LABIOPALATOSCHISIS AND ITS

RELATION WITH GODS CURSE

Problem Based Learning

By:

Group C
FAKULTAS KEDOKTERAN GIGI
UNIVERSITAS AIRLANGGA
SURABAYA
2014

Dea Delicia 021411131023

Rara Anjani Kusuma D. 021411131024

Nihal Dea Ananda 021411131025

Rizantika Alvanta 021411131026

Annisa Noor Ragilia 021411131028

Vitra Nuraini Helmi 021411131029

Fenella Andrata 021411131030

Raissa Tryantakarina N. 021411131031

M. Yudhistira R. K. J 021411131032

Zhafira Nur Shabrina 021411131033

Ulfi Putriadi G. 021411133009

Karunia Nurensa 021411133010

Mahardika Sri J. 021411133012

Khairal Fataya 021411133049

BACKGROUND
the incidence of
cleft lip averaged
8 per 10,000
births in the
world

patients with cleft

lip that happen in
Indonesia
increased by an
average of 7,500
people per year

Labiopalatoschisis or
so-called cleft lip and
cleft

FORMULATION OF
PROBLEM
1.

What is cleft lip and cleft palate?

2.

What causes cleft lip and cleft palate?

3.

How does cleft lip and cleft palate work?

4.

What is the impact to the body or system organ?

5.

Are they a curse?

Theoretical basis
Cleft palate is a state that does not close completely,
leaving the opening of which can be extended to the
nasal cavity and also involve the other side of the
palate, which extends to the anterior hard palate in the
mouth extends to the soft palate to the throat (Kim EK,
et al, 2010).

Labioschisis or cleft lip is a congenital abnormalities

which caused by facial malformation during the
gestation period. This deformity is due to the failure of
the facial process fusions to grow accurately and
connect to one another. This bonding process involves
ectoderms cover contacts each other (Medicine:Cleftlips Craft, 1997).

To know about cleft lip and cleft palate.

To know the causes and factors of cleft lip and cleft

palate.

To know the impact of cleft lip and cleft palate.

To explains how to prevent from cleft lip and cleft

palate.

To explains how to handling cleft lip and cleft palate.

To explains that the cleft lip and cleft palate are not a
curse from God.

To make students think critically and selective in

choosing resources.

PURPOSE OF WRITING

Cl
sk ini
ill ca
l

BENEFIT OF WRITING

d
ire y
qu g
In rate
st

REVIEW OF THE LITERATURE

Classification of Cleft Palate
According Veau divided into 4 groups (Sudiono, 2008) :

Figure 2.1 Classification of cleft palates (Ross & Johnston, 1972)

1. Class I (Cleft palatum molle) :

Cracks in the soft palate.
2. Class II (Cleft palatum molle and durum ) :
Cracks in the soft palate and hard palate behind the incisive foramen.
defects in soft and hard palate , extends not beyond the incisive foramen and
is confined to the secondary palate.

3. Class III (Cleft lip and palatum unilateral complete):

Cracks in the soft palate and hard over the alveolar bone and the
lip on one side.
cleft palate can be complete or incomplete . Cleft palate complete
covering soft and hard palate until incisive foramen . Incomplete cleft
include soft and hard palate but does not extend to the incisive
foramen . Complete unilateral cleft and extends from the uvula to the
incisive foramen underlined the central and unilateral alveolar process
also includes class III.
4. Class IV (Cleft lip and palatum bilateral complete):
Cracks in the soft palate and hard over the alveolar bone and the
lip on two sides.

Classification of cleft lip

Defect structure

Defect location

Defect area

Lip

Unilateral (right or left)

Complete or not

Bilateral

Alveoli

Unilateral (right or left)

Bilateral

Palate

complete

Complete or not
complete

Hard palate or soft

Complete or not

palate

complete, submucous

Table 1 : Simple classification of cleft lip and palate

Source : King Nigel M, dan Wei Stephen HY. The Management of Children With Cleft Lip and Palate
in Pediatric Dentistry: Total Patient Care.

CHAPTER 3
CONCEPTUA
L
FRAMEWOR
K

IMPACT OCCURS IN BABY

CHAPTER 4
DISCUSSION
Children with cleft sometimes have a hearing loss. This is due to the
possibility of Tuba Eustachias infection. All of normal childrens ears
produce a sticky ear fluid. This fluid can accumulate behind the
eardrum. The existence of cleft can increase the possibility of ear
drums formation, causing disruption or teven temporary hearing loss.
(Patu, 2010; Valentine, 2010).
Symptoms includes:
Lips separation
Palate separation
Lip and palate separation
Nasal distortion
Bones infection
Weight doesnt increase
Nasal regurgitation when breastfeeding (The milk out of the nostrils)

Genetic factors:
1. Gene Mutation
This factor is usually genetically inherited from family history genetic
mutation. Genetic factors only 20% -30% effect the occurrence of cleft lip or
cleft palate. The incidence of cleft lip
with or without cleft palate 1: 750-1000.
2. Ethnic / racial
Factor ethnically incidence of cleft lip with or without cleft palate in
the Asian race 1: 500 births, Caucasian, 1: 1,750 births, African American race
1: 2000 births.

Environmental factors:
1. Nutritional deficiencies
2. Radiation
3. Several types of drugs
example: phenytoin, alcohol, retinoic acid, cigarette
4. Virus
5. Lack of vitamin

TREATMENT
Due to the number of oral health and medical
problems associated with cleft lip and palate,
treatment to care of the patient need a team consists
of doctor and specialist in their field. In the treatment
of Cleft Lip and Cleft Palate there are phases where
the patient is treated based on the ages.
Implementation of Treatment Based On The Ages
(Erlianda, 2008).

This is an
implementation table
treatment of cleft lip
and cleft palate
(Erlianda,

2008)

VON LANGENBECK PALATOPLASTY

Use

mucoperiosteal flap bipedicle in palatum durum

and palatum molle to cover the defect crack of the palate

(+) This technique is easy to do within short operating time

(-) Its not able to elongate palatum to posterior thus the

possibility of velopharyngeal incompetence is higher and
speech function is not optimal

V-Y PUSHBACK
(VEAUWARDILLKILNER
PALATOPLASTY)

V-Y procedure is performed so that the whole

mucoperiosteal flap and the soft palate are retro posed
and the palate is lengthenen (Sudiono, 2008)

To increase the lengthening of the soft palate George Dorrance

advocated horizontal back cut in the nasal lining at the
junction of hard and soft palate leave a large raw area
on the nasal surface

Surgery to repair the lip shape quickly performed in cases

with any age, but the babies were all done at an early
age,
usually around the age of 3 months based on the Rules
of
Ten. There are:
Body weight at least 4,5 kg (10 pon)
Age at least 10 weeks
Hemoglobin level more than 10%
The number of leukocyte less than 10.000/mm 3

Surgery Technique
Milliard

Surgery

The Millard Procedure rotates the tissue and creates a "Z"

shaped scar
instead. The "Z" shape gives the tissue more elasticity,
resulting in
greater flexibility and restoration of the Cupids Bow
(Medicine: Cleft
Lip Craft)

Tennison-Randall Surgery

It is use the method of triangular repair. Why used it?

Because the rotation advancement technique of Millard
has the greatest number of followers and is recognized as a
simple method once experience is obtained.

Image Source : Smith HW (1983). Comprehensive surgical atlases in otolaryngology and head and neck surgery:
The atlas of cleft lip and cleft palate surgery. New York: Grune & Stratton, Inc.

Onizuka Surgery

Same like Milliard Surgery, but this is the modification from

Milliard
Surgery and Tennison Randal. Therefore the percentage of
the success
surgery can be increased

But in this case the patient is the patient is 5

years old boys so this ruled cant be use
anymore.

There are several technique of labioplasty

surgery what can be use for children or adult
above 3 months, like Milliard, TennisonRandall and Onizuka Surgery. Every technique
has different functions and ways to get the
main purpose of the labioplasty surgery.

WHAT WE SHOULD DO?

VITAMI
N B6

FOLIC
ACID

CHAPTER 5
FINALE

Conclusion
Genetic factors
Environmental
factors

Labiopalatoschi
sis

Avoid marriage with a

cleft lip or cleft palate
Avoid smoking and
alcohol consumption
Consumption of folic
acid

Cleft Lip and Cleft Palate not a

curse from the God

Millard Surgery
Onizuka
Surgery
Le Messurier
Surgery
Tennison-randal
Surgery

Suggestion
For mothers during pregnancy can prevent the occurrence of
congenital
abnormalities by eating nutritious foods and vitamin B - 6 ,
whereas
that must be avoided is the consumption of alcohol , drugs , and
nicotine . A pregnant woman must often read to find out
information
about pregnancy and baby health so that if there are problems in
the
fetus , parents can consult to the gynecologist .

THANK YOU