Craniofacial

Abnormalities

CF Anomalies Devastating Occur

Relatively common

Rare Never be witness === clinical professional lifes

CF Surgery Founding Father Tessier

Anatomic Correction Achieved by stright allignment of

the twisted, osteotomies, replacing, and stable fixation

CF anomalies Enormous
Craniofacial Cleft (CFC)
Craniosynostosis Non Syndromal and syndromal
malformations

Center difference

Timing and Technic of the operation

Basic Craniofacial
surgical
Thin Veneer and Variety Expression Child Face End

Complex Organ that produce

Sight , Olfaction , Hearing, Speech and Mastification

Each anomalies be Handled by Team Work, long-term care in

Experiencing hands

Primary Concern Timing Op. is Preserve and Restoration of

Function
Remember !!!!!! Inherent Disparated Growth of the part
malformation
= CLASSIFICATION IS Variuosly , Wide acceptance Tessiers class.

CLEFT LIP

ANATOMI

Normal .. Simetris dasar dan pinggir hidung.

Pembagian :
* unilateral cleft incomplete with nasal deformity.
* unilateral cleft complete with nasal deformity
* bilateral incomplete cleft with or with out adequate

collumella.
* bilateral cleft complete one side and incomplete the other

side.
* bilateral complete cleft with inadequate collumella
* median cleft ( jarang ).

Rekonstruksi

Kapan ?

Rule of over ten .

Lebih 10 minggu

Lebih 10 pound ( 45.5 kg )

Hb lebih 10 gr%

Cara

* straight line closure

* quadrilateral flap.

* Triangular flap MIRAULT-BLAIR-BROWN methode

TENNISON RANDALL methode

* rotation advancement Flap ( Millards Technique)

CLEFT PALATE

ANATOMI

Didepan Hard palate ( tulang ) --- prepalatal

Dibelakang Soft palate ( jaringan lunak ).----palatal

Soft plalate veloparingeal closure.

Suara normal :

* mekanisme bicara yang kompeten.

* pendengaran yang baik

* inteligensia

* veloparingeal closure.

Embryologi dan etiologi

Kegagalan pertumbuhan mesodermal.
Ada 3 pulau mesoderm sentral dan 2 lateral.
Kegagalan menyatu ketiga pulau cleft.
Experiment defisiensi vitamin ( A ,RIBOFLAVIN,FOLIC

ACID,PANTOTENIK ASID,NIKOTINIK ASID)

Juga karena kelebihan vit.A .. Kelaparan .. Hipoksia ..

Keracunan nitrogen mustard .. Antagonis nukleik asid ..

Kortikosteroid.. ACTH .. Irradiasi .. Kekurangan cairan
amnion .. Dll.
Pada laki herediter > wanita.

KLASSIFIKASI

PREPALATAL CLEFT complte atau incomplete

PALATAL CLEFT complete atau incomplete

( dibatasi foramen insisivus )

Perawatan umum cleft palate

Masa neonatus .

1.
2.
3.
4.

makanan
perawatan saluran nafas.
peny.telinga tengah
kelainan kongenital lain.

1. makanan .
Kehilangan fungsi menghisap makanan harus diletak
diposterior .
Putting susu artifisial
Botol plastik yang bisa dipencet.( sembur )
Posisi setengah duduk ( kepala 45 derajat )
Banyak menelan udara gembung .

2. maintenance air way

Waspada resiko aspirasi waktu tidur.

Sebaiknya tidur tengkurap.

3. peny.telinga tengah

Neonatus banyak cairan dan gendang tengah mendatar.

Anak besar infeksi telinga tengah.

Cleft palate 40-50 % permanent hearing loss.

koreksi

Rata rata usia 4-5 tahun ( hard palate )

Sebaiknya sebelum usia 18 bulan ( soft palate ).

Atau sebelum berbicara .

T E R I M A
H

K A S I

By: Allison Spadaro

Student majoring in Communication Disorders at Marshall

University
*Please click on your mouse to view slides*

Getting Information on
Cleft Lip and Palate
The more you learn the better equipped you

will be to handle a situation involving a friend

or family member born with a cleft lip/palate.
Start with the basics, and then talk to others

to gain more information and gain a better

perspective on the disorder.

As a parent where do I
begin?
Begin by asking your OB/GYN about information

regarding a cleft palate team that is ready to help you.

The team usually consist of a craniofacial surgeon,

pediatrician, nutritionist, speech therapist, occupational

therapist, audiologist, psychologist, and pediatric
dentist. Each professional is dedicated to helping your
child in their specific area of specialization.
Start asking questions and learn the basics regarding

your childs disorder and what you can do!

The Basics:
What is a Cleft Lip and
Palate?
Cleft palate: An opening in the roof of the mouth (the
palate) due to a failure of the palatal shelves to come
fully together from either side of the mouth and fuse.

Cleft lip: The presence of one or two vertical clefts in

the upper lip; cleft lip can be on one side only
(unilateral), or on both sides (bilateral), resulting from
failure of the normal process of fusion of the lip to
come to completion during embryonic life.

What can be done to fix

Cleft Lip/Palate?
Surgery for cleft palate can be performed usually when the
child is 9 to 18 months old. A surgeon will take tissue from each
side of the cleft and pull it together at the roof of the mouth.
This rebuilds the palate and joins various muscles on each side.
Go to Furlow Palatoplasty at this site to view surgery.

Surgery for cleft lip can be performed as early as 10 to 12

weeks of age. A surgeon will make an incision on either side of
the cleft from the mouth into the nostril. They then turn the
dark pink outer portion of the cleft down and pull the muscle
and the skin of the lip together to close the separation. Go to
Hagedorn Repair at this site to view surgery.

Frequently Asked
Questions:
How will I feed my child? -Initially feeding your child will

be difficult do to their inability to form suction with a

nipple. Several cleft palate nursers are available though,
such as Haberman Feeder and the Mead-Johnson Nurser.

Will my childs speech be impaired? Your childs speech

will probably initially sound very nasal, but working with

a speech-language pathologist should help your child
begin to produce clear sounds.

Will my child encounter frequent ear infections? Many

cleft palate children do simply because their Eustachian

Tubes are angled normally, which prevents proper
drainage. Ear infections can be treated with antibiotics,
so watch your child closely for any sign of infection.

Are there other families

experiencing this
Yes, and the best way to learn to cope is to get
disorder?
involved and talk to other families that understand
your situation.
Cleft palates appear in 1 out of every 700 births,

making it one of the most common birth defects.

Join a cleft palate family connection team to talk

to other families online, receive free information,

get your questions answered, and to receive
support and guidance for you and your family.

As my child gets OLDER

Continue to love and nurture your child as

they get older.

Kids in school can be cruel, but always remind

your child that everyone is different and

special. Someday you can even explain to
your child how they had surgery and overcame
so much at such a young age.

Secondary surgeries can become necessary as

children grow into adolescents. Skeletal growth

can interfere with speech, and teens may want
surgery to improve the appearance of scars.

References:

www.cleftadvocate.org
www.medterms.com
www.techsurgery.org

Or contact Allison Spadaro at spadaro1@marshall.edu if you have

any questions or comments.

This presentation was created by Allison Spadaro, a student at Marshall University, in order to fulfill the requirements of
her CD 315 course. Thecontents of this piece contains information regarding her Multigenre Research Project on Cleft Lip
and Palate. Please visit her HOME page for more information. Last updated: August 12, 2003 @ 6:00 pm est

Marshall University-One John Marshall Drive Huntington, WV 25755

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