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Reconstructive Surgery

SURGERY DEPARTMENTFACULTY OF MEDICINEYARSI UNIVERSITYJAKARTA

ABNORMAL NORMAL

CONGENITAL

TUMOUR

TRAUMA

INFECTION

DEGENERATIVE

Abnormalities caused by :

1. Congenital Facial

congenital anomalies

Hipospadia Microtya Polydactily Syndactily

2. Trauma Facial injuries Burns

3. Tumour Hemangioma Facial

malignancy tumours

4. Infection Elephantiasis

filaria5. Degenerative

CONGENITAL DISORDERS

FACE CONGENITAL DISORDERS1. Craniosynostosis Syndrome

Premature closure of one or more cranial sutureCausa :

Genetic factors Sporadic / spontaneously mutation

Abnormalities on mid face (mid face growth disturbances or ungrowth)

a. Crouzon’s Syndrome (craniofacial dysostosis)Craniosynostosis (>> bicoronal)

Hipoplasia orbits, zygomas, maxillaMid face hipoplasia mal occlusion

class III Autosomal dominan1 : 25.000 births

b. Apert’s Syndrome (acrocephalosyndactyly)

CraniosynostosisExo orbitsm, hipoplasia orbitsMid face hipoplasia mal occlusion

class IIISyndactily, symmetric, hand & footSporadic, some autosomal dominant

2. Cranio facial clefts

Tessier (1969) : number 0-14.Most : number 1

Cleft number 0 = celah on mid-line : nose to chin

Cleft number 1 = labioschisis, labiopalatoshisis, labiognatoshisis

Cleft number 2 = rare

Carnio facial cleft Cleft number 3 = oblique facial cleft (oro-nasal-

occular cleft) Cleft number 4 = oro-occular cleft Cleft number 5 = rare Cleft number 6 = incomplete treacher colling

syndrome Cleft number 7 =

Hemifacial microgoniaCranio facial microsomiaSyndrome arcus brachialis I dan IIOtomandibula dysostosis

Cleft number 5 = rare

Cranio facial cleftCleft number 6,7 & 8 = treacher

collins syndromeSymmetric malar flatteningAnti mongoloid eyeColoboma lower eye lidMicrotiaMandibula hipoplasia

Cleft number 14 = fronto nasal encephacocele

KLasifikasi cleft menurut Tessier (1969)

Key landmark : orbit, nose, mouth

Cleft Lip and Palate

(CLP)

CLP…Congenital disorders : cleft on lip,

alveolus and hard/soft palates1st trisemester pregnancyCleft lip :

Failure of the nasomedial & nasolateral process

Failure of mesodermal migration (mesodermal penetration theory)

Cleft palate:Incomplete fusion of 2 lateral palates (12th

weeks)

CLP…

Factor : malnutrition, drugs, viral infection, radiation, depression, smoking, trauma and genetic

Complications : otitis media, hearing disturbance, teeth & maxillomandibula growth disturbance

1 in 650 – 750 births1:1000 for whites, 0,41:1000 for blacks13% others birth defects

TreatmentBirth : psychology, nutrition, infection,

speechBirth : obturator, special dots3 months : labioplasty ( rule of ten )18-24 months : palatoplastySpeech therapyBefore school age ; revision6 years : pharingoplasty7 years : bone graftProthesa, orthodonti17 years : osteotomy & maxillotomy Orthodonti

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