Challenges and Long-Term Management of Patients with Craniofacial Clefts in Thailand
Bowonrnsilp Chowchuen MD, MBA*, Palakorn Surakunprapha MD*, Prathana Chowchuen MD**, Keith Godfrey MDS, Dr.Dent***
Affiliation : * Division of Plastic Surgery, Department of Surgery, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand ** Department of Radiology, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand *** Department of Orthodontics, Faculty of Dentistry Khon Kaen University, Khon Kaen, Thailand
Objective : To report challenges and long-term management of patients with craniofacial clefts, treated at Srinagarind
Hospital, Khon Kaen, Thailand.
Material and Method: Patients who were treated at Srinagarind Hospital, between 1993 and 2001. A review of data was
performed including general information, classifications, photographs, radiographic findings, dental records, reconstructive
surgeries, and long-term management.
Results : A total of 20 patients were recruited; six males and 14 females, grouped into six median, two paramedian and 12
oblique clefts. Age of the first treatment ranged from one to 39 years, age of the last follow-up ranged from 11 to 48 years and
the range of follow-ups was 11 to 24 years. The reconstructive procedures included a variety of techniques of plastic surgery
for soft tissue repairs and bone grafting for facial reconstructions. Four patients with median clefts and paramedian clefts
died. One patient lost to follow-up. Fifteen patients were followed-up and the results were satisfying.
Conclusion : Diagnosis, evaluation, and treatment of clefts and craniofacial deformities are complex. The proper management
is challenging because of socioeconomic, cause difficulties in follow-ups according to the planned protocol. Other associated
anomalies are important. Protocols with well-co-ordination of an interdisciplinary team in Craniofacial Center and continuing
evaluation at appropriate schedule and age group until completion of facial growth are critical factors. Establishment of a
foundation and comprehensive care model with families, local health professionals and school will benefit the most to this
group of patients.
Keywords : Craniofacial clefts, Challenges, Long-term management, Thailand
