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ANALYSIS OF MAXILLARY FRACTURE PATIENTS PROFILE IN A TERTIARY GENERAL HOSPITAL (2018-2020) I Dewa Gde Daniswara Suarta; Agus Santoso Budi; Rosy Setiawati; Magda Rosalina Hutagalung
Jurnal Rekonstruksi dan Estetik Vol. 8 No. 1 (2023): Jurnal Rekonstruksi dan Estetik, June 2023
Publisher : Universitas Airlangga

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.20473/jre.v8i1.37353

Highlights: Maxillary fractures predominantly affected adult males aged between 18 and 64, comprising 92.36% of the cases studied. The most common type of maxillary fracture observed was Le Fort 3, followed by other Le Fort classes. The preferred treatment method for maxillary fractures was ORIF mini plating, which resulted in favorable outcomes with minimal complications. Abstract: Introduction: The maxilla is a crucial bone in the midface, playing a significant role both functionally and cosmetically. Analyzing the medical records of maxillary fractures at Dr. Soetomo General Academic Hospital would offer an overview of the various treatments used and their corresponding outcomes were the aim of this study. This data would provide a general understanding of the patient’s conditions during maxillary fracture treatment and could potentially support further research in this field. Methods: In this study, data on the profile, treatment, and management of maxillary fractures were taken from patient medical records at Dr. Soetomo General Academic Hospital between 2018 and 2020. Result: The study examined 144 cases of maxillary fractures at Dr. Soetomo General Academic Hospital, analyzing medical records and surgery reports from 2018 to 2020. Most of the patients (92.36%) were adult males (78.47%) aged between 18 and 64. The most common type of maxillary fracture observed was Le Fort 3 (47.22%), while other Le Fort classes accounted for fewer cases. The preferred treatment method was ORIF mini plating (81.25%), and the average hospital stay was around 12.56 days. Only one patient experienced post-treatment malocclusion in the 144 cases. In terms of complications, there were minimal instances of infections and exposed plates, with a total of four cases reported. Conclusion: The treatment outcomes at Dr. Soetomo General Academic Hospital showed lower incidence rates of post-surgical issues like malocclusion, infections, and exposed plates when compared to other current datasets.

MODIFIED CLEFT LIP EVALUATION PROFILE (MCLEP) INDEX FOR UNILATERAL CLEFT LIP REPAIR OUTCOME ASSESSMENT IN SURABAYA CLP CENTER Magda Rosalina Hutagalung; Sitti Rizaliyana
Jurnal Rekonstruksi dan Estetik Vol. 5 No. 1 (2020): Jurnal Rekonstruksi dan Estetik, June 2020
Publisher : Universitas Airlangga

Highlights: The study revealed that there were no notable variations in the ultimate scores, regardless of whether the cleft lip was complete or an alveolar cleft was present. If the palate cleft was not present, unilateral cleft lip repair yielded considerably superior results, showing enhancements in both total lip and nose scores. Abstract: Introduction: Cleft lip and/or palate is the most common craniofacial congenital anomaly encountered by the plastic surgeon. Both reconstruction and outcome assessment are challenging. This study aimed to assess the outcome of unilateral cleft lip repair in the Surabaya CLP Center. Methods: All patients who underwent unilateral cleft lip repair in 2017 were included in the study. Those without complete photographs at minimally 52 weeks after surgery were excluded. The photographs of patients taken at least one-year post-surgery were assessed using a modified cleft lip evaluation profile (MCLEP) index. The data were then analyzed using statistical software. Results: There were 38 subjects included in the study. There was no significant difference in the final scores obtained based on completeness of the cleft lip and the presence of alveolar cleft. The total nose score was significantly better in the left side cleft (p = 0.002). When palate cleft was absent, the total lip score (p= 0.038), the total nose score (p = 0.008), and total score (p = 0.000) were also significantly better. Conclusion: The unilateral cleft lip repair in CLP Center Surabaya yielded good and symmetrically acceptable results. The study failed to observe the different outcomes of unilateral cleft lip repair based on completeness of the cleft lip and the presence of alveolar cleft. However, the unilateral cleft lip repair outcome was significantly better in the absence of palate cleft.

EFFICACY OF AMNIOTIC MEMBRANE MESENCHYMAL STEM CELL THERAPY FOR BURN WOUNDS: META-ANALYSIS STUDY Bayu Fasi Bermani; Agus Santoso Budi; Magda Rosalina Hutagalung
Jurnal Rekonstruksi dan Estetik Vol. 5 No. 1 (2020): Jurnal Rekonstruksi dan Estetik, June 2020
Publisher : Universitas Airlangga

Highlights: The healing potential of stem cell therapy for burn wounds, primarily attributed to angiogenesis and anti-inflammatory effects. AM-MSC therapy has a beneficial impact on burn wound healing, particularly by promoting angiogenesis and reducing inflammation. Abstract: Introduction: Burn injury is a trauma with high morbidity and mortality that requires special management from the start. stem cells have generated great hopes for the treatment of numerous conditions including burns. The Metaanalysis was performed for these preclinical studies to assess the efficacy and possible mechanisms of Amniotic Membrane Mesenchymal Stem Cell (AM- MSC) in treating burn wounds. Methods: Seven studies identified by searching PubMed, MEDLINE, databases from inception to October 2020. In addition, a manual search of references of studies was performed to obtain potential studies. Stata 16 was used for all data analysis. Results: The overall meta-analysis showed that AM-MSC therapy significantly improved burn healing rate (SMD 3.34, 95% CI 1.82 to 4.86), irrespective of transplant type, burn area, and treatment method in the control group. Conclusions: Meta-analysis showed that AM-MSC therapy exerts appears to exert a positive effect in burn wound healing, mainly through angiogenesis and anti- inflammatory actions. There is, therefore, justification for continued efforts to evaluate variations in future clinical studies using stem cells to treat a burn wound in order to maximize the effectiveness. the use of stem cells as an adjunct to first- line therapies in burns.

SUCCESSFUL PHARYNGOPLASTY AFTER LE FORT I ADVANCEMENT IN A SEVERELY NEGLECTED CLEFT LIP AND PALATE PATIENT Timotius Hansen Arista; Magda Rosalina Hutagalung
Jurnal Rekonstruksi dan Estetik Vol. 4 No. 1 (2019): Jurnal Rekonstruksi dan Estetik, June 2019
Publisher : Universitas Airlangga

Highlights: In a seriously neglected case, pharyngoplasty to a certain extent as a correction treatment of VPI was reliable. A posterior pharyngeal flap was seccessful to recover significant speech capacity. Abstract: Introduction: When indicated, velopharyngeal insufficiency (VPI) is treated with pharyngoplasty with consideration of patient’s age. Several studies have evaluated the relationship between age at surgery and speech outcome. The best results regarding reduction of open nasality were obtained when surgeries were performed around age of 5 to 6 years and operative complications were also less frequent in the younger age group than in older patients. Pre-operative assessment such as nasopharyngoscopy and/or videofluoroscopy gives surgeons a chance to estimate flap dimension to correct the defect causing the VPI. Moreover, velopharyngoplasty proceeded with speech therapy yields better recovery. Case Illustration: A seriously neglected case of cleft lip and palate was reported. A 24 years old female underwent two palatorrhaphy at age 13 and 14 years old, which were far beyond the recommended age of 10 –12 months. The resulting hypernasality was further worsened by absence of speech therapy which should have been followed from age 1–4 years old. On presentation, this patient requested to have immediate orthognatic surgery to repair his severe type 3 facial profile and malocclusion, a procedure which he underwent worsening the VPI. We decided to surgically correct the VPI. Discussion: Nasoendoscopic assessment revealed he had an antero-posterior velopharyngeal closure problem which indicated a pharyngoplasty using a superiorly- based pharyngeal flap. Three months post-operatively his speech was re-evaluated by a speech therapist and nasoendoscopically. Despite imperfectness, significant improvement was achieved. Conclusions: Pharyngoplasty could still be reliable to a certain extent as a correction treatment of VPI in a seriously neglected case. A posterior pharyngeal flap helped this patient to recover significant speech capacity.

THE EFFECT OF PROPANOLOL ON C-REACTIVE PROTEIN IN PATIENTS WITH SEVERE BURNS AT DR. SOETOMO GENERAL ACADEMIC HOSPITAL, SURABAYA, INDONESIA Muhammad Aulia U H; Iswinarno Doso Saputro; Magda Rosalina Hutagalung
Jurnal Rekonstruksi dan Estetik Vol. 4 No. 1 (2019): Jurnal Rekonstruksi dan Estetik, June 2019
Publisher : Universitas Airlangga

Highlights: The biochemical marker of inflammation and suggests a potential mechanism through which propranolol affects hypermetabolism in burn patients. The administration of propranolol giving effectivity of hypermetabolism which is characterized by decreasing in CRP levels. Abstract: Introduction: The incidence of burns in Indonesia progressively increases with the increase in its population and industries. From January to September 2000, 158 patients were treated in the burn unit of Dr. Soetomo General Academic Hospital with a mortality rate reaching 5.8%. Burns have a direct effect in causing both local and systemic changes in the body, not occurring in other injuries. In severe burns, a hypermetabolic state can occur, which increases cardiac workload and causes muscle atrophy and other morbidities. The purpose of this study is to examine the effect of propranolol on the hypermetabolic state in severely burned patients by measuring various clinical & laboratory parameters. Methods: This is an experimental study using pre and post test control group design with the objective of assessing the treatment outcome with oral propranolol given in 15 consecutive days for burn patients involving 25%- 60% TBSA. Measurements were taken three times, on day 0.7 and 14. Discussion: Obtained 16 samples divided into 2 groups. In the treatment group, there was a significant decrease in CRP levels on days 0.7 and 14 (p <0.05). The Mid Arm Circumference variable did not obtain a significant decreasing on days 0.7 and 14. The albumin level studied showed a significant decreasing on day 0 & 7 days with a value of p=0.045. From the comparison between the two groups, there were significant differences in CRP levels on days 0 & 14, with the mean value of the treatment group -5.12 + 2.88 and the mean value of the control group 2.86 + 7.37, and the value of p = 0.019. Conclusions: This study successfully proved that the administration of propranolol can overcome the effects of hypermetabolism which is characterized by decreasing in CRP levels.

ORTHOGNATHIC SURGERY COMBINED WITH ORTHODONTIC TREATMENT IN A PATIENT WITH BILATERAL CLEFT LIP, PALATE AND ALVEOLUS, WITHOUT ALVEOLAR BONE GRAFT: A CASE REPORT Yudi Siswanto; Magda Rosalina Hutagalung; Jusuf Sjamsudin
Jurnal Rekonstruksi dan Estetik Vol. 3 No. 1 (2018): Jurnal Rekonstruksi dan Estetik, June 2018
Publisher : Universitas Airlangga

Highlights: The orthognathic surgery combined with orthodontic intervention, leads to positive functional and aesthetic outcomes in individuals diagnosed with bilateral cleft lip and palate. It emphasizes the continued importance of adhering to the standard protocol, including alveolar bone grafting before permanent canine eruption, to achieve optimal outcomes. Abstract: Introduction: The incidence of cleft lip and palate is 8 in every 10,000 live births. A patient with this condition experiences a deficiency in maxillary growth. Maxillary hypoplasia leads to malocclusion and skeletal disharmony. Orthognathic surgery at skeletal maturity is the standard procedure at the end of the protocol to correct maxillary hypoplasia resulting in malocclusion not correctable with orthodontics alone. Case Illustration: We report the result of orthognathic surgery performed on a 23 year old male with complete bilateral cleft lip, palate, and alveolus. We proceeded with bimaxillary surgery despite the alveolar cleft. We also recorded a neglected alveolar cleft in which he should have had undergone alveolar bone graft prior to the current procedure. The pre-maxillary segment was stabilized with miniplate followed by Le Fort 1 advancement and mandibular setback guided by an occlusal wafer. Malar augmentation was done by onlay bone grafts. Mandibulo-maxillary fixation was maintained. Postoperatively, a good occlusion and better facial harmony were achieved. He was planned to undergo a septorhinoplasty in the near future. Discussion: Despite adequate treatments following the protocol recommended by many centres, some patients developed some degree of maxillary hypoplasia. A quarter of this population need osteotomies and Le Fort I maxillary osteotomy is the most common procedure to correct retrognathic maxilla. Conclusion: Orthognathic surgery combined with orthodontic treatment in a patient with bilateral cleft lip and palate provided good functional and aesthetic result. However, this procedure cannot replace the standard protocol of having an alveolar.

PALATAL FRACTURE FIXATION ON SEVERE PANFACIAL FRACTURE: IS THERE ANY CLINICAL SIGNIFICANCE? Arif Tri Prasetyo; Magda Rosalina Hutagalung; Lobredia Zarasade
Jurnal Rekonstruksi dan Estetik Vol. 3 No. 1 (2018): Jurnal Rekonstruksi dan Estetik, June 2018
Publisher : Universitas Airlangga

Highlights: A panfacial fracture patient received effective surgical treatment, with a primary focus on aligning the upper jaw arch by addressing the hard palate through various surgical methods. Palate fractures, while relatively rare, require plate stabilization and can lead to challenges such as teeth misalignment and wound issues. Abstract: Introduction: Fractures of the hard palate are infrequent. They are found in less then 10% of patients with midfacial fractures. They practically never occur in isolation and are usually part of alveolar process fractures or more complex midfacial fractures of the Le Fort type. Treatment of palatal fractures is planned and performed with the goal of restoring the transverse width of the palate, the anteroposterior projection of the maxillary arch, and the patient’s pretraumatic occlusal plane, as well as maintaining horizontal stability of the midface. Case Illustration: Reporting patient female 17 years old with panfacial fracture due to traffic accident. There was slight epidural haemorrhage on frontal area. The fractures are on upper face, midface, and lower face including the hard palate. We performed open reduction internal fixation on palate to correct the arch of the upper jaw. The other fracture site can be corrected easier. The approaches that we done are bicoronal, subsilier, and intraoral. Discussion: In a case of severe panfacial fracture with upper jaw misalignment and an existing laceration, we opted to use miniplates for palatal fixation without making new incisions. Palate fractures are relatively uncommon and are associated with significant rates of malocclusion and wound complications. These injuries are typically managed with plate fixation of the alveolar ridge with variable approaches to the palatal vault. Conclusion: The patient was successfully treated using bottom-up and outside-in sequence by accessing all facial injuries. Postoperatively, radiograph examination revealed good reduction and fixation of titanium plates, and physical examination revealed good functional and aesthetic outcomes. However, it's important to note that there's a risk of osteosynthesis material exposure in the future.

SURGICAL TECHNIQUE FOR COMPLEX SYNDACTYLY IN APERT SYNDROME: A SERIAL CASE Williams Mesang; Agus Santoso Budi; Magda Rosalina Hutagalung
Jurnal Rekonstruksi dan Estetik Vol. 4 No. 2 (2019): Jurnal Rekonstruksi dan Estetik, December 2019
Publisher : Universitas Airlangga

Highlights: Complex syndactyly in Apert syndrome, particularly when complicated with synonychia and synostosis, poses a significant surgical challenge. Successful surgical techniques for Apert syndrome syndactyly are crucial to achieving these goals. Abstract: Introduction: Complex syndactyly in Apert syndrome, especially complicated with synonychia and synostosis, is a surgical challenge. The incidence of Apert Syndrome is reported to be approximately 1 per 100,000 to 160,000 live births and its incidence in Indonesia is not yet known. It is practically symmetrical causing significant dysfunction and infection if not treated properly. The goals in the treatment are the separation of independent digits without disturbing function and growth, the creation of a lined commissure, the provision of skin cover for the denuded nail edge and exposed bone, and to creation of aesthetically pleasing individual fingertips with proper nails, nail folds, and adequate pulp fullness. This is due to the unreliability of the vascular branching pattern to the digits. Case Illustration: In this serial case, we reported 5 cases of Apert syndrome. We described the clinical findings, incision design, immediate and post-surgery follow-ups. Discussion: In this case, we combined dorsal rectangular flap and palmar triangular flap to make a new web space, Buck Gramcko pulp flap for the nail fold reconstruction, and full thickness skin graft w was taken from the groin to cover the raw areas. Absorbable 5.0 simple interrupted sutures were used in each patient. The results were uneventful, with satisfying function and aesthetic appearance. Conclusion: Choosing the best surgical technique for releasing the web space in syndactyly depends on the patient’s condition and the plastic surgeon’s decision was needed. In 5 patients, up there was no meaningful complication attained from the postoperative result.

SEVERE CONSTRICTED HEAD – AN EXTREME FORM OF CROUZON SYNDROME POSING CHALLENGING FRONTO-ORBITAL ADVANCEMENT: A CASE SERIES REPORTS Ciptomurti Lupitasari; Lobredia Zarasade; Magda Rosalina Hutagalung
Jurnal Rekonstruksi dan Estetik Vol. 4 No. 2 (2019): Jurnal Rekonstruksi dan Estetik, December 2019
Publisher : Universitas Airlangga

Highlights: Severe Constricted Head in Crouzon Syndrome. Complex surgical interventions to address severe craniofacial abnormalities in Crouzon syndrome. Abstract: Introduction: Constricted head or cloverleaf deformity in Crouzon syndrome is a severe form of the syndrome involving trilobed coronal and lambdoid synostosis. Crouzon syndrome with acanthosis nigricans is distinct from the classic Crouzon syndrome, characterized by thick and dark skin in body folds. The major problems resulting from constricted head are related to craniostenosis, orbitostenosis developing from abnormalities of the skull base associated with progressive rise in intracranial and intraorbital pressures which could progress to hydrocephalus and cerebellar herniation. Case Illustration: Two cases with severe Crouzon syndrome were reported. The first was a five month old girl associated with acanthosis nigricans and the other was a sixteen month old boy, both whose phenotypic expressions were at the extreme severe end of the disease spectrum. On examination there was serious corneal exposure, visual loss, severely narrow head, midface hypoplasia, and beaked nose. CT scan showed typical cloverleaf skull, expanded middle cranial fossa, foreshortened anterior and posterior fossae and honeycomb appearance in the occiput involving pansutural synostosis and extensive copper beaten deformity from the high intracranial pressure . Both were complicated with hydrocephalus requiring ventricul operitoneal shunt. Discussion: This required an arduous effort in releasing the brain from the multiply punctured calvaria, avoiding excessive dural tear and bleeding and ultimately preserving the brain. Excessive bleeding was also caused by the raised ICP. Both patients are planned to undergo occipital expansion three months later. Conclusion: Severely constricted head in Crouzon syndrome is an extreme manifestation and late stage of the syndrome which not only will result in irreversible complication but will require meticulous surgical technique.

DETEKSI KADAR TRANSFORMING GROWTH FACTOR (TGF-β) PADA LUKA AKUT Pratidina Wulandari; Magda Rosalina Hutagalung
Jurnal Rekonstruksi dan Estetik Vol. 6 No. 1 (2021): Jurnal Rekonstruksi dan Estetik, Juni 2021
Publisher : Universitas Airlangga

Highlights: Peningkatan kadar TGF-β dalam fase proliferasi luka dapat berperan dalam stimulasi fibroblas untuk menghasilkan lebih banyak kolagen dalam pembentukan jaringan parut. Kadar TGF-β pada luka akut kulit tikus menunjukkan adanya peningkatan yang signifikan dari fase inflamasi ke fase proliferasi dengan nilai p=0,003. Abstrak: Latar Belakang: TGF-β merupakan faktor pertumbuhan yang paling dominan dalam peningkatan sintesis kolagen, memiliki peran utama pada penyembuhan luka dengan menstimulasi fibroblas sehingga menimbulkan penyembuhan dan berperan serta dalam pembentukan parut, baik itu parut normal maupun abnormal seperti parut hipertrofik dan keloid. Penelitian ini bertujuan untuk mengukur kadar TGF-β pada fase penyembuhan luka. Metode: Penelitian eksperimental ini menggunakan randomized post test only control group design. Dua belas luka akut kulit tikus dirandomisasi menjadi dua kelompok, dimana kelompok 1 diambil spesimen pada hari ke-5 dan kelompok 2 pada hari ke-21 dan dilakukan pemeriksaan ELISA untuk mengukur kadar TGF-β. Hasil: Pengukuran kadar TGF-β pada luka akut kulit tikus didapatkan jumlah yang meningkat secara signifikan dari hari ke-5 (fase inflamasi) ke hari ke-21 (fase proliferasi) dengan nilai p=0,003. Kesimpulan: Terjadi peningkatan kadar TGF- β pada akhir fase proliferasi atau awal fase remodelling. Hal ini menyebabkan peningkatan proliferasi fibroblas untuk mensintesis kolagen yang nantinya dapat menjadi parut hipertrofik dan keloid.

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