Sumbing Bibir, Gusi dan Langit-langitCleft Lip and Palate
Rosadi SeswandhanaAesthetic & Reconstructive Plastic SurgeonDepartment of Surgery, Faculty of Medicine
Gadjah Mada University
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
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
Labioschisis Unilateral Incomplete
Labiognatopalatoschisis Unilateral Complete
Labiognatopalatoschisis Bilateral Complete
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
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