bibir sumbing prof.ppt
TRANSCRIPT
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etiologi
EMBRIOLOGI
ANATOMI
oleh :Drg slamet
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DEFINISI
Celah bibir/palatal ad kelainanbawaan yg terjadi o/k tidak adanya
penyatuan (fusi) secara normal pada
bibir/palatal pada proses embrional ygdapat terjadi secara sebagian atau
sempurna (Morley 1958)
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Epidemiologi
88 - 175 /100.000 kelahiran hidup pertahun, Celah
bibir dan lelangit 1/1000 kelahiran, celah langit-langit1/2000 kelahiran.
Resiko : Asia , Amerika, Cina
Lebih sering 1 sisi Laki-laki > perempuan (3:2) Celah bibir lebih banyak laki-laki, celah lelangit pada
wanita.
CELAH
Bibir & langit-langit (45%) Bibir (20%) Langit-langit (35%)
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Bibir Sumbing
Celah Pada:2 Sisi Bibir Atas, Gnato, Lelangit
Infeksi SaluranPernapasan
Proses Menghisap
& Menelan
Gangguan Dalam Proses Penyatuan Bibir/LangitPada Masa Embrio Awal
Sumbing Yang Berat
Gangguan
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ETIOLOGI CELAH BIBIR dan
LANGIT
Belum Diketahui Secara Pasti
Alkohol
Asap Rokok
KekuranganGizi
Faktor Herediter
PernikahanAntar Kerabat
Terjadi Kelainan Pada Bibir/ Palatum
Menyebabkan
Kegagalan Mesoderm Bermigrasi ke Medial
Obat-obatan dan JamuTrauma
Bibir
Hipotesis
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Beberapa teori
1. Gangguan nutrisi
a. Malnutrisi Zn, vit B
b. Nutrisi kurang
2. Herediter : 30 50%
3. Pengaruh / mekanisme kimia / pada janin
4. Pengaruh psikologis ibu hamil
5. Obat-obatan, radiasi dan infeksi
Etiologi Celah
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Embriologi Bibir terbentuk pada usia kandungan 4-7
minggu
Palatum terbentuk pada usia 7-12 minggu.
Celah mulai bisa nampak pada usia 18minggu kehamilan dan bisa dilihat dengangelombang ultrasonik.
Diagnosis ditegakkan setelah kelahiran.
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Celah bibir Menurut teori klasik Wilhem His (Cit Stark, 1977)
Bagian tengah wajah diisi oleh rongga mulut, tepidibatasi dua prosesus maksilaris, dibagian atas
frontalis, celah bibir terjadi akibat gagalnyapenggabungan prosessus nasalis medialis danmaksilaris
Menurut (Stark, 1968) langit2 primer terbentuk
minggu ke4 -7 tdd : Prolabium (merah bibir),
Premaksila(Maksila anterior,))
Columella (Lengkung bibir)
Septum nasal (anterior)
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Development of the Face 5 facial primordia
Frontonasal prominence Paired maxillary prominences
Paired mandibular prominences
Surround primordial mouth (stomodeum)
Neural crest: source for almost all connective
tissues in the face
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Celah langit
Langit sekunder terbentuk minggu 7-12 yg terdiri
Palatum molle Palatum durum
Gagalnya penyatuan anatara prominentia maksilaris
kedua sisi
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Development of the Palate:
1. Primary Palate
Palatal development begins
in week 6, but weeks 7-12
are most critical
Formation of intermaxillary
segment from merged
medial nasal prominences
Palate forms from
median palatine process
Ossifies as the premaxillary
portion of the maxilla
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Ultra Sound at 18th Week of
Pregnancy
12thJuly 2008
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ANATOMI
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ANATOMI lanjut
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OTOTOTOT PADA WAJAH
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Labiognatoshisiz
unilateral komplit
Collumnela
Prolabium
Vermillion
Premaksila
Anatomi bibir sumbing
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Anatomi otot
1.M.Levator LabiiSup
2.MZygomaticus minor
3. M.Zygomaticus mayor
4.M.Orbicularis oris7.MDepresi anguli oris
6.M.Mentalis
5.M.Depressi labii inferior
1
2
3
6
4
5
7
8.M.buccinatorius
8
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GAMBAR VASKULARISASI
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TERIMA KASIH
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INERVASI PADA WAJAH
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PEMBULUH DARAH DAN LYMPHATIC
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MORFOGENESIS
Labioshsiz : terjadi pada periode embrionik
tidak terjadi penggabungan antara
prominentia nasalis medialis dan prominentia
maksilaris
Palatoshisiz : tidak terjadi penyatuan antara
prominetia maksilaris kedua sisi
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DEVELOPMENT OF THE FACE (I)
5 facial primordia Frontonasal prominence
Paired maxillary prominences
Paired mandibular prominences
Surround primordial mouth
(stomodeum)
Neural crest: source for almost all
connective tissues in the face
Frontonasal prominence forms forehead
and nose and a short margin of mouth
Lower jaw and lip form first
Nasal placodes (and pit): surrounded bymedial & lateral nasal prominences
Nasal pit remains connected to mouth
Maxillary prominences grow toward
each other, pushing nasal prominences
Medially
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DEVELOPMENT OF THE FACE (II)
Medial nasal prominencesmerge with each other and with
lateral nasal & maxillary
prominences
Nasolacrimal groove: between
lateral nasal and maxillary
prominences Becomes nasolacrimal duct
Intermaxillary segment
Merger of medial nasal
prominences
Gives rise to philtrum,
premaxillary bones, primary
palate
From Moore, 1982
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DEVELOPMENT OF THE PALATE:
1. PRIMARY PALATE
Palatal development begins
in week 6, but weeks 6-9
are most critical
Formation of intermaxillary
segment from merged
medial nasal prominences
Primary palate forms from
median palatine process
Ossifies as the premaxillary
portion of the maxilla
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CONTOH : ANATOMI BIBIR SUMBINGMillard Rotation
AdvancementTechnique:ReferencePoints
1. Center (low point) of Cupidsbow noncleft side (NCS)
2. Peak of Cupids bowlateralNCS
3. Peak of Cupids bowmedial
NCS4. Alar baseNCS
5. Columellar baseNCS
X. Back-cut pointNCS
6. CommissureNCS
7. Commissurecleft side (CS)8. Peak of Cupids bowCS
9. Medial tip of advancementflapCS
10. Midpoint of alar baseCS
11. Lateral alar baseCS
http://en.wikipedia.org/wiki/Image:CleftLip3.pnghttp://en.wikipedia.org/wiki/Image:CleftLip2.pnghttp://en.wikipedia.org/wiki/Image:CleftLip1.png -
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Unilateral incomplete Unilateral complete Bilateral complete
Incomplete cleft palate Unilateral complete lip andpalate
Bilateral complete
TERIMA KASIH
http://en.wikipedia.org/wiki/Image:Cleftpalate2.pnghttp://en.wikipedia.org/wiki/Image:Cleftpalate1.pnghttp://en.wikipedia.org/wiki/Image:Cleftpalate3.pnghttp://en.wikipedia.org/wiki/Image:Cleftpalate2.pnghttp://en.wikipedia.org/wiki/Image:Cleftpalate1.pnghttp://en.wikipedia.org/wiki/Image:Cleftpalate3.pnghttp://en.wikipedia.org/wiki/Image:CleftLip3.pnghttp://en.wikipedia.org/wiki/Image:CleftLip2.pnghttp://en.wikipedia.org/wiki/Image:CleftLip1.pnghttp://en.wikipedia.org/wiki/Image:CleftLip3.pnghttp://en.wikipedia.org/wiki/Image:CleftLip2.pnghttp://en.wikipedia.org/wiki/Image:CleftLip1.png -
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TERIMA KASIH
http://en.wikipedia.org/wiki/Image:Cleftpalate2.pnghttp://en.wikipedia.org/wiki/Image:Cleftpalate1.pnghttp://en.wikipedia.org/wiki/Image:Cleftpalate3.pnghttp://en.wikipedia.org/wiki/Image:CleftLip3.pnghttp://en.wikipedia.org/wiki/Image:CleftLip2.pnghttp://en.wikipedia.org/wiki/Image:CleftLip1.png -
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TIMING OF CLEFT REPAIRS
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FACIAL MORPHOGENESIS
In facial morphogenesis, neural crest cellsmigrate into the facial region, where they formthe skeletal and connective tissue and all dentaltissues except the enamel. Vascular
endothelium and muscle are of mesodermalorigin (Cohen, 2000).
The upper lip is derived from medial nasal andmaxillary processes.
Failure of merging between the medial nasaland maxillary processes at the fifth week ofembryonic development, on one or both sides,results in CL.
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CL occurs when an epithelial bridge fails,due to lack of mesodermal delivery and
proliferation. CL usually occurs at thejunction between the central and lateral partsof the upper lip on either side. The cleft mayaffect only the upper lip, or it may extendmore deeply into the maxilla and the primary
palate. (Cleft of the primary palate includesCL and cleft of the alveolus.)
If the fusion of palatal shelves is impairedalso, the CL is accompanied by CP, forming
the CLP abnormality. In general, patients with clefts have a
deficiency of tissue and not merely adisplacement of normal tissue.
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Clefts of the primary palate occur anterior
to the incisive foramen.
Clefts of the secondary palate are due to
lack of fusion of the palatal shelves, and
always occur posterior to the incisiveforamen
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WAKTU
Seawal mungkin
48 jam6 bulan
Role of Ten 10 minggu 10 gr%
- Berat badan minimal 10 pon
- Hemoglobin minimal 10 gram/%
- Lekosit di bawah 10.000/mm3
- Umur minimal 10 minggu
Triple of Ten 10 pound < 10.000/mm
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Celah Bibir
(kelainan kongenital)
Faktor Keturunan Faktor Lingkungan Faktor Trauma
Rendah diri
Canggung dlm pergaulanKelainan bicara
Masa depan sulit dlm menghadapi kehidupan
Bedah MulutFKG-UGM
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FREKWENSI KEJADIAN
88 - 175 /100.000 kelahiran hidup pertahun
Lebih sering 1 sisi
Laki-laki > perempuan (3:2)
CELAH
Bibir & langit-langit (45%) Bibir (20%) Langit-langit (35%)
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CELAH BIBIR
ringan :
tampak sbg celah kecil di atas bibir
berat :
tjd di ke2 sisi bibir atas & mbentuk celahs/d lubang hidung & langit-langit
(labiopalatoschizis).
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WAKTU
Seawal mungkin
48 jam6 bulan
Role of Ten 10 minggu 10 gr%
- Berat badan minimal 10 pon
- Hemoglobin minimal 10 gram/%
- Lekosit di bawah 10.000/mm3
- Umur minimal 10 minggu
Triple of Ten 10 pound < 10.000/mm
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Celah Bibir
(kelainan kongenital)
Faktor Keturunan Faktor Lingkungan Faktor Trauma
Rendah diri
Canggung dlm pergaulanKelainan bicara
Masa depan sulit dlm menghadapi kehidupan
Bedah MulutFKG-UGM
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TIMING OF CLEFT REPAIRS
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CELAH BIBIR
ringan :
tampak sbg celah kecil di atas bibir
berat :
tjd di ke2 sisi bibir atas & mbentuk celahs/d lubang hidung & langit-langit
(labiopalatoschizis).
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ETIOLOGI
1. Faktor Herediter
Ortu celah bibir/lelangit sex
linked recessive gene 15 %
keturunan
2. Faktor Lingkungan
- Def Vit A,B
- Infeksi Virus trisemester I kehamilan
- Radiasi
- Obat-obatan
- Hormonal dll
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DEFINISI
Celah bibir ad kelainan bawaan yg terjadi
o/k tidak adannya penyatuan (fusi) secara
normal pada bibir pada proses embrional yg
dapat terjadi secara sebagian atau sempurna