We present a case of midface distraction in a bilateral cleft lip and palate patient. The patient... more We present a case of midface distraction in a bilateral cleft lip and palate patient. The patient was a 10-year-old who underwent a high LeFort I osteotomy followed by placement of the Rigid External Distraction halo. Distraction was commenced on the fifth postoperative day at a rate of 1 to 1.5 mm per day until a total of 17 mm of maxillary advancement had been achieved. There were no complications and follow up was at 9 months post distraction. Results show that the patient had improved facial aesthetics and dental occlusion which was overcorrected to a Class III relationship. Velopharyngeal function was unaffected. Distraction osteogenesis of the midfacial skeleton in cleft patients offers the possibility to remodel not only the underlying bony skeleton but also all the soft tissues of the face and palate.
During the study period from January 1985 to December 1994, there were 1105 new cleft cases seen ... more During the study period from January 1985 to December 1994, there were 1105 new cleft cases seen in the Department of Plastic Surgery, Singapore General Hospital. These included newborn as well as unoperated children and adult cases. During the same period, the total number of recorded births in Singapore was 474,542. Out of the 1105 new cleft cases seen, 984 were Singaporeans. The incidence of this hospital-based study of cleft population in Singapore was 2.07 per 1000 livebirths. Chinese had the highest incidence of 1.64 per 1000 as compared to Malay, Indian and other races. The most common type of cleft deformity was complete cleft lip and palate. The left side was found to be more affected than the right side in all types of cleft deformity. There was no significant difference in sex distribution; the male to female ratio was 1.1:1. However, females had a higher incidence of cleft palate than males. Associated congenital deformities occurred in 1.5% of the total cleft population.
The aim of this article was to present a retrospective audit on a single surgeon'... more The aim of this article was to present a retrospective audit on a single surgeon's experience with orthognathic surgery. This was a retrospective review of orthognathic cases performed from January 1, 2000, to January 1, 2006. There were 37 male and 65 female patients with a mean age of 20 years. Predisposing conditions included: unilateral cleft lip and palate (40), bilateral cleft lip and palate (15), cleft palate (three), hemifacial microsomia (three), posttraumatic (three), fibrous dysplasia (one), Romberg's disease (one), cavernous hemangioma (one), Crouzon's syndrome (one), and developmental deformities (34: 13 prognathism, 12 class III, six class II, three vertical maxillary excess). Indications for surgery included: class III malocclusion (89), class II malocclusion (six), facial asymmetry (three), vertical maxillary excess (three), crossbite (one). The majority of surgeries performed were Le Fort I osteotomy alone (33) and bimaxillary osteotomy (32). Overall median duration for all surgery was 2 hours 45 minutes (range, 1 hour 15 minutes to 8 hours 45 minutes), median blood loss was 720 mL (range, 100-6500 mL), and mean hospitalization stay was 4.3 days (range, 1-10 days). The mean duration of follow up was 24 months. Postoperatively, class I occlusion was obtained in 92 patients and class II occlusion in two patients. Relapse occurred in five (4.9%) patients (one had reoperation). Readjustment was done for three patients. Excessive bleeding occurred from the facial artery, maxillary artery, and pterygoid plexus separately in three patients. Readmission for secondary hemorrhage occurred twice and inferior alveolar nerve injury occurred once.
Polymer Based Systems on Tissue Engineering, Replacement and Regeneration, 2002
... BIORESORBABLE SCAFFOLDS AND BONE MARROW ASPIRATES DW Hutmacher*-**, D. Rohner*'®... more ... BIORESORBABLE SCAFFOLDS AND BONE MARROW ASPIRATES DW Hutmacher*-**, D. Rohner*'®, V. Yeow*, ST. ... Boyd EM Jr, Ng J., Mauffray RO (1999) Benefits of stereolithography in orbital reconstruction ... Reconstr Surg Mar; 101 (3): 604-12 9. Ono I., Tateshita T., Satou M ...
Annals of the Academy of Medicine, Singapore, 1999
Multiple segment orthognathic (MSO) surgery is an effective approach to deal with a wide range of... more Multiple segment orthognathic (MSO) surgery is an effective approach to deal with a wide range of dento-facial deformities that have occlusal problems. The indications for MSO surgery were patients with dentofacial deformities and malocclusion requiring stable correction within a short overall treatment period. From 1991 to 1998, 107 patients had MSO orthognathic procedures done at Chang Gung Memorial Hospital for maxillary protrusion/deformity (34 cases), maxillary protrusion and mandibular prognathism (69 cases), and non-cleft maxillary retrusion (4 cases). Follow up period ranged from 6 months to 7 years and results showed stability in movements with only 3 complications. The average overall treatment time was approximately 15 months. Our experience with 107 consecutive patients have shown the results of MSO surgery to be good and the procedure safe with no tooth or segment loss.
Annals of the Academy of Medicine, Singapore, 1999
Establishment of animal models used for allogeneic tissue transplantation, MHC phenotyping as wel... more Establishment of animal models used for allogeneic tissue transplantation, MHC phenotyping as well as quantitative detection of immunochimera were carried out in this study. Both Buffalo (BUF) and Lewis (LEW) rats were chosen as the target animals. The rats were treated with single dose cyclophosphamide (Cy) of 25 to 100 mg/kg to mimic the standard conditioning therapy. Total white blood cells (WBC) were monitored daily for up to 8 days: WBC reached the nadir by day 4 and started to recover by day 5 with an obvious rebounce at day 7 of Cy treatment. Flow cytometric techniques were used to determine the haplotypes of the major histocompatibility complex (MHC) as well as quantitative detection of immunochimerism in unfractionated rat WBC. Monoclonal antibodies against the rat class-I MHC antigens RT1Aab and RT1Au were used to label the class-I MHC antigens on total rat WBC. The results showed that the BUF rats were positive for both RT1Aab and RT1Au antigens, whilst the LEW rats were ...
The principles for reconstruction of inferior sternal clefts include: (1) rigid protection of the... more The principles for reconstruction of inferior sternal clefts include: (1) rigid protection of the heart without compression, (2) preferable use of autologous tissue, (3) dynamic reconstruction of the thoracic cage, (4) uncompromised growth, and (5) minimal donor site morbidity.
The nasoalveolar molding (NAM) therapy is advocated to reduce the severity of alveolar cleft and ... more The nasoalveolar molding (NAM) therapy is advocated to reduce the severity of alveolar cleft and nasal deformity. NAM therapy has demonstrated to be an effective method for reducing cleft and improve nose anatomy. This paper presents a case report of three cleft lip and palate individuals treated with NAM therapy. Furthermore, the paper highlights the advantages of NAM therapy along with an enumeration of literature suggesting in favor of NAM therapy and otherwise. Regardless of controversies and divergent views involved with NAM therapy, the immediate success of NAM therapy facilitating primary lip repair surgery cannot be under-emphasized.
The technique of using a poly-L-lactic-polyglycolic (PLLA-PGA) plate for the reconstruction of lo... more The technique of using a poly-L-lactic-polyglycolic (PLLA-PGA) plate for the reconstruction of lower sternal defects is described in this chapter. In patients with pentalogy of Cantrell or inferior sternal defects causing ectopia cordis, corrective cardiac surgery and sternal reconstruction is usually performed after 2 years of age if there are minimal intracardiac defects (when the child gains more cardiovascular reserve and to allow growth of the thorax). Autologous reconstruction is recommended due to a lower risk of infection and its ability to remodel according to patient growth. However, autogenous tissue may not be adequate in patients who require surgery (eg. early corrective cardiac surgery) before 2 years of age. The PLLA-PGA plate is resorbable and can be placed during this setting. It acts as a temporary shield, obviating the use of permanent alloplastic materials. When the child is older, definitive sternal reconstruction can be performed when more reliable autologous r...
Background: There is a lack of reliable information on outcomes following cleft surgery. Options ... more Background: There is a lack of reliable information on outcomes following cleft surgery. Options for timing and choice of primary cleft surgery had not been compared in randomised trials. Methods: Non-syndromic infants, aged 6 months, with isolated cleft of the secondary palate without associated lip deformity, were included in this prospective randomised controlled trial to one of four options: Veau-Wardill-Kilner palatoplasty at 6 months of age (VWK06) or 12 months of age (VWK12), or two-flap palatoplasty with intra-velar veloplasty at 6 months of age (2F-IVV06) or 12 months of age (2F-IVV12). Outcome measures are early and late postoperative complications, velopharyngeal inadequacy symptoms, nasality, articulation and presence of otitis media at three years of age. Results: Of the 76 infants included in the trial, 90.8% received surgery: VWK06 (n=18), VWK12 (n=16), 2F-IVV06 (n=18) and 2F-IVV12 (n=17). Early postoperative complications occurred in two VWK infants (6.1%) and three ...
To evaluate pharyngeal airway space (PAS; nasopharyngeal, oropharyngeal, and total airway) volume... more To evaluate pharyngeal airway space (PAS; nasopharyngeal, oropharyngeal, and total airway) volume and the correlation of an obstructive sleep apnea (OSA) and hypopnea syndrome screening questionnaire (STOP-BANG) with various mandibular setbacks during bimaxillary surgery and compare these findings with an age- and gender-matched skeletal Class I control group. This retrospective cohort study was composed of patients with skeletal Class III discrepancy who underwent bimaxillary jaw surgery and were assessed with STOP-BANG score, cephalometry, and cone-beam computed tomography (of the PAS). The predictor variable was bimaxillary jaw surgery and included 4-, 6-, and 8-mm setbacks. The primary outcome variables were PAS volume, body mass index, and STOP-BANG score evaluated at 1 week before surgery and after comprehensive orthodontic treatment (11.25 ± 1.95 months). Other variables were grouped into the following categories: demographic and cephalometric parameters. Statistical intragroup and intergroup differences were assessed by paired t and independent t tests (P < .05), respectively. The study sample was composed of 48 patients (18 to 25 yr old); group I received 4-mm setback (n = 16), group II received 6-mm setback (n = 16), and group III received 8-mm setback (n = 16) mandibular surgery, and all test groups received 4-mm maxillary advancement. The entire study group was compared with a skeletal Class I control group (n = 16). The total PAS volume after orthodontic treatment in groups I and II showed a significant decrease compared with the presurgical PAS (P < .001), but the decrease was not less than that in the control group (P > .05). In contrast, the total PAS volume in group III after orthodontic treatment (23,574 ± 1,394 mm(3)) was less than that in the control group (23,884 ± 1,543 mm(3)). After surgery, patients with Class III discrepancy exhibited a decrease in oropharynx volume; however, the STOP-BANG score showed no change in risk factors scores for OSA at 4- to 8-mm setback surgery of the mandible in bimaxillary jaw surgery.
Thorough planning and execution is the key for successful treatment of dentofacial deformity invo... more Thorough planning and execution is the key for successful treatment of dentofacial deformity involving surgical orthodontics. Presurgical planning (paper surgery and model surgery) are the most essential prerequisites of orthognathic surgery, and orthodontist is the one who carries out this procedure by evaluating diagnostic aids such as crucial clinical findings and radiographic assessments. However, literature pertaining to step-by-step orthognathic surgical guidelines is limited. Hence, this article makes an attempt to provide an insight and nuances involved in the planning and execution. The diagnostic information revealed from clinical findings and radiographic assessments is integrated in the "paper surgery" to establish "surgical-plan." Furthermore, the "paper surgery" is emulated in "model surgery" such that surgical bite-wafers are created, which aid surgeon to preview the final outcome and make surgical movements that are deemed esse...
We present a case of midface distraction in a bilateral cleft lip and palate patient. The patient... more We present a case of midface distraction in a bilateral cleft lip and palate patient. The patient was a 10-year-old who underwent a high LeFort I osteotomy followed by placement of the Rigid External Distraction halo. Distraction was commenced on the fifth postoperative day at a rate of 1 to 1.5 mm per day until a total of 17 mm of maxillary advancement had been achieved. There were no complications and follow up was at 9 months post distraction. Results show that the patient had improved facial aesthetics and dental occlusion which was overcorrected to a Class III relationship. Velopharyngeal function was unaffected. Distraction osteogenesis of the midfacial skeleton in cleft patients offers the possibility to remodel not only the underlying bony skeleton but also all the soft tissues of the face and palate.
During the study period from January 1985 to December 1994, there were 1105 new cleft cases seen ... more During the study period from January 1985 to December 1994, there were 1105 new cleft cases seen in the Department of Plastic Surgery, Singapore General Hospital. These included newborn as well as unoperated children and adult cases. During the same period, the total number of recorded births in Singapore was 474,542. Out of the 1105 new cleft cases seen, 984 were Singaporeans. The incidence of this hospital-based study of cleft population in Singapore was 2.07 per 1000 livebirths. Chinese had the highest incidence of 1.64 per 1000 as compared to Malay, Indian and other races. The most common type of cleft deformity was complete cleft lip and palate. The left side was found to be more affected than the right side in all types of cleft deformity. There was no significant difference in sex distribution; the male to female ratio was 1.1:1. However, females had a higher incidence of cleft palate than males. Associated congenital deformities occurred in 1.5% of the total cleft population.
The aim of this article was to present a retrospective audit on a single surgeon'... more The aim of this article was to present a retrospective audit on a single surgeon's experience with orthognathic surgery. This was a retrospective review of orthognathic cases performed from January 1, 2000, to January 1, 2006. There were 37 male and 65 female patients with a mean age of 20 years. Predisposing conditions included: unilateral cleft lip and palate (40), bilateral cleft lip and palate (15), cleft palate (three), hemifacial microsomia (three), posttraumatic (three), fibrous dysplasia (one), Romberg's disease (one), cavernous hemangioma (one), Crouzon's syndrome (one), and developmental deformities (34: 13 prognathism, 12 class III, six class II, three vertical maxillary excess). Indications for surgery included: class III malocclusion (89), class II malocclusion (six), facial asymmetry (three), vertical maxillary excess (three), crossbite (one). The majority of surgeries performed were Le Fort I osteotomy alone (33) and bimaxillary osteotomy (32). Overall median duration for all surgery was 2 hours 45 minutes (range, 1 hour 15 minutes to 8 hours 45 minutes), median blood loss was 720 mL (range, 100-6500 mL), and mean hospitalization stay was 4.3 days (range, 1-10 days). The mean duration of follow up was 24 months. Postoperatively, class I occlusion was obtained in 92 patients and class II occlusion in two patients. Relapse occurred in five (4.9%) patients (one had reoperation). Readjustment was done for three patients. Excessive bleeding occurred from the facial artery, maxillary artery, and pterygoid plexus separately in three patients. Readmission for secondary hemorrhage occurred twice and inferior alveolar nerve injury occurred once.
Polymer Based Systems on Tissue Engineering, Replacement and Regeneration, 2002
... BIORESORBABLE SCAFFOLDS AND BONE MARROW ASPIRATES DW Hutmacher*-**, D. Rohner*'®... more ... BIORESORBABLE SCAFFOLDS AND BONE MARROW ASPIRATES DW Hutmacher*-**, D. Rohner*'®, V. Yeow*, ST. ... Boyd EM Jr, Ng J., Mauffray RO (1999) Benefits of stereolithography in orbital reconstruction ... Reconstr Surg Mar; 101 (3): 604-12 9. Ono I., Tateshita T., Satou M ...
Annals of the Academy of Medicine, Singapore, 1999
Multiple segment orthognathic (MSO) surgery is an effective approach to deal with a wide range of... more Multiple segment orthognathic (MSO) surgery is an effective approach to deal with a wide range of dento-facial deformities that have occlusal problems. The indications for MSO surgery were patients with dentofacial deformities and malocclusion requiring stable correction within a short overall treatment period. From 1991 to 1998, 107 patients had MSO orthognathic procedures done at Chang Gung Memorial Hospital for maxillary protrusion/deformity (34 cases), maxillary protrusion and mandibular prognathism (69 cases), and non-cleft maxillary retrusion (4 cases). Follow up period ranged from 6 months to 7 years and results showed stability in movements with only 3 complications. The average overall treatment time was approximately 15 months. Our experience with 107 consecutive patients have shown the results of MSO surgery to be good and the procedure safe with no tooth or segment loss.
Annals of the Academy of Medicine, Singapore, 1999
Establishment of animal models used for allogeneic tissue transplantation, MHC phenotyping as wel... more Establishment of animal models used for allogeneic tissue transplantation, MHC phenotyping as well as quantitative detection of immunochimera were carried out in this study. Both Buffalo (BUF) and Lewis (LEW) rats were chosen as the target animals. The rats were treated with single dose cyclophosphamide (Cy) of 25 to 100 mg/kg to mimic the standard conditioning therapy. Total white blood cells (WBC) were monitored daily for up to 8 days: WBC reached the nadir by day 4 and started to recover by day 5 with an obvious rebounce at day 7 of Cy treatment. Flow cytometric techniques were used to determine the haplotypes of the major histocompatibility complex (MHC) as well as quantitative detection of immunochimerism in unfractionated rat WBC. Monoclonal antibodies against the rat class-I MHC antigens RT1Aab and RT1Au were used to label the class-I MHC antigens on total rat WBC. The results showed that the BUF rats were positive for both RT1Aab and RT1Au antigens, whilst the LEW rats were ...
The principles for reconstruction of inferior sternal clefts include: (1) rigid protection of the... more The principles for reconstruction of inferior sternal clefts include: (1) rigid protection of the heart without compression, (2) preferable use of autologous tissue, (3) dynamic reconstruction of the thoracic cage, (4) uncompromised growth, and (5) minimal donor site morbidity.
The nasoalveolar molding (NAM) therapy is advocated to reduce the severity of alveolar cleft and ... more The nasoalveolar molding (NAM) therapy is advocated to reduce the severity of alveolar cleft and nasal deformity. NAM therapy has demonstrated to be an effective method for reducing cleft and improve nose anatomy. This paper presents a case report of three cleft lip and palate individuals treated with NAM therapy. Furthermore, the paper highlights the advantages of NAM therapy along with an enumeration of literature suggesting in favor of NAM therapy and otherwise. Regardless of controversies and divergent views involved with NAM therapy, the immediate success of NAM therapy facilitating primary lip repair surgery cannot be under-emphasized.
The technique of using a poly-L-lactic-polyglycolic (PLLA-PGA) plate for the reconstruction of lo... more The technique of using a poly-L-lactic-polyglycolic (PLLA-PGA) plate for the reconstruction of lower sternal defects is described in this chapter. In patients with pentalogy of Cantrell or inferior sternal defects causing ectopia cordis, corrective cardiac surgery and sternal reconstruction is usually performed after 2 years of age if there are minimal intracardiac defects (when the child gains more cardiovascular reserve and to allow growth of the thorax). Autologous reconstruction is recommended due to a lower risk of infection and its ability to remodel according to patient growth. However, autogenous tissue may not be adequate in patients who require surgery (eg. early corrective cardiac surgery) before 2 years of age. The PLLA-PGA plate is resorbable and can be placed during this setting. It acts as a temporary shield, obviating the use of permanent alloplastic materials. When the child is older, definitive sternal reconstruction can be performed when more reliable autologous r...
Background: There is a lack of reliable information on outcomes following cleft surgery. Options ... more Background: There is a lack of reliable information on outcomes following cleft surgery. Options for timing and choice of primary cleft surgery had not been compared in randomised trials. Methods: Non-syndromic infants, aged 6 months, with isolated cleft of the secondary palate without associated lip deformity, were included in this prospective randomised controlled trial to one of four options: Veau-Wardill-Kilner palatoplasty at 6 months of age (VWK06) or 12 months of age (VWK12), or two-flap palatoplasty with intra-velar veloplasty at 6 months of age (2F-IVV06) or 12 months of age (2F-IVV12). Outcome measures are early and late postoperative complications, velopharyngeal inadequacy symptoms, nasality, articulation and presence of otitis media at three years of age. Results: Of the 76 infants included in the trial, 90.8% received surgery: VWK06 (n=18), VWK12 (n=16), 2F-IVV06 (n=18) and 2F-IVV12 (n=17). Early postoperative complications occurred in two VWK infants (6.1%) and three ...
To evaluate pharyngeal airway space (PAS; nasopharyngeal, oropharyngeal, and total airway) volume... more To evaluate pharyngeal airway space (PAS; nasopharyngeal, oropharyngeal, and total airway) volume and the correlation of an obstructive sleep apnea (OSA) and hypopnea syndrome screening questionnaire (STOP-BANG) with various mandibular setbacks during bimaxillary surgery and compare these findings with an age- and gender-matched skeletal Class I control group. This retrospective cohort study was composed of patients with skeletal Class III discrepancy who underwent bimaxillary jaw surgery and were assessed with STOP-BANG score, cephalometry, and cone-beam computed tomography (of the PAS). The predictor variable was bimaxillary jaw surgery and included 4-, 6-, and 8-mm setbacks. The primary outcome variables were PAS volume, body mass index, and STOP-BANG score evaluated at 1 week before surgery and after comprehensive orthodontic treatment (11.25 ± 1.95 months). Other variables were grouped into the following categories: demographic and cephalometric parameters. Statistical intragroup and intergroup differences were assessed by paired t and independent t tests (P < .05), respectively. The study sample was composed of 48 patients (18 to 25 yr old); group I received 4-mm setback (n = 16), group II received 6-mm setback (n = 16), and group III received 8-mm setback (n = 16) mandibular surgery, and all test groups received 4-mm maxillary advancement. The entire study group was compared with a skeletal Class I control group (n = 16). The total PAS volume after orthodontic treatment in groups I and II showed a significant decrease compared with the presurgical PAS (P < .001), but the decrease was not less than that in the control group (P > .05). In contrast, the total PAS volume in group III after orthodontic treatment (23,574 ± 1,394 mm(3)) was less than that in the control group (23,884 ± 1,543 mm(3)). After surgery, patients with Class III discrepancy exhibited a decrease in oropharynx volume; however, the STOP-BANG score showed no change in risk factors scores for OSA at 4- to 8-mm setback surgery of the mandible in bimaxillary jaw surgery.
Thorough planning and execution is the key for successful treatment of dentofacial deformity invo... more Thorough planning and execution is the key for successful treatment of dentofacial deformity involving surgical orthodontics. Presurgical planning (paper surgery and model surgery) are the most essential prerequisites of orthognathic surgery, and orthodontist is the one who carries out this procedure by evaluating diagnostic aids such as crucial clinical findings and radiographic assessments. However, literature pertaining to step-by-step orthognathic surgical guidelines is limited. Hence, this article makes an attempt to provide an insight and nuances involved in the planning and execution. The diagnostic information revealed from clinical findings and radiographic assessments is integrated in the "paper surgery" to establish "surgical-plan." Furthermore, the "paper surgery" is emulated in "model surgery" such that surgical bite-wafers are created, which aid surgeon to preview the final outcome and make surgical movements that are deemed esse...
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