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Introduction: Epiphora is an uncommon but clinically significant complication after orbital wall reconstruction. It may occur due to lacrimal drainage disturbance, soft tissue adhesion, or implant-related obstruction. We report a case of postoperative epiphora caused by mesh migration after reconstruction of medial orbital wall and orbital floor fractures.

Methods: A patient sustained left medial orbital wall, orbital floor, and nasal bone fractures following a head-on collision between a bicycle and a vehicle. Extraocular movements were intact, with no diplopia or visual impairment. Orbital wall reconstruction was performed through a transconjunctival-caruncular approach using a bioresorbable mesh which is radiopacity allowing the implant to be clearly visualized on postoperative computed tomography. One month after surgery, the patient developed persistent epiphora. Although ophthalmologic evaluation revealed no definite abnormalities, computed tomography demonstrated displacement of the radiopaque mesh, enabling precise localization of the migrated implant. Based on the correlation between the imaging findings and the patient’s symptoms, surgical exploration and implant complete removal were performed.

Results: The mesh was accurately localized and found to be displaced anteriorly with compressing the lacrimal drainage pathway. Adhesiolysis was performed, and the implant was completely removed. The intraoperative location of the migrated mesh corresponded closely with its position on preoperative computed tomography. At 3 months, the patient reported complete resolution of symptoms without diplopia, visual impairment, or limitation of extraocular movement.

Conclusion: Mesh migration after orbital wall reconstruction may cause delayed epiphora even when ocular motility and vision are normal. Careful evaluation of implant position should be considered in patients with persistent postoperative epiphora. Transcaruncular exploration with implant removal and adhesiolysis may be an effective treatment option.

A Review of Orthodontic Considerations before and after Alveolar Bone Grafting in Patients with Cleft Lip and Palate*

Cecile Tuano Cabrera, DMD, MSD

Noordhoff Craniofacial Foundation Philippines
College of Dentistry, University of the Philippines Manila
Smile Train Craniofacial Center, Manila
Our Lady of Peace Hospital, Paranaque

Introduction
Successful orthodontic management in cleft lip and palate, in relation alveolar bone grafting depends on key factors: timing, treatment sequencing, pre-graft preparation and post-graft management. This review highlights current management concepts and protocols.

Methods
A selective literature search was conducted using PubMed and Google Scholar with keywords related to alveolar bone grafting, orthodontics, cleft lip and palate, maxillary expansion, and maxillary protraction.

Results and Key Findings
Assessment should begin at the mixed dentition stage to determine optimal timing and sequence of grafting and related procedures. Regular clinical and radiographic evaluation is essential. Indications for pre‑graft orthodontics include severe collapse of alveolar segments, traumatic occlusion near the cleft, and inadequate surgical access. Grafting is ideally performed when the canine root adjacent to the cleft is one‑half to two‑thirds developed, though some centers graft earlier when the lateral incisor is adjacent. After grafting, maxillary expansion may be performed in patients who have not received pre-graft orthodontics. Some patients may benefit from maxillary protraction during the late mixed or early permanent dentition stage. Following bone graft surgery, orthodontic treatment may either proceed—depending on the individual case—or be paused until the patient achieves full skeletal maturity.

Conclusion
Orthodontic care is integral to interdisciplinary management of cleft lip and palate. Each patient presents unique needs, and collaboration among cleft team members is vital to create individualized treatment plans that optimize outcomes.

*This article was published in: Acta Medica Philippina in 2024. Free full text link in Pubmed: https://pmc.ncbi.nlm.nih.gov/articles/PMC11694040/

Introduction: Pierre Robin sequence (PRS) is a congenital condition characterized by micrognathia, glossoptosis, and upper airway obstruction, frequently accompanied by cleft palate. While global birth prevalence ranges from 7 to 18 per 100,000 live births, no such data exists from Southeast Asia. This study aimed to characterize the clinical profile of PRS, including classification, associated cleft types, congenital malformations, and syndromes, among patients registered at the Tawanchai Cleft Center, Khon Kaen University, Thailand.

Materials and Methods: A retrospective hospital-based study was conducted using the Tawanchai Cleft Center registry, Khon Kaen University, Thailand. Patients with confirmed PRS (ICD-10: Q87.0) born between 2018 and 2023 were included. Cases were classified as isolated PRS, PRS-plus (associated anomalies without a defined syndrome), or syndromic PRS. Associated congenital malformations were categorized by organ systems using ICD-10 coding. Descriptive statistics were used for data analysis.

Results: Forty-one PRS cases were identified (27 female; 65.9%). Cleft palate was present in 97.6% of cases, most commonly cleft of the hard and soft palate (Q35.5; 43.9%) and cleft of the soft palate only (Q35.3; 41.5%). Cases were classified as isolated PRS (46.3%), PRS-plus (41.5%), and syndromic PRS (12.2%). Associated syndromes included Treacher Collins, Stickler, 22q11.2 deletion, and Glass (SATB2-associated) syndromes, along with chromosomal abnormality. Associated congenital malformations were identified in 51.2% of cases, most frequently involving musculoskeletal (22.0%), circulatory (14.6%), and digestive systems (12.2%). The most common specific malformations were cardiac septal defects (Q21; 23.5%), head and face deformities (Q67; 23.5%), and laryngeal malformations (Q31; 17.6%).

Conclusion: PRS cases in this Thai tertiary cleft center demonstrated a high proportion of associated congenital malformations and syndromic diagnoses. These findings represent the first clinical profile of PRS from Thailand, underscoring the importance of comprehensive multidisciplinary evaluation and systematic registry-based surveillance in Southeast Asia.

INTRODUCTION: Social media platforms are used for support and getting health information to manage or overcome disease. Since 2006, The Noordhoff Craniofacial Foundation Philippines, Inc. (NCFP) has provided subsidies for treatment of cleft lip and palate to indigent patients. In 2018, it began utilizing Facebook and Messenger to foster supportive environments for patient communication and education. The study objective was to determine the perception of using these platforms.

METHODS: A quantitative descriptive study design was employed. Cleft lip and palate patients or their caregivers answered a 6-part online questionnaire. The survey included questions on general information and their perception of the NCFP platforms. Responses were collected in 4 weeks, and data were analyzed using STATA ver.16.0.

RESULTS: The 138 participants were members of 1, 2, or all 3 groups. Of the participants, 90.6% (125) were part of the Facebook Group (Group I), 12.3% (17) were part of the Peer Messenger Group (Group II), and 21.7% (30) were part of the Parents’ Messenger Group (Group III). Group I was found to be the easiest to use by 76.8% of the respondents. In total, 94.6% of Group I, 48.5% of Group II, and 47.3% of Group III thought these groups helped them in treatment decision-making. The 45%, 25.7%, and 28% for Groups I, II, and III, respectively felt a decrease in their perceived need for in-person visits. Patient satisfaction was 95.4%, 50.5%, and 52.7% in Groups I, II, and III, respectively.

CONCLUSION: The perception on the use of social media platforms is different among the 3 groups. Group I ranked the highest in ease of use and help with decision-making but less than half the participants found that the 3 groups led to a decrease in the perceived need for in-person visits. Overall, their experience of using social media groups was positive.