Friday, May 11, 2007

Primary Cleft Closure in Indonesia

Cleft lip and palate are the most common congenital anomalies in Indonesia. Nearly one to 600-700 babies born with these anomalies. In Indonesia every year born 5500-6500 new babies with cleft. The treatment we do usually only primary closure for lip and palate.

We do this procedure in the centre of OMFS and charity or public service program in Indonesia, these cases usualy affect the lower level people.

In the centre we start the treatment on 7 days old babies with feeding plate, 3 months old for lip repair, 18-24 months old for palate repair, 11-13 years old for ABGA (Alveolar Bone GraftAugmentation) and 18 years old for Orthognatic Surgery (if necessary). In the charity program we just do the primary closure for lip and palate and the patient usualy come in various ages.

We start this procedure usually 10-12 weeks old babies. We use Tenisson triangular flap technique for Unilateral Cleft closure with modification of Dr. Noordhof technique for nasal reconstruction, this procedure is easy to learn, the point marker are obvious and can be utilized on the several of wide cleft.

Some of the patients are teenager, sometimes we do the surgery under local anesthesia for cooperative patients. For bilateral cleft closure we use Veau III straight-line closure and we do both side on one procedure. We also do management of the muscle to repair the muscle.

For the over protrusive premaxilla, we do reposition by fracturing the premaxilla bone in front of the sutura, reduce the protusive and fix it with small wire on the same procedure with lip repair.

The palate repair start on 18-24 months old. The repair for hard palate and soft palate are done in one procedure. We used push back technique and combine with Z-plasty for lengthening the soft palate.

6 comments:

.\Goio said...

As I have mention before, I was born with cleft lips (perhaps mild cleft lips?). And I am Indonesian. Which means I'm one of the contributor to the stats you've mention =).

Anyway, I'm wondering, What exactly is cause of Cleft lips? And, can it be prevented?

Thanks

Evy., DDS., OMFS said...

The cause of these anomalies is not really clear today, some report in the literature but there is no specific cause. Multifactor trauma during pregnancy, genetic, lack of nutrition especially folic acid, environment for example pestisida, stress during pregnancy etc but all of this were happend during the first semester of pregnancy. Well but this anomalies are easy to repair like in ur case, there is no more cleft after repair, so this is the most important part to make them smile :)

devi mohapatra said...

dear evy,
what exactly is the veau III repair, and ur muscle approximation technique, can u please detail me about the markings for bilateral cleft lip repair..
i am into plastic surgery residency program in india
thanks
devi

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