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Komplikasi celah langit-langit: 1.

Infeksi telinga Infeksi terjadi karena tuba eustachius tidak berfungsi dengan baik sehingga terjadi penumpukan cairan di telinga tengah. Penumpukan cairan ini merupakan suatu media yang baik bagi perkembangan infeksi. Oleh karena itu, pada operasi rekonstruksi pertama, dilakukan penanaman suatu tuba khusus pada anak agar tidak terjadi infeksi telinga. . !angguan berbicara ". #asalah gigi, seperti gigi yang hilang, gigi yang berlebih, malformasi, dan karies. $. !angguan pendengaran %. Kesulitan saat menyusui &ibir sumbing menyebabkan anak sulit untuk mengisap, sedangkan celah pada palatum menyebabkan susu yang diisap sering masuk ke hidung. Pada beberapa kasus dapat digunakan obturator untuk membantu makan dan minum. '. (erapi celah langit-langit: )ekarang ini telah banyak kemajuan ilmu medis dalam pera*atan celah bibir dan langitlangit. Operasi rekonstruksi dapat memperbaiki celah bibir dan langit-langit. +iagnosis biasanya dibuat saat lahir, atau beberapa saat setelah lahir, *alaupun pada beberapa kasus dapat pula didiagnosis dari pemeriksaan ,)!. Pada celah langit-langit submukosa diagnosis tidak dapat dibuat sampai anak tersebut mengalami kesulitan berbicara saat )+. )ejak kelahiran beberapa hari, bayi dengan celah langit-langit akan dirujuk ke bedah plastik. Perbaikan langit-langit dilakukan secara bertahap. Perbaikan bibir kebanyakan dilakukan pada usia " bulan dan ' bulan, sementara perbaikan langit-langit dilakukan antara usia " bulan dan 1$ bulan. Pada anak-anak dengan celah langit-langit saja dan tidak ada bibir sumbing, perbaikan langit-langit dapat dilakukan pada usia 1- bulan. Pada saat yang sama dengan perbaikan palatum, telinga diperiksa oleh ahli (.(, dan bila ada tanda-tanda terdapatnya glue ear, dapat dilakukan terapi pula untuk telinga tengah. Pada kasus-kasus celah pada palatum yang komplit, dapat dirujuk ke ortodontis untuk mempertahankan dan meningkatkan hubungan antara tulang di kedua sisi celah. (ujuannya adalah agar tulang dapat sejajar sebelum dilakukan perbaikan pada jaringan lunak, dimana hal ini akan mempermudah teknik operasi, tapi juga dipercaya memiliki hasil yang lebih baik. (eknik perbaikan primer celah palatum: (erdapat berbagai cara untuk memperbaiki celah pada palatum dan penggunaannya tergantung pada kasus yang dihadapi. Pada kebanyakan kasus, pemilihan teknik didasarkan kepada luas celah, gambaran anatomis, dan kecenderungan ahli bedah. )etiap perbaikan celah bibir dan palatum diperlukan anestesi umum, karena anak harus dapat berbaring diam untuk jangka *aktu yang cukup lama /sekitar 1 0 $ jam1. )etiap perbaikan celah bibir dan palatum dilaksanakan dengan pasien supinasi, jalan nafas aman dan dilindungi oleh endotracheal tube, kepala ekstensi, dan ahli bedah duduk di bagian kepala meja operasi. &iasanya diberikan anestesi lokal /adrenalin atau epinefrin1 pada palatum dan bibir yang akan dilakukan perbaikan, kegunaannya adalah untuk mengurangi rasa sakit dan

mencegah terjadinya perdarahan sehingga operasi dapat berjalan lebih mudah dan lebih cepat. Pada masa post-operasi, jalan nafas perlu dijaga. Celah Inkomplit (Soft Palate Clefts) Perbaikan celah dilakukan dengan cara memisahkan setiap sisi palatum ke dalam " lapisan yaitu mukosa nasal, mukosa oral, dan otot, kemudian dilakukan penjahitan di setiap bagian ini secara terpisah untuk menghindari terjadinya penutupan ke-" lapisan. Ini disebut dengan perbaikan direk. ,sually, it *ill incorporate an intra2elar 2eloplasty, *hich in2ol2es freeing the muscles from their erroneous insertion into the posterior edge of the hard palate and suturing them to each other, across the midline, so as to restore the muscle sling *hich *ill enable the palate to be pulled up and back *ith muscle contraction. 3n elegant approach to the repair of the soft palate cleft is to use the techni4ue described by 5eonard 6urlo* - the double re2ersing 7-plasty. (his raises t*o 7-plasties, one in the palatal mucosa and one in the nasal mucosa. (he muscle on one side is raised *ith the oral mucosa and on the other *ith the nasal layer. 8hen the 7-plasty flaps are s*itched, the t*o muscle bearing layers are brought across the midline, and the 7-plasties help to lengthen the palate. Celah Komplit Perbaikan lebih sulit dilakukan karena the bone of the hard palate is di2ided into lateral shel2es. )een from belo*, the inferior or lo*er edge of the 2omer, *hich normally forms a (-junction *ith the bony palate, is on sho* in the cleft. In order to repair such a defect, se2eral techni4ues ha2e been e2ol2ed o2er the last century. )ome in2ol2e the splitting of the mucosa o2er the 2omer and turning this back to meet the mucosal co2ering, freed from the upper, or nasal surface of the bony palatal shel2es )uturing these together forms the nasal layer. 9e:t, the muscle must be freed from the posterior palatal shelf edge. In most cases this is raised together *ith the o2erlying oral mucosa, either freeing completely, the front end of the flap from the bone of the palate, and pushing the flaps back*ards, as they are se*n together in the midline - a so called pushback repair, as in the method of ;eau and of 8ardill and Kilner. 3lternati2ely, the anterior edge of the palatal flap can be left in place, and the flap raised on t*o pedicles, posterior and anterior, the so called 2on 5angenbeck techni4ue. &oth these techni4ues utili7e a releasing incision, placed postero-laterally around the posterior edge of the al2eolus, *hich frees the soft tissue palatal flap, allo*ing it to be transposed to*ard the midline< the secondary defect heals rapidly and does not re4uire closure. )e2eral other 2ariations on the theme are possible, and your surgeon should be able to ad2ise you, together *ith illustrati2e dra*ings, of precisely *hat the proposed surgery *ill entail for your baby. KOMPLIKASI OPERASI: Pada $ 0 $= jam post-op: 1. Perdarahan

. Pembengkakan yang akan menghalangi jalan nafas Komplikasi lambat: 1. 6istula !ejala yang timbull antara lain terdapatnya cairan atau regurgitasi makanan le*at hidung dan mungkin terdapat gangguan berbicara. &iasanya dapat diperbaiki dengan operasi sekunder. . )car restriktif )etelah dilakukan perbaikan primer celah palatum, pasien harus terus kontrol ke bedah plastik, (.(, terapi bicara, dan ortodontis. Pada usia sekitar > tahun dapat dilakukan grafting pada tulang al2eolar. (o do this, the cleft soft tissue is separated o2er the al2eolus, and the gap bet*een the bone of the t*o al2eolar segments, packed *ith cancellous bone taken from the hip /iliac crest1, cranium /skull1 or tibia /shin1. (his both unites the t*o al2eolar segments and allo*s the orthodontist to mo2e the teeth into the space *hich has no* been filled *ith bone. VELO-PHAR !"EAL I!COMPE#E!CE (erdapat satu lagi inter2ensi operatif yang dibutuhkan. (erkadang terjadi kegagalan penutupan 2elum ke faring. !ejala yang timbul pada berbicara hipernasal atau 2elopharyngeal incompetence atau ;PI. 9asendoskopi dilakukan untuk melihat pergerakan palatum dari arah atas. #ukosa nasal akan diberikan anestesi lokal /spray :ylocaine1 dan setelah endoskopi diposisikan, pasien diminta untuk mengucapkan beberapa kata, dan gambaran endoskopi direkam. )etelah diagnosis ditegakkan, operasi dilakukan dengan flap faringeal atau faringoplasti sphincter. Keduanya dilakukan di rumah sakit dengan anestesi umum, berlangsung sekitar 0 " jam. OR#HO"!A#HIC S$R"ER %A! %E&I!I#IVE RHI!OPLAS# &anyak pasien sumbing akan mengalami hipoplasia dan defisiensi maksilar dimana pada pasien ini, maksila gagal bertumbuh ke depan. .al ini dapat terjadi karena penurunan pertumbuhan jaringan yang disebabkan oleh adanya celah. 3kan tetapi dapat pula disebabkan oleh scar restriktif yang dibuat pada saat perbaikan bibir dan palatum secara operasi. Pada banyak kasus, supaya oklusi gigi dan rahang baik, ortodontis akan mengusulkan dilakukannya operasi orthognathic. +ilakukan operasi untuk melepaskan maksila dari tulang tengkorak dan menyamakannya dengan mandibula. Kedua rahang ini akan disejajarkan, dan difiksasi dengan plate titanium dan scre* atau *ire. Operasi ini biasanya dilaksanakan apabila pasien mendekati kematangan tulang tengkorak /1% atau 1? tahun pada *anita dan 1> tahun pada pria1. &ila dilakukan lebih a*al dapat menyebabkan operasi dilakukan kembali karena masih terdapatnya pertumbuhan tulang fasial setelah operasi. (ahap akhir yang harus dilakukan pasien adalah rhinoplasti definitif yang dilakukan setelah operasi orthognathic.

http://www.medic8.com/healthguide/articles/cleft lip.html

Treating Clefts
The good news is that there have been many medical advancements in the treatment of oral clefting. Reconstructive surgery can repair cleft lips and palates, and in severe cases, plastic surgery can address specific appearance-related concerns.

A child with oral clefting will need to see a variety of specialists who will work together as a team to treat the condition. Treatment usually begins in the first few months of an infant's life, depending on the health of the infant and the extent of the cleft.

embers of a child's cleft lip and palate treatment team usually include!

a geneticist a plastic surgeon an ear, nose, and throat physician "otolaryngologist# an oral surgeon an orthodontist a dentist a speech pathologist "often called a speech therapist# an audiologist a nurse coordinator a social worker and$or psychologist

The team specialists will evaluate your child's progress regularly, examining your child's hearing, speech, nutrition, teeth, and emotional state. They will share their recommendations with you, and can forward their evaluation to your child's school, and any speech therapists that your child may be working with.

%n addition to treating your child's cleft, the specialists will work with your child on any issues related to feeding, social problems, speech, and how you approach the condition with your child. They'll provide feedback and recommendations to help you through the phases of your child's growth and treatment.

&urgery for 'ral (lefting


&urgery is usually performed during the first )* to )+ months to repair cleft lip and$or cleft palate. ,oth types of surgery are performed in the hospital under general anesthesia.

(left lip often re-uires only one reconstructive surgery, especially if the cleft is unilateral. The surgeon will make an incision on each side of the cleft from the lip to the nostril. The two sides of the lip are then sutured together. ,ilateral cleft lips may be repaired in two surgeries, about a month apart, and usually re-uires a short hospital stay.

(left palate surgery involves drawing tissue from either side of the mouth to rebuild the palate. %t re-uires * or . nights in the hospital, with the first night spent in the intensive care unit. The initial surgery is intended to create a functional palate, reduce the chances that fluid will develop in the middle ears, and help the child's teeth and facial bones develop properly. %n addition, this functional palate will help your child's speech development and feeding abilities.

The necessity for more operations depends on the skill of the surgeon as well as the severity of the cleft, its shape, and the thickness of available tissue that can be used to create the palate. &ome children with a cleft palate re-uire more surgeries to help improve their speech. Additional surgeries may also improve the appearance of the lip and nose, close openings between the mouth and nose, help breathing, and stabili/e and realign the 0aw. &ubse-uent surgeries are usually scheduled at least 1 months apart to allow a child time to heal and to reduce the chances of serious scarring.

%t's a good idea to meet regularly with your child's plastic surgeon to determine what's most appropriate in your child's case. 2inal repairs of the scars left by the initial surgery may not be performed until adolescence, when facial structure is more fully developed. &urgery is designed to aid in normali/ing function and cosmetic appearance so that the child will have as few difficulties as possible.

Dental Care and Orthodontia


(hildren with oral clefting often undergo dental and orthodontic treatment to help align the teeth and take care of any gaps that exist because of the cleft.

Routine dental care may get lost in the midst of these ma0or procedures, but healthy teeth are critical for a child with clefting because they're needed for proper speech.

A child with oral clefting generally needs the same dental care as other children - regular brushing supplemented with flossing once the child's 1-year molars come in. 3epending on the shape of your child's mouth and teeth, your child's dentist may recommend a toothette, a soft sponge that contains mouthwash, rather than a toothbrush. As your child grows, you may be able to switch to a soft children's toothbrush. The key is to make sure that your child brushes regularly and well.

(hildren with cleft palate often have an alveolar ridge defect. The alveolus is the bony upper gum that contains teeth, and defects can!

displace, tip, or rotate permanent teeth prevent permanent teeth from appearing prevent the alveolar ridge from forming

These problems can be fixed by grafting bone matter onto the alveolus, which allows the placement of your child's teeth to be corrected orthodontically.

'rthodontic treatment usually involves a number of phases, with the first phase beginning as the permanent teeth start to come in. %n the first phase, which is called an orthopalatal expansion, the upper dental arch is rounded out and the width of the upper 0aw is increased. A device called an expander is placed inside the child's mouth. The widening of the 0aw may be followed by a bone graft in the alveolus.

4our child's orthodontist may wait until the remainder of your child's permanent teeth come in before beginning the second phase of orthodontic treatment. The second phase may involve removing extra teeth, adding dental implants if teeth are missing, or applying braces to straighten teeth.

%n about *56 of children with a unilateral cleft lip and palate, the upper 0aw growth does not keep up with the lower 0aw growth. %f this occurs, your child may need orthognathic surgery to align the teeth and help the upper 0aw to develop.

2or these children, phase-two orthodontics may include an operation called an osteotomy on the upper 0aw that moves the upper 0aw both forward and down. This usually re-uires another bone graft for stability.

Speech Therapy
A child with oral clefting may have trouble speaking - the clefting can make the voice nasal and difficult to understand. &ome will find that surgery fixes the problem completely.

(atching speech problems early can be a key part of solving them. %t's a good idea to take your child to a speech therapist between the ages of )+ months and * years. any speech therapists like to talk with parents at least once during the child's first 1 months to provide an overview of the treatment and suggest specific language- and speech-stimulation games to play with the baby.

&hortly after the initial surgery is completed, the speech pathologist will see your child for a complete assessment. The therapist will evaluate your child's developing communication skills by assessing the number of sounds he or she makes and the actual words your child tries to use, and by observing interaction and play behavior.

This analysis helps determine what, if any, speech exercises your child needs and if further surgery is re-uired. The speech pathologist will often continue to work with your child through additional surgeries. any children who have clefts work with a speech therapist throughout their grade-school years.

Dealing With Emotional and Social ssues


'ur society often focuses on people's appearances, and this can make childhood - and, especially, the teen years - very difficult for someone with a physical difference. ,ecause a child with oral clefting has a prominent facial difference, your child may experience painful teasing, which can damage self-esteem. 7art of the cleft palate and lip treatment team includes psychiatric and emotional support personnel.

8ays that you can support your child include!

Try not to focus on your child's cleft and do not allow it to define your child as an individual.

(reate a warm and supportive home environment, where each person's individual worth is openly celebrated. 9et your child know that you feel good about who he or she is by showing acceptance and by not trying to make your child into your idea of who he or she should be. :ncourage your child to develop friendships with people from diverse backgrounds. The best way to do this is to lead by example and to be open to all people yourself. 7oint out positive attributes in others that do not involve physical appearance. :ncourage autonomy by giving your child the freedom to make decisions and take appropriate risks, letting your child's own accomplishments lead to a sense of personal value. ,y providing opportunities for your child to make decisions early on - like picking out what clothes to wear - he or she can gain more confidence and the ability to make bigger decisions down the road.

4ou might also consider encouraging your child to present information about clefting to his or her class with a special presentation that you arrange with the teacher. 'r perhaps your child would like you to talk to the class. This can be especially effective with young children.

%f your child does experience teasing, encourage discussions about it and be a patient listener. ;ive your child the tools to confront the teasers by asking what he or she would like to say and then practicing those statements.

%f your child seems to have ongoing self-esteem problems, you may want to consult with a child psychologist or social worker for support and information. Together with the members of your child's treatment team, you can help your child through tough times.

Also, it's important to keep the lines of communication open as your child approaches adolescence so that you can address any concerns he or she may have about appearance.

Reviewed by! ,arbara 7. <omeier, 3ate reviewed! &eptember *==5

3 3, 7<

'riginally reviewed by! 9ouis :. ,artoshesky,

http:@@kidshealth.org@parent@medical@ears@cleftAlipApalate.html

Komplikasi celah langit-langit: ?. 3 =. 3 (erapi celah langit-langit: )ekarang ini telah banyak kemajuan ilmu medis dalam pera*atan celah bibir dan langitlangit. Operasi rekonstruksi dapat memperbaiki celah bibir dan langit-langit. (ujuan akhir perbaikan celah langit-langit adalah membuat katup 2elopharyngeal yang normal dengan cara merekonstitusi mekanisme spinchter otot dari sling le2ator palatine. Orang tua pasien harus diberi pengertian bah*a terapi bicara yang intensif akan memerlukan *aktu bertahun-tahun sebelum anak mampu berkomunikasi secara adekuat.