Reconstructive Surgery

SURGERY DEPARTMENT FACULTY OF MEDICINE YARSI UNIVERSITY JAKARTA

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 filaria 5. egenerative

CONGENITAL DISORDERS
FACE CONGENITAL DISORDERS
1. Craniosynostosis Syndrome

Premature closure of one or more cranial suture Causa :

 Genetic factors  Sporadic / spontaneously mutation
Abnormalities on mid face (mid face growth disturbances or ungrowth)

a. Crouzons Syndrome (craniofacial dysostosis)

 Craniosynostosis (>> bicoronal)  Hipoplasia orbits, zygomas, maxilla  Mid face hipoplasia mal occlusion class III  Autosomal dominan  1 : 25.000 births

b. Aperts Syndrome (acrocephalosyndactyly)

 Craniosynostosis  Exo orbitsm, hipoplasia orbits  Mid face hipoplasia mal occlusion class III  Syndactily, symmetric, hand & foot  Sporadic, 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 microgonia Cranio facial microsomia Syndrome arcus brachialis I dan II Otomandibula dysostosis Cleft number 5 = rare

Cranio facial cleft

Cleft number 6,7 & 8 = treacher collins syndrome Symmetric malar flattening Anti mongoloid eye Coloboma lower eye lid Microtia Mandibula 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 palates 1st trisemester pregnancy Cleft 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 births 1:1000 for whites, 0,41:1000 for blacks 13% others birth defects

Treatment
Birth : psychology, nutrition, infection, speech Birth : obturator, special dots 3 months : labioplasty ( rule of ten ) 18-24 months : palatoplasty Speech therapy Before school age ; revision 6 years : pharingoplasty 7 years : bone graft Prothesa, orthodonti 17 years : osteotomy & maxillotomy Orthodonti

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