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Tetrapod Fracture: Surgical Anatomy Revisited As A Guide For 3D Reduction Using Carroll Girard T-Bar Screw Prasetyanugraheni Kreshanti; Livia Faranita Gianni
Jurnal Plastik Rekonstruksi Vol. 4 No. 1 (2017): January Issue
Publisher : Lingkar Studi Bedah Plastik Foundation

Background: Zygomaticomaxillary complex plays a key role in the structure, function, and aesthetic appearance of the facial skeleton. Using Carroll Girard T-bar screw allows easy manipulation of the zygomaticomaxillary complex fracture. The goal of the treatment is three dimensional (3-D) restoration of the disturbed anatomy. Methods: After exposing the fracture sites using technique such as lower eyelid, Dingman (lateral brow) or maxillary vestibular approach, the Carroll Girard T-bar screw is then attached to the lateral aspect of the malar eminence to freely move the zygoma according to the x,y, and z axis. Zygomaticosphenoid suture acts as the anatomical landmark for adequate reduction. Conclusion: Open reduction and internal fixation is the principle of management in displaced ZMC fractures, aided by the use of Carroll Girard T-bar screw which allows easy manipulation and rotation for the zygomatic bone using the reference axis x, y and z.

Lip Symmetry Evaluation Of The Gentur's Method Compared To Fisher Techniques For Unilateral Cleft Lip Repair Prasetyanugraheni Kreshanti; Muhammad Irsyad Kiat
Jurnal Plastik Rekonstruksi Vol. 4 No. 1 (2017): January Issue
Publisher : Lingkar Studi Bedah Plastik Foundation

Background : Cleft lip and palate are the most common congenital anomalies that were found in plastic surgery. There are so many techniques for unilateral cleft lip repair. Rotation-advancement method by Gentur based on Millard technique has become the most widely used in unilateral cleft lip repair in RSCM. The Fisher technique repair is a modified technique based on approximation of anatomical subunit of the lip. The purpose of this study is to objectively compare and evaluate the lip symmetry of these two techniques. Method : Two senior board-certified plastic surgeons will perform different surgical techniques for the unilateral cleft lip: rotation-advancement technique by Gentur and Fisher technique. This study prospectively analyzed preoperative and postoperative of randomized single blinded patients who underwent unilateral cleft lip repair performed by each surgeon in 2016. Using caliper, facial points on the cleft and non-cleft sides were measured, including height and symmetry of Cupid’s bow, width and height of the nasal vestibule, height of the vermilion, and alar base position. Ratios of cleft side to non cleft side measurements were calculated to standardize comparisons between patients. Result : From July-October 2016, 14 patients performed surgery as preliminary data, showed that there are statistically difference in length of design and surgery time. Preoperative, comparable of cupid’s bow and vermillion showed statistically difference. Although, we found no statistically difference in postoperative ratio. Conclusion : Lip symmetry outcomes after cheiloplasty procedure are same between Gentur method and Fisher technique.

Use of Resorbable Plate and Screws in Pediatric Craniofacial Reconstructive Surgery Prasetyanugraheni Kreshanti; Siti Handayani; Kristaninta Bangun; Melina Tiza
Jurnal Plastik Rekonstruksi Vol. 2 No. 3 (2013): July Issue
Publisher : Lingkar Studi Bedah Plastik Foundation

Background: To evaluate two pediatric patients with syndromic craniofacial anomaly that underwent craniofacial reconstructive surgery using resorbable plate-screw systems which have been claimed as biodegradable fixation materials and used in craniofacial reconstructive procedures owing to their advantages such as adequate biomechanical resistance, longer dwelling time, elimination through physiological routes without causing any foreign body reaction and/or significant sequale. Patient and Method: Resorbable plate-screw systems used in 2 patiens for craniofacial reconstructive procedures such as bilateral fronto-orbital advancement and segmental right orbita (four wall box) osteotomy were evaluated as for their efficacy. Result: Adequate fixation was obtained in both patient, but Infection complication was seen in segmental right orbita osteotomy patient that appear localized abcess formation on subciliary incision and fronto medial insicion. After drainage insicion and antibiotic administration for 1 week, the infection was relieved. Summary: Owing to resorbable copolymer which contain a polyester derivate of L- lactidc and glycolic acid are ideal fixation materials used favourably in pediatric craniofacial reconstructive surgery and have further advantages such as adequate biomechanical resistance against distraction and compression forces in the early postoperative period, longer dwelling time and elimination from the body through physiological routes without causing any foreign body reaction.

Speech Outcome Evaluation Of Cleft Palate Patients Underwent Palatoplasty In Plastic Surgery Division Cipto Mangunkusumo Hospital Indonesia Prasetyanugraheni Kreshanti; Vania Aramita Sari; Grace Wangge; Luh Karunia Wahyuni
Jurnal Plastik Rekonstruksi Vol. 5 No. 1 (2018): January Issue
Publisher : Lingkar Studi Bedah Plastik Foundation

Background: Speech is the primary goal of palatoplasty, however, there is no current data available about the long term speech evaluation after palatoplasty in our hospital which is the national referral hospital that has the only cleft craniofacial center in Indonesia. The initial data of speech outcome is required for further research which assessment should be standardized and applicable to Indonesian children that mostly speak bahasa. This study aims to get initial data by evaluating speech outcome of patients that underwent palatoplasty with adapted perceptual assessment words in Indonesian language, and describe factors influencing speech. Method: This research is a cross-sectional study to evaluate speech outcome of patients underwent palatoplasty in Cipto Mangunkusumo Hospital from October 2010–December 2012 conducted from December 2017 – July 2018. Result: Total 23 samples were measured for articulation rating where 17 (74%) patients had normal production of majority of phonemes, while there were 6 (26%) patients had predominantly distortion of phonemes. The hypernasality rating were normal in 12 (52%) patients, mild in 5 (22%) patients and moderate in 6 (26%) patients. The speech intelligibility rating were dominantly normal which all speech is understood in 17 (74%) patients and the rest of 6 (26%) patients were listeners attention needed. The velopharyngeal competence were good in 16 (70%) patients, fair in 1 (4%) patients and poor in 6 (26%) patients. Conclusion: Management of cleft palate patients will be achieved by well integrated services including speech pathologist and orthodontist. By giving the long term follow up to the patients, the optimal outcomes will be achieved. This research can be used as a reference for speech outcome evaluation in cleft palate patients in Indonesia.

Long Term Evaluation Of Maxillary Growth After ‘The Non Denuded Palatoplasty’ Technique Prasetyanugraheni Kreshanti; Siti Handayani; Maulina Rachmasari; Julieta Pancawati; Amila Jeni Susanto; Grace Wangge; Alita Indania
Jurnal Plastik Rekonstruksi Vol. 5 No. 2 (2018): July Issue
Publisher : Lingkar Studi Bedah Plastik Foundation

Background : Conventional Two Flap Palatoplasty technique will produce lateral defects without any periosteal coverage. These denuded lateral defects are prone to contamination and infection. These will result in wound contraction, scar formation and maxillary growth impairment. In 2011, we studied “The Non Denuded Palatoplasty” technique. This technique precipitated the epithelialization process of the lateral defects. Faster epithelialization is expected to decrease wound contraction and good maxillary growth. Method : This is a case control study to compare the maxillary growth of 2 groups consists of unilateral cleft lip and palate patients repaired with “The Non Denuded Palatoplasty” technique and Conventional Two Flap Palatoplasty. The outcome will be evaluated from cephalometry and the dental cast for each patient is evaluated using GOSLON YARDSTICK method. Data will be analyzed using SPSS version 20. Result : A total of 4 patients in The Non Denuded Palatoplasty group and 10 in the Conventional Two Flap Palatoplasty. The cephalometric SNA, SNB and ANB point showed Class III skeletal jaw relationship or deficient maxilla. Meanwhile the GOSLON yardstick type III are the most common GOSLON on both group with good inter-ratter reliability (p=0.839) based on Mann Whitney test. In these study, there was no correlation between cephalometric variables with GOSLON score. Conclusion: Our results showed that modification (The Non Denuded Palatoplasty) technique made no statistically significant difference to the maxillary growth. However this study has several limitations, one of which being the small sample size due to family, social and other factors that are beyond the control of the investigating team. Also the evaluation was conducted in patients aged 7-9 years, hence the result of this study is not the final outcome. Keywords: maxillary growth evaluation, cephalometry, Goslon Yardstick, two flap palatoplasty

Maxillary Growth Evaluation Of Patients With Unilateral Complete Cleft Lip And Palate After Two Flap Palatoplasty With Honey Oral Drops Prasetyanugraheni Kreshanti; Siti Handayani; Forry Fortuna; Julieta Pancawati; Amila Jeni Susanto; Grace Wangge; Alita Indania
Jurnal Plastik Rekonstruksi Vol. 5 No. 2 (2018): July Issue
Publisher : Lingkar Studi Bedah Plastik Foundation

Background : Honey given as oral drops significantly precipitate epithelialization of the lateral palatal defects post two-flap palatoplasty by 2.1 times. Honey is believed to reduce wound contraction, scar formation, and would contribute as an important factor that will result in a satisfactory maxillary growth. The aim of this study is to evaluate maxillary growth as the long-term effect of rapid epithelialization of the palates treated by honey oral drops. Method : This is a case control study consisting of 2 groups; comparing maxillary growth of the UCCLP patients that were and were not given honey as oral drops following their two-flap palatoplasty in 2011-2012. The cephalometric measurements were recorded and the dental cast are evaluated using GOSLON Yardstick method.Result : This study included a total of 20 patients. Goslon Yardstick type IV are the most frequent GOSLON on both groups (40%) with moderate inter-rater reliability between examiner 1-2 and 2-3 (kappa; 0.583 and 0.512) and substantial between examiner 1-3 (kappa 0.716). Forty-percent of SNA angle in the honey group were considered as normal, while only 20% normal SNA angle were found in the control group.Conclusion: Honey oral drops following two-flap palatoplasty resulted in satisfactory SNA angle. As the completion of maxillary growth occurs at the age of 20, the results of this study would only serve as a preliminary report. Other measures to support maxillary growth should also be taken into account. Further studies are warranted to discover innovations in surgical technique that may be a major contributing factor in maxillary growth. Keywords: Maxillary growth, Two Flap Palatoplasty, honey

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