Komplikasi celah langit-langit:1. Infeksi telinga

Infeksi terjadi karena tuba eustachius tidak berfungsi dengan baik sehingga terjadi penumpukan cairan di telinga tengah. Penumpukan cairan ini merupakan suatu media yang baik bagi perkembangan infeksi. Oleh karena itu, pada operasi rekonstruksi pertama, dilakukan penanaman suatu tuba khusus pada anak agar tidak terjadi infeksi telinga.

2. Gangguan berbicara3. Masalah gigi, seperti gigi yang hilang, gigi yang berlebih, malformasi, dan karies.4. Gangguan pendengaran5. Kesulitan saat menyusui

Bibir sumbing menyebabkan anak sulit untuk mengisap, sedangkan celah pada palatum menyebabkan susu yang diisap sering masuk ke hidung. Pada beberapa kasus dapat digunakan obturator untuk membantu makan dan minum.

6.

Terapi celah langit-langit:Sekarang ini telah banyak kemajuan ilmu medis dalam perawatan celah bibir dan langit-langit. Operasi rekonstruksi dapat memperbaiki celah bibir dan langit-langit.Diagnosis biasanya dibuat saat lahir, atau beberapa saat setelah lahir, walaupun pada beberapa kasus dapat pula didiagnosis dari pemeriksaan USG. Pada celah langit-langit submukosa diagnosis tidak dapat dibuat sampai anak tersebut mengalami kesulitan berbicara saat SD.Sejak kelahiran beberapa hari, bayi dengan celah langit-langit akan dirujuk ke bedah plastik. Perbaikan langit-langit dilakukan secara bertahap. Perbaikan bibir kebanyakan dilakukan pada usia 3 bulan dan 6 bulan, sementara perbaikan langit-langit dilakukan antara usia 3 bulan dan 14 bulan. Pada anak-anak dengan celah langit-langit saja dan tidak ada bibir sumbing, perbaikan langit-langit dapat dilakukan pada usia 10 bulan. Pada saat yang sama dengan perbaikan palatum, telinga diperiksa oleh ahli THT, dan bila ada tanda-tanda terdapatnya glue ear, dapat dilakukan terapi pula untuk telinga tengah.Pada kasus-kasus celah pada palatum yang komplit, dapat dirujuk ke ortodontis untuk mempertahankan dan meningkatkan hubungan antara tulang di kedua sisi celah. Tujuannya adalah agar tulang dapat sejajar sebelum dilakukan perbaikan pada jaringan lunak, dimana hal ini akan mempermudah teknik operasi, tapi juga dipercaya memiliki hasil yang lebih baik.Teknik perbaikan primer celah palatum:Terdapat berbagai cara untuk memperbaiki celah pada palatum dan penggunaannya tergantung pada kasus yang dihadapi. Pada kebanyakan kasus, pemilihan teknik didasarkan kepada luas celah, gambaran anatomis, dan kecenderungan ahli bedah. Setiap perbaikan celah bibir dan palatum diperlukan anestesi umum, karena anak harus dapat berbaring diam untuk jangka waktu yang cukup lama (sekitar 1 – 4 jam). Setiap perbaikan celah bibir dan palatum dilaksanakan dengan pasien supinasi, jalan nafas aman dan dilindungi oleh endotracheal tube, kepala ekstensi, dan ahli bedah duduk di bagian kepala meja operasi.Biasanya diberikan anestesi lokal (adrenalin atau epinefrin) pada palatum dan bibir yang akan dilakukan perbaikan, kegunaannya adalah untuk mengurangi rasa sakit dan

mencegah terjadinya perdarahan sehingga operasi dapat berjalan lebih mudah dan lebih cepat. Pada masa post-operasi, jalan nafas perlu dijaga.Celah Inkomplit (Soft Palate Clefts)Perbaikan celah dilakukan dengan cara memisahkan setiap sisi palatum ke dalam 3 lapisan yaitu mukosa nasal, mukosa oral, dan otot, kemudian dilakukan penjahitan di setiap bagian ini secara terpisah untuk menghindari terjadinya penutupan ke-3 lapisan. Ini disebut dengan perbaikan direk.Usually, it will incorporate an intravelar veloplasty, which involves freeing the muscles from their erroneous insertion into the posterior edge of the hard palate and suturing them to each other, across the midline, so as to restore the muscle sling which will enable the palate to be pulled up and back with muscle contraction.An elegant approach to the repair of the soft palate cleft is to use the technique described by Leonard Furlow - the double reversing z-plasty. This raises two z-plasties, one in the palatal mucosa and one in the nasal mucosa. The muscle on one side is raised with the oral mucosa and on the other with the nasal layer. When the z-plasty flaps are switched, the two muscle bearing layers are brought across the midline, and the z-plasties help to lengthen the palate.Celah KomplitPerbaikan lebih sulit dilakukan karena the bone of the hard palate is divided into lateral shelves. Seen from below, the inferior or lower edge of the vomer, which normally forms a T-junction with the bony palate, is on show in the cleft. In order to repair such a defect, several techniques have been evolved over the last century.

Some involve the splitting of the mucosa over the vomer and turning this back to meet the mucosal covering, freed from the upper, or nasal surface of the bony palatal shelves Suturing these together forms the nasal layer.

Next, the muscle must be freed from the posterior palatal shelf edge. In most cases this is raised together with the overlying oral mucosa, either freeing completely, the front end of the flap from the bone of the palate, and pushing the flaps backwards, as they are sewn together in the midline - a so called pushback repair, as in the method of Veau and of Wardill and Kilner.

Alternatively, the anterior edge of the palatal flap can be left in place, and the flap raised on two pedicles, posterior and anterior, the so called von Langenbeck technique. Both these techniques utilize a releasing incision, placed postero-laterally around the posterior edge of the alveolus, which frees the soft tissue palatal flap, allowing it to be transposed toward the midline; the secondary defect heals rapidly and does not require closure.

Several other variations on the theme are possible, and your surgeon should be able to advise you, together with illustrative drawings, of precisely what the proposed surgery will entail for your baby.

KOMPLIKASI OPERASI:Pada 24 – 48 jam post-op:1. Perdarahan

2. Pembengkakan yang akan menghalangi jalan nafasKomplikasi lambat:1. Fistula

Gejala yang timbull antara lain terdapatnya cairan atau regurgitasi makanan lewat hidung dan mungkin terdapat gangguan berbicara. Biasanya dapat diperbaiki dengan operasi sekunder.

2. Scar restriktif

Setelah dilakukan perbaikan primer celah palatum, pasien harus terus kontrol ke bedah plastik, THT, terapi bicara, dan ortodontis. Pada usia sekitar 9 tahun dapat dilakukan grafting pada tulang alveolar. To do this, the cleft soft tissue is separated over the alveolus, and the gap between the bone of the two alveolar segments, packed with cancellous bone taken from the hip (iliac crest), cranium (skull) or tibia (shin). This both unites the two alveolar segments and allows the orthodontist to move the teeth into the space which has now been filled with bone.

VELO-PHARYNGEAL INCOMPETENCETerdapat satu lagi intervensi operatif yang dibutuhkan. Terkadang terjadi kegagalan penutupan velum ke faring. Gejala yang timbul pada berbicara hipernasal atau velopharyngeal incompetence atau VPI.Nasendoskopi dilakukan untuk melihat pergerakan palatum dari arah atas. Mukosa nasal akan diberikan anestesi lokal (spray xylocaine) dan setelah endoskopi diposisikan, pasien diminta untuk mengucapkan beberapa kata, dan gambaran endoskopi direkam.Setelah diagnosis ditegakkan, operasi dilakukan dengan flap faringeal atau faringoplasti sphincter. Keduanya dilakukan di rumah sakit dengan anestesi umum, berlangsung sekitar 2 – 3 jam.

ORTHOGNATHIC SURGERY DAN DEFINITIVE RHINOPLASTYBanyak pasien sumbing akan mengalami hipoplasia dan defisiensi maksilar dimana pada pasien ini, maksila gagal bertumbuh ke depan. Hal ini dapat terjadi karena penurunan pertumbuhan jaringan yang disebabkan oleh adanya celah. Akan tetapi dapat pula disebabkan oleh scar restriktif yang dibuat pada saat perbaikan bibir dan palatum secara operasi. Pada banyak kasus, supaya oklusi gigi dan rahang baik, ortodontis akan mengusulkan dilakukannya operasi orthognathic.Dilakukan operasi untuk melepaskan maksila dari tulang tengkorak dan menyamakannya dengan mandibula. Kedua rahang ini akan disejajarkan, dan difiksasi dengan plate titanium dan screw atau wire.Operasi ini biasanya dilaksanakan apabila pasien mendekati kematangan tulang tengkorak (15 atau 17 tahun pada wanita dan 19 tahun pada pria). Bila dilakukan lebih awal dapat menyebabkan operasi dilakukan kembali karena masih terdapatnya pertumbuhan tulang fasial setelah operasi.Tahap akhir yang harus dilakukan pasien adalah rhinoplasti definitif yang dilakukan setelah operasi orthognathic.

http://www.medic8.com/healthguide/articles/cleftlip.html

Treating Clefts

The good news is that there have been many medical advancements in the treatment of oral

clefting. Reconstructive surgery can repair cleft lips and palates, and in severe cases, plastic

surgery can address specific appearance-related concerns.

A child with oral clefting will need to see a variety of specialists who will work together as a

team to treat the condition. Treatment usually begins in the first few months of an infant's life,

depending on the health of the infant and the extent of the cleft.

Members of a child's cleft lip and palate treatment team usually include:

a geneticist

a plastic surgeon

an ear, nose, and throat physician (otolaryngologist)

an oral surgeon

an orthodontist

a dentist

a speech pathologist (often called a speech therapist)

an audiologist

a nurse coordinator

a social worker and/or psychologist

The team specialists will evaluate your child's progress regularly, examining your child's

hearing, speech, nutrition, teeth, and emotional state. They will share their recommendations

with you, and can forward their evaluation to your child's school, and any speech therapists

that your child may be working with.

In addition to treating your child's cleft, the specialists will work with your child on any issues

related to feeding, social problems, speech, and how you approach the condition with your

child. They'll provide feedback and recommendations to help you through the phases of your

child's growth and treatment.

Surgery for Oral Clefting

Surgery is usually performed during the first 12 to 18 months to repair cleft lip and/or cleft

palate. Both types of surgery are performed in the hospital under general anesthesia.

Cleft lip often requires only one reconstructive surgery, especially if the cleft is unilateral. The

surgeon will make an incision on each side of the cleft from the lip to the nostril. The two sides

of the lip are then sutured together. Bilateral cleft lips may be repaired in two surgeries, about

a month apart, and usually requires a short hospital stay.

Cleft palate surgery involves drawing tissue from either side of the mouth to rebuild the palate.

It requires 2 or 3 nights in the hospital, with the first night spent in the intensive care unit. The

initial surgery is intended to create a functional palate, reduce the chances that fluid will

develop in the middle ears, and help the child's teeth and facial bones develop properly. In

addition, this functional palate will help your child's speech development and feeding abilities.

The necessity for more operations depends on the skill of the surgeon as well as the severity of

the cleft, its shape, and the thickness of available tissue that can be used to create the palate.

Some children with a cleft palate require more surgeries to help improve their speech.

Additional surgeries may also improve the appearance of the lip and nose, close openings

between the mouth and nose, help breathing, and stabilize and realign the jaw. Subsequent

surgeries are usually scheduled at least 6 months apart to allow a child time to heal and to

reduce the chances of serious scarring.

It's a good idea to meet regularly with your child's plastic surgeon to determine what's most

appropriate in your child's case. Final repairs of the scars left by the initial surgery may not be

performed until adolescence, when facial structure is more fully developed. Surgery is

designed to aid in normalizing function and cosmetic appearance so that the child will have as

few difficulties as possible.

Dental Care and Orthodontia

Children with oral clefting often undergo dental and orthodontic treatment to help align the

teeth and take care of any gaps that exist because of the cleft.

Routine dental care may get lost in the midst of these major procedures, but healthy teeth are

critical for a child with clefting because they're needed for proper speech.

A child with oral clefting generally needs the same dental care as other children - regular

brushing supplemented with flossing once the child's 6-year molars come in. Depending on the

shape of your child's mouth and teeth, your child's dentist may recommend a toothette, a soft

sponge that contains mouthwash, rather than a toothbrush. As your child grows, you may be

able to switch to a soft children's toothbrush. The key is to make sure that your child brushes

regularly and well.

Children with cleft palate often have an alveolar ridge defect. The alveolus is the bony upper

gum that contains teeth, and defects can:

displace, tip, or rotate permanent teeth

prevent permanent teeth from appearing

prevent the alveolar ridge from forming

These problems can be fixed by grafting bone matter onto the alveolus, which allows the

placement of your child's teeth to be corrected orthodontically.

Orthodontic treatment usually involves a number of phases, with the first phase beginning as

the permanent teeth start to come in. In the first phase, which is called an orthopalatal

expansion, the upper dental arch is rounded out and the width of the upper jaw is increased. A

device called an expander is placed inside the child's mouth. The widening of the jaw may be

followed by a bone graft in the alveolus.

Your child's orthodontist may wait until the remainder of your child's permanent teeth come in

before beginning the second phase of orthodontic treatment. The second phase may involve

removing extra teeth, adding dental implants if teeth are missing, or applying braces to

straighten teeth.

In about 25% of children with a unilateral cleft lip and palate, the upper jaw growth does not

keep up with the lower jaw growth. If this occurs, your child may need orthognathic surgery

to align the teeth and help the upper jaw to develop.

For these children, phase-two orthodontics may include an operation called an osteotomy on

the upper jaw that moves the upper jaw both forward and down. This usually requires another

bone graft for stability.

Speech Therapy

A child with oral clefting may have trouble speaking - the clefting can make the voice nasal

and difficult to understand. Some will find that surgery fixes the problem completely.

Catching speech problems early can be a key part of solving them. It's a good idea to take

your child to a speech therapist between the ages of 18 months and 2 years. Many speech

therapists like to talk with parents at least once during the child's first 6 months to provide an

overview of the treatment and suggest specific language- and speech-stimulation games to

play with the baby.

Shortly after the initial surgery is completed, the speech pathologist will see your child for a

complete assessment. The therapist will evaluate your child's developing communication skills

by assessing the number of sounds he or she makes and the actual words your child tries to

use, and by observing interaction and play behavior.

This analysis helps determine what, if any, speech exercises your child needs and if further

surgery is required. The speech pathologist will often continue to work with your child through

additional surgeries. Many children who have clefts work with a speech therapist throughout

their grade-school years.

Dealing With Emotional and Social Issues

Our society often focuses on people's appearances, and this can make childhood - and,

especially, the teen years - very difficult for someone with a physical difference. Because a

child with oral clefting has a prominent facial difference, your child may experience painful

teasing, which can damage self-esteem. Part of the cleft palate and lip treatment team

includes psychiatric and emotional support personnel.

Ways that you can support your child include:

Try not to focus on your child's cleft and do not allow it to define your child as an

individual.

Create a warm and supportive home environment, where each person's individual

worth is openly celebrated.

Let your child know that you feel good about who he or she is by showing acceptance

and by not trying to make your child into your idea of who he or she should be.

Encourage your child to develop friendships with people from diverse backgrounds.

The best way to do this is to lead by example and to be open to all people yourself.

Point out positive attributes in others that do not involve physical appearance.

Encourage autonomy by giving your child the freedom to make decisions and take

appropriate risks, letting your child's own accomplishments lead to a sense of personal

value. By providing opportunities for your child to make decisions early on - like

picking out what clothes to wear - he or she can gain more confidence and the ability

to make bigger decisions down the road.

You might also consider encouraging your child to present information about clefting to his or

her class with a special presentation that you arrange with the teacher. Or perhaps your child

would like you to talk to the class. This can be especially effective with young children.

If your child does experience teasing, encourage discussions about it and be a patient listener.

Give your child the tools to confront the teasers by asking what he or she would like to say and

then practicing those statements.

If your child seems to have ongoing self-esteem problems, you may want to consult with a

child psychologist or social worker for support and information. Together with the members of

your child's treatment team, you can help your child through tough times.

Also, it's important to keep the lines of communication open as your child approaches

adolescence so that you can address any concerns he or she may have about appearance.

Reviewed by: Barbara P. Homeier, MD

Date reviewed: September 2005

Originally reviewed by: Louis E. Bartoshesky, MD, MPH

http://kidshealth.org/parent/medical/ears/cleft_lip_palate.html

Komplikasi celah langit-langit:7. A8. A

Terapi celah langit-langit:Sekarang ini telah banyak kemajuan ilmu medis dalam perawatan celah bibir dan langit-langit. Operasi rekonstruksi dapat memperbaiki celah bibir dan langit-langit. Tujuan akhir perbaikan celah langit-langit adalah membuat katup velopharyngeal yang normal dengan cara merekonstitusi mekanisme spinchter otot dari sling levator palatine. Orang tua pasien harus diberi pengertian bahwa terapi bicara yang intensif akan memerlukan waktu bertahun-tahun sebelum anak mampu berkomunikasi secara adekuat.