Digital Poster

Accepted E-Poster presentations from registered participants.

Category: All Case Report Research

RP-0019

Title: Early Growth Trajectories in Infants with Cleft Lip and Palate Receiving Digital NAM: A Longitudinal Comparison with WHO Child Growth Standards
Author(s): Suteera Pradubwong
Affiliation: Tawanchai Cleft Center, Khon Kaen University, Thailand

Suteera Pradubwong · Research

Introduction
Infants with cleft lip and palate are at risk of feeding difficulties and impaired early growth. Digital nasoalveolar molding (NAM) may support feeding and presurgical management, but evidence on early growth trajectories during NAM therapy remains limited. Monitoring growth alongside caregiver competency may help optimize early, family-centered care.
Objective
To evaluate early growth trajectories in infants with cleft lip and palate receiving digital nasoalveolar molding (NAM) and to compare growth patterns with WHO Child Growth Standards.
Methods
A prospective cohort study was conducted among 12 infants with cleft lip and palate enrolled at ≤4 weeks of age at the Cleft Center of Excellence, Northeastern Thailand. Infants received digital nasoalveolar molding (NAM) therapy with caregiver training and feeding support. Data were collected at approximately 1, 2–3, and 5–6 months of age. Weight, length, head circumference, feeding methods, and caregiver appliance-management skills were assessed. Growth trajectories were analyzed using descriptive statistics and mixed-effects restricted maximum likelihood (REML) regression.
Results
Most participants were male (58.33%) and had unilateral complete cleft lip and palate (91.67%). Caregivers demonstrated progressively improved appliance management skills over time, with few complications. Feeding was primarily achieved through alternative methods, while direct breastfeeding was limited. Weight increased significantly over time, with age significantly predicting weight gain. Mixed formula bottle feeding showed a positive trend but was not statistically significant. Caregiver competence in device-assisted feeding, particularly during the nasal and alveolar molding phase, was significantly associated with improved weight gain.
Conclusions
Early growth in infants with cleft lip and palate receiving digital NAM is influenced by both biological factors and caregiver competency. These findings support the importance of integrated, family-centered care consistent with WHO child growth and development principles.

CP-0027

Title: From Cleft to Contour: Post-operative Nasal Molding Using The PSU Nasal Clip in a Patient with Cleft lip and Alveolus
Author(s): PANUMAT INTHAMON
Affiliation: Center of Excellence in Correction and Rehabilitation of Dentofacial Deformities Faculty of Dentistry, Prince of Songkla University, Hat Yai, Thailand

PANUMAT INTHAMON · Case Report

Introduction
Cleft lip are associated with nasolabial and maxillary dentoalveolar defects. Early dental and surgical treatment aims to restore function and achieve acceptable esthetic outcomes, reducing psychosocial challenges and improving the quality of life for both patients and their parents.

Materials and methods: Case report
A 1-month-old female with right complete cleft lip and alveolus and left incomplete cleft lip was referred to the center. Due to collapse of the nasal bridge toward the complete cleft side, the patient experienced breathing discomfort and difficulty breastfeeding.
After 6 months of molding, the alveolar ridge achieved near-normal alignment, and the patient was referred for cheiloplasty.
To prevent relapse of nostril, a PSU Nasal Clip was applied one week after surgery, once the upper lip and nasal structures had healed. The clip provided postoperative nasal support and maintain the patient’s nostril morphology. The PSU Nasal Clip has small hollow acrylic component allows clear breathing while supporting the nasal cartilage and soft tissue in a position. Each set includes 6 different acrylic sizes in 2 colors. The connecting wire can be adjusted to fit the nostrils. The appliance is recommended for continuous use for 6–9 months after lip repair, with gradual replacement by larger sizes as the patient grows.

Conclusion
Dental treatment planning depends on the severity of the cleft and nasal asymmetry. The main goals are to restore feeding function and esthetics. Scar contraction after cheiloplasty may cause relapse, making postoperative nasal support essential for maintaining surgical correction.
The PSU Nasal Clip was designed as a compact appliance. It is placed separately from the intraoral obturator, making it less visible and easier to clean in daily use. The PSU Nasal Clip provided post-operative nostril support and maintain the postoperative nasal shape.

E-Poster CP-0030

CP-0030

Title: First Successful Le Fort III Distraction in a Patient with Beare-Stevenson Syndrome
Author(s): Nobuyuki Mitsukawa
Affiliation: 1) Department of Plastic, Reconstructive, and Aesthetic Surgery, Graduate School of Medicine, Chiba University

Nobuyuki Mitsukawa · Case Report

Objective: Beare-Stevenson syndrome is a genetic disorder, caused by FGFR2 gene mutations, characterized by craniosynostosis, midface hypoplasia, Chiari malformation, and other extensive congenital abnormalities. We performed Le Fort III distraction osteogenesis on a girl with this condition and achieved favorable outcomes. This report describes the world's first successful Le Fort III distraction for a patient with Bear-Stevenson syndrome.
Methods: The patient is a 5-year-old girl. She was diagnosed with Beare-Stevenson syndrome shortly after birth and underwent a tracheostomy due to respiratory distress. At 2 month of age, a VP shunt placement was performed, followed by occipital cranial expansion at 1 year and fronto-orbital distraction at 2 years. She was referred to our department for treatment of midface hypoplasia. Clinical findings and imaging studies revealed severe proptosis, very severe midface hypoplasia, and reverse occlusion. We planned Le Fort III distraction using a halo-type external distraction device. Surgery was performed with utmost caution regarding the shunt tube and skull defects.
Results: Postoperatively, an approximately 25 mm distraction was achieved without major complications, 2 years after the operation, significant improvements in proptosis, occlusion, and facial profile were observed, with an excellent clinical course.
Discussion: Beare-Stevenson syndrome is an extremely rare condition presenting with severe midface hypoplasia, with only around 30 reported cases. Due to the poor prognosis associated with respiratory complications, this is, to our knowledge, this case represents the first successful report of Le Fort III distraction. Given the high incidence of Chiari malformations along with the characteristic craniofacial abnormalities, early intervention by both pediatric neurosurgeons and plastic surgeons is crucial. This syndrome presents with severe midface hypoplasia and is associated with poor prognosis due to respiratory complications. However, for cases considered to have a relatively favorable prognosis, Le Fort III distraction should be actively pursued.

E-Poster CP-0031

CP-0031

Title: Orbital Reconstruction Using Dermal Fat Graft After Removal of Magnetic Orbital Prosthesis
Author(s): Nobuyuki Mitsukawa
Affiliation: Department of Plastic, Reconstructive, and Aesthetic Surgery, Graduate School of Medicine, Chiba University

E-Poster CP-0032

CP-0032

Title: Combination of Various Maxillary Distraction Osteogenesis for Patients with Severe Complicated Cleft Maxillary Hypoplasia
Author(s): Nobuyuki Mitsukawa
Affiliation: Department of Plastic, Reconstructive, and Aesthetic Surgery, Graduate School of Medicine, Chiba University

E-Poster CP-0033

CP-0033

Title: A Patient of True Median Cleft Lip with Unilateral Anophthalmia and Morning Glory Syndrome
Author(s): Nobuyuki Mitsukawa
Affiliation: Department of Plastic, Reconstructive, and Aesthetic Surgery, Chiba University Graduate School of Medicine

Nobuyuki Mitsukawa · Case Report

Objective:
Median cleft lip is an extremely rare condition, accounting for approximately 0.1–0.7% of cleft lip and palate cases. We report a case of true median cleft lip associated with unilateral anophthalmia and morning glory syndrome.
Case Report:
A male infant weighing 2608 g was born at 37 weeks and 1 day of gestation via normal delivery from a GBS-positive mother. At birth, a fissure was observed in the midline of the upper lip and alveolar ridge, along with a bilobed protuberant lesion in the alveolar cleft region. No brain malformations were detected, and a bifid frenulum was present, confirming the diagnosis of true median cleft lip. Additionally, the patient had right-sided morning glory syndrome and left-sided anophthalmia.
Results:
At six months of age, the patient underwent primary closure of the cleft, wedge excision at the nasal base, and resection of the protuberant lesion in the alveolar cleft region. Histopathological examination revealed that the lesion primarily consisted of immature cartilage-like tissue with vascular proliferation, suggesting a hamartoma caused by heterotopic jawbone-derived tissue. The postoperative course was uneventful, and at two years post-surgery, the patient maintains a favorable lip morphology.
Discussion:
Median cleft lip can be classified into true median cleft lip, characterized by a fissure separating the tissues, and pseudo-median cleft lip, which results from hypoplasia of the midfacial structures. True median cleft lip is attributed to failure of fusion of the medial nasal prominences between the 5th and 8th weeks of gestation. The severity of the cleft varies from a minor notch in the vermilion to involvement of the external nose and mandible. Since this condition is not typically associated with brain malformations or growth impairments, the prognosis is generally favorable.

E-Poster RP-0032

RP-0032

Title: An Anatomic Investigation of Human Fetal Upper Eyelid
Author(s): Nobuyuki Mitsukawa
Affiliation: Department of Plastic and Reconstructive Surgery, Chiba University Graduate School of Medicine

Nobuyuki Mitsukawa · Research

Introduction: In this study, the authors investigated the anatomic morphology of the upper eyelid in prenatal human fetuses to elucidate the cause of congenital palpebral conditions such as congenital blepharoptosis. Although much has been published on the anatomy of the adult upper eyelid, hardly any reports have dealt with neonatal morphology in the immediate postpartum period or infants and children. From a developmental perspective, to better understand the development and aging effects in the upper eyelid, knowledge is needed of the anatomic characteristics of the upper eyelid in neonates immediately after birth. Also, to elucidate the cause of congenital blepharoptosis, the authors investigated the anatomy of the upper eyelid in human fetuses.
Materials & Methods: Subjects comprised 6 Japanese fetuses between 6 and 10 months of gestation for a total of 12 eyelids. Sagittal tissue slices of the excised upper eyelid were embedded in paraffin, sliced thinly, then stained with HE and Van Gieson. The specimens were carefully examined under light microscopy. Next, these samples were compared with adult upper eyelid tissue images to determine differences in development and morphology.
Results: Fetal characteristics observed were as follows: the morphologic characteristics of the palpebrae superioris muscle and levator aponeurosis were underdeveloped and connections to the orbicularis oculi muscle were sparse, whereas the Müller muscle was markedly thicker than those in adults.
Conclusion: Fetal eyes tend to be closed in amniotic fluid, and so before fetuses begin to move, the levator palpebrae superioris muscle tends to be poorly developed, whereas eye-opening is speculated to be controlled primarily by Müller muscle. Findings suggest muscle fibers develop due to eye-opening movements, and the differentiation and development of the levator palpebrae superioris muscle are believed to be closely related to the development of congenital blepharoptosis.

E-Poster RP-0033

RP-0033

Title: Special distraction osteogenesis before bone grafting for alveolar cleft defects to correct maxillary deformities in patients with bilateral cleft lips and palates
Author(s): Nobuyuki Mitsukawa
Affiliation: Department of Plastic, Reconstructive, and Aesthetic Surgery, Graduate School of Medicine, Chiba University

Nobuyuki Mitsukawa · Research

Introduction: Patients with bilateral cleft lips and palates have premaxillary protrusion and characteristic jaw deformities involving three-dimensional malposition of the premaxilla and bilateral maxillary bone segments. This study examined patients with bilateral cleft lips and palates who had deviation and hypoplasia of the premaxillas and bilateral maxillary segments. Before bone grafting, the patients were treated with special distraction performed separately for each bone segment using a halo-type external device. This report describes this novel treatment method which produced good results.
Material and methods: The subjects were five patients with severe jaw deformities due to bilateral cleft lip and palate. They were treated with maxillary Le Fort I osteotomy and subsequent distraction performed separately for each bone segment using a halo device. In three of five patients, premaxillary osteotomy was not performed, and osteotomy and distraction were performed only for the right and left lateral segments with severe hypoplasia.
Results: All patients achieved distraction close to the desired amount. The widths of the alveolar clefts were narrowed, and satisfactory occlusion and maxillary arch form were achieved. After the surgery, three of five patients underwent bone grafting for bilateral alveolar cleft defects and the bone graft survival was satisfactory.
Conclusions: This method had many benefits, including narrowing of alveolar clefts, improvement of maxillary hypoplasia, and achievement of a good maxillary arch form. In addition, subsequent bone grafting for alveolar cleft defects was beneficial, dental prostheses were unnecessary, and frequency of surgery and surgical invasiveness were reduced. This method is a good surgical procedure that should be considered for patients with bilateral cleft lips and palates who have premaxillary protrusion and hypoplasia of the right and left lateral segments.

E-Poster CP-0028

CP-0028

Title: A Patient With Mild Trigonocephaly and Concomitant Horizontal Constricting Ring of the Skull
Author(s): Nobuyuki Mitsukawa
Affiliation: Department of Plastic, Reconstructive, and Aesthetic Surgery, Graduate School of Medicine, Chiba University

Nobuyuki Mitsukawa · Case Report

Introduction:
Metopic craniosynostosis causes characteristic cranial deformities such as a keel-shaped forehead, known as trigonocephaly. Mild trigonocephaly refers to cases of metopic craniosynostosis in which the cranial deformity is generally mild. We report a case of mild trigonocephaly accompanied by an atypical horizontal constricting ring of the skull that was successfully treated surgically.
Case Report:
The patient was a 3-month-old boy. CT revealed premature fusion of the metopic suture, and he was referred to our department for surgical treatment. A midline frontal ridge was observed but the keel-shaped forehead was not prominent, and the patient was diagnosed with mild trigonocephaly. Mild depression was observed in the temporal regions, and CT demonstrated a horizontal constricting ring of the skull (circumferential depression) extending approximately three-quarters of the way from the frontal region to both temporal areas. At 11 months of age, one-stage cranial reconstruction was performed for mild trigonocephaly, along with correction of the constricting deformity. Through a coronal incision, the supraorbital bar and frontal bone flap were removed and reshaped. The parietal and temporal bones posterior to the frontal bone flap were barrel-staved, and the depressed bone fragments were elevated to reconstruct the constricted region. Postoperatively, the frontal contour improved, and the constricting ring observed before surgery resolved, resulting in an overall satisfactory cranial shape. One year after surgery, no signs of developmental delay or neurological impairment were observed.
Conclusion:
Cases of nonsyndromic craniosynostosis with a horizontal constricting ring are extremely rare, and to our knowledge, none have been previously reported. Possible etiologies include an amniotic constriction band, a constricting ring caused by squamosal suture fusion as seen in cloverleaf skull, or compensatory deformation associated with restricted cranial growth; however, the exact mechanism remains unclear.

E-Poster RP-0029

RP-0029

Title: Survey of chief complaints in patients with cleft lip and/or palate with jaw deformity
Author(s): Natsuko Uchino
Affiliation: Department of Oral-Maxillofacial Surgery and Orthodontics，The University of Tokyo Hospital

Natsuko Uchino · Research

Objective: This study aimed to retrospectively evaluate the content and priority of chief complaints in patients with cleft lip.
Materials and Methods: Fifteen patients with cleft lip and palate accompanied by jaw deformities (FD+CLP) who initiated second-phase orthodontic treatment at our department between January 2016 and July 2025 and had clearly recorded chief complaints were included. Twelve patients with jaw deformities without cleft lip and palate (FD) were enrolled as a control group. The variables analyzed were sex, age at the start of second-phase treatment, total number of chief complaints, and the content and priority of complaints. Chief complaints were classified as esthetic (“appearance”) or functional.
Kruskal–Wallis tests were used for four-group comparisons based on disease and sex and for multigroup comparisons combining disease, sex, and age category, followed by Steel–Dwass multiple comparisons when significant differences were detected. Mann–Whitney U tests were applied for two-group comparisons of the total number of complaints. The significance level was set at P<0.05.
Results: Patients in the FD+CLP group were significantly younger than those in the FD group at the start of second-phase treatment, and within the FD+CLP group, males were significantly older than females (P<0.05). The total number of chief complaints was significantly greater in females than in males (P<0.05), and significant differences were observed among multigroup(P<0.01). Logistic regression analyses suggested that disease was most strongly associated with the content of the first chief complaint (OR 1.9), whereas sex was most strongly associated with the content of the second chief complaint (OR 3.6).
Conclusions: Factors associated with chief complaints differed according to their priority. Disease was associated with the first chief complaint, whereas sex was associated with the second. Further prospective studies with larger sample sizes are warranted.

E-Poster RP-0027

RP-0027

Title: Three-Dimensional Assessment of Upper Airway Changes After Mandibular Distraction Osteogenesis in Patients With Severe Micrognathia
Author(s): Kahoko Yamada
Affiliation: Department of Plastic, Reconstructive, and Aesthetic Surgery, Graduate School of Medicine, Chiba University, Chiba, Japan

Kahoko Yamada · Research

Introduction:
Congenital micrognathia may cause severe upper airway obstruction, and mandibular distraction osteogenesis can facilitate tracheostomy avoidance or decannulation. However, the anatomical changes associated with postoperative airway enlargement remain incompletely understood. This study evaluated upper airway volume before and after mandibular distraction osteogenesis using three-dimensional computed tomography and examined its relationship with anterior displacement of the chin and hyoid bone.

Materials & Methods:
We retrospectively reviewed 10 patients with congenital micrognathia who underwent mandibular distraction osteogenesis at our institution between April 2013 and September 2018. Preoperative and postoperative computed tomography images were reconstructed using three-dimensional image-analysis software. Upper airway volume was calculated within a standardized region defined using the palatal plane, uvular tip, and inferior surface of the fifth cervical vertebra. A three-dimensional coordinate system based on the lowest point of the sella turcica and the Frankfort horizontal plane was used to measure anterior displacement of the chin and hyoid bone. Associations between these displacements and changes in upper airway volume were examined.

Results:
Upper airway volume increased overall after mandibular distraction osteogenesis. The mean absolute increase was approximately 2,500 mm³, and the mean postoperative-to-preoperative volume ratio was approximately 2.2. Anterior displacement of the chin measured by three-dimensional computed tomography showed a strong positive correlation with the proportional increase in upper airway volume (r = 0.718). Hyoid displacement varied considerably among patients and showed no strong correlation with airway volume change.

Conclusion:
Anterior displacement of the chin after mandibular distraction osteogenesis was associated with proportional enlargement of the upper airway. Three-dimensional computed tomography enables quantitative assessment of postoperative airway changes and may complement conventional cephalometric evaluation in patients with severe micrognathia.

E-Poster CP-0023

CP-0023

Title: Simultaneous Fronto-Orbital Advancement and Le Fort III Distraction in Saethre–Chotzen Syndrome Initially Suspected of Having Carpenter Syndrome
Author(s): Kahoko Yamada
Affiliation: Department of Plastic, Reconstructive, and Aesthetic Surgery, Graduate School of Medicine, Chiba University, Chiba, Japan

Kahoko Yamada · Case Report

Introduction:
Saethre–Chotzen syndrome is a TWIST1-related craniosynostosis with variable craniofacial and digital manifestations. Phenotypic overlap with other syndromic craniosynostoses may complicate clinical diagnosis. We report a patient initially suspected of having Carpenter syndrome who was genetically diagnosed with Saethre–Chotzen syndrome and treated with simultaneous fronto-orbital advancement and Le Fort III distraction.

Materials & Methods:
We retrospectively reviewed the clinical course of a 14-year-old girl who had undergone fronto-orbital advancement with distraction osteogenesis in infancy. During growth, she developed recurrent headaches, malocclusion, snoring, and obstructive sleep apnea. Because both cranial and midfacial advancement were required, simultaneous fronto-orbital advancement and Le Fort III distraction osteogenesis were performed to allow independent control of the advancement distances and vectors. She also had a submucous cleft palate, atrial septal defect, intellectual disability, obesity, and mild digital anomalies. Spectral karyotyping and chromosomal microarray analysis were performed to clarify the underlying diagnosis.

Results:
The cranial vault and midface were advanced by 30 mm and 15 mm, respectively. Postoperatively, facial profile and occlusion improved, snoring resolved, and recurrent headaches disappeared. These improvements were maintained at 2-year follow-up. Spectral karyotyping demonstrated an abnormality involving chromosome 7p15.1–p21, and subsequent chromosomal microarray analysis identified a deletion involving TWIST1, establishing the diagnosis of Saethre–Chotzen syndrome.

Conclusion:
Simultaneous fronto-orbital advancement and Le Fort III distraction allowed separate control of cranial and midfacial advancement and achieved stable functional and aesthetic improvement. Genetic testing subsequently clarified the diagnosis as Saethre–Chotzen syndrome in this patient with an atypical craniosynostosis phenotype.

Page 1 of 5 (52 poster(s))

Digital Poster

Early Growth Trajectories in Infants with Cleft Lip and Palate Receiving Digital NAM: A Longitudinal Comparison with WHO Child Growth Standards RP-0019

From Cleft to Contour: Post-operative Nasal Molding Using The PSU Nasal Clip in a Patient with Cleft lip and Alveolus CP-0027

First Successful Le Fort III Distraction in a Patient with Beare-Stevenson Syndrome CP-0030

Orbital Reconstruction Using Dermal Fat Graft After Removal of Magnetic Orbital Prosthesis CP-0031

Combination of Various Maxillary Distraction Osteogenesis for Patients with Severe Complicated Cleft Maxillary Hypoplasia CP-0032

A Patient of True Median Cleft Lip with Unilateral Anophthalmia and Morning Glory Syndrome CP-0033

An Anatomic Investigation of Human Fetal Upper Eyelid RP-0032

Special distraction osteogenesis before bone grafting for alveolar cleft defects to correct maxillary deformities in patients with bilateral cleft lips and palates RP-0033

A Patient With Mild Trigonocephaly and Concomitant Horizontal Constricting Ring of the Skull CP-0028

Survey of chief complaints in patients with cleft lip and/or palate with jaw deformity RP-0029

Three-Dimensional Assessment of Upper Airway Changes After Mandibular Distraction Osteogenesis in Patients With Severe Micrognathia RP-0027

Simultaneous Fronto-Orbital Advancement and Le Fort III Distraction in Saethre–Chotzen Syndrome Initially Suspected of Having Carpenter Syndrome CP-0023