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Open access

Pornthep Pungrasmi and Sahatad Haetanurak



Maxillofacial injury is a common injury in trauma patients. The incidence, associated injuries and causes have been never reported for King Chulalongkorn Memorial Hospital (KCMH).


To report the incidence, associated injuries, age groups, treatments, and behavioral risks in maxillofacial patients who were admitted to KCMH in the past decade.


We conducted a retrospective descriptive analysis of patients from January 1, 2006, to December 31, 2015, to evaluate the age groups, causes, sites of facial bone fracture, associated injuries, treatments, and behavioral risks.


There were 1,275 patients (79% male and 21% female). The most common age group was 21–30 years (30.6%), followed by 11–20 years (19.5%) and 31–40 years (18.8%). The most common cause of injury was motorcycle accident (39.7%), and the most common associated injury was head injury (58%). The total number of fractures were 1,526, with the most common fracture site being the zygomaticomaxillary complex (38.6%), followed by mandible (21.8%) and nasal bone (17.8%). Most fractures were treated using open reduction and internal fixation with plates and screws.


The main cause of maxillofacial injury is motorcycle accident even though the government launched a policy named “Decade of Action for Road Safety 2011–2020” to reduce road traffic deaths. Thailand continues to need stronger law enforcement to reduce risky motorcycle driving behavior.

Open access

Pornthep Pungrasmi, Anon Chayasadom and Apichai Angspatt


Background: Injection of alloplastic material underneath the penile skin for penile augmentation causes many complications such as inflammation, infection, ulceration, and pain during sexual activity. One of the treatments for complications after these penile augmentation procedures is surgical excision of the foreign body granuloma followed by penile skin coverage with bilateral scrotal flaps. There are no prior prospective studies published about anatomical and functional outcomes.

Objective: To study the anatomical and functional outcome of one-stage bilateral scrotal flap reconstruction in patients after surgical removal of paraffinoma from penile shafts.

Methods: Patients who suffered from complications of penile foreign body granuloma were treated by surgical excision and reconstruction with bilateral scrotal flaps. The penile lengths and circumferences when flaccid and erect were recorded preoperatively and postoperatively. The patients were interviewed using questionnaires and satisfaction scored to determine their sexual experiences were recorded before and after surgery.

Results: Thirteen patients were enrolled in this study. The mean follow-up time was 23.5 (11.5-40.5) weeks. The mean erectile length and the maximal circumference were 11.8 (9-15) cm, 14.5 (11.5-17) cm preoperatively, and 11.7 (10-14) cm, 11.8 (10-13) cm postoperatively. Satisfaction scores of sexual activity is 6.84 (0-9) preoperatively, and 8.38 (5-10) postoperatively.

Conclusion: One-stage bilateral scrotal flap coverage is a good option for penile skin reconstruction. This technique can achieve satisfactory results both anatomically and functionally.

Open access

Pornthep Pungrasmi, Jiraroch Meevassana, Kassaya Tantiphlachiva, Poonpissamai Suwajo, Apichai Angspatt, Sirachai Jindarak and Prayuth Chokrungvaranont


Background: Male-to-female sex reassignment surgery (MTF-SRS) is a treatment for gender identity disorders (GID) wherein the penis is removed and an epithelialized neovagina is created in the retroprostatic or rectovesical space. This is a space between the double layers of Denonvilliers’ fascia that contains motor, sensory, and autonomic nerves to the pelvic organs. Injury to these nerves may lead to anorectal dysfunction. However, there has been no objective study of anorectal physiologic changes after SRS.

Objectives: To compare anorectal physiological parameters, before and after, male-to-female sex reassignment surgery (SRS) and to evaluate the effects of SRS on anorectal physiology.

Methods: In 10 patients with MTF GID who underwent SRS at King Chulalongkorn Memorial Hospital, anorectal manometry was performed using a water perfused catheter (Mui Scientific, Ontario, Canada) and a state-of-the-art anorectal manometry system (Medtronic, Minneapolis, MN, USA) at the Gastrointestinal Motility Research Unit at 2 weeks before and 3 months after the SRS. Data were analyzed using PolygramNet software. Anal sphincter pressures (mmHg) with volume used to elicit rectal sensation (mL).

Results: There was no significant change in the resting anal sphincter pressure, anal sphincter squeezing pressure, sustained squeezing pressure, and duration of squeeze, rectal sensation, and threshold of the desire to defecate affected by SRS. Cough reflex and rectoanal inhibitory reflex were normal both before and after SRS in all patient participants.

Conclusions: Sex reassignment surgery seems to produce no effect on clinical anorectal functions. This was proven by absence of clinically significant changes in anorectal manometry.