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Maxillary Growth and Speech Outcome in Patient with Cleft Lip and Palate after Two-Stage Palate Repair: A Systematic Review Mulyadi, Mulyadi; Kreshanti, Prasetyanugraheni; Handayani, Siti; Bangun, Kristaninta
Jurnal Plastik Rekonstruksi Vol. 1 No. 4 (2012): July Issue
Publisher : Lingkar Studi Bedah Plastik Foundation

Background: The management of patients with cleft lip and palate is complex, where the treatment outcome is judged on the balance between aesthetics, speech, and maxillary growth. Up to now, there is no generally accepted treatment protocol. Every center must find the best-suited protocol treatment for their population. Methods: A systematic review through literature search was conducted for English-language studies in PubMed. This search was conducted in September 2011 using EndNote X3 with keywords: Two-stage Palate Repair and Maxillary Growth and Two-stage Palate Repair and Speech Outcome. Both retrospective and prospective studies on maxillary growth and speech outcome in patient with cleft lip and palate after two-stage palate repair published from 2001 to 2012 were included. Result: From the reviewed of 37 articles, only 14 articles fit the inclusions criteria, three articles discussed the outcome of maxillary growth and speech outcome, eight articles only discussed the maxillary growth and the rest of articles only discussed the speech outcome. Conclusion:From this review we found that most of the two-stage palate repair results in better maxillary growth, but only few of them results in good speech outcome. We will perform further study based on this review to discover a new protocol for the management of palate repair in our center.

Secondary Rhinoplasty On Cleft Lip Nose Sudjatmiko, Gentur; Kreshanti, Prasetyanugraheni
Jurnal Plastik Rekonstruksi Vol. 1 No. 4 (2012): July Issue
Publisher : Lingkar Studi Bedah Plastik Foundation

By definition a secondary rhinoplasty is a procedure to correct the nasal shape deformity in cleft lip patients, which is performed not in conjunction with the labioplasty procedure. Several important factors to be considered in doing rhinoplasty procedures in cleft lip patients are: (1) Open rhinoplasty is more beneficial in assessing the whole nasal deformity, especially the nasal cartilage in cleft lip patients, (2) Releasing the latero-superior cartilage attached to the nasal bone and skin, which caused webbing inside the nostrils, (3) Addition of strut in columella as a pillar to adjust the dropping nose to the upright position, (4) Addition of cartilage plate whenever needed in the cleft side, (5) The nostril narrowing on the cleft side could be reduced by enlarging the nostril diameter, (6) The new nostril shape is maintained using a device (nasal retainer) for several weeks until the healing process is achieved, (7) The suture removal in nose is not as easy as of those in lip. The suture removal could be performed under mild sedation especially in uncooperative patients.

Management of Traumatic Undiagnosed Condyle Fracture in Children Rizal, Syamsul; Kreshanti, Prasetyanugraheni; Handayani, Siti; Bangun, Kristaninta
Jurnal Plastik Rekonstruksi Vol. 1 No. 5 (2012): September Issue
Publisher : Lingkar Studi Bedah Plastik Foundation

Background: Condyle trauma is considered to be the major cause of TMJ ankylosis but it is also the most neglected and under-managed problem in children. ?TMJ ankylosis leads to be malocclusion and facial disfigurement. The aim of early treatment is to restore the mandibular mobility and to enhance further growth in order to reduce the possibility of future facial asymmetry. Patients and Methods: We report two patients with inability to open mouth few months following injury. They most probably suffered missed diagnosis condyle fracture by the previous physician. The latest physical examination and radiological finding shows the mandible was micrognathic and unilateral TMJ ankylosis was confirmed. A sequential protocol of TMJ ankylosis management based on aggressive resection of ankylotic mass was performed and followed withphysiotherapy.Result: In 2 month-follow up, both patients showed significant improvement in mouth opening and the mastication function was restored, accompanied with physical therapy to gain maximum mouth opening for at least a year.Summary: A detail history, clinical and functional examination, radiographic examination facilitating correct diagnosis followed by immediate surgical intervention, and physiotherapy can help us to restore physical, psychological, and emotional health of the child patient.

The Effect Of Honey Give As Oral Drops In Precipitating Epithelialization Of Lateral Palatal Defects Post TwoFlap Palatoplasty Kreshanti, Prasetyanugraheni; Sudjatmiko, Gentur; Bangun, Kristaninta
Jurnal Plastik Rekonstruksi Vol. 1 No. 5 (2012): September Issue
Publisher : Lingkar Studi Bedah Plastik Foundation

Background : Two-flap palatoplasty, which is a very common technique used including in our institution, will result in lateral palatal defects without any periosteal coverage. Faster epithelialization is expected to decrease wound contraction thus reducing scar formation, and in the long run will result in good maxillary growth. In our institution, the retrospective study showed a fair maxillary growth (mean GOSLON score=3.5). Thus, we explore possibilities to precipitate the epithelialization process in pursuit of good maxillary growth in the future.Method :This is a prospective cohort study conducted in Cipto Mangunkusumo Hospital, on consecutive patients who underwent two-flap palatopasty from October 2010-February 2011. We followed up these patients weekly for 4 consecutive weeks to observe the rate of epithelialization of the lateral palatal defects.Result : Two-flap palatoplasty was performed in 48 patients, 23 among them were given honey as oral drops. Eighty-seven point five percent had unilateral complete cleft lip and palate and 12.5% had bilateral complete cleft lip and palate. Faster epithelialization of the lateral palatal defects post two-flap palatoplasty was significantly in!uenced by intraoral honey application on the wound as oral drops (RR 2.1, 95% CI 1.314 - 3.391, p < 0.001).Conclusion: Honey given as oral drops significantly precipitates the epithelialization process of the lateral palatal defects post two flap palatoplasty 2.1 times faster.

Traumatic Palatal Defect Closure With Prosthesis Post Surgical Reconstruction: A Team Approach Martina, Nungki Ratna; Kreshanti, Prasetyanugraheni; Handayani, Siti; Bangun, Kristaninta
Jurnal Plastik Rekonstruksi Vol. 1 No. 5 (2012): September Issue
Publisher : Lingkar Studi Bedah Plastik Foundation

Background: Palatal defect may be a result of congenital malformations, trauma or tumors. In most maxillopalatal trauma, surgical reconstruction is required to restore the function and appearance. Any palatal defect caused by maxillopalatal loss that cannot be achieved with surgical reconstruction needs special and comprehensive treatment. This can be done by prosthodontist prosthesis rehabilitation.Patients and Methods: A 20-year-old man underwent open reduction and internal fixation for severe maxillopalatal fracture and palatal loss. Intraoperative, the palatal defect could not be approximated due to palatal loss. In 3-month-follow up, there was a palatal defect and slight malocclusion due to anterior dental loss. Instead of performing complicated surgical procedures, we collaborate with the prosthodontist to assemble prosthesis with dental prosthesis that accommodate the closure of defect and improve appearance aesthetically. Result: The use of prosthesis improves functional and psychological wellbeing. It does not only close the palatal defect, but it also fills the anterior dental loss thus overcoming the malocclusion. Satisfying functional and aesthetic outcome was achieved. Summary: Rehabilitation of maxillopalatal defect has been well defined for prosthodontists and surgeons. A successful prosthetic design for functional restoration of the palatal defect utilizes the remaining palate and dentition to maximize the support, stability and appearance. In this case,prosthodontist and dentition prosthesis was used as modalities that offer simple solution to close the palatal defect compared to a more complicated surgical intervention.

The Eficiency in The Management of Facial Fracture Patients in Developing Country by Using OsiriX®, A Free 3D-Rendering Software Kreshanti, Prasetyanugraheni; Bangun, Kristaninta
Jurnal Plastik Rekonstruksi Vol. 1 No. 6 (2012): November Issue
Publisher : Lingkar Studi Bedah Plastik Foundation

Background: Being a developing country with a GNI (Gross National Income) per capita of US$3,830, the cost for managing patients with facial fractures was often unaffordable. The use of a free 3D-rendering software presumably would decrease cost. With OsiriX, a free and open source 3D-rendering software, complex images manipulations and real-time 3D image visualization is easily accessible anytime and anywhere from the surgeon’s personal computer, making diagnosis and preoperative planning more convenient for the surgeons. Patients and methods: From December 2009 to January 2010, 14 patients with facial fracture were admitted to our unit. Seven of them underwent surgery. Preoperatively, diagnosis & surgery plan was developed using OsiriX. Results: By using OsiriX, more accurate diagnosis was made at a lower cost. Patients could save up to 48.1% from total diagnostic cost (19.2% from monthly income). OsiriX provided easier access to multidimensional navigation and visualization tools in personal computers, making easier planning possible for surgical steps and materials needed. Summary: OsiriX being free and open source is bene!cial from !nancial point of view, which is an important point for patients in a developing country. It is user friendly and ef!cient in developing treatment plan for facial fracture patients.

Reconstruction of Traumatic Partial Ear Amputations Using Two-Stage Skin Flap Pocket Technique Hakim, Intan Friscilla; Kreshanti, Prasetyanugraheni; Handayani, Siti; Bangun, Kristaninta
Jurnal Plastik Rekonstruksi Vol. 2 No. 1 (2013): January Issue
Publisher : Lingkar Studi Bedah Plastik Foundation

Background: Various reconstructive techniques for partial traumatic ear amputations have been reported. The choice of technique is based on the missing ear components and the availability of tissue for defect coverage. The goal is to obtain an aesthetically acceptable ear. The authors report a two-stage skin flap pocket technique for the reconstruction of traumatic ear amputations. Patient and Method: Three cases of partial traumatic ear amputation due to bite is reported. After sufficient debridement, skin flap pocket was created on the retroauriculomastoid area. Conchal cartilage graft was used to replace cartilage defect in one case. The other 2 cases utilized their amputated cartilage graft, deepithelialized and then resutured to the remaining cartilage. All three cases underwent second stage surgeries for flap division, three weeks after the pocketing. Result: In 2 months follow-up, all of 3 cases showed no signs of infection. Normal dimension of the ears were achieved and aesthetic appearances were perceived as acceptable to the patients and other viewers. One case was able to be followed one year post surgery with acceptable aesthetics, and no sign of cartilage resorption. Summary: The technique used in these cases provided acceptable results in reconstructing the size and shape of the partially amputated ears. Cartilage grafts implanted in the pockets retained their shape with no infection or resorption.

Pericranial Hinged Flap for Congenital Posterior Meningoencephalocele Closure Atmaja, Tessa Miranda; Kreshanti, Prasetyanugraheni; Handayani, Siti; Bangun, Kristaninta
Jurnal Plastik Rekonstruksi Vol. 2 No. 1 (2013): January Issue
Publisher : Lingkar Studi Bedah Plastik Foundation

Background: Posterior meningoencephalocele is a complicated case that requires adequate method for closure of the defect. Congenital meningoencephalocele is a rare incidence estimated at 1:3000 to 10000 live births; with occipital encephaloceles are the most common. The method for closure should prevent leakage of cerebrospinal fluid (CSF) and coverage for the calvarial bone. Meningoencephalocele are treated by excising the non-functional brain tissue and closed the defect using thick connective tissue graft, alloplastic material and local flaps. The problems with closure are continuous leakage of cerebrospinal fluid and infection, especially when alloplastic material is used. In this case report, a pericranial flap is used to close the dura. Patient and Method: A neonate with occipital meningoencephalocele was consulted to the Plastic Surgery Department with wound dehiscence and recurrent herniation of brain tissue after undergoing first surgery by the neurosurgery team. On the second operation, a premilene mesh was placed which was later infected and causing wound dehiscence. We then close the defect using pericranial hinged flap and primary closure of the skin and subcutaneous tissue. Result: After the closure using pericranial hinged flap, there were no signs of infection and no CSF leakage. In 4 month follow up, the defect has completely healed. Summary: Closure of calvarial bone defect with pericranial-hinged flap provides a tight closure of the intracranial space, without increased risk of infection. Pericranial hinged flap should be considered as a method of choice for closure of intracranial defect, preventing leakage of cerebrospinal fluid and reducing risk of infection.

The Versatility of Temporalis Muscle Flap in Reconstruction of Maxillofacial Region Harsono, Anastasia Dessy; Kreshanti, Prasetyanugraheni; Handayani, Siti; Bangun, Kristaninta
Jurnal Plastik Rekonstruksi Vol. 2 No. 1 (2013): January Issue
Publisher : Lingkar Studi Bedah Plastik Foundation

Background: The temporalis muscle !ap (TMF) is a very versatile and valuable axial flap, which could be used in various reconstructive procedures in and around the maxillofacial region. The surgical anatomy, vascular pattern and technique of elevation of the flap are described, associated with our experience in different reconstructive situations. Patient and Method: There were two patients, one case of TMJ ankylosis and one case of facial paralysis. The TMF was used as an interpositional arthroplasty for TMJ ankylosis, as a dynamic facial reanimation for facial paralysis. Result: In the first patient, he was able to open his mouth 4 cm in 2 weeks following the surgery. There was no pain or other complication complained. In second patient, in two weeks follow up after the surgery, we found the edema was decrease gradually. The contraction on the right nasolabial sulcus was slightly seen. Summary: These report described the reliability, versatility and reproducibility of temporalis muscle flap. The rich vascularized tissue and its proximity to the reconstruction site make this flap reliable. TMF should be taken into consideration before deciding on more extensive reconstructive procedures.

Incomplete Cleft Palate in Cornelia de Lange Syndrome Fortuna, Fory; Kreshanti, Prasetyanugraheni; Handayani, Siti; Bangun, Kristaninta
Jurnal Plastik Rekonstruksi Vol. 2 No. 1 (2013): January Issue
Publisher : Lingkar Studi Bedah Plastik Foundation

Background: Cornelia de Lange Syndrome (CdLS) is a rare congenital anomaly inheritance syndrome. The prevalence is 1.6-2.2/100.000 of 8,558,346 births in Europe. Cleft palate is less frequent malformation of this syndrome (21,7%) than other associated malformations. The diagnosis can be obtained clinically based on CdLS diagnostic criteria by USA CdLS Foundation. This is the first case in our hospital. Patient and Method: A case of a 4-year-old girl who came to our attention at Cleft and Craniofacial Center Cipto Mangunkusumo National General Hospital for incomplete cleft palate. Parents’ major concerns was feeding problem. The clinical investigations showed that the child met diagnostic criteria for CdLS as described in literatures. We manage this case in collaboration with paediatric department and other related specialists, including radiologist and craniofacial orthodontist. We performed Veau-Wardill-Kilner’s palataoplasty for the incomplete cleft palate. Paediatric department arranged provision of dietary. Result: This patient with incomplete cleft palate whom we treated by palatoplasty was moderately involved by CdLS (severity score 17). After 3 weeks follow-up, we have overcome feeding problem and body weight gained. Summary: Patient with CdLS needs early multidisciplinary team approach management for maximum outcome, because variety of associated malformations may present and life-threatening. Diagnostic criteria by USA CdLS Foundation assist health care personnel recognize this syndrome early.

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