Sumbing Bibir, Gusi dan Langit-langitCleft Lip and Palate

Rosadi SeswandhanaAesthetic & Reconstructive Plastic SurgeonDepartment of Surgery, Faculty of Medicine

Gadjah Mada University

Craniofacial Clefts

Tessier Cleft Calssification(1969)Key Landmark : Orbit, Nose, Mouth

Cleft Lip & Palate

• Failure of complete union of the medial nasal prominence and the maxillary prominence

• Variable extent of clefting• Incidence

• Overall : 1 in 1000• White : 1 in 750• Asian : 1 in 500• African : 1 in 2000

Embryology

• The lip has usually formed by 5-6 weeks of intrauterine life.

• The palate has formed by 10 weeks

• The cleft may be picked up by high resolution ultrasound at 20 weeks gestation.

• Diagnosis is otherwise made after delivery.

12th July 2008Dr. Christine Underhill

Classification

LAHSHAL Classification (Kriens , 1989)

Gender

• For Clefts affecting the Lip only or Lip and Palate (CL[P]), males are more commonly affected than females (approx 2-1).

• Clefts palate alone (CP) is found in approx 1 in 2000; females are more often affected than males.

Problems

• Family• Psychosocial• Funding

• Patient• Nutrition• Speech• Middle ear infection (OMI)• Dentition• Aesthethic• Psychosocial

Principles And PhilosophyManagement of Cleft Lip &Palate

• Cleft Management > Surgery Alone¡ Interdisciplint ¡ Long-term management¡ Documentation and Evaluation¡ Research

Jadwal penatalaksanaanIn the 1st consultation à Education

• 0-1 mg : Advice to sleep in lateral decubitusNutrition: semi-erect position,

special bottle , Preoperative taping• 1-2 mg : Feeding plate / Obturator / NAM• 3 bl/10 mg : Labioplasty / Lip repair• 1,5 - 2 th : Palatoplasty / Palate repair• 2 - 4 th : Speech therapy• 4 - 6 th : Velopahryngoplasty• 6 - 8 th : Orthodontic• 8 - 9 th : Alveolar bone grafting• 9 - 17 th : Orthodontic• 17 / 18 th : Le Fort Osteotomy

Oral bottle/spoon feeding

Feeding Plate/obturator

Nasoalveolar moulding device

Labioschisis Unilateral Incomplete

Labiognatopalatoschisis Unilateral Complete

Labiognatopalatoschisis Bilateral Complete

Myringotomy

Hypernasal (Nasal Escape) Sound Problem

Nasendoscopy examination• Velopharyngeal (VP) closure

has an important role in normal speech production.

• Incomplete closure of the velopharyngeal complex, known as velopharyngeal insufficiency (VPI), is characterized by hypernasalresonance

Rose Thomson

Tennison-Randall

Le Mesurier

Millard

Labioplasty

(10 weeks, 10 pounds, Hb > 10 g%)

3 Bulan 7 tahun

Bilateral Cleft Lip

Palatoplasty

( 12 – 24 months)

Oral mucosa elevation

sinus sinus sinus sinus

septumseptum septum

Nasal mucosaNasal mucosaNasal mucosaNasal mucosa

Nasal mucosa preparation

Hypernasal (Nasal Escape) Sound Problem

Nasendoscopy examination

• Velopharyngeal (VP) closure has an important role in normal speech production

• Incomplete closure of the velopharyngeal complex, known as velopharyngeal insufficiency (VPI), is characterized by hypernasalresonance

Velopharyngoplasty / Pharyngeal Flap(2 - 4 years)

Alveolar bone graft (8-9 years old)

Cleft Lip Nose

Pre-Operatif Post-Operatif

Terapi Orthodontik

Le Fort advancement osteotomy (maloklusi III)(18 years old)

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”Thank You Terimakasih Maturnuwun