds were followed up to assess complete wound closures on day 21. RESULTS: There were 20 burn sites included in the study. There was a significant difference in the marked areas between clinical assessment and ICGA (mean, 57.3 ± 44.1%; P = 0.001). The maximum difference found was as high as 160.9%. The correction rate of ICGA marking to complete wound closure on day 21 was 95.0%. Over 90% of the decreased areas of excision-which were assessed by ICGA to be superficial burns but evaluated by clinical assessment to be deep burns-were completely healed on day 21. CONCLUSIONS: ICGA contributes to a significant difference versus clinical assessment in the marking for excision of indeterminate burns and strongly associates with long-term wound outcomes. The burn wounds can be assessed precisely to reduce unnecessary excision and prevent inadequate excision.

Risk Factors of Fistula Following Primary Palatoplasty.

BACKGROUND: Oronasal fistula (ONF) is a common complication following cleft palate surgery. This study aims to determine the prevalence of ONF and the factors that influence development of ONF following primary palatoplasty. MATERIALS AND METHODS: There were 234 patients undergoing primary palatoplasty during 2012 to 2016 included in this cross-sectional study. Patient demographics, surgeon's experience, age at the time of primary palatoplasty, cleft type by Veau classification, cleft width, and operative technique were recorded. The prevalence of fistulae was the primary outcome. Association of age at the time of repair, cleft type, cleft associated with syndromes, cleft width, and surgeon's experience with fistula rate were secondary outcomes. RESULTS: There were 234 consecutive patients (128 boys [54.7%] and 106 girls [45.3%]). The mean age at primary palatoplasty was 13 months. Oronasal fistulae occurred in 61 (26.07%) patients. There was a statistically significant association between postoperative oronasal fistulae and the following independent variables: Veau classification (adjusted odds ratio 2.1; 95% confidence interval [CI] = 1.45-3.1, P < 0.01), cleft associated with syndromes (adjusted odds ratio 4.76; 95% CI = 1.48-15.2, P < 0.01) and cleft width more than 11.5 mm (adjusted odds ratio 1.96; 95% CI = 1.00-3.85, P = 0.04). CONCLUSION: The overall number of fistulae was moderate in patients who had undergone primary palatoplasty in our center. Cleft severity as defined by the Veau classification, cleft width, and cleft associated with syndromes were predictive factors for development of postoperative fistulae.

Is Adjunctive Hyperbaric Oxygen Treatment Alone or with Surgery the Proper Management for Active and Persistent Osteoradionecrosis?

ABSTRACT: This study enrolled patients with stage 3 osteoradionecrosis. There were three treatment modalities: antibiotics, hyperbaric oxygen therapy (HBOT), and surgery. Complete healing was the primary outcome. Multiple logistic regression analysis demonstrated that surgery with HBOT improved wound healing better than HBOT alone.

Accumulated ambient air pollution and colon cancer incidence in Thailand.

This research examined the relationship between colon cancer risks and pollution in various areas of Thailand, using satellites to gather quantities of aerosols in the atmosphere. Bayesian hierarchical spatio-temporal model and the Poisson log-linear model were used to examine the incidence rates of colon cancer standardized by national references; from the database of the National Health Security Office, Ministry of Public Health of Thailand and NASA's database from aerosol diagnostics model. Modern-Era Retrospective Analysis for Research and Applications, Version 2 (MERRA-2) was used to explore disease-gender-specific spatio-temporal patterns of colon cancer incidences and accumulated air pollution-related cancers in Thailand between 2010 and 2016. A total of 59,605 patients were selected for the study. Due to concerns regarding statistical reliability between aerosol diagnostics model and colon cancer incidences, the posterior probabilities of risk appeared the most in dust PM2.5. It could be interpreted as relative risk in every increase of 10 µg/m3 in black carbon, organic carbon, and dust-PM2.5 levels were associated respectively with an increase of 4%, 4%, and 15% in the risks of colon cancer. A significant increase in the incidence of colon cancer with accumulated ambient air quality raised concerns regarding the prevention of air pollution. This study utilized data based on the incidences of colon cancer; the country's database and linked cancer data to pollution. According to the database from NASA's technology, this research has never been conducted in Thailand.

Radiation ulcer treatment with hyperbaric oxygen therapy and haemoglobin spray: case report and literature review.

OBJECTIVE: To explore the effectiveness of a combination of hyperbaric oxygen therapy and haemoglobin spray in radiation ulcer treatment. METHOD: We reviewed the available literature and present a case report in which radiation ulcer was treated with a combination of hyperbaric oxygen therapy and haemoglobin spray. RESULTS: After 30 sessions of hyperbaric oxygen therapy (2.4 ATA; 90 minutes each session) and administration of haemoglobin spray, the wounds showed gradual progress towards healing and a good granulating base was achieved. The wounds were closed after two months using a small split thickness skin graft. CONCLUSION: A combination of hyperbaric oxygen therapy and haemoglobin spray was effective as a short course of treatment for radiation ulcers.

A Prospective Randomized Double-blind study of silicone gel plus Herbal Extracts Versus Placebo in Pre-sternal hypertrophic scar prevention and amelioration.

OBJECTIVE: Post-surgical hypertrophic scar is more frequently reported in Asians. Many modalities can treat scars but there have not been any publications to define the efficacy of silicone gel plus herbal extracts for scar prevention or amelioration. DESIGN: 48 patients, who underwent median sternotomy were randomized and double-blinded to 2 groups to use topical silicone gel plus herbal extract gel or placebo for 6 months. Patients were treated either with topical silicone gel plus herbal extract gel or control using only placebo for 6 months. The scars were observed by experienced plastic surgeons using the Vancouver scar scale. SETTING: A single tertiary care center at Khon Kaen University. PATICIPANTS: 48 patients who underwent median sternotomy were enrolled in this study. All patients were aged over 18 years. All the wounds were sutured with polyglycolic 4/0 subcuticular suture material and did not receive other scar management before participating in this study. INTERVENTION: The silicone gel plus herbal extract gel (Bangkok Botanica, Bangkok, Thailand) in semi-liquid form was formulated from 15% Herbal extract (Allium Cepa extract, Centella Asiatica extract, Aloe Vera extract and Paper Mulberry extract), 50% polydemethysiloxane, 30% cyclopentasiloxane and 5% silica. The placebo gel was a composite of water, acrylate, C10-30 alkyl acrylate cross-polymer, polysorbate 20 and fragrance that was similar in color and consistency as that of the active gel and packed in the similar sealed packages. MAIN OUTCOME MEASURES: The scar was assessed using the Vancouver scar scale to determine pigmentation, vascularity, pliability and height. RESULTS: the study showed the silicone gel plus herbal extract gel could improve scar amelioration in height (p = 0.005) and pliability (p < 0.001) when compared to the placebo. The vascularity and pigmentation showed improvement using silicone gel plus herbal extracts but the improvement was not statistically significant. CONCLUSION: The silicone gel plus herbal extracts gel was effective for scar improvement in median sternotomy wounds.

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.

Construction of polluted aerosol in accumulation that affects the incidence of lung cancer.

BACKGROUND: This model demonstrated the correlation between lung cancer incidences and the parts of ambient air pollution according to the National Aeronautics and Space Administration (NASA)'s high resolution technology satellites. METHODS: Chemical type of aerosols was investigated by the Aerosol Diagnostics Model such as black carbon, mineral dust, organic carbon, sea-salt and SO4. The model investigated associations between the six year accumulation of each aerosol and lung cancer incidence by Bayesian hierarchical spatio-temporal model. Which also represented integrated geophysical parameters. RESULTS: In analyses of accumulated chemical aerosol component from 2010 - 2016, the incidence rate ratio (IRR) of patients in 2017 were estimated. We observed a significant increasing risk for organic carbon exposure (IRR 1.021, 95%CI 1.020-1.022), SO4, (IRR 1.026, 95% CI 1.025-1.028) and dust, (IRR 1.061, 95% CI 1.058-1.064). There was also suggestion of an increased risk with, every 1 ug/m3 increase in organic carbon compound is associated with 21% increased risk of lung cancer, whereas a 26% excess risk of cancer per 1 ug/m3 increase in mean SO4 and 61% increased risk of lung cancer for dust levels. The other variables were the negative IRR which did not increase the risk of the exposed group. CONCLUSION: With our results, this process can determine that organic carbon, SO4 and dust was significantly associated with the elevated risk of lung cancer.

Factors associated with patient satisfaction in laparoscopic adrenalectomy.

Laparoscopic adrenalectomy a treatment that is recommended for patients with adrenal adenoma and has been shown to lead to a 94% biochemical remission rate of aldosterone as well as improvements to quality of life in five domains of the SF-36. This method is also associated with high rates of patient satisfaction. However, there is little information available on the factors associated with patient satisfaction in cases of laparoscopic adrenalectomy. This study aimed to evaluate these factors in patients with Conn's syndrome who underwent laparoscopic adrenalectomy. This study was based on a survey and was conducted at Srinagarind Hospital at the Khon Kaen University Faculty of Medicine in Thailand. The inclusion criteria were that patients were between 15 and 60 years of age, had been diagnosed with adrenal gland tumors, and had undergone trnasperitoneal laparoscopic adrenalectomy. All eligible patients were asked to fill out a self-report questionnaire in which they rated their satisfaction (out of 10) and factors associated with their level of satisfaction in the areas of clinical treatment and scarring. There were 44 patients who participated in the study. The average (SD) age of all patients was 47.10 (10.90) years. The average overall satisfaction scores for the surgery and with regard to scarring post surgery were 9.47 (1.15) and 8.11 (2.21), respectively. Only the presence of headaches was an independent factor associated with the overall satisfaction, with a coefficient of -0.29 (p value 0.001). Only age was significantly predictive of overall satisfaction with regard to scarring with a coefficient of 0.05 and p value of 0.046. In conclusion, the presence of headaches was related to overall satisfaction and age was associated with satisfaction with regard to scarring in patients Conn's syndrome who underwent laparoscopic adrenalectomy.

Preschool Age Anthropometric Evaluation of the Nose After Bilateral Complete Cleft Lip Repair.

OBJECTIVE: To evaluate the aesthetic outcomes of surgery in preschool-aged bilateral complete cleft lip patients by comparing their nasal aesthetic parameters with those of normal children. SETTING AND SAMPLE POPULATION: Twenty-six 4 to 6-year-old (preschool age) patients with bilateral complete cleft lip who underwent primary cheiloplasty and a control group of 30 children in Northeast Thailand of the same age were enrolled. MATERIALS AND METHODS: Nasal aesthetic parameters were analyzed in terms of 3 ratios and 1 angle using three-dimensional photographs. The data from bilateral cleft lip patients were compared with those from a control group. RESULTS: The nasal parameters of patients in the cleft group were the same as those in the control group in terms of nasal tip height (NTH), columella height (CH), and dome height (DH) (P values were 0.361, 0.494, and 0.086), but nasal width (NW) was greater in the cleft group (P < 0.001). The nasal aesthetic parameters differed significantly between the 2 groups in terms of CLA (P < 0.001) and ratio of NTH and NW (P < 0.001), but not in terms of the CH:NW (P = 0.190) and DH:CH ratios (P = 0.147). CONCLUSION: This treatment protocol for bilateral cleft lip was able to achieve most of the aesthetic goals in terms of NTH, CH, DH, ratio of CH to NW, and ratio of DH to CH. However, more surgical correction of NW and CLAs may be needed.