Predisposing factors of non-syndromic cleft lip and cleft palate in the northern Thai population: A 10-year retrospective case-control study.

The most common congenital anomaly is orofacial cleft, which is categorized into two main types: cleft lip with or without cleft palate (CL/P) and cleft palate only (CPO). One of the most accepted etiologies is multifactorial (gene-environment). This study aimed to identify the amendable risk factors of an orofacial cleft in Northern Thailand. A retrospective case-control study in Maharaj Nakorn Chiang Mai Hospital was conducted from 2011 to 2020. One hundred and seventeen cases of CL/P and CPO were included. Forty-nine normal children were enrolled in a time-matched control group. Exploratory survey data on maternal exposures were collected. Multivariate logistic regression was used to estimate the adjusted association between maternal exposures and CL/P, and CPO occurrence. Multivariate analysis identified three predisposing factors that increased the risk of CL/P and CPO. The first factor was caffeine consumption with a total amount of 560 mg/week (adjusted OR: 7.59; 95% CI: 2.48-23.23; p < 0.001). The second factor was any smoker or passive smoking (adjusted OR: 8.47; 95% CI: 1.63-43.92; p = 0.011). The third factor was a low socioeconomic status (income of lower than 270 USD/month; adjusted OR: 4.05; 95% CI: 1.07-15.27; p = 0.039). From the 10-year study in Northern Thailand: caffeine consumption, exposure to cigarette smoke, and low socioeconomic status were identified as associated negative factors for orofacial clefts. We propose that preconceptional counseling for risk reduction should be emphasized in reducing the mother's exposure to these factors. Future investigations in large multicenter populations are suggested.

Alterations in DNA Methylation in Orofacial Clefts.

Orofacial clefts are among the most common craniofacial anomalies with multifactorial etiologies, including genetics and environments. DNA methylation, one of the most acknowledged mechanisms of epigenetics, is involved in the development of orofacial clefts. DNA methylation has been examined in patients with non-syndromic cleft lip with cleft palate (nsCL/P) from multiple specimens, including blood, saliva, lip, and palate, as well as experimental studies in mice. The results can be reported in two different trends: hypomethylation and hypermethylation. Both hypomethylation and hypermethylation can potentially increase the risk of nsCL/P depending on the types of specimens and the specific regions on each gene and chromosome. This is the most up-to-date review, intending to summarize evidence of the alterations of DNA methylation in association with the occurrence of orofacial clefts. To make things straightforward to understand, we have systematically categorized the data into four main groups: human blood, human tissues, animal models, and the factors associated with DNA methylation. With this review, we are moving closer to the core of DNA methylation associated with nsCL/P development; we hope this is the initial step to find a genetic tool for early detection and prevention of the occurrence of nsCL/P.

Large Isolated Nasoorbital Type of Frontoethmoidal Encephalomeningocele: A Case Report With Long-Term Follow-up.

ABSTRACT: Frontoethmoidal encephalomeningocele (FEEM) is a rare congenital craniofacial malformation with increased incidence in Southeast Asia, especially in Thailand. Because of its rarity, main treatment obstacles include the lack of surgical treatment techniques and long-term postoperative follow-up data. The authors present the case of a 9-month-old boy who was born with a large isolated nasoorbital type of FEEM, which had a pressure effect on his right eye, nose, and facial complex. Preoperative computed tomography of the facial bone was performed to evaluate the external bony defect. This study aims to present surgical correction of FEEM with Chula's technique and long-term 7-year postoperative follow-up including both clinical and imaging aspects.

The relationship between external bony defects and widened lateral interorbital distance in frontoethmoidal encephalomeningocele.

PURPOSE: The aim of this study was to identify the prevalence of the abnormal lateral interorbital distance (LIOD), micropthalmia or anopthalmia and incidence of hydrocephalus in frontoethmoidal encephalomeningocele (FEEM), and to identify the correlation between the external bony defects and a widened lateral orbital wall. MATERIALS AND METHODS: FEEM patients who were treated in the Faculty of Medicine, Chiang Mai University between January 1, 2006, and December 31, 2016, were retrospectively reviewed from the medical records. We included the patients who had undergone head computed tomography (CT) of the facial bones. Exclusion criteria were any patients who had undergone prior facial surgery or had maxillofacial bone trauma before they underwent a CT scan, craniofacial disease such as facial clefts, frontonasal dysplasia, craniosynostosis, and inter-frontal encephalocele. Measurements were taken from the CT images to establish the diameter of the external bony defect, medial interorbital distance and lateral interorbital distance. The relationships between the external bony defect and widened LIOD were analyzed. Patients were divided into two groups: those with normal LIOD and those with wide LIOD. RESULTS: A total of 94 FEEM patients were evaluated. Thirteen patients (13.83%) had a wider than normal LIOD. The incidence of micropthalmia or anopthalmia was 9.57% and hydrocephalus was 45.74%. From a univariable model, there were no statistically significant differences in terms of patient characteristics between the LIOD groups, except for sex. The proportion of wide LIOD was higher in male patients (male vs female; 20.34% vs 2.86%, p = 0.027). The proportion between the external bony defect and the LIOD (EL ratio) associated with a wide LIOD was shown in a cutoff point of 23% (AuROC = 73.27%, 95%CI = 59.87%-86.66%). The multivariable analysis indicated factors associated with abnormal LIOD were an EL ratio of 23% (adjusted RR = 1.98, 95% CI = 1.58-2.51) and male sex (adjusted RR = 6.85, 95% CI = 2.00-23.55). CONCLUSION: There is an association between the EL ratio and widening of the LIOD. An EL ratio greater than 23% could be used to moderately predict a wide LIOD. A large external bony defect may be associated with lateral displacement of the orbit causing true hypertelorism. Therefore, orbital translocation must be considered in patients with a wide LIOD.

Internasal: A New Type of Frontoethmoidal Encephalomeningocele.

IMPORTANCE: Frontoethmoidal encephalomeningocele (FEEM) is a congenital anomaly with a skull base defect at the foramen caecum and a protrusion of meninges and brain tissue through an external defect on the face. The external defect was classified to nasofrontal, nasoethmoidal, naso-orbital, combined, and abortive type. OBJECTIVE: The aim of our study was to present a newly discovered internasal type (IN) of FEEM. DESIGN, SETTING, PARTICIPANTS: Ninety-six FEEM patients' preoperative 3-dimensional computer tomography scans were studied in the Department of Surgery, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand followed by treatment from 2006 to 2016. FINDINGS: Sixteen patients had an external bony defect between the nasal bone that could not be classified in any previous classification. We suggest a new type of FEEM called "IN." The bony defect of this IN can be located on the upper nasal bone (4 cases), middle nasal bone (5 cases), or combined with naso-orbital type (7 cases) counted in the combined type. CONCLUSIONS AND RELEVANCE: Our study presents a newly discovered IN of FEEM. This IN can cause hypertelorism when the nasofrontal type could not. Preoperative 3-dimensional computer tomography scans are very helpful for surgical planning.

Pressure Ulcers: Risk Stratification and Prognostic Factors That Promote Recurrence After Reconstructive Surgery.

The aim of this study was to identify overall recurrence rates after reconstructive surgery in patients with pressure ulcers and to identify risk factors that associated with recurrence after reconstructive surgery. This study was done in Faculty of Medicine Chiang Mai University, including recurrence at the same site as well as on new sites, between January 1998 and December 2015. 165 patients with 272 pressure ulcers were retrospectively collected and analyzed. The overall pressure ulcer recurrence rate was 16.54% (45 from 272 ulcers) from an overall patient recurrence of 19.39% (32 from 165 patients). From multivariable analysis, we found 9 prognostic factors that were statistically significant for recurrence after surgery, divided into 2 groups: uncontrollable and controllable factors. Uncontrollable factors consisted of being female (hazard ratio [HR]=1.90;95%CI=1.54-2.34), being older than 45 years (HR=1.67;95%CI=1.40-2.0), and location of pressure ulcers on ischium (HR=1.65; 95% CI=1.51-1.80) and sacrum (HR=1.17;95%CI=1.10-1.23). Controllable factors included spasticity (HR=1.11;95%CI=1.04-1.20), incomplete healing before discharge (HR=5.42;95% CI=3.95-7.44), serum albumin level ≤3 g/dL (HR=1.27;95%CI=1.13-1.43), pressure ulcer stage 4 (HR=1.90;95%CI=1.41-2.54), non -muscle-based procedure (HR=3.82;95%CI=2.54-5.76), and length of hospitalization >21 days (HR=2.94;95%CI=1.60-5.40). Patients with these factors were strongly advised to address and improve all these factors for decreasing the recurrence rate after reconstructive surgery.

The epidemiology of mandibular fractures treated at Chiang Mai University Hospital: a review of 198 cases.

BACKGROUND: Mandibular fractures constitute a substantial proportion of maxillo-facial trauma cases in Chiang Mai. The present study investigated the prevalence, sex, age group, alcohol consumption, crash helmet use, causes, site, treatment, and postoperative result of mandibular fractures at Chiang Mai University Hospital, Thailand. MATERIAL AND METHOD: The medical records and radiographs of 198 patients treated for mandibular fracture at Chiang Mai University Hospital over a 1.5 year period (from 1 January 2005 to 30 June 2006) were reviewed Data on the patients' age, sex, alcohol and helmet use, mechanism of injury, site of fracture, treatment modality, and post-operative result were recorded and assessed. RESULTS: Men of 21 to 30 years of age sustained the most mandibular fractures. The ratio of males to females was 5:1. Most fractures were caused by motorcycle accidents (MCA) (75.75%), followed by body assault (13.63%), and falls (4.54%). Alcohol consumption was a contributing factor at the time of injury in 79% of fractures according to the information available. The most common fracture sites were, in descending order the parasymphysis (45.3%), angle (19.51%), condyle (15.68%), symphysis (13.24%), body (3.83%), and ramus (2.09%). Nearly 3/4 of all cases were treated by open reduction (76%). CONCLUSION: The incidence and causes of mandibular fracture reflect trauma patterns within the community and can provide a guide to the design of programs geared toward prevention and treatment.

Comparison among Op-site, polyvinyl chloride film and tulle gauze in the treatment of skin graft donor sitet.

A prospective analytic study was performed at the Division of Plastic and Reconstructive Surgery, Department of Surgery, King Chulalongkorn Memorial University Hospital and the Department of Surgery, Chiang Mai University Hospital to compare among Polyvinyl chloride film (PVC film), Op-site and tulle gauze in the treatment of skin graft donor site. From October 1998 to January 2000, 81 donor sites in the same number of patients were treated by three different methods; tulle gauze (26 patients), Op-site (27 patients) and PVC film (28 patients). Each wound was followed until it was completely healed and visual analogue scale was used for pain evaluation. Donor site dressed with PVC film had a healing time of 10.44 days which was not different from Op-site (10.54 days) but significantly faster (p<0.001) than tulle gauze (17.84 days). Pain as measured with visual analogue scale in the group of PVC film (1.48) was not different from Op-site (1.34) but significantly less than (p<0.001) tulle gauze (5.45). There was no difference in the rate of infection between each group. In conclusion, the authors found no difference between Op-site and PVC film in healing time and pain. Both of them were better than tulle gauze. The results demonstrate the usefulness of PVC film as a donor site dressing as it promises relatively rapid healing, less pain and is inexpensive.