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PUSAT PELAYANAN TERPADU SUMBING
BIBIR DAN LANGIT- LANGIT
CLP CENTRE
Fakultas Kedokteran UMM
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Definition of CLP
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Introduction
A TEAM APPROACH IS REQUIRED
Anesthetician
Pediatrician
Orthodontist
ENT
Psychiatrist
Speech therapist
Nurse coordinator
Social worker
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Introduction
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Epidemiology
Syndromic CLAP
Nonsyndromic CLAP
diagnosis of exclusion
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Apert Syndrome
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Embryology
Primary versus secondary palate
divided by incisive foramen
primary palate develops 4-5 wks
secondary palate develops 8-9 wks
Primary palate
mesodermal proliferation of frontonasal and maxillary
processes
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Secondary palate
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Anatomy- normal
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Topography of the lip
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Anatomy palatal muscle
Muscles
Superior constrictor
primary sphincter
tenses palate
elevates palate
dilates ET
Salpingopharyngeus,
palatopharyngeous, palatoglossus:
minor contribution
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Cleft anatomy
lack of mesodermal
proliferation
cleft of orbicularis
medial portion to
columella
cleft of alveolus
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The nose
flattened
rotated downward
Short columella
Bifid tip
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Bilateral incomplete cleft
Simonart band
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Clefts of the primary
hard palate/alveolus
By definition there is
opening into nose
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Clefts of secondary palate
fusion at incisive
foramen
macroglossia
Vomer
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Bilateral Cleft Lip/Alveolus/nose
duplication of unilateral
defect
premaxilla
orbicularis to alar
cartilages bilaterally
bifid tip
Vomer
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Classification
Veau Classification - 1931
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Complete Clefts
vomer exposed
Incomplete Clefts
ex: submucous cleft (midline diasthasis, hard palatal notch, bifid uvula)
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Otto Kriens
Complete : L
Incomplete : l
Microform :(l)
L A H S H A L
28 9/15/14
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29 9/15/14
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Neonatal period
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Surgical Repair
Cleft Lip
Cleft Palate
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Toddler - years
Priority: Speech
Velopharyngeal insufficiency
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The School Grade Year
Three primary issues
Orthodontics
poor occlusion
psychological growth
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Teenage years
Midface retrusion
surgical correction Le Fort I (mid facial
advancement) osteotomies around age 18
Rhinoplasty
usually last procedure performed, around age 20
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Conclusion and future
direction
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