Lampang Medical Journal

Dental Management of a 21-Year-Old Thai Female with Goldenhar Syndrome Requiring Special Dental Care: A Case Report

Ratchaneewan Rattananupong — Fri, 11 Sep 2026 00:00:00 +0700

Goldenhar syndrome is a congenital craniofacial disorder with heterogeneous clinical manifestations, including facial asymmetry and abnormalities of the ears, eyes, jaws, and hearing. This report describes the dental management of a 21-year-old Thai woman diagnosed with Goldenhar syndrome and congenital bilateral hearing impairment. Her medical history included well-controlled epilepsy and asthma. Extraoral examination revealed hemifacial microsomia, facial asymmetry, maxillary and mandibular hypoplasia, widened oral commissure, incompetent lip closure, and abnormalities of the ears and eyes. Intraoral examination revealed dental caries in teeth 13, 24, and 46; deep pits and fissures in teeth 16, 17, 26, and 27; an embedded tooth 45; impacted teeth 38 and 48; Class II malocclusion with an open bite; and plaque-induced gingivitis. Dental management was provided within a special care dentistry framework. Systemic risks were assessed, communication strategies were adapted to the patient’s hearing impairment, and her caregiver assisted with communication. Treatment included scaling, oral hygiene instruction, fluoride varnish application, tooth-colored restorations, and pit and fissure sealants. At 1 year and 7 months after treatment initiation, her overall oral health had improved, and no new caries were detected. However, increased plaque accumulation at some sites and partial deterioration of several sealants were observed during follow-up. Professional cleaning, reinforcement of oral hygiene practices, and resealing were therefore provided as indicated. This case highlights the importance of patient-centered care, individualized communication, caregiver involvement, preventive dentistry, and long-term follow-up in the dental management of patients with Goldenhar syndrome who require special dental care.

Clinical Management of Orbital Infections Associated with Odontogenic Infection and Facial Trauma-Related Sinusitis: A Report of Two Cases

Suthee Chuchertkijwattana — Thu, 24 Sep 2026 00:00:00 +0700

Orbital infection is a potentially life-threatening condition that may result in permanent visual loss and intracranial complications. Although most cases are associated with paranasal sinusitis, odontogenic infection and trauma-related orbital infection are uncommon causes that present diagnostic and therapeutic challenges. This report describes the clinical management of two patients with orbital infection of different etiologies.
The first patient was a 38-year-old man from Myanmar who developed orbital infection following extraction of the right maxillary second premolar associated with maxillary sinusitis.
Computed tomography revealed a subperiosteal abscess and orbital cellulitis. The patient underwent surgical drainage combined with a Caldwell–Luc procedure. The second patient was a 25-year-old Thai man with a history of facial trauma resulting in orbital and paranasal sinus fractures. Computed tomography demonstrated orbital cellulitis and a subperiosteal abscess.
Surgical drainage was performed in conjunction with endoscopic sinus surgery and anterior ethmoidectomy. Both patients received multidisciplinary care and intravenous broad-spectrum antibiotics. Clinical outcomes were favorable, with resolution of infection, recovery of ocular motility and visual function, and no evidence of recurrent infection during follow-up.
These cases highlight the importance of identifying the primary source of infection, the role of computed tomography in defining disease extent and guiding surgical management, and the value of timely multidisciplinary intervention in preventing serious complications and preserving vision.

Comparison of Oral Patient-Controlled Analgesia versus Intravenous Nurse-Controlled Analgesia After Unilateral Total Knee Arthroplasty: A Randomized Non-Inferiority Trial

Tue, 01 Sep 2026 00:00:00 +0700

Background: Postoperative pain control after total knee arthroplasty may remain inadequate despite the use of multimodal analgesia. Oral patient-controlled analgesia (PCA) may provide more timely access to rescue medication; however, evidence comparing this approach with intravenous analgesia administered by nurses remains limited.
Objective: To determine whether oral PCA is non-inferior to intravenous nurse-controlled analgesia (NCA) for pain control after unilateral total knee arthroplasty (TKA).
Materials and methods: This randomized controlled non-inferiority trial included patients aged 50–70 years undergoing unilateral TKA. When rescue analgesia was required, participants were randomly assigned to receive either intravenous morphine 3 mg administered by a nurse at a minimum interval of 4 hours or immediate-release oral morphine 10 mg self-administered at a minimum interval of 1 hour. The primary outcome was the mean pain score at rest during 36–48 hours after surgery. The prespecified non-inferiority margin was 1.8 points on a 0–10 numerical rating scale.
Results: Sixty-four patients were randomized, with 32 assigned to each group. One patient in the oral PCA group did not receive the allocated intervention. The per-protocol analysis therefore included 63 patients. The mean resting pain score at 36–48 hours was 3.3±2.0 in the oral PCA group and 3.2±1.7 in the NCA group. The mean difference (NCA minus oral PCA) was 0.0 points (95% confidence interval [CI], −1.0 to 0.9), and the entire CI lay within the prespecified non-inferiority margin. Patients in the oral PCA group received morphine more frequently than those in the NCA group (median, 3 vs. 0 doses; p<0.001) and were more likely to report high or very high satisfaction (90.3% vs. 56.2%; p=0.022). Nausea, vomiting, and dry mouth were more common in the oral PCA group. All adverse effects were mild, and none required withdrawal from the study.
Conclusion: Oral PCA was non-inferior to NCA for controlling resting pain at 36–48 hours after unilateral TKA and was associated with higher patient satisfaction. However, mild adverse effects occurred more frequently with oral PCA. Oral PCA may therefore be considered an alternative analgesic strategy in resource-limited settings for appropriately selected patients.

Early Institutional Experience of Transcatheter Device Closure of Perimembranous Ventricular Septal Defect in Adults at Lampang Hospital: A Case Series

Jakkrawal Huntrakul — Fri, 11 Sep 2026 00:00:00 +0700

Background: Transcatheter closure of perimembranous ventricular septal defect (pmVSD) is a less invasive alternative to surgical repair in selected patients. However, data from regional hospitals in Thailand remain limited.
Objective: To report the clinical outcomes, complications, and feasibility of transcatheter pmVSD closure using
the Cocoon® VSD Occluder in selected adult patients at Lampang Hospital.
Materials and methods: A retrospective case series including all consecutive patients (n = 4) who underwent transcatheter pmVSD closure at the Cardiology Unit, Lampang Hospital, between May 2022 and July 2024. The Cocoon® VSD Occluder (Vascular Innovations Co., Ltd., Thailand) was used in all cases. Clinical, echocardiographic, and electrocardiographic outcomes were assessed at baseline and at 1, 6, and 12 months post-procedure.
Results: All four patients (mean age 31.8 ± 7.0 years; 50% female) achieved procedural success. Complete device closure was confirmed immediately after deployment by transesophageal echocardiography in all cases. No major complications were observed, including no complete atrioventricular block (CAVB), no device embolization, no new aortic regurgitation, and no hemolysis. Mean right ventricular systolic pressure (RVSP) showed a decreasing trend from 43.1 ± 22.4 mmHg at baseline to 28.9 ± 6.2 mmHg at 12 months. Mean left ventricular internal diameter at diastole (LVIDd) decreased from 47.8 ± 5.3 mm at baseline to 44.5 ± 3.3 mm at 12 months; however, individual changes were not uniform across all patients. All patients remained in New York Heart Association (NYHA)
functional class I throughout follow-up, with resolution of exertional dyspnea in the one symptomatic patient. Post-procedural hospital stay was 1 day in all patients.
Conclusion: Transcatheter closure of pmVSD using the Cocoon® VSD Occluder appeared feasible with no major
complications observed in this small early experience at a regional tertiary hospital. Longer follow-up and studies in larger cohorts are needed to confirm these findings.