E-Poster
CP-0014
CP-0014
Digital Poster
Accepted E-Poster presentations from registered participants.
Nasal reconstruction using costal cartilage and paramedian forehead flap in nasomaxillary hypoplasia in Binder’s syndrome; a case report CP-0014
Nurardhilah Vityadewi · Case Report
• Introduction: The condition of nasomaxillary hypoplasia in Binder’s syndrome has a very wide range of variations. Nasal reconstruction in patients with severe nasal hypoplasia is very difficult and complex. The stages of reconstruction are also adapted to the patient’s age. In adult patients, definitive nasal reconstruction can be determined. Costal cartilage remains the superior choice for reconstructing the nasal framework. In cases with soft tissue deficiency, the paramedian forehead flap is the most ideal option.
• Methods: Patient, male, 18 year old with flattened nasal bridge, lack of a defined nasal tip, and a widened, flattened, and short columella. The 3D CT scans clearly show complete severe hypoplasia of the nasal bones. The anterior nasal spine appears to be missing. Nasal reconstruction performed with autologous costal cartilage to create the framework of the nasal bridge and the tip. The nasal framework was created using the costal graft. The design incision placed above the nostril to keep the alar and columella. The widen and flattened columella are move inferiorly and outward to create the tip projection. The soft tissue defect was covered with paramedian forehead flap.
• Results: One month postoperatively, the projection of the tip and nasal bridge was adequate. No skin necrosis was observed despite division and release of the nostril and columella, with only minimal complications. No functional disturbances were reported, and the aesthetic outcome was acceptable.
• Conclusion: The degree of nasal malformation in Binder’s syndrome varies significantly and surgical correction needs to be tailored individually. The reconstruction surgery is very challenging and successful nasal reconstruction is highly dependent on a good understanding of the pathological anatomy, which involves both the bony structures and the soft tissues. Structural grafting is very helpful in reshaping the nose that requires maximal projection from the bridge to the tip.
• Methods: Patient, male, 18 year old with flattened nasal bridge, lack of a defined nasal tip, and a widened, flattened, and short columella. The 3D CT scans clearly show complete severe hypoplasia of the nasal bones. The anterior nasal spine appears to be missing. Nasal reconstruction performed with autologous costal cartilage to create the framework of the nasal bridge and the tip. The nasal framework was created using the costal graft. The design incision placed above the nostril to keep the alar and columella. The widen and flattened columella are move inferiorly and outward to create the tip projection. The soft tissue defect was covered with paramedian forehead flap.
• Results: One month postoperatively, the projection of the tip and nasal bridge was adequate. No skin necrosis was observed despite division and release of the nostril and columella, with only minimal complications. No functional disturbances were reported, and the aesthetic outcome was acceptable.
• Conclusion: The degree of nasal malformation in Binder’s syndrome varies significantly and surgical correction needs to be tailored individually. The reconstruction surgery is very challenging and successful nasal reconstruction is highly dependent on a good understanding of the pathological anatomy, which involves both the bony structures and the soft tissues. Structural grafting is very helpful in reshaping the nose that requires maximal projection from the bridge to the tip.
E-Poster
RP-0012
RP-0012
- Title
- A comparative study of primary palatoplasty techniques for predictive factors of Palatal fistula formation.
- Author(s)
- Paveena Lawanlakkana
- Affiliation
- Pranangklao Hospital
A comparative study of primary palatoplasty techniques for predictive factors of Palatal fistula formation. RP-0012
Paveena Lawanlakkana · Research
Introduction:
Cleft lips and palates in children may lead to various complications. It requires continuous treatment involving a multidisciplinary team. Palatal fistula is one of the disappointing expected outcomes of cleft palate surgery. Primary cleft palate surgery includes a two-layer, tension-free, watertight closure with preservation of the greater palatine neurovascular pedicle. while the influence of surgical technique on fistula incidence and characteristics remains controversial. This study aimed to compare the occurrence of palatal fistula after primary palatoplasty techniques for investigating the predictive of factors of fistula after cleft palate surgery.
Methods:
A retrospective study was performed by collecting and analyzing data from the patients who undergo primary palatoplasty in the Department of the plastic & reconstructive surgery in Pranangklao hospital between 2016 and 2026. We examined the evidence regarding the number of palatal fistulas found after surgery, the age at which the primary palatoplasty was performed, the patient’s gender, the type of cleft, the duration of surgery and complications.
Results:
A total of 71 cases were included for analysis. Palatal fistulas formation was significantly associated with the surgical technique, and the type of cleft was found. Radical intravelar palatoplasty demonstrated a significantly lower fistula rate compared with another techniques. No evidence was found to demonstrate a significant relationship between the number of fistulae and the patient’s gender, the duration of surgery, or complications.
Conclusion:
This study concludes that surgical technique plays a significant role in palatal fistula development after primary palatoplasty depends on type of cleft palate as well. Radical intravelar palatoplasty and muscle repair with limited incisions is associated with reduces the risk of palatal fistulas.
Cleft lips and palates in children may lead to various complications. It requires continuous treatment involving a multidisciplinary team. Palatal fistula is one of the disappointing expected outcomes of cleft palate surgery. Primary cleft palate surgery includes a two-layer, tension-free, watertight closure with preservation of the greater palatine neurovascular pedicle. while the influence of surgical technique on fistula incidence and characteristics remains controversial. This study aimed to compare the occurrence of palatal fistula after primary palatoplasty techniques for investigating the predictive of factors of fistula after cleft palate surgery.
Methods:
A retrospective study was performed by collecting and analyzing data from the patients who undergo primary palatoplasty in the Department of the plastic & reconstructive surgery in Pranangklao hospital between 2016 and 2026. We examined the evidence regarding the number of palatal fistulas found after surgery, the age at which the primary palatoplasty was performed, the patient’s gender, the type of cleft, the duration of surgery and complications.
Results:
A total of 71 cases were included for analysis. Palatal fistulas formation was significantly associated with the surgical technique, and the type of cleft was found. Radical intravelar palatoplasty demonstrated a significantly lower fistula rate compared with another techniques. No evidence was found to demonstrate a significant relationship between the number of fistulae and the patient’s gender, the duration of surgery, or complications.
Conclusion:
This study concludes that surgical technique plays a significant role in palatal fistula development after primary palatoplasty depends on type of cleft palate as well. Radical intravelar palatoplasty and muscle repair with limited incisions is associated with reduces the risk of palatal fistulas.
E-Poster
RO-0056
RO-0056
- Title
- Usefulness of the pedicled latissimus dorsi flap for diverse defective wounds developed in the trunk.
- Author(s)
- Junghyun Lee
- Affiliation
- Department of Plastic and Reconstructive Surgery, Hallym University Dongtan Sacred Heart Hospital, Hwaseong, Korea
Usefulness of the pedicled latissimus dorsi flap for diverse defective wounds developed in the trunk. RO-0056
Junghyun Lee · Research
Introduction: The latissimus dorsi (LD) flap is a reliable regional flap with consistent vascularity, a broad arc of rotation, and sufficient soft-tissue volume. It remains useful for reconstruction of complex defects requiring durable vascularized coverage. This study aimed to evaluate the clinical utility of pedicled LD flap reconstruction for trunk defects in various reconstructive settings.
Methods: A retrospective review was conducted of 8 patients who underwent pedicled LD flap reconstruction between January 2024 and February 2026. Defect locations included the axilla, upper chest, mid back with spinal exposure, flank, upper back, and breast. The defects that came from hidradenitis suppurativa, postoperative wound complications, breast cancer-related soft-tissue defects, and defects after wide oncologic resection of melanoma, sarcoma, and dermatofibrosarcoma protuberans were included in.
Results: All 8 patients achieved stable soft-tissue coverage without total flap loss. No patient required reoperation for total flap failure; however, 3 patients underwent revision surgery for a surgical delay procedure. One patient subsequently underwent debulking surgery because of excessive flap bulk. Adjunctive negative-pressure wound therapy was applied to promote flap settlement, stabilize the wound, subside the edema and facilitate healing.
Conclusion: Pedicled LD flap reconstruction is a versatile and dependable option for complex truncal defects. It provides robust vascularized tissue and durable coverage in oncologic, infected, postoperative, and implant-based breast reconstruction settings. Especially, the pedicled LD flap is a versatile and reliable option for patients who underwent postoperative radiation therapy after oncologic reconstruction.
Methods: A retrospective review was conducted of 8 patients who underwent pedicled LD flap reconstruction between January 2024 and February 2026. Defect locations included the axilla, upper chest, mid back with spinal exposure, flank, upper back, and breast. The defects that came from hidradenitis suppurativa, postoperative wound complications, breast cancer-related soft-tissue defects, and defects after wide oncologic resection of melanoma, sarcoma, and dermatofibrosarcoma protuberans were included in.
Results: All 8 patients achieved stable soft-tissue coverage without total flap loss. No patient required reoperation for total flap failure; however, 3 patients underwent revision surgery for a surgical delay procedure. One patient subsequently underwent debulking surgery because of excessive flap bulk. Adjunctive negative-pressure wound therapy was applied to promote flap settlement, stabilize the wound, subside the edema and facilitate healing.
Conclusion: Pedicled LD flap reconstruction is a versatile and dependable option for complex truncal defects. It provides robust vascularized tissue and durable coverage in oncologic, infected, postoperative, and implant-based breast reconstruction settings. Especially, the pedicled LD flap is a versatile and reliable option for patients who underwent postoperative radiation therapy after oncologic reconstruction.
E-Poster
CP-0009
CP-0009
- Title
- Postoperative Retrobulbar Hematoma With Irreversible Visual Loss After Orbital Fracture Reconstruction In An Older Patient
- Author(s)
- Junghyun Lee
- Affiliation
- Department of Plastic and Reconstructive Surgery, Hallym University Dongtan Sacred Heart Hospital, Hwaseong, Korea
Postoperative Retrobulbar Hematoma With Irreversible Visual Loss After Orbital Fracture Reconstruction In An Older Patient CP-0009
Junghyun Lee · Case Report
Introduction: Retrobulbar hematoma is a rare but vision-threatening complication after orbital fracture repair. Because visual prognosis depends on rapid decompression, delayed symptom recognition may result in irreversible blindness. This report describes postoperative retrobulbar hematoma after orbital fracture reconstruction in an older patient and emphasizes preventive monitoring strategies.
Methods: The clinical course, operative findings, ophthalmologic examinations, and computed tomography findings of an 82-year-old woman who underwent reconstruction for right zygomaticomaxillary complex and orbital floor fractures were reviewed. Open reduction and internal fixation were performed through subciliary and upper vestibular approaches, and the orbital floor was reconstructed with titanium mesh. Preoperative visual acuity and pupillary reflexes were normal.
Results: No intraoperative bleeding or abnormal ocular tension was observed. On postoperative day 1, the patient developed blurred vision and a sensation of retro-orbital pressure but did not immediately report these symptoms. On postoperative day 2, she presented with severe orbital pain, proptosis, a fixed dilated pupil, and no light perception. Computed tomography revealed a dense retrobulbar hematoma compressing the posterior globe and optic nerve. Emergency orbital exploration and hematoma evacuation were performed through the previous subciliary incision, and approximately 4 mL of clotted blood was removed. No active arterial bleeding was identified, suggesting that the hematoma resulted from postoperative oozing. Although orbital decompression successfully normalized the intraocular pressure and follow-up computed tomography confirmed complete resolution of the hematoma with satisfactory fracture healing, visual function did not recover. At the 1-month follow-up, optic disc pallor and a profound visual field defect confirmed permanent visual loss.
Conclusion: Postoperative retrobulbar hematoma requires immediate recognition and decompression within the critical ischemic window. In older patients, clear symptom education, meticulous hemostasis, early ophthalmologic collaboration, and structured postoperative visual monitoring are essential to prevent avoidable blindness after orbital reconstruction.
Methods: The clinical course, operative findings, ophthalmologic examinations, and computed tomography findings of an 82-year-old woman who underwent reconstruction for right zygomaticomaxillary complex and orbital floor fractures were reviewed. Open reduction and internal fixation were performed through subciliary and upper vestibular approaches, and the orbital floor was reconstructed with titanium mesh. Preoperative visual acuity and pupillary reflexes were normal.
Results: No intraoperative bleeding or abnormal ocular tension was observed. On postoperative day 1, the patient developed blurred vision and a sensation of retro-orbital pressure but did not immediately report these symptoms. On postoperative day 2, she presented with severe orbital pain, proptosis, a fixed dilated pupil, and no light perception. Computed tomography revealed a dense retrobulbar hematoma compressing the posterior globe and optic nerve. Emergency orbital exploration and hematoma evacuation were performed through the previous subciliary incision, and approximately 4 mL of clotted blood was removed. No active arterial bleeding was identified, suggesting that the hematoma resulted from postoperative oozing. Although orbital decompression successfully normalized the intraocular pressure and follow-up computed tomography confirmed complete resolution of the hematoma with satisfactory fracture healing, visual function did not recover. At the 1-month follow-up, optic disc pallor and a profound visual field defect confirmed permanent visual loss.
Conclusion: Postoperative retrobulbar hematoma requires immediate recognition and decompression within the critical ischemic window. In older patients, clear symptom education, meticulous hemostasis, early ophthalmologic collaboration, and structured postoperative visual monitoring are essential to prevent avoidable blindness after orbital reconstruction.
E-Poster
CP-0015
CP-0015
- Title
- LOWER-LID SWITCH FLAP TO MAINTAIN FUNCTION AND AESTHETIC RESULTS OF UPPER EYELID AFTER FULL-THICKNESS WIDE EXCISION OF SQUAMOUS CELL CARCINOMA
- Author(s)
- Faustine Emanuela
- Affiliation
- Plastic Reconstructive and Aesthetic Surgery Unit, Pusat Angkatan Laut dr. Ramelan Hospital, Surabaya, Indonesia
LOWER-LID SWITCH FLAP TO MAINTAIN FUNCTION AND AESTHETIC RESULTS OF UPPER EYELID AFTER FULL-THICKNESS WIDE EXCISION OF SQUAMOUS CELL CARCINOMA CP-0015
Faustine Emanuela · Case Report
Background: Eyelid tumors are relatively rare and heterogeneous. Malignant eyelid tumors tend to display aggressive histopathological behavior, complete surgical excision is essential in their management. Achieving maximal preservation of both cosmetic appearance and function remains a challenging task even for experienced surgeons.
Objective: To describe a two-stage lower-lid switch flap technique for reconstructing the upper eyelid and perserving its function after full-thickness wide excision of squamous cell carcinoma.
Methods: A case report of a 45-year-old man with squamous cell carcinoma of the right upper eyelid.
Result: Reconstruction after full-thickness excision involving more than 75% of the upper eyelid must not only close the defect but also preserve eyelid function. The porcedure was performed in two stages: the lower-eyelid flap was first attached to the upper-eyelid defect, and the flap was the devided after 21 days. Ini ths case, the defect was closed using a lower-lid switch flap based on the marginal arcade, a technique chosen to preserve the tarsal plate and levator palpebrae muscle so that eyelid openinig and closing remained functional. This approach yielded good functional and aesthetic outcomes without complications.
Conclusion: Malignant neoplasms are a leading indication for reconstructive surgery in the periorbital region. Closing an upper-eyelid defect without reconstructing the levator palpebrae muscle is restored and the tarsus is preserved as the lid margin, thereby maintaining eyelid function.
Objective: To describe a two-stage lower-lid switch flap technique for reconstructing the upper eyelid and perserving its function after full-thickness wide excision of squamous cell carcinoma.
Methods: A case report of a 45-year-old man with squamous cell carcinoma of the right upper eyelid.
Result: Reconstruction after full-thickness excision involving more than 75% of the upper eyelid must not only close the defect but also preserve eyelid function. The porcedure was performed in two stages: the lower-eyelid flap was first attached to the upper-eyelid defect, and the flap was the devided after 21 days. Ini ths case, the defect was closed using a lower-lid switch flap based on the marginal arcade, a technique chosen to preserve the tarsal plate and levator palpebrae muscle so that eyelid openinig and closing remained functional. This approach yielded good functional and aesthetic outcomes without complications.
Conclusion: Malignant neoplasms are a leading indication for reconstructive surgery in the periorbital region. Closing an upper-eyelid defect without reconstructing the levator palpebrae muscle is restored and the tarsus is preserved as the lid margin, thereby maintaining eyelid function.
E-Poster
RP-0015
RP-0015
- Title
- Orthodontic Management Protocols in Orthognathic Surgery for Cleft and Non-Cleft and Their Treatment Outcomes: A Systematic Review
- Author(s)
- WAN SALBIAH WAN ABDUL RAZAK
- Affiliation
- University Technology MARA / Oral Health Division , The Ministry of Health, Malaysia
Orthodontic Management Protocols in Orthognathic Surgery for Cleft and Non-Cleft and Their Treatment Outcomes: A Systematic Review RP-0015
WAN SALBIAH WAN ABDUL RAZAK · Research
Background: Orthognathic surgery is an established intervention for severe dentofacial deformities; however, orthodontic management protocols vary between cleft and non-cleft patients because of differences in skeletal discrepancy, dental compensation, residual alveolar defects, scar-related soft tissue restriction, facial asymmetry, and relapse risk. This systematic literature review aimed to synthesise orthodontic management protocols used in orthognathic surgery for cleft and non-cleft patients and to evaluate reported treatment outcomes.
Methods: This review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) framework. Advanced searches were performed in Scopus and Web of Science using the keywords “orthodontic management protocols,” “orthognathic surgery,” “cleft,” “non-cleft,” and “treatment outcome.” Studies published between 2020 and 2026 were screened using predefined eligibility criteria. A total of 32 primary studies were included for qualitative synthesis.
Results: Three major themes were identified: orthognathic treatment protocols and sequencing; cleft orthognathic surgery and craniofacial reconstruction; and general orthognathic surgery with technological and diagnostic innovations. Conventional orthodontics-first protocols remained important for dental decompensation, arch coordination, extraction management, and correction of complex transverse, vertical, and asymmetrical discrepancies. Surgery-first protocols demonstrated reduced overall treatment duration, earlier facial improvement, and acceptable skeletal stability in selected skeletal Class III cases. In cleft-related deformities, treatment commonly required staged orthodontic preparation, multidisciplinary planning, careful maxillary movement, and management of residual alveolar defects, scar-related tissue limitations, and relapse risk. Digital planning, three-dimensional imaging, computer-aided simulation, three-dimensional printed splints, and clear aligner systems were increasingly applied to improve diagnostic accuracy and surgical precision.
Conclusion: Orthodontic management for orthognathic surgery should be individualised according to skeletal pattern, dental compensation, cleft-related anatomical complexity, functional requirements, and patient-centred outcomes. Further prospective studies with standardised protocols and long-term follow-up are required to strengthen comparative evidence.
Methods: This review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) framework. Advanced searches were performed in Scopus and Web of Science using the keywords “orthodontic management protocols,” “orthognathic surgery,” “cleft,” “non-cleft,” and “treatment outcome.” Studies published between 2020 and 2026 were screened using predefined eligibility criteria. A total of 32 primary studies were included for qualitative synthesis.
Results: Three major themes were identified: orthognathic treatment protocols and sequencing; cleft orthognathic surgery and craniofacial reconstruction; and general orthognathic surgery with technological and diagnostic innovations. Conventional orthodontics-first protocols remained important for dental decompensation, arch coordination, extraction management, and correction of complex transverse, vertical, and asymmetrical discrepancies. Surgery-first protocols demonstrated reduced overall treatment duration, earlier facial improvement, and acceptable skeletal stability in selected skeletal Class III cases. In cleft-related deformities, treatment commonly required staged orthodontic preparation, multidisciplinary planning, careful maxillary movement, and management of residual alveolar defects, scar-related tissue limitations, and relapse risk. Digital planning, three-dimensional imaging, computer-aided simulation, three-dimensional printed splints, and clear aligner systems were increasingly applied to improve diagnostic accuracy and surgical precision.
Conclusion: Orthodontic management for orthognathic surgery should be individualised according to skeletal pattern, dental compensation, cleft-related anatomical complexity, functional requirements, and patient-centred outcomes. Further prospective studies with standardised protocols and long-term follow-up are required to strengthen comparative evidence.
E-Poster
CP-0011
CP-0011
- Title
- Clear Aligner Therapy as Presurgical Orthodontic Preparation for Alveolar Bone Grafting in Bilateral Cleft Lip and Palate: A Case Report
- Author(s)
- Pran Pitaksanurat
- Affiliation
- Department of Orthodontics, Faculty of Dentistry, Khon Kaen University, 40002, Thailand / Department of Orthodontics, College of Dental Medicine, Rangsit University, Pathum Thani, 12000, Thailand
Clear Aligner Therapy as Presurgical Orthodontic Preparation for Alveolar Bone Grafting in Bilateral Cleft Lip and Palate: A Case Report CP-0011
Pran Pitaksanurat · Case Report
Introduction
Secondary alveolar bone grafting (SABG) requires presurgical orthodontic preparation to coordinate dental arches, correct transverse deficits, align teeth, and position roots adjacent to the cleft site. Traditionally, this preparation relies on a multistage approach involving palatal expansion followed by fixed appliances. However, evidence supporting the use of clear aligner before SABG remains limited. This case report describes presurgical orthodontic management using clear aligners in a patient with bilateral cleft lip and palate (BCLP) after conventional expansion therapy yielded inadequate progress.
Materials and Methods
A 12-year-old male with repaired BCLP underwent presurgical orthodontic preparation before SABG. Initial transverse expansion and premaxillary protraction were attempted using a removable 3-way expansion screw plate with a posterior bite plane. Expansion was inadequate, and severe premaxillary tipping resulted in poor appliance fit. Rather than transitioning to fixed appliances, treatment was revised to clear aligners to achieve arch expansion, tooth alignment, premaxillary repositioning, cleft-site opening, and root uprighting adjacent to the clefts. Periodic presurgical evaluations were performed.
Results
The patient completed 2 rounds of aligner therapy comprising 72 stages (38 and 34), achieving satisfactory dental alignment and arch coordination for SABG. After a 1.5-year loss to follow-up, the patient returned for surgery. Following SABG, the premaxilla was semi-rigidly splinted, and aligner therapy was temporarily suspended during healing to prevent jiggling forces from aligner insertion and removal. SABG was completed successfully with satisfactory clinical outcomes.
Conclusion
This case demonstrates that clear aligners can be incorporated into presurgical orthodontic management of selected patients with BCLP when conventional appliance therapy yields limited results. Strict oral hygiene and interdisciplinary coordination were essential for graft readiness and postsurgical stability. Further studies are needed to establish indications, treatment protocols, and long-term outcomes of clear aligner therapy before SABG.
Secondary alveolar bone grafting (SABG) requires presurgical orthodontic preparation to coordinate dental arches, correct transverse deficits, align teeth, and position roots adjacent to the cleft site. Traditionally, this preparation relies on a multistage approach involving palatal expansion followed by fixed appliances. However, evidence supporting the use of clear aligner before SABG remains limited. This case report describes presurgical orthodontic management using clear aligners in a patient with bilateral cleft lip and palate (BCLP) after conventional expansion therapy yielded inadequate progress.
Materials and Methods
A 12-year-old male with repaired BCLP underwent presurgical orthodontic preparation before SABG. Initial transverse expansion and premaxillary protraction were attempted using a removable 3-way expansion screw plate with a posterior bite plane. Expansion was inadequate, and severe premaxillary tipping resulted in poor appliance fit. Rather than transitioning to fixed appliances, treatment was revised to clear aligners to achieve arch expansion, tooth alignment, premaxillary repositioning, cleft-site opening, and root uprighting adjacent to the clefts. Periodic presurgical evaluations were performed.
Results
The patient completed 2 rounds of aligner therapy comprising 72 stages (38 and 34), achieving satisfactory dental alignment and arch coordination for SABG. After a 1.5-year loss to follow-up, the patient returned for surgery. Following SABG, the premaxilla was semi-rigidly splinted, and aligner therapy was temporarily suspended during healing to prevent jiggling forces from aligner insertion and removal. SABG was completed successfully with satisfactory clinical outcomes.
Conclusion
This case demonstrates that clear aligners can be incorporated into presurgical orthodontic management of selected patients with BCLP when conventional appliance therapy yields limited results. Strict oral hygiene and interdisciplinary coordination were essential for graft readiness and postsurgical stability. Further studies are needed to establish indications, treatment protocols, and long-term outcomes of clear aligner therapy before SABG.
E-Poster
RP-0009
RP-0009
- Title
- Duration of Presurgical Orthodontic Preparation for Alveolar Bone Grafting in Unilateral Cleft Lip and Palate: Comparison of Clear Aligner, Removable Appliance, and Quad Helix
- Author(s)
- กฤษฏี ปัณณะรัส
- Affiliation
- Queen Sirikit National Institute of Child health
Duration of Presurgical Orthodontic Preparation for Alveolar Bone Grafting in Unilateral Cleft Lip and Palate: Comparison of Clear Aligner, Removable Appliance, and Quad Helix RP-0009
กฤษฏี ปัณณะรัส · Research
Introduction (background and objective):
Presurgical orthodontic correction of the collapsed alveolar segment is required before alveolar bone grafting (ABG) in patients with complete unilateral cleft lip and palate (UCLP). Clear aligners, conventional removable appliances (RA), and quad helix (QH) devices are all used for this purpose, but comparative data on treatment duration are limited, making it difficult to counsel families on expected timelines. This study described the duration of presurgical orthodontic preparation for ABG in UCLP patients and compared this duration among clear aligner, RA, and QH groups.
Materials & Methods:
A retrospective review of 31 UCLP patients who underwent presurgical orthodontic treatment before ABG was conducted (clear aligner, n = 11; RA, n = 10; QH, n = 10). The primary outcome was treatment duration (days) from orthodontic treatment initiation to surgeon-confirmed readiness for secondary alveolar bone grafting. Data normality was assessed using the Shapiro–Wilk test, and homogeneity of variances was evaluated using Levene's test. Because the assumption of equal variances was violated, treatment duration among the three groups was compared using Welch's ANOVA, followed by Games–Howell post hoc pairwise comparisons.
Result(s):
Mean treatment duration was 231 ± 93 days for the clear aligner group, 201 ± 100 days for the QH group, and 400 ± 292 days for the RA group. Welch's ANOVA showed no significant difference in treatment duration among the three appliance groups (p = 0.165), and Games–Howell post hoc comparisons were not significant (all p > 0.05).
Conclusion:
No appliance demonstrated significantly faster presurgical preparation for ABG despite numerical differences favoring quad helix. Given wide individual variability, likely influenced by operating-room scheduling, patient cooperation, and laboratory turnaround, clinicians should counsel UCLP families to expect a variable, often prolonged, preparation period and closely monitor canine eruption throughout, regardless of appliance chosen.
Presurgical orthodontic correction of the collapsed alveolar segment is required before alveolar bone grafting (ABG) in patients with complete unilateral cleft lip and palate (UCLP). Clear aligners, conventional removable appliances (RA), and quad helix (QH) devices are all used for this purpose, but comparative data on treatment duration are limited, making it difficult to counsel families on expected timelines. This study described the duration of presurgical orthodontic preparation for ABG in UCLP patients and compared this duration among clear aligner, RA, and QH groups.
Materials & Methods:
A retrospective review of 31 UCLP patients who underwent presurgical orthodontic treatment before ABG was conducted (clear aligner, n = 11; RA, n = 10; QH, n = 10). The primary outcome was treatment duration (days) from orthodontic treatment initiation to surgeon-confirmed readiness for secondary alveolar bone grafting. Data normality was assessed using the Shapiro–Wilk test, and homogeneity of variances was evaluated using Levene's test. Because the assumption of equal variances was violated, treatment duration among the three groups was compared using Welch's ANOVA, followed by Games–Howell post hoc pairwise comparisons.
Result(s):
Mean treatment duration was 231 ± 93 days for the clear aligner group, 201 ± 100 days for the QH group, and 400 ± 292 days for the RA group. Welch's ANOVA showed no significant difference in treatment duration among the three appliance groups (p = 0.165), and Games–Howell post hoc comparisons were not significant (all p > 0.05).
Conclusion:
No appliance demonstrated significantly faster presurgical preparation for ABG despite numerical differences favoring quad helix. Given wide individual variability, likely influenced by operating-room scheduling, patient cooperation, and laboratory turnaround, clinicians should counsel UCLP families to expect a variable, often prolonged, preparation period and closely monitor canine eruption throughout, regardless of appliance chosen.
E-Poster
CP-0005
CP-0005
- Title
- Modification of Nasoalveolar Molding in a Bilateral Cleft Lip and Palate Patient with a Rotated Premaxilla: A Case Report
- Author(s)
- Thitirath Joongjai
- Affiliation
- Division of Orthodontics, Faculty of Dentistry, Khon Kaen University, Khon Kaen, Thailand
Modification of Nasoalveolar Molding in a Bilateral Cleft Lip and Palate Patient with a Rotated Premaxilla: A Case Report CP-0005
Thitirath Joongjai · Case Report
Introduction: Bilateral cleft lip and palate (BCLP) often involves a severely protruded premaxilla lacking bony continuity with the lateral palatal segments. Conventional nasoalveolar molding (NAM) primarily exerts a single linear retraction vector, which fails to correct premaxillary rotation.
Methods: A 1.5-month-old girl with non-syndromic complete BCLP presented to the Cleft Lip and Palate Center, Khon Kaen University. Clinical features included complete bilateral nostril obstruction, leftward septal deviation, and severe premaxillary rotation (left side positioned more anteriorly). To introduce a derotational force, two core protocol modifications were implemented. First, the working model was sectioned into premaxillary and bilateral posterior segments, then repositioned to fabricate a plate targeted to an improved arch alignment. Second, lip strapping was applied asymmetrically, directing greater retractive force on the more protruded left side. A retraction screw was integrated with a newborn-sized (6 mm) Digital Nasal Stent (DNS). This was later upgraded to a standard-sized (8 mm) DNS with Lip Band (DNSLB) alongside a second chair-side plate. Primary cheiloplasty was performed two months after treatment initiation.
Results: Records were compared at initial presentation, pre-cheiloplasty, and three months post-cheiloplasty. Pre-cheiloplasty scans showed reduction in premaxillary rotation with patent nostrils and a lengthened columella, although minor residual rotation remained. By three months post-cheiloplasty, the premaxilla achieved complete derotation and alignment to a symmetrical arch form.
Conclusion: Integrating a segmental model setup and asymmetric lip strapping effectively address complex premaxillary rotation where linear retraction falls short. DNS and DNSLB help improved collapsed nostrils with DNSLB providing additional retraction force on the protruded premaxilla. Surgical reconstruction of the orbicularis oris muscle during cheiloplasty provides the continuous molding force necessary to complete arch derotation postoperatively.
Methods: A 1.5-month-old girl with non-syndromic complete BCLP presented to the Cleft Lip and Palate Center, Khon Kaen University. Clinical features included complete bilateral nostril obstruction, leftward septal deviation, and severe premaxillary rotation (left side positioned more anteriorly). To introduce a derotational force, two core protocol modifications were implemented. First, the working model was sectioned into premaxillary and bilateral posterior segments, then repositioned to fabricate a plate targeted to an improved arch alignment. Second, lip strapping was applied asymmetrically, directing greater retractive force on the more protruded left side. A retraction screw was integrated with a newborn-sized (6 mm) Digital Nasal Stent (DNS). This was later upgraded to a standard-sized (8 mm) DNS with Lip Band (DNSLB) alongside a second chair-side plate. Primary cheiloplasty was performed two months after treatment initiation.
Results: Records were compared at initial presentation, pre-cheiloplasty, and three months post-cheiloplasty. Pre-cheiloplasty scans showed reduction in premaxillary rotation with patent nostrils and a lengthened columella, although minor residual rotation remained. By three months post-cheiloplasty, the premaxilla achieved complete derotation and alignment to a symmetrical arch form.
Conclusion: Integrating a segmental model setup and asymmetric lip strapping effectively address complex premaxillary rotation where linear retraction falls short. DNS and DNSLB help improved collapsed nostrils with DNSLB providing additional retraction force on the protruded premaxilla. Surgical reconstruction of the orbicularis oris muscle during cheiloplasty provides the continuous molding force necessary to complete arch derotation postoperatively.
E-Poster
CP-0007
CP-0007
- Title
- Long-Term Outcomes of Korat Nasoalveolar Molding in a Patient with Complete Unilateral Cleft Lip and Palate: A 16-Years Interdisciplinary Follow-up
- Author(s)
- Somsri Klachoho
- Affiliation
- Cleft Center Maharat Nakhon Ratchasima Hospital
Long-Term Outcomes of Korat Nasoalveolar Molding in a Patient with Complete Unilateral Cleft Lip and Palate: A 16-Years Interdisciplinary Follow-up CP-0007
Somsri Klachoho · Case Report
Introduction:
To present the comprehensive interdisciplinary treatment protocol and long-term outcomes of a patient with unilateral cleft lip and palate (UCLP) using the Korat Nasoalveolar Molding (Korat-NAM) protocol from infancy through adolescence.
Materials & Methods:
A 4-day-old male infant presented with a right complete UCLP, wide alveolar and palatal cleft and severe cleft lip nasal deformity. Korat-NAM-I was initiated immediately after birth to approximate the alveolar segments, reduce the alveolar and palatal clefts, elevate the collapsed nasal dome, improve columellar length, and mold the nasal cartilage. Primary cleft-lip repair with nasal-floor closure and primary rhinoplasty was performed at 6-months-old. Korat-NAM-II was worn until primary palatoplasty at 18 months -old to maintain nasal correction, followed by Korat-NAM-III from 18 months to further preserve nasal morphology. At 7.6-year-old, a fan-shaped maxillary-expansion-appliance was used to correct mid-arch collapse in preparation for secondary alveolar bone grafting. Comprehensive orthodontic treatment with extraction of the four first premolars using fixed appliances commenced at 13.4-year-old to resolve malocclusion. Speech therapy was provided continuously throughout growth.
Results:
At 15.8-year-old, patient demonstrated a straight facial profile with good nasal-projection, satisfactory lip and nasal esthetics, Class I occlusion, and 1-mm overjet. Serial lateral-cephalometric analysis from 7.6-year-old to 15.8-year-old showed ANB angle change from 2° to −1°, reflecting mandibula- growth while maintaining acceptable skeletal and dental relationships. Functional, esthetics and speech outcomes were satisfactory.
Discussion:
Korat-NAM represents a critical first step in the interdisciplinary management of complete UCLP. Early correction of alveolar and nasal deformities facilitates subsequent surgical, orthodontic, and speech interventions, reducing treatment complexity and the need for secondary surgical procedures.
Conclusions:
This case demonstrates that early nasoalveolar molding, integrated with coordinated interdisciplinary protocol, can achieve favorable functional and esthetic outcomes that are maintained through adolescence.
To present the comprehensive interdisciplinary treatment protocol and long-term outcomes of a patient with unilateral cleft lip and palate (UCLP) using the Korat Nasoalveolar Molding (Korat-NAM) protocol from infancy through adolescence.
Materials & Methods:
A 4-day-old male infant presented with a right complete UCLP, wide alveolar and palatal cleft and severe cleft lip nasal deformity. Korat-NAM-I was initiated immediately after birth to approximate the alveolar segments, reduce the alveolar and palatal clefts, elevate the collapsed nasal dome, improve columellar length, and mold the nasal cartilage. Primary cleft-lip repair with nasal-floor closure and primary rhinoplasty was performed at 6-months-old. Korat-NAM-II was worn until primary palatoplasty at 18 months -old to maintain nasal correction, followed by Korat-NAM-III from 18 months to further preserve nasal morphology. At 7.6-year-old, a fan-shaped maxillary-expansion-appliance was used to correct mid-arch collapse in preparation for secondary alveolar bone grafting. Comprehensive orthodontic treatment with extraction of the four first premolars using fixed appliances commenced at 13.4-year-old to resolve malocclusion. Speech therapy was provided continuously throughout growth.
Results:
At 15.8-year-old, patient demonstrated a straight facial profile with good nasal-projection, satisfactory lip and nasal esthetics, Class I occlusion, and 1-mm overjet. Serial lateral-cephalometric analysis from 7.6-year-old to 15.8-year-old showed ANB angle change from 2° to −1°, reflecting mandibula- growth while maintaining acceptable skeletal and dental relationships. Functional, esthetics and speech outcomes were satisfactory.
Discussion:
Korat-NAM represents a critical first step in the interdisciplinary management of complete UCLP. Early correction of alveolar and nasal deformities facilitates subsequent surgical, orthodontic, and speech interventions, reducing treatment complexity and the need for secondary surgical procedures.
Conclusions:
This case demonstrates that early nasoalveolar molding, integrated with coordinated interdisciplinary protocol, can achieve favorable functional and esthetic outcomes that are maintained through adolescence.
E-Poster
CP-0002
CP-0002
- Title
- Clear Aligner Therapy for Anterior Crossbite with Severe Incisor Rotation in a Patient with Unilateral Cleft Lip: A Case Report
- Author(s)
- Krispijyakorn Sangharn
- Affiliation
- Institute of Dentistry, Suranaree University of Technology, Faculty of Dentistry, Khonkean University
Clear Aligner Therapy for Anterior Crossbite with Severe Incisor Rotation in a Patient with Unilateral Cleft Lip: A Case Report CP-0002
Krispijyakorn Sangharn · Case Report
Introduction: Patients with cleft lip (CL) frequently exhibit residual malocclusion following cheiloplasty and alveolar bone grafting, often requiring comprehensive orthodontic treatment. Although clear aligner therapy has become increasingly popular, its application as definitive orthodontic treatment in patients with cleft lip /palate patients has rarely been reported. Moreover, the correction of anterior crossbite and severe tooth rotation remains one of the greatest challenges for clear aligners, with reported accuracy ranging from 36% to 85%. This report presents the successful treatment of a male patient with unilateral cleft lip and residual malocclusion using clear aligner therapy as an effective treatment modality in carefully selected cleft cases
Materials & Methods: A 16-year-old male with left unilateral CL, brachyfacial type, and a mild concave profile presented with a supernumerary tooth between teeth 22 and 23, severe distal rotation of tooth 22, left anterior crossbite, upper dental midline deviation to the right, and Class II canine and molar relationships on the left side (subdivision). The supernumerary tooth was extracted prior to treatment. Clear aligner therapy incorporated interproximal reduction (IPR) of the lower anterior teeth, vertical rectangular attachments, and Class II elastics, delivered across 64 total trays (32 initial trays plus 32 additional aligners) over 20 months.
Results: All treatment goals were achieved: facial profile improved, tooth 22 rotation was fully corrected, the anterior crossbite resolved, and the upper midline aligned with the facial midline. Class I canine and molar relationships were established bilaterally, with overjet and overbite within normal limits. A wraparound removable retainer was used for retention.
Conclusion: This case demonstrates that clear aligner therapy can effectively resolve complex residual malocclusion in CL patients, including severe rotation, crossbite, midline deviation, and apparent Class II relationships, supporting its role as a viable treatment option for appropriately selected adolescent patients with CL.
Materials & Methods: A 16-year-old male with left unilateral CL, brachyfacial type, and a mild concave profile presented with a supernumerary tooth between teeth 22 and 23, severe distal rotation of tooth 22, left anterior crossbite, upper dental midline deviation to the right, and Class II canine and molar relationships on the left side (subdivision). The supernumerary tooth was extracted prior to treatment. Clear aligner therapy incorporated interproximal reduction (IPR) of the lower anterior teeth, vertical rectangular attachments, and Class II elastics, delivered across 64 total trays (32 initial trays plus 32 additional aligners) over 20 months.
Results: All treatment goals were achieved: facial profile improved, tooth 22 rotation was fully corrected, the anterior crossbite resolved, and the upper midline aligned with the facial midline. Class I canine and molar relationships were established bilaterally, with overjet and overbite within normal limits. A wraparound removable retainer was used for retention.
Conclusion: This case demonstrates that clear aligner therapy can effectively resolve complex residual malocclusion in CL patients, including severe rotation, crossbite, midline deviation, and apparent Class II relationships, supporting its role as a viable treatment option for appropriately selected adolescent patients with CL.
E-Poster
RP-0011
RP-0011
- Title
- Reconstruction with bilateral hatchet flaps for medium sized scalp defects.
- Author(s)
- Junghyun Lee
- Affiliation
- Department of Plastic and Reconstructive Surgery, Hallym University Dongtan Sacred Heart Hospital, Hwaseong, Korea
Reconstruction with bilateral hatchet flaps for medium sized scalp defects. RP-0011
Junghyun Lee · Research
Introduction: Reconstruction of scalp defects is challenging because of the convex contour, hair-bearing skin, and need for durable calvarial coverage. The hatchet flap combines advancement and rotation, redistributes tension, and preserves adjacent hair-bearing tissue. This study evaluated the clinical utility and surgeon-assessed outcomes of hatchet flap reconstruction for medium-sized scalp defects after excision of benign or malignant lesions.
Methods: We retrospectively reviewed 18 patients who underwent hatchet flap-based scalp reconstruction between March 2024 and 2026. Indications included skin cancer, soft-tissue mass, nevus sebaceous, seborrheic keratosis, epidermal cyst, infected cystic mass, and scalp skin necrosis. After excision or debridement, primary closure was not feasible because of defect size, location, or closure tension. Flaps were designed according to defect location and surrounding tissue mobility. Postoperative flap viability, wound complications, revision surgery, hair-bearing appearance, aesthetic outcomes, and local symptoms were reviewed.
Results: Defects involved the scalp, occiput, vertex, or temple. All patients achieved successful wound closure. No total or partial flap necrosis occurred, and no patient required reoperation or secondary reconstruction. The operating surgeon assessed postoperative contour, tissue match, and preservation of hair-bearing scalp as satisfactory. Pain, pruritus, and other local discomfort were minimal or tolerable during follow-up.
Conclusion: Hatchet flap-based reconstruction is a reliable and versatile option for scalp defects that cannot be closed primarily. It provides durable coverage, favorable tissue matching, preservation of hair-bearing scalp, and satisfactory surgeon-assessed aesthetic outcomes. Longer follow-up is required to evaluate scar maturation, alopecia, long-term aesthetic results, and symptom changes.
Methods: We retrospectively reviewed 18 patients who underwent hatchet flap-based scalp reconstruction between March 2024 and 2026. Indications included skin cancer, soft-tissue mass, nevus sebaceous, seborrheic keratosis, epidermal cyst, infected cystic mass, and scalp skin necrosis. After excision or debridement, primary closure was not feasible because of defect size, location, or closure tension. Flaps were designed according to defect location and surrounding tissue mobility. Postoperative flap viability, wound complications, revision surgery, hair-bearing appearance, aesthetic outcomes, and local symptoms were reviewed.
Results: Defects involved the scalp, occiput, vertex, or temple. All patients achieved successful wound closure. No total or partial flap necrosis occurred, and no patient required reoperation or secondary reconstruction. The operating surgeon assessed postoperative contour, tissue match, and preservation of hair-bearing scalp as satisfactory. Pain, pruritus, and other local discomfort were minimal or tolerable during follow-up.
Conclusion: Hatchet flap-based reconstruction is a reliable and versatile option for scalp defects that cannot be closed primarily. It provides durable coverage, favorable tissue matching, preservation of hair-bearing scalp, and satisfactory surgeon-assessed aesthetic outcomes. Longer follow-up is required to evaluate scar maturation, alopecia, long-term aesthetic results, and symptom changes.
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