E-Poster
RP-0027
RP-0027
Digital Poster
Accepted E-Poster presentations from registered participants.
Three-Dimensional Assessment of Upper Airway Changes After Mandibular Distraction Osteogenesis in Patients With Severe Micrognathia RP-0027
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.
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
Simultaneous Fronto-Orbital Advancement and Le Fort III Distraction in Saethre–Chotzen Syndrome Initially Suspected of Having Carpenter Syndrome CP-0023
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.
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.
E-Poster
CP-0021
CP-0021
- Title
- Proactive Management for Collaborative Cleft Lip and Cleft Palate Care in Upper Northern Part of Thailand
- Author(s)
- Supaksiri Suwiwattana
- Affiliation
- Princess Sirindhorn IT Foundation Craniofacial Center Chiang Mai University
Proactive Management for Collaborative Cleft Lip and Cleft Palate Care in Upper Northern Part of Thailand CP-0021
Supaksiri Suwiwattana · Case Report
Introduction
Proactive Management for Collaborative Cleft Lip and Cleft Palate Care in Upper Northern Part of Thailand is a system innovation addressing fragmentation in Thailand’s cleft care. It links university hospitals, Ministry of Public Health hospitals, and community networks into one coordinated, patient-centered system, ensuring continuous care from birth through early adulthood.
Essence of Innovation:
The new data-driven workflow eliminates fragmented care. Built on Chiang Mai University’s multidisciplinary expertise (Medicine, Dentistry, Associated Medical Sciences, Engineer, Information Technology Service Center, and Craniofacial Center), it closes workflow gaps. This collaboration combines network databases with the ThaiCleftLink program to streamline operations, empowering 38 hospitals across 8 northern provinces with standardized care, becomes model for expansion across Southeast Asia. The concept of this innovation system aligns with CMU’s core mission and vision as Thailand’s first regional university, advancing local and national development while supporting its current strategic objectives.
Starting Point:
Began as a CMU multidisciplinary collaboration, then scaled to a regional network linking university, Ministry of Public Health hospitals, and primary care units.
Steps Taken:
Phase 1: Collaborative Network – Established a common vision for coordinated care.
Phase 2: Centralized Data System – Developed the unified ThaiCleftLink platform for patient tracking.
Phase 3: Proactive Management – Conducted a gap analysis, then introduced rotating surgical teams, speech therapy, integrated dental care, telemedicine, and referral systems, dramatically reducing loss-to-follow-up.
Resources Used:
Backed by Chiang Mai University's president, SCFC, and a Ministry of Public Health partnership. Chiang Mai University provided academic/technical expertise, health offices provided personnel, and ITSC provided IT infrastructure.
Impact:
Financial: Patient travel expenses dropped by ~17%. Social/Health Equity: The program supports 2,873 patients via 57 hospitals, and 546 professionals. With the Social Return on Investment (SROI) ratio of 6.28:1, demonstrating high social/economic value.
Proactive Management for Collaborative Cleft Lip and Cleft Palate Care in Upper Northern Part of Thailand is a system innovation addressing fragmentation in Thailand’s cleft care. It links university hospitals, Ministry of Public Health hospitals, and community networks into one coordinated, patient-centered system, ensuring continuous care from birth through early adulthood.
Essence of Innovation:
The new data-driven workflow eliminates fragmented care. Built on Chiang Mai University’s multidisciplinary expertise (Medicine, Dentistry, Associated Medical Sciences, Engineer, Information Technology Service Center, and Craniofacial Center), it closes workflow gaps. This collaboration combines network databases with the ThaiCleftLink program to streamline operations, empowering 38 hospitals across 8 northern provinces with standardized care, becomes model for expansion across Southeast Asia. The concept of this innovation system aligns with CMU’s core mission and vision as Thailand’s first regional university, advancing local and national development while supporting its current strategic objectives.
Starting Point:
Began as a CMU multidisciplinary collaboration, then scaled to a regional network linking university, Ministry of Public Health hospitals, and primary care units.
Steps Taken:
Phase 1: Collaborative Network – Established a common vision for coordinated care.
Phase 2: Centralized Data System – Developed the unified ThaiCleftLink platform for patient tracking.
Phase 3: Proactive Management – Conducted a gap analysis, then introduced rotating surgical teams, speech therapy, integrated dental care, telemedicine, and referral systems, dramatically reducing loss-to-follow-up.
Resources Used:
Backed by Chiang Mai University's president, SCFC, and a Ministry of Public Health partnership. Chiang Mai University provided academic/technical expertise, health offices provided personnel, and ITSC provided IT infrastructure.
Impact:
Financial: Patient travel expenses dropped by ~17%. Social/Health Equity: The program supports 2,873 patients via 57 hospitals, and 546 professionals. With the Social Return on Investment (SROI) ratio of 6.28:1, demonstrating high social/economic value.
E-Poster
RP-0025
RP-0025
- Title
- Alveolar Bone Grafting in Patients with Cleft Lip and Palate: An 11 years Retrospective Review from Sarawak General Hospital
- Author(s)
- Fathin alyaa Mohamad farid
- Affiliation
- Sarawak General Hospital, Malaysia
Alveolar Bone Grafting in Patients with Cleft Lip and Palate: An 11 years Retrospective Review from Sarawak General Hospital RP-0025
Fathin alyaa Mohamad farid · Research
Background:
Alveolar bone grafting is an essential component of comprehensive cleft care. It aims to restore alveolar continuity, provide bony support for eruption of the permanent dentition, facilitate orthodontic treatment, and closure of oronasal fistulae. Autologous iliac crest bone remains a commonly used graft source. We describe our experience with alveolar bone grafting at Sarawak General Hospital.
Methods:
A retrospective descriptive review was conducted of patients who underwent alveolar bone grafting under the Plastic and Reconstructive Surgery Department between 2015 and 2026(11years). Data on patient demographics, cleft characteristics, operative details, graft donor site.
Results:
A total of 23 reviewed cases included 9 female patients and 14 male patients with age ranging from 11 years old to 2 years old with unilateral and bilateral cleft lip, alveolus and/or palate. Most patients had unilateral cleft deformities, while bilateral clefts were also represented. Patients underwent alveolar bone grafting using autologous bone harvested predominantly from the anterior iliac crest. Both left and right iliac crest donor sites were utilised according to operative requirements.
Several patients underwent concomitant procedures, including lip revision, correction of nostril, and dermal fat grafting. Operative procedures were performed electively under general anaesthesia. Recorded operative durations varied from approximately 71 to 169 minutes. The cases demonstrated no donor site morbidity. however, our limitation was in tracing the OPG / bone graft uptake.
Conclusion:
Alveolar bone grafting using autologous iliac crest bone remains an important component of cleft reconstruction at our centre. This study reflects the role of regional centres in providing longitudinal reconstructive care for patients with cleft lip and palate.
Alveolar bone grafting is an essential component of comprehensive cleft care. It aims to restore alveolar continuity, provide bony support for eruption of the permanent dentition, facilitate orthodontic treatment, and closure of oronasal fistulae. Autologous iliac crest bone remains a commonly used graft source. We describe our experience with alveolar bone grafting at Sarawak General Hospital.
Methods:
A retrospective descriptive review was conducted of patients who underwent alveolar bone grafting under the Plastic and Reconstructive Surgery Department between 2015 and 2026(11years). Data on patient demographics, cleft characteristics, operative details, graft donor site.
Results:
A total of 23 reviewed cases included 9 female patients and 14 male patients with age ranging from 11 years old to 2 years old with unilateral and bilateral cleft lip, alveolus and/or palate. Most patients had unilateral cleft deformities, while bilateral clefts were also represented. Patients underwent alveolar bone grafting using autologous bone harvested predominantly from the anterior iliac crest. Both left and right iliac crest donor sites were utilised according to operative requirements.
Several patients underwent concomitant procedures, including lip revision, correction of nostril, and dermal fat grafting. Operative procedures were performed electively under general anaesthesia. Recorded operative durations varied from approximately 71 to 169 minutes. The cases demonstrated no donor site morbidity. however, our limitation was in tracing the OPG / bone graft uptake.
Conclusion:
Alveolar bone grafting using autologous iliac crest bone remains an important component of cleft reconstruction at our centre. This study reflects the role of regional centres in providing longitudinal reconstructive care for patients with cleft lip and palate.
E-Poster
CP-0020
CP-0020
- Title
- Craniosynostosis in East Malaysia: Diagnostic and Surgical Challenges in a Case Series from Regional Tertiary Centre
- Author(s)
- Fathin alyaa Mohamad farid
- Affiliation
- Sarawak General Hospital, Malaysia
Craniosynostosis in East Malaysia: Diagnostic and Surgical Challenges in a Case Series from Regional Tertiary Centre CP-0020
Fathin alyaa Mohamad farid · Case Report
Background:
Craniosynostosis is characterised by premature fusion of one or more cranial sutures, resulting in abnormal cranial growth and characteristic skull deformities. Management requires accurate identification of affected sutures, appropriate radiological assessment, and timely surgical intervention. In East Malaysia, geographical and healthcare access considerations may present additional challenges in the diagnosis and management of these uncommon conditions. We describe our experience managing paediatric craniosynostosis at Sarawak General Hospital, highlighting the varied clinical and radiological presentations and surgical challenges encountered.
Methods:
A retrospective descriptive review was conducted of four paediatric patients with craniosynostosis managed at Sarawak General Hospital. Clinical presentation, syndromic status, radiological findings, operative findings, surgical procedures, and postoperative considerations were reviewed.
Four patients were identified, comprising two with brachycephaly and two with scaphocephaly. The cases demonstrated considerable heterogeneity in suture involvement and surgical complexity. A 4-year-2-month-old girl with Apert syndrome developed re-synostosis following previous cranial vault reconstruction and fronto-orbital advancement at one year of age. Reoperation demonstrated fusion of bilateral coronal, sagittal and lambdoid sutures and the anterior fontanelle. Redo cranial vault remodelling using a modified Pi technique with fronto-orbital re-advancement was performed.
A 1-year-3-month-old boy with brachycephaly underwent cranial vault remodelling using a modified Pi technique. A 1-year-1-month-old boy with scaphocephaly and isolated sagittal synostosis underwent cranial vault remodelling. The fourth patient, aged 1 year 9 months, had complex craniosynostosis involving the posterior sagittal, superior lambdoid and bilateral squamous sutures. CT demonstrated a copper-beaten calvarium with bilateral frontal subdural effusions without hydrocephalus. Despite extensive radiological abnormalities, he remained developmentally appropriate without clinical features of raised intracranial pressure.
This case series highlights the challenges of managing craniosynostosis, particularly complex multi-suture disease, syndromic craniosynostosis, and postoperative re-synostosis. Careful clinical assessment, detailed cranial imaging, multidisciplinary care, appropriate surgical timing, and long-term surveillance are essential for optimal management in the regional setting.
Craniosynostosis is characterised by premature fusion of one or more cranial sutures, resulting in abnormal cranial growth and characteristic skull deformities. Management requires accurate identification of affected sutures, appropriate radiological assessment, and timely surgical intervention. In East Malaysia, geographical and healthcare access considerations may present additional challenges in the diagnosis and management of these uncommon conditions. We describe our experience managing paediatric craniosynostosis at Sarawak General Hospital, highlighting the varied clinical and radiological presentations and surgical challenges encountered.
Methods:
A retrospective descriptive review was conducted of four paediatric patients with craniosynostosis managed at Sarawak General Hospital. Clinical presentation, syndromic status, radiological findings, operative findings, surgical procedures, and postoperative considerations were reviewed.
Four patients were identified, comprising two with brachycephaly and two with scaphocephaly. The cases demonstrated considerable heterogeneity in suture involvement and surgical complexity. A 4-year-2-month-old girl with Apert syndrome developed re-synostosis following previous cranial vault reconstruction and fronto-orbital advancement at one year of age. Reoperation demonstrated fusion of bilateral coronal, sagittal and lambdoid sutures and the anterior fontanelle. Redo cranial vault remodelling using a modified Pi technique with fronto-orbital re-advancement was performed.
A 1-year-3-month-old boy with brachycephaly underwent cranial vault remodelling using a modified Pi technique. A 1-year-1-month-old boy with scaphocephaly and isolated sagittal synostosis underwent cranial vault remodelling. The fourth patient, aged 1 year 9 months, had complex craniosynostosis involving the posterior sagittal, superior lambdoid and bilateral squamous sutures. CT demonstrated a copper-beaten calvarium with bilateral frontal subdural effusions without hydrocephalus. Despite extensive radiological abnormalities, he remained developmentally appropriate without clinical features of raised intracranial pressure.
This case series highlights the challenges of managing craniosynostosis, particularly complex multi-suture disease, syndromic craniosynostosis, and postoperative re-synostosis. Careful clinical assessment, detailed cranial imaging, multidisciplinary care, appropriate surgical timing, and long-term surveillance are essential for optimal management in the regional setting.
E-Poster
RP-0024
RP-0024
- Title
- Reconnecting Cleft Patients to Care: The Role of Combined Cleft Clinics in Strengthening Multidisciplinary Follow-up Across Sarawak, Malaysia
- Author(s)
- Daphne Dewi Stephen
- Affiliation
- Hospital Umum Sarawak
Reconnecting Cleft Patients to Care: The Role of Combined Cleft Clinics in Strengthening Multidisciplinary Follow-up Across Sarawak, Malaysia RP-0024
Daphne Dewi Stephen · Research
Background:
Cleft lip and palate requires coordinated multidisciplinary care extending beyond primary repair into adolescence and adulthood. Patients who default follow-up may miss timely orthodontic treatment, alveolar bone grafting (ABG), or assessment of previous ABG outcomes. A Combined Cleft Clinic was developed in Sarawak to re-engage patients and facilitate coordinated decision-making between Plastic Surgery, Paediatric Dental and Orthodontics.
Methods:
A retrospective review of Combined Cleft Clinics conducted from 2021–2026 at Sarawak General Hospital (SGH), Hospital Miri and Hospital Bintulu was performed. Patients previously under departmental follow-up, including those who had defaulted scheduled care, were reviewed jointly by the multidisciplinary team. Clinic activity, patient attendance and indications for multidisciplinary assessment were evaluated.
Results:
Between 2021 and 2026, 57 Combined Cleft Clinics were conducted, involving 172 patient reviews. SGH conducted 48 clinics involving 142 patients, Hospital Miri conducted eight clinics involving 25 patients, and Hospital Bintulu conducted one clinic involving five patients. Patients with cleft lip and palate were jointly assessed to determine their current treatment requirements. Key decisions included initiation or continuation of orthodontic treatment, assessment of readiness for primary ABG, postoperative evaluation following ABG, and identification of patients requiring redo ABG. The combined clinic enabled simultaneous assessment and consensus treatment planning across surgical, dental and orthodontic specialties, particularly for patients requiring re-establishment of follow-up.
Conclusion:
Combined Cleft Clinics provide an effective platform to reconnect cleft patients with multidisciplinary care while addressing treatment needs that may become apparent following interrupted follow-up. Extending this model beyond the tertiary centre facilitates coordinated decision-making closer to patients across Sarawak. A structured recall system and longitudinal registry are needed to identify patients at risk of defaulting follow-up and maintain continuity of cleft care through adolescence and adulthood.
Cleft lip and palate requires coordinated multidisciplinary care extending beyond primary repair into adolescence and adulthood. Patients who default follow-up may miss timely orthodontic treatment, alveolar bone grafting (ABG), or assessment of previous ABG outcomes. A Combined Cleft Clinic was developed in Sarawak to re-engage patients and facilitate coordinated decision-making between Plastic Surgery, Paediatric Dental and Orthodontics.
Methods:
A retrospective review of Combined Cleft Clinics conducted from 2021–2026 at Sarawak General Hospital (SGH), Hospital Miri and Hospital Bintulu was performed. Patients previously under departmental follow-up, including those who had defaulted scheduled care, were reviewed jointly by the multidisciplinary team. Clinic activity, patient attendance and indications for multidisciplinary assessment were evaluated.
Results:
Between 2021 and 2026, 57 Combined Cleft Clinics were conducted, involving 172 patient reviews. SGH conducted 48 clinics involving 142 patients, Hospital Miri conducted eight clinics involving 25 patients, and Hospital Bintulu conducted one clinic involving five patients. Patients with cleft lip and palate were jointly assessed to determine their current treatment requirements. Key decisions included initiation or continuation of orthodontic treatment, assessment of readiness for primary ABG, postoperative evaluation following ABG, and identification of patients requiring redo ABG. The combined clinic enabled simultaneous assessment and consensus treatment planning across surgical, dental and orthodontic specialties, particularly for patients requiring re-establishment of follow-up.
Conclusion:
Combined Cleft Clinics provide an effective platform to reconnect cleft patients with multidisciplinary care while addressing treatment needs that may become apparent following interrupted follow-up. Extending this model beyond the tertiary centre facilitates coordinated decision-making closer to patients across Sarawak. A structured recall system and longitudinal registry are needed to identify patients at risk of defaulting follow-up and maintain continuity of cleft care through adolescence and adulthood.
E-Poster
RP-0023
RP-0023
- Title
- A Decade of Cleft Care in Sarawak, Malaysia: A Statewide Registry Review of Cleft Patterns and Surgical Management
- Author(s)
- Daphne Dewi Stephen
- Affiliation
- Hospital Umum Sarawak
A Decade of Cleft Care in Sarawak, Malaysia: A Statewide Registry Review of Cleft Patterns and Surgical Management RP-0023
Daphne Dewi Stephen · Research
Background:
Cleft lip and palate (CLP) and isolated cleft palate (CP) require staged surgical and multidisciplinary care from infancy through adulthood. Long-term registry data provide valuable insight into patient demographics, cleft patterns and evolving surgical practices. This study describes a 10-year experience of cleft care in Sarawak, Malaysia, using data from a statewide cleft registry.
Methods:
A retrospective review of cleft registry data collected over a 10-year period from Sarawak General Hospital/PJS and divisional hospitals in Miri, Bintulu, Sibu and Sri Aman was performed. Variables included gender, ethnicity, cleft type, age at primary lip repair and palatoplasty, primary surgical techniques and revision procedures. Data were analysed descriptively. Records with missing variables were retained where relevant data were available.
Results:
A total of 568 cleft records were identified, comprising 478 CLP and 90 isolated CP cases. Among records with available demographic data, males constituted 52.9% and females 47.1%. Malay patients were the largest ethnic group (42.5%), followed by Iban (24.9%), Chinese (15.2%) and Bidayuh (11.4%). Complete CLP predominated among classified CLP cases, while secondary cleft palate was the commonest documented isolated-palate phenotype. Median age at primary lip repair was 5 months (IQR 4–7) and median age at palatoplasty for CLP was 12.5 months (IQR 11–16). The most common cleft lip procedure technique is Modified Millard Lip repair, while palatoplasty techniques include Bardach two-flap and Von Langenbeck repairs. Revision procedures included lip-scar revision, secondary rhinoplasty, redo palatoplasty and fistula closure.
Conclusion:
This 10-year registry provides an overview of cleft patterns and surgical care across Sarawak. Incomplete records, missing follow-up data and inconsistent retrospective data entry and operative terminology limit detailed longitudinal analysis. Standardised prospective data collection and a unified statewide cleft registry are essential to strengthen outcome monitoring, continuity of care and future cleft research.
Cleft lip and palate (CLP) and isolated cleft palate (CP) require staged surgical and multidisciplinary care from infancy through adulthood. Long-term registry data provide valuable insight into patient demographics, cleft patterns and evolving surgical practices. This study describes a 10-year experience of cleft care in Sarawak, Malaysia, using data from a statewide cleft registry.
Methods:
A retrospective review of cleft registry data collected over a 10-year period from Sarawak General Hospital/PJS and divisional hospitals in Miri, Bintulu, Sibu and Sri Aman was performed. Variables included gender, ethnicity, cleft type, age at primary lip repair and palatoplasty, primary surgical techniques and revision procedures. Data were analysed descriptively. Records with missing variables were retained where relevant data were available.
Results:
A total of 568 cleft records were identified, comprising 478 CLP and 90 isolated CP cases. Among records with available demographic data, males constituted 52.9% and females 47.1%. Malay patients were the largest ethnic group (42.5%), followed by Iban (24.9%), Chinese (15.2%) and Bidayuh (11.4%). Complete CLP predominated among classified CLP cases, while secondary cleft palate was the commonest documented isolated-palate phenotype. Median age at primary lip repair was 5 months (IQR 4–7) and median age at palatoplasty for CLP was 12.5 months (IQR 11–16). The most common cleft lip procedure technique is Modified Millard Lip repair, while palatoplasty techniques include Bardach two-flap and Von Langenbeck repairs. Revision procedures included lip-scar revision, secondary rhinoplasty, redo palatoplasty and fistula closure.
Conclusion:
This 10-year registry provides an overview of cleft patterns and surgical care across Sarawak. Incomplete records, missing follow-up data and inconsistent retrospective data entry and operative terminology limit detailed longitudinal analysis. Standardised prospective data collection and a unified statewide cleft registry are essential to strengthen outcome monitoring, continuity of care and future cleft research.
E-Poster
CP-0019
CP-0019
- Title
- Less rigid fixation with non - absorbable sutures in sagittal craniosynostosis in single instituition experiences (Hospital Tunku Azizah, Kuala Lumpur , Malaysia)
- Author(s)
- Hamidah Mohd Zainal
- Affiliation
- Hospital Kuala Lumpur
Less rigid fixation with non - absorbable sutures in sagittal craniosynostosis in single instituition experiences (Hospital Tunku Azizah, Kuala Lumpur , Malaysia) CP-0019
Hamidah Mohd Zainal · Case Report
Introduction:
Sagittal Synostosis is the most common craniosynostosis in our center. We performed Cranial vault remodelling using Modified Pi techniques. Due to financial constraints we use non absorbable sutures for bone fixation.
Methods
Retrospective study analysed patient who underwent open anterior cranial vault surgery for saggittal synostosis between . 2017 until 2025 were performed. Demographic data, surgical complication, postoperative asthetic outcomes evaluated. Surgical technique using Modified Pi techniques with bitemporal expansion using non absorbable sutures.
Results:
25 patients of sagittal synostosis with mean age 1.7 month operated using modified pi technique and all cases use nylon 2/0 for bone fixation. Non of our series of case has complication related to suture used, ie: suture extrusion, infection or wound breakdown. All the cases gives good aesthetic outcome.
Conclusion:
Our technique of open cranial vault reconstruction with non absorbabble sutures nylon 2/0 as sole methods of fixation has resulted in good aesthethic outcome with no reoperation and complication rate.
Sagittal Synostosis is the most common craniosynostosis in our center. We performed Cranial vault remodelling using Modified Pi techniques. Due to financial constraints we use non absorbable sutures for bone fixation.
Methods
Retrospective study analysed patient who underwent open anterior cranial vault surgery for saggittal synostosis between . 2017 until 2025 were performed. Demographic data, surgical complication, postoperative asthetic outcomes evaluated. Surgical technique using Modified Pi techniques with bitemporal expansion using non absorbable sutures.
Results:
25 patients of sagittal synostosis with mean age 1.7 month operated using modified pi technique and all cases use nylon 2/0 for bone fixation. Non of our series of case has complication related to suture used, ie: suture extrusion, infection or wound breakdown. All the cases gives good aesthetic outcome.
Conclusion:
Our technique of open cranial vault reconstruction with non absorbabble sutures nylon 2/0 as sole methods of fixation has resulted in good aesthethic outcome with no reoperation and complication rate.
E-Poster
RP-0007
RP-0007
- Title
- Community-Based Folate Promotion for Preventing Non-Syndromic Cleft Lip and Palate Among High-Risk Mothers in the Thai–Lao–Myanmar Border Region
- Author(s)
- Siriporn Sasakul
- Affiliation
- Northern Women's Development Foundation, Thailand
Community-Based Folate Promotion for Preventing Non-Syndromic Cleft Lip and Palate Among High-Risk Mothers in the Thai–Lao–Myanmar Border Region RP-0007
Siriporn Sasakul · Research
Introduction: Non-syndromic cleft lip and palate (NSCL/P) is a significant congenital anomaly despite evidence supporting periconceptional folic acid (FA) supplementation for primary prevention. Underserved border communities face challenges in accessing health information and preconception care. The Northern Women's Development Foundation (NWDF) collaborates with vulnerable families to bridge this gap. This study explored how community-based interventions support successful prevention among 4 high-risk mothers.
Materials & Methods: A qualitative descriptive study used semi-structured interviews with 1 experienced practitioner and 4 high-risk mothers from Myanmar (2), Thailand (1), and Laos (1). Reflexive thematic analysis examined how community health promotion facilitated FA uptake and preventive maternal behaviors.
Result(s): The reflexive analysis identified 4 themes reflecting a journey from risk-related fear to proactive empowerment: (1) Trust as a Catalyst for Engagement, where long-term community presence enabled identifying high-risk women; (2) Reclaiming Agency Through FA Protocols, mothers with personal CLP history (3 cases) or a previous cleft child (1 case) shifted from anxiety to empowerment through strict folic acid (FA) adherence and clinical consultations; (3) Holistic Lifestyle Synergy, where avoiding household smoke and heavy labor complemented medical care; and (4) Generative Advocacy, where the concrete success of 4 healthy infants born without CLP motivated mothers to become community peer advocates.
Conclusion: Successful NSCL/P prevention is achievable in resource-limited settings through integrated community-based and formal maternal healthcare. These concrete successes demonstrate that structural preconception support and folic acid adherence can effectively reduce the lifelong burden of cleft conditions.
Materials & Methods: A qualitative descriptive study used semi-structured interviews with 1 experienced practitioner and 4 high-risk mothers from Myanmar (2), Thailand (1), and Laos (1). Reflexive thematic analysis examined how community health promotion facilitated FA uptake and preventive maternal behaviors.
Result(s): The reflexive analysis identified 4 themes reflecting a journey from risk-related fear to proactive empowerment: (1) Trust as a Catalyst for Engagement, where long-term community presence enabled identifying high-risk women; (2) Reclaiming Agency Through FA Protocols, mothers with personal CLP history (3 cases) or a previous cleft child (1 case) shifted from anxiety to empowerment through strict folic acid (FA) adherence and clinical consultations; (3) Holistic Lifestyle Synergy, where avoiding household smoke and heavy labor complemented medical care; and (4) Generative Advocacy, where the concrete success of 4 healthy infants born without CLP motivated mothers to become community peer advocates.
Conclusion: Successful NSCL/P prevention is achievable in resource-limited settings through integrated community-based and formal maternal healthcare. These concrete successes demonstrate that structural preconception support and folic acid adherence can effectively reduce the lifelong burden of cleft conditions.
E-Poster
RP-0005
RP-0005
- Title
- Families’ Lived Experiences, Quality of Life, and Health Equity in Childhood Nonsyndromic Clefts in Transboundary Haze Areas: A Hermeneutic Study with Border Health NGOs
- Author(s)
- Siriporn Sasakul
- Affiliation
- Dentistry Department, Nation University
Families’ Lived Experiences, Quality of Life, and Health Equity in Childhood Nonsyndromic Clefts in Transboundary Haze Areas: A Hermeneutic Study with Border Health NGOs RP-0005
Siriporn Sasakul · Research
Introduction: This qualitative study aimed to understand and interpret the lived experiences, quality of life, and health equity of families of children with nonsyndromic cleft lip and/or palate in border areas affected by transboundary haze. Perspectives from border health nongovernmental organizations (NGOs) were incorporated to illuminate the broader systemic context.
Methods: Hermeneutic phenomenology, informed by van Manen, provided the principal philosophical framework for interpreting lived experience. Data were analyzed using the six phases of reflexive thematic analysis to enhance methodological rigor and transparency in theme development. Participants were purposively selected from family members, primary caregivers, and key informants from border health NGOs, yielding 15 data sources. Data were collected through individual semi-structured interviews, family interviews, and small-group discussions. Family narratives and systemic perspectives were analyzed separately before interpretive synthesis.
Results: Six themes were identified: (1) from emotional shock to acceptance; (2) feeding as a mission for survival; (3) between the social gaze and everyday normalcy; (4) borders turning treatment into a long-term journey; (5) constructing meanings of causation amid uncertainty; and (6) NGOs as bridges to health equity. The essence of the experience was families’ sustained effort to help their children survive, grow, communicate, and attain social belonging. These outcomes depended not only on individual resilience but also on nutrition, income, language, documentation, distance, information, referral systems, and support networks.
Conclusion: The findings support family-centered cleft care, case coordination, multilingual communication, and cross-border collaboration grounded in health equity. Participants’ perceptions of haze and chemical exposure should be regarded as hypothesis-generating contextual evidence rather than epidemiological confirmation of causation.
Methods: Hermeneutic phenomenology, informed by van Manen, provided the principal philosophical framework for interpreting lived experience. Data were analyzed using the six phases of reflexive thematic analysis to enhance methodological rigor and transparency in theme development. Participants were purposively selected from family members, primary caregivers, and key informants from border health NGOs, yielding 15 data sources. Data were collected through individual semi-structured interviews, family interviews, and small-group discussions. Family narratives and systemic perspectives were analyzed separately before interpretive synthesis.
Results: Six themes were identified: (1) from emotional shock to acceptance; (2) feeding as a mission for survival; (3) between the social gaze and everyday normalcy; (4) borders turning treatment into a long-term journey; (5) constructing meanings of causation amid uncertainty; and (6) NGOs as bridges to health equity. The essence of the experience was families’ sustained effort to help their children survive, grow, communicate, and attain social belonging. These outcomes depended not only on individual resilience but also on nutrition, income, language, documentation, distance, information, referral systems, and support networks.
Conclusion: The findings support family-centered cleft care, case coordination, multilingual communication, and cross-border collaboration grounded in health equity. Participants’ perceptions of haze and chemical exposure should be regarded as hypothesis-generating contextual evidence rather than epidemiological confirmation of causation.
E-Poster
RP-0006
RP-0006
- Title
- Clinical guidelines for cleft lip and palate care: a systematic review
- Author(s)
- Omar Barasain
- Affiliation
- University of Alberta
Clinical guidelines for cleft lip and palate care: a systematic review RP-0006
Omar Barasain · Research
Abstract
Objectives: The care of patients with cleft lip and/or cleft palate is not standardized across centres. High quality and evidence-based standards to guide clinical decision-making are critical. The objective of this review is to appraise the scope, quality, adequacy, consistency, and limitations of guidelines relating to the management of CL/CLP in children across all disciplines of care.
Design: (PRISMA) guidelines, MEDLINE, EMBASE, SCOPUS, Web of Science, and Cochrane Database of Systematic Reviews databases were systematically searched for guidelines relating to the care and management of children with CL/CLP. Guidelines were assessed utilizing the Appraisal of Guidelines for Research & Evaluation II (AGREE II) instrument.
Results: Fifty-Four standards were selected for inclusion. Most studies were performed in the United States (44.4%) and United Kingdom (38.9%). Standards consisted of primarily expert consensus recommendations (38%). Recommendations were principally developed by a task force or after expert consensus (39.6%). Recommendations were coded according to nine thematic domains: "Feeding ", "Orthodontics", "Surgery", "Speech", "Breathing”, “Appearance", "Psychosocial Outcome", "Team Composition and Dynamics", and "Cost of Care ". No guideline encompassed all domains. Discrepancies were observed across domains, guideline setting, and data collection method.
Conclusions: Existing guidelines can effectively be organized into nine categories. Based on appraised quality of evidence for recommendations, they are supported by moderate quality of evidence and should be utilized to guide clinical decision-making to improve outcomes for CL/CLP patients. Nonetheless, there is an ongoing need for high-quality practice guidelines for comprehensive CL/CLP care.
Objectives: The care of patients with cleft lip and/or cleft palate is not standardized across centres. High quality and evidence-based standards to guide clinical decision-making are critical. The objective of this review is to appraise the scope, quality, adequacy, consistency, and limitations of guidelines relating to the management of CL/CLP in children across all disciplines of care.
Design: (PRISMA) guidelines, MEDLINE, EMBASE, SCOPUS, Web of Science, and Cochrane Database of Systematic Reviews databases were systematically searched for guidelines relating to the care and management of children with CL/CLP. Guidelines were assessed utilizing the Appraisal of Guidelines for Research & Evaluation II (AGREE II) instrument.
Results: Fifty-Four standards were selected for inclusion. Most studies were performed in the United States (44.4%) and United Kingdom (38.9%). Standards consisted of primarily expert consensus recommendations (38%). Recommendations were principally developed by a task force or after expert consensus (39.6%). Recommendations were coded according to nine thematic domains: "Feeding ", "Orthodontics", "Surgery", "Speech", "Breathing”, “Appearance", "Psychosocial Outcome", "Team Composition and Dynamics", and "Cost of Care ". No guideline encompassed all domains. Discrepancies were observed across domains, guideline setting, and data collection method.
Conclusions: Existing guidelines can effectively be organized into nine categories. Based on appraised quality of evidence for recommendations, they are supported by moderate quality of evidence and should be utilized to guide clinical decision-making to improve outcomes for CL/CLP patients. Nonetheless, there is an ongoing need for high-quality practice guidelines for comprehensive CL/CLP care.
E-Poster
RP-0021
RP-0021
- Title
- Combined Intraoral Distraction Osteogenesis and Bilateral Sagittal Split Osteotomy Treatment in Cleft Lip and Palate: A Case Report
- Author(s)
- Jarintorn Kotheeranurak
- Affiliation
- Thai Association of Orthodontists, Sawanpracharak Hospital, Faculty of Dentistry- Naresuan University, Pattanalak Craniofacial Center- Naresuan University
Combined Intraoral Distraction Osteogenesis and Bilateral Sagittal Split Osteotomy Treatment in Cleft Lip and Palate: A Case Report RP-0021
Jarintorn Kotheeranurak · Research
Background: Patients with a history of cleft lip and palate (CLP) often present with severe midface hypoplasia and skeletal discrepancies that require advanced reconstructive techniques. Objectives: To present the comprehensive management of a severe maxillofacial deformity utilizing intraoral distraction osteogenesis (IDO).
Materials & Methods: An 18-year-old male patient with a right unilateral complete CLP presented with marked facial asymmetry, characterized by a larger left side and chin deviated
5-mm to the left. Clinical and cephalometric evaluations revealed a midface deficiency, concave profile, prognathic chin, retruded upper lip, and acute nasolabial angle. Diagnoses included a skeletal and dental Class III relationship, severe maxillary hypoplasia, mandibular orthognathism, laterognathia and a severe anterior crossbite.
The interdisciplinary treatment plan included pre-surgical orthodontics, strategic tooth extractions, and an alveolar bone graft. The primary surgical intervention featured a LeFort I osteotomy with maxillary distraction using IDO combined with a bilateral sagittal split osteotomy (BSSO). The IDO treatment followed a staged protocol: a 4-day latency period, a 19-day activation period, and a 5-week consolidation phase. The activation phase successfully achieved 10 mm of maxillary advancement. Elastic traction was applied to close a residual open bite. The devices were surgically removed 70 days post-operation. Following the removal of the distractors, the patient entered post-surgical orthodontic detailing which included correction of anterior/posterior crossbite and posterior openbite.
Results:
Treatment resulted in significant improvements in facial esthetics, dental esthetics, and oral function. Enhanced midface projection and improved upper lip support produced a more harmonious facial profile and smile. Normal overjet/overbite, well-aligned dental arches, coincident dental midlines, and excellent intercuspation were achieved, resulting in a stable postoperative occlusion.
Conclusion: This staged interdisciplinary approach effectively corrected the skeletal, dental and soft tissue discrepancies. Final aesthetic refinements, including planned lip scar revision and rhinoplasty, thereby demonstrating the efficacy of IDO in complex facial reconstruction.
Materials & Methods: An 18-year-old male patient with a right unilateral complete CLP presented with marked facial asymmetry, characterized by a larger left side and chin deviated
5-mm to the left. Clinical and cephalometric evaluations revealed a midface deficiency, concave profile, prognathic chin, retruded upper lip, and acute nasolabial angle. Diagnoses included a skeletal and dental Class III relationship, severe maxillary hypoplasia, mandibular orthognathism, laterognathia and a severe anterior crossbite.
The interdisciplinary treatment plan included pre-surgical orthodontics, strategic tooth extractions, and an alveolar bone graft. The primary surgical intervention featured a LeFort I osteotomy with maxillary distraction using IDO combined with a bilateral sagittal split osteotomy (BSSO). The IDO treatment followed a staged protocol: a 4-day latency period, a 19-day activation period, and a 5-week consolidation phase. The activation phase successfully achieved 10 mm of maxillary advancement. Elastic traction was applied to close a residual open bite. The devices were surgically removed 70 days post-operation. Following the removal of the distractors, the patient entered post-surgical orthodontic detailing which included correction of anterior/posterior crossbite and posterior openbite.
Results:
Treatment resulted in significant improvements in facial esthetics, dental esthetics, and oral function. Enhanced midface projection and improved upper lip support produced a more harmonious facial profile and smile. Normal overjet/overbite, well-aligned dental arches, coincident dental midlines, and excellent intercuspation were achieved, resulting in a stable postoperative occlusion.
Conclusion: This staged interdisciplinary approach effectively corrected the skeletal, dental and soft tissue discrepancies. Final aesthetic refinements, including planned lip scar revision and rhinoplasty, thereby demonstrating the efficacy of IDO in complex facial reconstruction.
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