LABIOSKISIS DAN PALATOSKISIS

P E M B I M B I N G : D R . U TA M A A B D I TA R I G A N , S P. B P - R E ( K )
INTRODUCTION
 A cleft lip and palate is a type of birth defect that affects the upper lip and the roof of the
palate.
 During the 6th to 10th week of pregnancy, the bones and tissues of a baby’s upper jaw,
nose, and mouth normally fuse to form the palate and the upper lip.
 If the tissue in the developing mouth and the palate don’t fuse together  cleft lip or cleft
palate.
 Cleft lip and palate are the one of the commonest group of congenital malformations
affecting the head and neck.
INSIDENSI DAN EPIDEMIOLOGI

 The incidence of cleft lip with or without cleft

palate is approximately 1 in 750 white births;
 the incidence of cleft palate alone is approximately
1 in 2,500 white births.
 Clefts of the lip are more common in males
EMBRYOLOGY
V
 ETIOLOGY
 The exact cause of clefting is unknown.
 Multifactorial etiology: chemical exposures, radiation, maternal
hypoxia, teratogenic drugs (steroid, phenytoin, diazepam), nutritional
deficiencies, physical obstruction, or genetic influences.
 Some of these genes include the MSX, LHX, goosecoid, and
DLX genes.
 Genetic factors (ie, genes participating in the etiology of nonsyndromic orofacial
clefts) are passed to the next generation, thus creating an increased risk for such
anomaly in offspring. The risk of recurrence also differs with respect to proportion of
genetic and nongenetic factors.
 DEFECTS IN CLEFT LIP AND PALATE PATIENTS
Deformities:
1. Dental Problems: Number, Shape, Eruption, Mineralization.
2. Skeletal Problems: Max. deficiency, Mand. Prognth, Class III Occlusion.
3. Nasal problems: Alae flared, Columella pulled to non cleft side.
4. Feeding Problems: Nasal Regurg, Weak sucking, Weak swallowing reflux.
5. Ear Problems: Recurrent Middle Ear infection, Possible Deafness
6. Speech Problems: Retardation of consonants, Hypernasality, Articulation
Defects, Hearing problem
7. Associated Anomalies: Congenetal heart defects, Mental retardation
TREATMENT

 Multidisciplinary

•Pediatrician •Geneticist •Social worker

•Nurse practitioner •Genetic counselor •Psychologist
•Plastic surgeon •Speech pathologist
•Pediatric dentist •Orthodontist [44]
•Otolaryngologist •Maxillofacial surgeon
 Newborn –
 Diagnostic examination, general counseling of parents, feeding instructions,
palatal obturator (if necessary); genetic evaluation and specification of
diagnosis; empiric risk of recurrence of cleft calculated; recommendation of
a protocol for the prevention of a cleft recurrence in the family
•Age 3 months - Repair of CL (and placement of ventilation tubes)
•Age 6 months - Presurgical orthodontics, if necessary; first
speech evaluation
•Age 9 months - Speech therapy begins
•Age 9-12 months - Repair of CP (placement of ventilation tubes if
not done at the time of CL repair)
•Age 1-7 years - Orthodontic treatment
•Age 7-8 years - Alveolar bone graft
•Older than 8 years - Orthodontic treatment continues
The most common surgical procedures for a child with a CLP anomaly are as follows:
 Repair of the CL
 Repair of the CP
 Revision of the CL
 Closure and bone grafting of the alveolar cleft
 Closure of palatal fistulae
 Palatal lengthening
 Pharyngeal flap
 Pharyngoplasty
 Columellar lengthening
 Cleft lip rhinoplasty and septoplasty
 Lip scar revision
 LeFort I maxillary osteotomy