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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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