HASIL PENELITIAN

HUBUNGAN ANTARA TINGKAT KEPARAHAN SUMBING

BIBIR BILATERAL TERHADAP KUALITAS SCAR PASCA OPERASI

DI CLEFT LIP PALATE CENTER FAKULTAS KEDOKTERAN

UNIVERSITAS MUHAMMADIYAH MALANG TAHUN 2011-2017

Oleh :

ALFIANI RAHMI MUKTI

201410330311069

FAKULTAS KEDOKTERAN

UNIVERSITAS MUHAMMADIYAH MALANG

2018

HASIL PENELITIAN

HUBUNGAN ANTARA TINGKAT KEPARAHAN SUMBING

BIBIR BILATERAL TERHADAP KUALITAS SCAR PASCA OPERASI

DI CLEFT LIP PALATE CENTER FAKULTAS KEDOKTERAN

UNIVERSITAS MUHAMMADIYAH MALANG TAHUN 2011-2017

KARYA TULIS AKHIR

Diajukan kepada Universitas Muhammadiyah Malang

Untuk Memenuhi Salah Satu Persyaratan Dalam Menyelesaikan Program Sajarna

Fakultas Kedokteran

Oleh :

Alfiani Rahmi Mukti

201410330311069

FAKULTAS KEDOKTERAN

UNIVERSITAS MUHAMMADIYAH MALANG

2018

ii

PERNYATAAN ORISINALITAS

Karya tulis akhir ini adalah karya saya sendiri, dan semua sumber baik yang

dikutip maupun dirjuk telah saya nyatakan dengan benar.

Nama : Alfiani Rahmi Mukti

NIM : 201410330311069

Malang, 03 Agustus 2018

Alfiani Rahmi Mukti

iv

KATA PENGANTAR

Alhamdulillah dengan memanjatkan puji dan syukur kehadirat Tuhan

Yang Maha Esa serta dengan berkat dan rahmat-Nya sehingga tugas akhir

penulis dengan judul “Hubungara Antara Tingkat Keparahan Sumbing Bibir

Bilateral Terhadap Kualitas Scar Pasca Operasi” dapat terselesaikan dengan

baik. Segala sesuatu yang benar dalam tugas akhir ini datang dari Allah SWT

dan segala kekeliruan dalam penulisan ini datangnya dari diri penulis sendiri.

Dalam penyelesaian tugas akhir ini penulis banyak mengalami kesulitan,

tetapi berkat dukungan, bimbingan, dan bantuan dari dosen pembimbing

dalam rangka penyusunan dan dorongan serta ide-ide dari berbagai pihak

akhirnya penulis dapat menyelesaikan tugas akhir ini tepat pada waktunya.

Penulis menyadari bahwa karya tulis akhir ini belum sempurna, sehingga

masih membutuhkan saran dari berbagai pihak. Penulis berharap skripsi ini

dapat menjadi wujud ibadah penulis kepada Zat Yang Maha Mengetahui lagi

Bijaksana dan dapt memberikan manfaat bagi para pembaca.

Malang, 03 Agustus 2018

Penulis

v

UCAPAN TERIMA KASIH

Pada kesempatan ini penulis menyampaikan terima kasih yang sebesar-

besarnya kepada:

1. Dr.dr. Meddy Setiawan, Sp.PD, selaku Dekan Fakultas Kedokteran

Universitas Muhammadiyah Malang.

2. dr. Moch. Ma’roef, Sp.OG, selaku Pembantu Dekan I Fakultas

Kedokteran Universitas Muhammadiyah Malang.

3. dr. Sri Adila Nurainiwati, Sp.KK, selaku Pembantu Dekan II Fakultas

Kedokteran Universitas Muhammadiyah Malang.

4. dr. Indra Setiawan, Sp.THT, selaku Pembantu Dekan III Fakultas

Kedokteran Universitas Muhammadiyah Malang.

5. dr. Ruby Riana Asparini, Sp.BP-RE, selaku dosen pembimbing I saya

yang telah meluangkan waktu dan penuh kesabaran memberikan

bimbingan, inspirasi, dan masukan yang sangat membantu dalam

menyelesaikan tugas akhir ini dengan baik.

6. dr. Bambang Mulyawan, Sp.A, selaku dosen pembimbing II saya yang

telah memberikan waktu, motivasi, dan masukan dalam menyelesaikan

tugas akhir ini.

7. dr. Desy Andari, M.Biomed M.Si, selaku penguji yang telah

meluangkan waktu dan memberikan masukan untuk menyelesaikan

tugas akhir ini.

vi

8. dr. Irma Nur Sukmawati, selaku pembimbing MEARS yang telah

memberikan motivasi dan masukan dalam menyelesaikan tugas akhir

ini.

9. Kedua orang tua dan kedua kakak saya, Bapak Abdul Mukti dan Ita

Mustofa, Ach. Fahrur Rozi M., Moh. Irsyadul Fuad Jamhari M. yang

telah memberikan dukungan moral dan materi, kasih sayang, motivasi,

serta limpahan doa yang tiada henti dipanjatkan untuk saya selama ini.

10. Latifa Dinar Nur Indraswari, Anita Rosalina, Jihan Enggar Safira, Era

Zulia Samsa, Nur Fauziah Aulia, Sabrina Annisa, Intan Permata

Balqis, Bonanza Vidya Rashmi Nugroho, Amira, Laelatun Nafillah,

Pangastutik Santikrama, Sabrina Azima, selaku sahabat saya yang

selalu menegur saya ketika salah, memberikan semangat, motivasi,

pengalaman hidup, dukungan dan bantuan dalam segala hal yang tidak

dapat disebutkan, tempat berbagi keluh kesah serta kebahagiaan.

11. Laelatun Nafillah, Pangastutik Santikrama, Sabrina Azima, Arina

Makina, Nina Dwivo Ratnasari, Sabrina Annisa, Desva Arianti

Manurung, Erika Yulisusanti, dan Hajijah Zulaikha selaku teman

penelitian CLP yang telah memberikan ide, bantuan, motivasi, dan

semangat dalam penyelesaian tugas akhir ini.

12. Seluruh teman-teman angkatan 2014 yang tidak bisa saya sebutkan

satu persatu. Terima kasih atas segala bantuan dan motivasi selama

perkuliahan. Semoga ilmu yang telah kita dapat dapat bermanaat bagi

agama, bangsa, dan negara, aamiin.

vii

13. Para dosen pengajar di Fakultas Kedokteran Universitas

Muhammadiyah Malang yang dengan ikhlas dan penuh kesabaran

mendidik, memberikan bekal ilmu, dan pengalamannya.

14. Mas Nyono, Mas Miftah, Mbak Nuke, Mbak Citra, Ibu Fat, Mas Didit,

Pak Yono, Mas Heri, Pak Joko, Mas Joko, Mas Iwan, Mbak Dila

,Mbak Lia, serta para staf Fakultas Kedokteran Universitas

Muhammadiyah Malang yang telah memberi motivasi, nasihat, dan

telah membantu dalam kelancaran penyelesaian proses skripsi ini.

15. Mbak Deva dan Mas Dul, selaku staf MERS Fakultas Kedokteran

Universitas Muhammadiyah Malang yang telah memberi ilmu,

motivasi, nasihat dan telah banyak membantu dalam kelancaran

penyelesaian proses skripsi ini.

16. Mbak Niken, selaku staf rekam medis CLP Center Fakultas

Kedokteran Universitas Muhammadiyah Malang

17. Semua pihakyang turut membantu dalam penyelesaian karya tulis

akhir ini dan mendoakan demi suksenya karya tulis ini yang tidak bisa

penulis sebutkan satu-persatu.

x

DAFTAR ISI

LEMBAR PENGESAHAN ............................................................................... i

LAPORAN HASIL PENELITIAN .................................................................... i

PERNYATAAN ORISINALITAS ................................................................... ii

LEMBAR PENGUJIAN .................................................................................. iii

KATA PENGANTAR ..................................................................................... iv

UCAPAN TERIMA KASIH ............................................................................. v

ABSTRAK ..................................................................................................... viii

ABSTRACT ..................................................................................................... ix

DAFTAR ISI ..................................................................................................... x

DAFTAR TABEL .......................................................................................... xiv

DAFTAR GAMBAR ...................................................................................... xv

DAFTAR SINGKATAN ............................................................................... xvi

DAFTAR LAMPIRAN ................................................................................. xvii

BAB 1 PENDAHULUAN ................................................................................ 1

1.1 Latar Belakang .................................................................................. 1

1.2 Rumusan Masalah ............................................................................. 3

1.3 Tujuan Penelitian .............................................................................. 3

1.3.1 Tujuan umum .............................................................................. 3

xi

1.3.2 Tujuan khusus ............................................................................. 3

1.4 Manfaat Penelitian ............................................................................ 4

1.4.1 Manfaat Klinis ............................................................................ 4

1.4.2 Manfaat Akademis ...................................................................... 4

1.4.3 Manfaat Masyarakat ................................................................... 4

BAB 2 TINJAUAN PUSTAKA ....................................................................... 5

2.1 Rongga Mulut.................................................................................... 5

2.1.1 Embriologi Rongga Mulut .......................................................... 5

2.1.2 Anatomi Rongga Mulut .............................................................. 8

2.2 Sumbing Bibir ................................................................................. 10

2.2.1 Pembentukan Sumbing Bibir .................................................... 10

2.2.2 Faktor Resiko Sumbing Bibir ................................................... 11

2.2.3 Klasifikasi Sumbing Bibir Berdasarkan Letak Sumbing Bibir 15

2.2.4 Klasifikasi Sumbing Bibir Bilateral Berdasarkan Tingkat

Keparahan ................................................................................. 16

2.3 Teknik Operasi Linear (Straight Line Closure) .............................. 17

2.4 Penyembuhan Luka ......................................................................... 18

2.4.1 Inflamasi ................................................................................... 18

2.4.2 Proliferasi.................................................................................. 19

2.4.3 Remodeling ............................................................................... 19

xii

2.4.4 Pembentukan Jaringan Parut .................................................... 20

2.5 Faktor Menghalangi Penyembuhan luka ......................................... 21

2.6 Kualitas Scar ................................................................................... 22

BAB 3 KERANGKA KONSEP DAN HIPOTESIS ....................................... 25

3.1 Kerangka Konsep ............................................................................ 25

3.2 Hipotesis .......................................................................................... 26

BAB 4 METODE PENELITIAN.................................................................... 27

4.1 Jenis Penelitian ................................................................................ 27

4.2 Lokasi dan Waktu Penelitian .......................................................... 27

4.3 Populasi dan Sampel ....................................................................... 27

4.3.1 Populasi .................................................................................... 27

4.3.2 Sampel ...................................................................................... 27

4.3.3 Teknik Pengambilan Sampel .................................................... 27

4.3.4 Karakteristik Sampel Penelitian ............................................... 28

4.3.5 Variabel Penelitian ................................................................... 28

4.3.6 Definisi Oprasional ................................................................... 28

4.4 Instrumen Penelitian........................................................................ 30

4.5 Prosedur Penilitian .......................................................................... 31

4.5.1 Alur Penelitian .......................................................................... 31

4.5.2 Proses Pengumpulan Data ........................................................ 31

xiii

4.6 Analisis Data ................................................................................... 32

BAB 5 HASIL PENELITIAN DAN ANALISIS DATA ............................... 33

5.1 Hasil Penelitian ............................................................................... 33

5.1.1 Klasifikasi Tingkat Keparahan Pasien Sumbing Bibir Bilateral

………………………………………………………………..33

5.1.2 Karakteristik Hypertrophy Pasien Sumbing Bibir Bilateral..... 34

5.1.3 Karakteristik Discoloration Pasien Sumbing Bibir Bilateral ... 34

5.1.4 Karakteristik Spreading Pasien Sumbing Bibir Bilateral......... 35

5.1.5 Karakteristik Suture Mark Pasien Sumbing Bibir Bilateral ..... 35

5.2 Hasil Uji Analisis ............................................................................ 36

5.2.1 Hasil Analisis Tingkat Keparahan Sumbing Bibir Bilateral

Dengan Uji Korelasi Spearman ................................................ 36

BAB 6 PEMBAHASAN ................................................................................. 37

BAB 7 KESIMPULAN DAN SARAN........................................................... 42

7.1 Kesimpulan ..................................................................................... 42

7.2 Saran ................................................................................................ 42

DAFTAR PUSTAKA ..................................................................................... 43

LAMPIRAN .................................................................................................... 49

xiv

DAFTAR TABEL

Tabel 2.1 Indikator Kualitas Scar……………………………………………22

Tabel 5.1 Klasifikasi Tingkat Keparahan Pasien Sumbing Bibir Bilateral .... 33

Tabel 5.2 Hasil Penilaian Hypertrophy Sisi Kanan Dan Kiri Bibir Pasien

Sumbing Bibir Bilateral Pasca Operasi .......................................................... 34

Tabel 5.3 Hasil Penilaian Discoloration Sisi Kanan Dan Kiri Bibir Pasien

Sumbing Bibir Bilateral Pasca Operasi .......................................................... 34

Tabel 5.4 Hasil Penilaian Spreading Sisi Kanan Dan Kiri Bibir Pasien

Sumbing Bibir Bilateral Pasca Operasi .......................................................... 35

Tabel 5.5 Hasil Penilaian Suture Mark Sisi Kanan Dan Kiri Bibir Pasien

Sumbing Bibir Bilateral Pasca Operasi .......................................................... 35

Tabel 5.6 Kualitas Scar Pasca Operasi Menggunakan Uji Korelasi Spearman.

......................................................................................................................... 36

xv

DAFTAR GAMBAR

Gambar 2. 1 Tonjolan Muka ............................................................................. 5

Gambar 2. 2 Bentuk Lubang Hidung ................................................................ 6

Gambar 2. 3 Bentuk Ala Nasalis Bilateral........................................................ 6

Gambar 2. 4 Palatum ......................................................................................... 7

Gambar 2. 5 Bentuk Palatum Primer ................................................................ 7

Gambar 2. 6 Bentuk Palatum Sekunder ............................................................ 8

Gambar 2. 7 Anatomi normal............................................................................ 9

Gambar 2. 8 Pembantukan Sumbing ............................................................... 10

Gambar 2. 9 Tingkat Keparahan Sumbing Bibir Bilateral ............................. 17

xvi

DAFTAR SINGKATAN

CLP : Cleft Lip and Palate

EAST-AC : Erythrocyte Aspartate Aminotransferase Activity Coefficient

LAHSAL : Lips Alveolus Hard Palate Soft Palate

PDGF : Plateletderived Growth Factor

PLP : Plasma Pyridoxal-5’-Phosphate

TGF-β : Transforming Growth Factor Β

xvii

DAFTAR LAMPIRAN

Lampiran 1 ...................................................................................................... 49

Lampiran 2 ...................................................................................................... 51

Lampiran 3 ...................................................................................................... 54

Lampiran 4 ...................................................................................................... 55

Lampiran 5 ...................................................................................................... 57

Lampiran 6 ...................................................................................................... 58

Lampiran 7 ...................................................................................................... 59

43

DAFTAR PUSTAKA

Ajmal, S. et al., 2010. Evaluatig Anatomical Subunit Approximation

Technique for Unilateral Cleft Lip Repair. JPMI, 24(1), pp. 68 - 72.

Atiyeh, B. S., 2007. Nonsurgical Management of Hypertrophic Scars:

Evidence-Based. Aesth Plast Surg, Volume 31, p. 468–492.

Bell, J. C. et al., 2014. Maternal Alcohol Consumption during Pregnancy and

the Risk of Orofacial Clefts in Infants: a Systematic Review and Meta-

Analysis. Paediatric and Perinatal Epidemiology, 28(4), pp. 322-332.

Bermudez, L. M., Magee, W. D., Weatherley-White, C. M. & Rubin, R. M.,

2014. Nasolabial Evaluation of The Unilateral Cleft Lip Repair. operation

smile.

Bille, C. et al., 2007. Oral Clefts and Life Style Factors - A Case-Cohort

Study Based on Prospective Danish Data. European Journal of

Epidemiology, 22(3), p. 173–181.

Bishop, A., 2008. Role Of Oxygen in Wound Healing. Jornal of wound Care,

Volume 17, pp. 399 - 402.

Blomberg , S., 1980. Influence of Maternal Distress During Pregnancy on

Fetal Malformations. Acta Psychiatrica Scandinavica, 62(4), pp. 315-30.

Burg, M. L. et al., 2016. Epidemiology, Etiology, and Treatment of Isolated

Cleft Palate. Frontiers in Physiology, Volume VII, pp. 1-16.

Carmichael, S. L. et al., 2007. Maternal Stressful Life Events and Risks of

Birth Defects. Epidemiology, 18(3), p. 356–361.

Chao, A., Li, S. & Li, Z., 2012. Folic Acid Use and Nonsyndromic Orofacial

Clefts in China. epidemiology, 23(3).

DeRoo, L. A. et al., 2016. Maternal Alcohol Binge-Drinking in The First

Trimester and The Risk of Orofacial Clefts in Offspring: a Large

Population-Based Pooling Study. Perinatal Epidemiology.

DeRoo, L. A. et al., 2016. Maternal Alcohol Binge-Drinking in The First

Trimester and The Risk of Orofacial Clefts in Offspring: A Large

44

Population-Based Pooling Study. European Journal of Epidemiology,

31(10), p. 1021–1034.

Dudek, R. W., 2014. Head and Neck. In: High Yield Embriology.

Philadelphia: Lippincott and Wilkins, p. 95.

Elsherbiny, A. & Mazeed, A. S., 2017. Comprehensive and reliable

classification system for primary diagnosis of cleft lip and palate. Journal

of Cranio-Maxillo-Facial Surgery, Volume 45, pp. 1011 - 1014.

Gantwerker, E. A. & Hom, D. B., 2012. Skin: Histology and Physiology of

Wound Healing. pp. 85-96.

Garg, S., Dahiya, N. & Gupta, S., 2014. Surgical Scar Revision: An

Overview. Jurnal Of Cutaneous And Aesthetic Surgery, 7(1), pp. 3-13.

George, P., Brodie, S. J. & Bethpage, 1962. The Spreading Excision Scar.

Archives Of Dermatology, Volume 85, p. 146.

Gunnerbeck, A. et al., 2014. Maternal Snuff Use and Smoking and the Risk of

Oral Cleft Malformations - A Population-Based Cohort Study. Plos One ,

9(1), p. e84175.

Guo, S. & Dipetrio, L., 2010. Factors Affecting Wound Healing. J Dent Res,

3(89), pp. 220 - 221.

Herdiana, A. & Islamiyanti, N. A., 2007. Perawatan Ortodonsia pada

Kelainan Celah Bibir dan Langit-Langit. Indonesian Journal of Dentistry,

14(2), p. 119.

Hopper, R. A., 2014. Cleft Lip and Palate: Embryology, Principles, and

Treatment. In: Grabb & Smith's Plastic surgery. New York: Lippincott

Williams & Wilkins, a Wolters Kluwer business, p. 175.

Ingstrup, K. et al., 2013. Maternal Bereavement in The Antenatal Period and

Oral Cleft in The Offspring. Human Reproduction, 28(4), p. 1092–1099.

Jarayam, R. & Huppa, C., 2012. Surgical Correction of Cleft Lip and Palate.

In: M. Cobourne, ed. Cleft Lip and Palate Epidemiology, Aetiology, and

Treatment. Switzerland: Karger, pp. 106-107.

Kawalec, A., Nelke, K., Pawlas, K. & Gerber, H., 2015. Risk Factors

Involved in Orofacial Cleft. Open Medicine, I(10), pp. 163-175.

45

Kesande, T., Muwazi, L. M., Bataringaya, A. & Rwenyonyi, C. M., 2014.

Prevalence, pattern and perceptions of cleft lip and cleft palate among

children born in two hospitals in Kisoro District, Uganda. BMC Oral

Health, Volume 14, p. 1.

Keyes, B. E. et al., 2016. Impaired Epidermal to Dendritic T Cell Signaling

Slows Wound Repair in Aged Skin. Cell, Volume 167, p. 1323–1338.

Keylock, K. T. et al., 2008. Exercise Accelerates Cutaneous Wound Healing

and Decreases Wound Inflammation in Aged Mice. AJP-Regul Integr

Comp Physiol, Volume 294.

Li, S. et al., 2012. Folic Acid Use and Nonsyndromic Orofacial Clefts in

China. Epidemiology, 23(3), pp. 423-432.

Loho, J. N., 2013. Prevalensi Labioschisis Di Rsup. Prof. Dr. R. D. Kandou

Manado Periode Januari 2011 – Oktober 2012. Jurnal e-Biomedik (eBM),

1(1), p. 400.

Mashalkar, N. S. & Shetty, N., 2015. Straight line closure for correction of

congenital isolated bilateral macrostomia. Plast Aesthet Res, II(2), p. 97.

Matros, E. & Pribaz, J. J., 2014. Reconstruction of Acquired Lip Deformities.

In: Grabb and Smith's Plastic Surgery. New York: Lippincott Williams &

Wilkins, pp. 372-373.

Maxson, S. et al., 2012. Concise Review: Role of Mesenchymal Stem Cells in

Wound Repair. Stem Cells Translational Medicine, pp. 142 - 149.

Modi, M., 2009. Critical Evaluation of Suture Materials and Suturing

Techniques in Implant Dentistry. International Journal of Clinical

Implant Dentistry, 1(2), pp. 31-40.

Molina-Solana, R. et al., 2013. Current Concepts on The Effect of

Environmental Factors on Cleft Lip and Palate. International Journal of

Oral and Maxillofacial Surgery, 42(2), pp. 177-184.

Munger, R. G., Sauberlich, H. E., Christopher & Nepomuceno, B., 2004.

Maternal Vitamin B-6 and Folate Status and Risk of Oral Cleft Birth

Defects in The Philippines. Birth Defects Research (Part A): Clinical and

Molecular Teratology, Volume 70, pp. 264 - 271.

46

Munger, R. G. et al., 2004. Maternal Vitamin B-6 and Folate Status and Risk

of Oral Cleft Birth Defects in the Philippines. Birth Defects Research

(Part A): Clinical and Molecular Teratology, 70(7), pp. 464-471.

Munsie, J. W. et al., 2011. Maternal Bronchodilator Use and The Risk of

Orofacial Clefts. Human Reproduction, 26(11), pp. 3147-3154.

Murphy, V. et al., 2013. The Risk of Congenital Malformations, Perinatal

Mortality and Neonatal Hospitalisation Among Pregnant Women With

Asthma: A Systematic Review and Meta-Analysis. International Journal

of Obstetrics and Gynaecology, 120(7), pp. 812-822.

Mustoe, T. A. et al., 2002. International Clinical Recommendations on Scar

Management. Scar Management Recommendations, 110(2), pp. 560-571.

Nadine, B. & Semer, M., 2001. Scar Formation. In: Practical Plastic Surgery

for Nonsurgeon. California: Hanley & Belvus Inc., p. 138.

Nahai, F. R. et al., 2005. The Management of Cleft Lip and Palate: Pathways

for Treatment and Longitudinal Assessment. Seminars in Plastics

Surgery, 19(4).

Nakashima, M. et al., 2010. A Genome-Wide Association Study Identifies

Four Susceptibility Loci For Keloid in The Japanese Population. Nature

Genetics, 42(9), pp. 768-771.

Narayanan, P. V. & Adenwalla, H. S., 2013. Unfavourable Results in The

Repair of The Cleft Lip. Indian Journal of Plastic Surgery, 46(2).

Oginni, F. O. & Adenekan, A. T., 2012. Prevention of Oro-facial Clefts in

Developing World. Annals of Maxillofacial Surgery, 2(2), p. 163–169.

Prowse, P. & Shokrollahi, K., 2014. Leaving Our Marks-Are Suture Marks,

Acceptable?. The Royal College of Surgeons of England Bulletin, Volume

96, pp. 264-266.

Rahimov, F., Jugessure, a. & Murray, J. C., 2012. Genetics of Nonsyndromic

Orofacial Clefts. Cleft Palate–Craniofacial Journal, 49(1), pp. 73-91.

Riana, R., 2015. Distribusi Sumbing Bibir dan Langit-Langit di Cleft Lip and

Palate Center Fakultas Kedokteran Universitas Muhammadiyah Malang

Indonesia. XI(2), pp. 76-77.

47

Richards, A. M., 2002. Plastic Surgery. USA: Blackwell Science.

Riskesdas, 2013. Riset Kesehatan Dasar, Jakarta: Kesehatan, Badan

Penelitian dan Pengembangan Kementrian Kesehatan RI.

Sabiston, 2017. Sabiston Textbook of Surgery. In: Wound Healing. Canada:

Elsevier, p. 130.

Sadler, T. W., 2012. Head and Neck. In: Langman’s Medical Embryology.

China: Lippincott Williams & Wilkins, pp. 275 - 278.

Shaw, T. J. & Martin, P., 2009. Wound Repair at a Glance. Cell Science at a

Glance, 18(122), p. 3209.

Sianita, P. P. & Alawiyah, T., 2011. Kelainan Celah Bibir Serta Langit -

Langit dan Permasalahannya dalam Kaitan dengan Interaksi Sosial dan

Perilaku. JITEKGI, 8(2), pp. 42-46.

Sinto, l., 2018. Scar Hipertropik dan Keloid: Pathofisiologi dan Penangannya.

CKD 260, Volume 45, pp. 29 - 32.

Smith's & Grabb, 2014. Plastic Surgery. In: Cleft Lip and Palate:

Embryology, Principles, and Treatment. New York: Lippincott Williams

& Wilkins, a Wolters Kluwe business, p. 193.

Tamada, I. & Takijima, J., 2008. Detailed Assessment Of Cleft Lip Scar

Following Straight Line Repair. Journal of Plastic, Reconstructive &

Aesthetic Surgery, p. 63.

Tamura, T. et al., 2007. Maternal Plasma Pyridoxal-50-Phosphate

Concentrations and Risk of Isolated Oral Clefts in the Philippines. Birth

Defects Research (Part A): Clinical and Molecular Teratology, 79(4), pp.

276-280.

Vujkovic, M. et al., 2007. Maternal Western Dietary Patterns and the Risk of

Developing a Cleft Lip With or Without a Cleft Palate. Obstetrics &

Gynecology, 110(2), pp. 378-384.

Wahyu, N. S. & Latifa, S. N., 2016. Kondisi Lingkungan di Nusa Tenggara

Timur dan Prevalensi Kejadian Celah Bibir dan Celah Langitan. BIMKMI,

4(1), pp. 48 - 52.

48

Wallenstein, M. B., Shaw, G. M., Yang, W. & Carmichae, S. L., 2013.

Periconceptional Nutrient Intakes and Risks of Orofacial Clefts in

California. Pediatric Research, 74(4), pp. 457-465.

Wang, K. H., Heike, C. L., Clarkson, M. D. & Mejino, J. L. V., 2014.

Evaluation and Integration of Disparate Classification Systems for Cleft of

The Lip. Frontiers in Physicology, 5(163), pp. 1 - 11.

Xuan, Z. et al., 2016. Maternal Active Smoking and Risk of Oral Clefts: A

Meta-Analysis. Oral Surgery, Oral Medicine, Oral Pathology, Oral

Radiology, 122(6), pp. 680-690.

Z.F., T., S., P. & J., Z., 1997. Postburn Dyspigmentation: Its Assessment,

Management, And Relationship To Scarring--A Review Of The

Literature.. J Burn Care Rehabil, Volume 18, p. 435.