Labiopalatoschisis

(Cleft Lip and

Palate)

Definisi
Kelainan kongenital
Kegagalan pembentukan pada embryogenesis (6-9 minggu)
Multifactorial umur orang tua, penggunaan narkoba dan infeksi sewaktu
kehamilan, merokok sewaktu kehamilan, riwayat keluarga orofacial clefting
Kemungkinan clefting- riwayat orang tua- 4%

Epidemiologi
1 in 500 live white births
lower in African Americans and higher in Native Americans and Asians
Males predominate within the cleft lip and palate (CLP) group (60-80% of
cases)
mean incidence of cleft lip and palate is 2.1 cases per 1000 live births among
Asians, 1 case per 1000 live births among white people, and 0.41 cases per
1000 live births among black people

Anatomy
Primary palate- anterior incisura foramen- anterior palatum durum (premaxilla), bibir, alveolus, hidung
Secondary palate- posterior incisura foramen- palatum durum (hard palate),
palatum molle (soft palate)

Klasifikasi
Unilateral
Bilateral
Complete- seluruh bibir sehingga ke hidung
Incomplete- sebagian dari bibir, terdapat jaringan yang menjembatani bibir
tengah dengan lateral (simonarts band)

Davis and Ritchie

Group I - Clefts anterior to the alveolus (unilateral, median, or bilateral cleft
lip)
Group II - Postalveolar clefts (cleft palate alone, soft palate alone, soft palate
and hard palate, or submucous cleft)

Veau
Group I Defects of the soft palate only
Group II Defects involving the hard palate and soft palate
Group III Defects involving the soft palate to the alveolus,
usually involving the lip
Group IV Complete bilateral clefts

Penatalaksanaan
Team - surgeon, speech and language pathologist, social worker, craniofacial
orthodontist, geneticist, otorhinolaryngologist, and pediatrician
Pernapasan dan penyusuan- utama
Setelah itu- penanganan pada anomaly tersebut

Penatalaksanaan
presurgical infant orthopedics(PSIO)- prosedur seperti nasoalveolar molding
(NAM)

Penatalaksanaan
3-6 bulan, terapi definitive- repair nasoplasty- bibir dan hidung
9-12 bulan- repair palatum

Unilateral cleft lip

Rotation advancement repair

Bilateral Cleft Lip

Cleft Palate
Gangguan percakapan (speech)
Mencapai- velopharyngeal competence
Cleft palate- velopharyngeal incompetence
Gangguan menyusu
Infeksi telinga
Terapi- sebelum mulai perkembangan berkomunikasi (speech development)
6-18 bulan

Cleft Palate
Unipedicled hard palate mucoperiosteal flaps as in the Wardill-Veau-Kilner
repair
Bipedicled hard palate mucoperiosteal flaps as in the von Langenbeck repair
Soft palate- Z-plasty atau straight-line
Komplikasi Palatoplasty
1.
2.

fistula- breakdown suture line, 1-20%, recurrence 96%

incomplete correction of speech (VPI), 10-40%

TERIMA KASIH