BIBIR SUMBING prof.ppt

8/10/2019 BIBIR SUMBING prof.ppt

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etiologi

EMBRIOLOGI

ANATOMI

oleh :Drg slamet


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DEFINISI

Celah bibir/palatal ad kelainanbawaan yg terjadi o/k tidak adanya

penyatuan (fusi) secara normal pada

bibir/palatal pada proses embrional ygdapat terjadi secara sebagian atau

sempurna (Morley 1958)


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Epidemiologi

88 - 175 /100.000 kelahiran hidup pertahun, Celah

bibir dan lelangit 1/1000 kelahiran, celah langit-langit1/2000 kelahiran.

Resiko : Asia , Amerika, Cina

Lebih sering 1 sisi Laki-laki > perempuan (3:2) Celah bibir lebih banyak laki-laki, celah lelangit pada

wanita.

CELAH

Bibir & langit-langit (45%) Bibir (20%) Langit-langit (35%)


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Bibir Sumbing

Celah Pada:2 Sisi Bibir Atas, Gnato, Lelangit

Infeksi SaluranPernapasan

Proses Menghisap

& Menelan

Gangguan Dalam Proses Penyatuan Bibir/LangitPada Masa Embrio Awal

Sumbing Yang Berat

Gangguan


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ETIOLOGI CELAH BIBIR dan

LANGIT

Belum Diketahui Secara Pasti

Alkohol

Asap Rokok

KekuranganGizi

Faktor Herediter

PernikahanAntar Kerabat

Terjadi Kelainan Pada Bibir/ Palatum

Menyebabkan

Kegagalan Mesoderm Bermigrasi ke Medial

Obat-obatan dan JamuTrauma

Bibir

Hipotesis


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Beberapa teori

1. Gangguan nutrisi

a. Malnutrisi Zn, vit B

b. Nutrisi kurang

2. Herediter : 30 50%

3. Pengaruh / mekanisme kimia / pada janin

4. Pengaruh psikologis ibu hamil

5. Obat-obatan, radiasi dan infeksi

Etiologi Celah


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Embriologi Bibir terbentuk pada usia kandungan 4-7

minggu

Palatum terbentuk pada usia 7-12 minggu.

Celah mulai bisa nampak pada usia 18minggu kehamilan dan bisa dilihat dengangelombang ultrasonik.

Diagnosis ditegakkan setelah kelahiran.


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Celah bibir Menurut teori klasik Wilhem His (Cit Stark, 1977)

Bagian tengah wajah diisi oleh rongga mulut, tepidibatasi dua prosesus maksilaris, dibagian atas

frontalis, celah bibir terjadi akibat gagalnyapenggabungan prosessus nasalis medialis danmaksilaris

Menurut (Stark, 1968) langit2 primer terbentuk

minggu ke4 -7 tdd : Prolabium (merah bibir),

Premaksila(Maksila anterior,))

Columella (Lengkung bibir)

Septum nasal (anterior)


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Development of the Face 5 facial primordia

Frontonasal prominence Paired maxillary prominences

Paired mandibular prominences

Surround primordial mouth (stomodeum)

Neural crest: source for almost all connective

tissues in the face


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Celah langit

Langit sekunder terbentuk minggu 7-12 yg terdiri

Palatum molle Palatum durum

Gagalnya penyatuan anatara prominentia maksilaris

kedua sisi


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Development of the Palate:

1. Primary Palate

Palatal development begins

in week 6, but weeks 7-12

are most critical

Formation of intermaxillary

segment from merged

medial nasal prominences

Palate forms from

median palatine process

Ossifies as the premaxillary

portion of the maxilla


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Ultra Sound at 18th Week of

Pregnancy

12thJuly 2008


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ANATOMI


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ANATOMI lanjut


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OTOTOTOT PADA WAJAH


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Labiognatoshisiz

unilateral komplit

Collumnela

Prolabium

Vermillion

Premaksila

Anatomi bibir sumbing


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Anatomi otot

1.M.Levator LabiiSup

2.MZygomaticus minor

3. M.Zygomaticus mayor

4.M.Orbicularis oris7.MDepresi anguli oris

6.M.Mentalis

5.M.Depressi labii inferior

1

2

3

6

4

5

7

8.M.buccinatorius

8


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GAMBAR VASKULARISASI


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TERIMA KASIH


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INERVASI PADA WAJAH


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PEMBULUH DARAH DAN LYMPHATIC


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MORFOGENESIS

Labioshsiz : terjadi pada periode embrionik

tidak terjadi penggabungan antara

prominentia nasalis medialis dan prominentia

maksilaris

Palatoshisiz : tidak terjadi penyatuan antara

prominetia maksilaris kedua sisi


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DEVELOPMENT OF THE FACE (I)

5 facial primordia Frontonasal prominence

Paired maxillary prominences

Paired mandibular prominences

Surround primordial mouth

(stomodeum)

Neural crest: source for almost all

connective tissues in the face

Frontonasal prominence forms forehead

and nose and a short margin of mouth

Lower jaw and lip form first

Nasal placodes (and pit): surrounded bymedial & lateral nasal prominences

Nasal pit remains connected to mouth

Maxillary prominences grow toward

each other, pushing nasal prominences

Medially


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DEVELOPMENT OF THE FACE (II)

Medial nasal prominencesmerge with each other and with

lateral nasal & maxillary

prominences

Nasolacrimal groove: between

lateral nasal and maxillary

prominences Becomes nasolacrimal duct

Intermaxillary segment

Merger of medial nasal

prominences

Gives rise to philtrum,

premaxillary bones, primary

palate

From Moore, 1982


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DEVELOPMENT OF THE PALATE:

1. PRIMARY PALATE

Palatal development begins

in week 6, but weeks 6-9

are most critical

Formation of intermaxillary

segment from merged

medial nasal prominences

Primary palate forms from

median palatine process

Ossifies as the premaxillary

portion of the maxilla


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CONTOH : ANATOMI BIBIR SUMBINGMillard Rotation

AdvancementTechnique:ReferencePoints

1. Center (low point) of Cupidsbow noncleft side (NCS)

2. Peak of Cupids bowlateralNCS

3. Peak of Cupids bowmedial

NCS4. Alar baseNCS

5. Columellar baseNCS

X. Back-cut pointNCS

6. CommissureNCS

7. Commissurecleft side (CS)8. Peak of Cupids bowCS

9. Medial tip of advancementflapCS

10. Midpoint of alar baseCS

11. Lateral alar baseCS
http://en.wikipedia.org/wiki/Image:CleftLip3.pnghttp://en.wikipedia.org/wiki/Image:CleftLip2.pnghttp://en.wikipedia.org/wiki/Image:CleftLip1.png


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Unilateral incomplete Unilateral complete Bilateral complete

Incomplete cleft palate Unilateral complete lip andpalate

Bilateral complete

TERIMA KASIH
http://en.wikipedia.org/wiki/Image:Cleftpalate2.pnghttp://en.wikipedia.org/wiki/Image:Cleftpalate1.pnghttp://en.wikipedia.org/wiki/Image:Cleftpalate3.pnghttp://en.wikipedia.org/wiki/Image:Cleftpalate2.pnghttp://en.wikipedia.org/wiki/Image:Cleftpalate1.pnghttp://en.wikipedia.org/wiki/Image:Cleftpalate3.pnghttp://en.wikipedia.org/wiki/Image:CleftLip3.pnghttp://en.wikipedia.org/wiki/Image:CleftLip2.pnghttp://en.wikipedia.org/wiki/Image:CleftLip1.pnghttp://en.wikipedia.org/wiki/Image:CleftLip3.pnghttp://en.wikipedia.org/wiki/Image:CleftLip2.pnghttp://en.wikipedia.org/wiki/Image:CleftLip1.png


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TERIMA KASIH
http://en.wikipedia.org/wiki/Image:Cleftpalate2.pnghttp://en.wikipedia.org/wiki/Image:Cleftpalate1.pnghttp://en.wikipedia.org/wiki/Image:Cleftpalate3.pnghttp://en.wikipedia.org/wiki/Image:CleftLip3.pnghttp://en.wikipedia.org/wiki/Image:CleftLip2.pnghttp://en.wikipedia.org/wiki/Image:CleftLip1.png


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TIMING OF CLEFT REPAIRS


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FACIAL MORPHOGENESIS

In facial morphogenesis, neural crest cellsmigrate into the facial region, where they formthe skeletal and connective tissue and all dentaltissues except the enamel. Vascular

endothelium and muscle are of mesodermalorigin (Cohen, 2000).

The upper lip is derived from medial nasal andmaxillary processes.

Failure of merging between the medial nasaland maxillary processes at the fifth week ofembryonic development, on one or both sides,results in CL.


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CL occurs when an epithelial bridge fails,due to lack of mesodermal delivery and

proliferation. CL usually occurs at thejunction between the central and lateral partsof the upper lip on either side. The cleft mayaffect only the upper lip, or it may extendmore deeply into the maxilla and the primary

palate. (Cleft of the primary palate includesCL and cleft of the alveolus.)

If the fusion of palatal shelves is impairedalso, the CL is accompanied by CP, forming

the CLP abnormality. In general, patients with clefts have a

deficiency of tissue and not merely adisplacement of normal tissue.


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Clefts of the primary palate occur anterior

to the incisive foramen.

Clefts of the secondary palate are due to

lack of fusion of the palatal shelves, and

always occur posterior to the incisiveforamen


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WAKTU

Seawal mungkin

48 jam6 bulan

Role of Ten 10 minggu 10 gr%

- Berat badan minimal 10 pon

- Hemoglobin minimal 10 gram/%

- Lekosit di bawah 10.000/mm3

- Umur minimal 10 minggu

Triple of Ten 10 pound < 10.000/mm


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Celah Bibir

(kelainan kongenital)

Faktor Keturunan Faktor Lingkungan Faktor Trauma

Rendah diri

Canggung dlm pergaulanKelainan bicara

Masa depan sulit dlm menghadapi kehidupan

Bedah MulutFKG-UGM


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FREKWENSI KEJADIAN

88 - 175 /100.000 kelahiran hidup pertahun

Lebih sering 1 sisi

Laki-laki > perempuan (3:2)

CELAH

Bibir & langit-langit (45%) Bibir (20%) Langit-langit (35%)


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CELAH BIBIR

ringan :

tampak sbg celah kecil di atas bibir

berat :

tjd di ke2 sisi bibir atas & mbentuk celahs/d lubang hidung & langit-langit

(labiopalatoschizis).


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WAKTU

Seawal mungkin

48 jam6 bulan

Role of Ten 10 minggu 10 gr%

- Berat badan minimal 10 pon

- Hemoglobin minimal 10 gram/%

- Lekosit di bawah 10.000/mm3

- Umur minimal 10 minggu

Triple of Ten 10 pound < 10.000/mm


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Celah Bibir

(kelainan kongenital)

Faktor Keturunan Faktor Lingkungan Faktor Trauma

Rendah diri

Canggung dlm pergaulanKelainan bicara

Masa depan sulit dlm menghadapi kehidupan

Bedah MulutFKG-UGM


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TIMING OF CLEFT REPAIRS


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CELAH BIBIR

ringan :

tampak sbg celah kecil di atas bibir

berat :

tjd di ke2 sisi bibir atas & mbentuk celahs/d lubang hidung & langit-langit

(labiopalatoschizis).


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ETIOLOGI

1. Faktor Herediter

Ortu celah bibir/lelangit sex

linked recessive gene 15 %

keturunan

2. Faktor Lingkungan

- Def Vit A,B

- Infeksi Virus trisemester I kehamilan

- Radiasi

- Obat-obatan

- Hormonal dll


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DEFINISI

Celah bibir ad kelainan bawaan yg terjadi

o/k tidak adannya penyatuan (fusi) secara

normal pada bibir pada proses embrional yg

dapat terjadi secara sebagian atau sempurna

Documents

BIBIR SUMBING prof.ppt