CLEFT LIP AND PALATE

( CLAP )
Labiognatopalato schizis
 CONGENITAL
INCIDENCE 1 : Normal Births
Gender :
Types
PATHOPHYSIOLOGY / EMBRYOLOGY :
Intrauterine development Types
THERAPHY Surgery Goal : Function
Form
Time of repair : emergency
elective
(OPTIMAL TIME)
 CLAP
INCIDENCE
Most common
congenital deformity
Fogh Anderson
1 : 665 Births
Asian
1 : 500 births
Gender
>
EMBRYOLOGY TYPES

(Primary Palate)
Primary & Secondary Palate

Mesoderm

Fusi
anterior

pasterior

Cleft Palate Gabungan Cleft Lip & Palate

ETHIOLOGY

Hereditary
Deficiency
Infection / Virus
Radiation
Drugs : steroid, diazepam,
anticonvulsant
Stress
 MANAGEMENT
LABIOPLASTY
MAIN GOAL AESTHETIC LIP - NOSE
Evaluation psychosocial
( parent and family )
Time of Surgery : 1. 0 Unlimited
2. Optimal repair
"Rule of Ten"
- Age 10 weeks
- B.W 10 pounds
- Hb > 10 gr %
- Leuco < 10.000
 TECHNIQUE LABIOPLASTY
1. PRIMARY
Millard : - Rotation & Advancement Flap

A : Flap Philtrum
B : Flap Rotasi
C : Flap Advansi

2. BILATERAL CLEFT LIP

One Stage : Manchester
3. SECONDARY LABIOPLASTY
Aesthetic Revition (mm !!!)
 LABIOPLASTY CASES
1. PRIMARY

Newborn
10 weeks / Rule of 10
School age

Adult
Teenagers / sweet seventeen
2. BILATERAL
3. SECONDARY LABIOPLASTY / REVISION
PALATOPLASTY
TECHNIQUE
Push back (Wardill-Kilner)
Posterior pharyngeal flap
Sphcter pharyngoplasty
Complication : FISTULA

Problems before/after palatoplasty:

1. Neonatal Feeding
Recommend : position 450
direct above tongue
Prevent Regurgitation

2. Post Op Speech function

Rehabilitation : 1. Active Speech Therapist
2. Pasive self excercise
Optimal palatoplasty : 1 2 years
speech completely
HYPOSPADIA
Definisi : OUE terletak disebelah
ventral penis dapat di distal pada
glans sampai ke proxima pada
perineum dan arah penis
membengkok kebawah akibat
tarikan chordee suatu fibrosis
rudimenter dari corpora spongiosa
distal.
 Incidence 1 : 300 male births
Most common in male
Frequently associated : CHORDEE
Cryptorchismus
Time of repair pre school age
Main Goal : FUNCTION 1. Reproductive
2. Sexual
( PSYCHOSEXUAL !!! )
EMBRYOLOGI
CRYPTORCHISMUS (ANDESCENDED TESTICLE)
 TECHNIQUE
Various. Principe of repair :
Chordectomy

Urethroplasty
Reconstr : Distal Urethra

Complic : - FISTULA
- STENOSIS
 Haram disunat Hypospadi
Rujuk untuk diperbaiki
Preputium sangat berharga untuk
sumber bahan baku pembentukan pipa
urethra
Hasil operasi Hypospadi bentuk sudah
tersunat
EPISPADIA / BLADDER EXSTROPHY
Incidence 1 : 30.000 40.000 births
Symphisis Pubis Separation

Edisi Kuliah Prof. BK 2003