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All Journal Jurnal Plastik Rekonstruksi

Bangun, Kristaninta

Division Of Plastic, Reconstructive, And Aesthetic Surgery, Department Of Surgery, Faculty Of Medicine Universitas Indonesia, Cipto Mangunkusumo General Hospital

Author-ID : 1015944

Civil Engineering, Building, Construction & Architecture Other

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Frontoethmoidal Encephalomeningocele Revisited : The Convenience Of Teamwork Approach, A CaseSeries Kusumastuti, Nadia; Handayani, Siti; Hatibie, Mendy; Diah, Enrina; Bangun, Kristaninta
Jurnal Plastik Rekonstruksi Vol. 1 No. 5 (2012): Jurnal Plastik Rekonstruksi
Publisher : Lingkar Studi Bedah Plastik Foundation

Background: Frontoethmoidal encephalomeningocele (FEEM) is a congenital defect of the skull which poses many problems to the patient as it results in many craniofacial and neural morbidities. While recently surgical correction of this disease is done in a single-stage procedure, many in Indonesia still perform twostage surgery which bears more risks and is technically difficult to achieve good aesthetic results. This case series intend to assess the feasibility and convenience of teamwork approach between plastic surgeon and neurosurgeon in correcting FEEM in a single-stage operation. Methods:We reviewed 8 patients with FEEM treated in Plastic and Reconstructive Surgery Division, Cipto Mangunkusumo Hospital Jakarta from November 2005 until March 2010. Four of the cases were secondary cases from Neurosurgery Department, and the other 4 cases were treated in single-stage operation, in teamwork with Neurosurgery Department, using the Chula technique. Results of each surgery was assessed using objective parameters, which are Intercanthal Distance (ICD) and Interorbital Distance (IOD); and also subjective parameters which is aesthetic improvement.Result: All of the patients showed significant improvements in ICD and IOD measurements. No complication was found intra and post-operatively. All patients, especially the ones treated with singlestage surgery show good aesthetic results. Conclusion: To achieve goals of defect correction and aesthetically pleasant appearance, single-stage surgery in teamwork with the neurosurgery department seems to be most suitable and convenient.

Management of Traumatic Undiagnosed Condyle Fracture in Children Rizal, Syamsul; Kreshanti, Prasetyanugraheni; Handayani, Siti; Bangun, Kristaninta
Jurnal Plastik Rekonstruksi Vol. 1 No. 5 (2012): Jurnal Plastik Rekonstruksi
Publisher : Lingkar Studi Bedah Plastik Foundation

Background: Condyle trauma is considered to be the major cause of TMJ ankylosis but it is also the most neglected and under-managed problem in children. ?TMJ ankylosis leads to be malocclusion and facial disfigurement. The aim of early treatment is to restore the mandibular mobility and to enhance further growth in order to reduce the possibility of future facial asymmetry. Patients and Methods: We report two patients with inability to open mouth few months following injury. They most probably suffered missed diagnosis condyle fracture by the previous physician. The latest physical examination and radiological finding shows the mandible was micrognathic and unilateral TMJ ankylosis was confirmed. A sequential protocol of TMJ ankylosis management based on aggressive resection of ankylotic mass was performed and followed withphysiotherapy.Result: In 2 month-follow up, both patients showed significant improvement in mouth opening and the mastication function was restored, accompanied with physical therapy to gain maximum mouth opening for at least a year.Summary: A detail history, clinical and functional examination, radiographic examination facilitating correct diagnosis followed by immediate surgical intervention, and physiotherapy can help us to restore physical, psychological, and emotional health of the child patient.

The Effect Of Honey Give As Oral Drops In Precipitating Epithelialization Of Lateral Palatal Defects Post TwoFlap Palatoplasty Kreshanti, Prasetyanugraheni; Sudjatmiko, Gentur; Bangun, Kristaninta
Jurnal Plastik Rekonstruksi Vol. 1 No. 5 (2012): Jurnal Plastik Rekonstruksi
Publisher : Lingkar Studi Bedah Plastik Foundation

Background : Two-flap palatoplasty, which is a very common technique used including in our institution, will result in lateral palatal defects without any periosteal coverage. Faster epithelialization is expected to decrease wound contraction thus reducing scar formation, and in the long run will result in good maxillary growth. In our institution, the retrospective study showed a fair maxillary growth (mean GOSLON score=3.5). Thus, we explore possibilities to precipitate the epithelialization process in pursuit of good maxillary growth in the future.Method :This is a prospective cohort study conducted in Cipto Mangunkusumo Hospital, on consecutive patients who underwent two-flap palatopasty from October 2010-February 2011. We followed up these patients weekly for 4 consecutive weeks to observe the rate of epithelialization of the lateral palatal defects.Result : Two-flap palatoplasty was performed in 48 patients, 23 among them were given honey as oral drops. Eighty-seven point five percent had unilateral complete cleft lip and palate and 12.5% had bilateral complete cleft lip and palate. Faster epithelialization of the lateral palatal defects post two-flap palatoplasty was significantly in!uenced by intraoral honey application on the wound as oral drops (RR 2.1, 95% CI 1.314 - 3.391, p < 0.001).Conclusion: Honey given as oral drops significantly precipitates the epithelialization process of the lateral palatal defects post two flap palatoplasty 2.1 times faster.

Traumatic Palatal Defect Closure With Prosthesis Post Surgical Reconstruction: A Team Approach Martina, Nungki Ratna; Kreshanti, Prasetyanugraheni; Handayani, Siti; Bangun, Kristaninta
Jurnal Plastik Rekonstruksi Vol. 1 No. 5 (2012): Jurnal Plastik Rekonstruksi
Publisher : Lingkar Studi Bedah Plastik Foundation

Background: Palatal defect may be a result of congenital malformations, trauma or tumors. In most maxillopalatal trauma, surgical reconstruction is required to restore the function and appearance. Any palatal defect caused by maxillopalatal loss that cannot be achieved with surgical reconstruction needs special and comprehensive treatment. This can be done by prosthodontist prosthesis rehabilitation.Patients and Methods: A 20-year-old man underwent open reduction and internal fixation for severe maxillopalatal fracture and palatal loss. Intraoperative, the palatal defect could not be approximated due to palatal loss. In 3-month-follow up, there was a palatal defect and slight malocclusion due to anterior dental loss. Instead of performing complicated surgical procedures, we collaborate with the prosthodontist to assemble prosthesis with dental prosthesis that accommodate the closure of defect and improve appearance aesthetically. Result: The use of prosthesis improves functional and psychological wellbeing. It does not only close the palatal defect, but it also fills the anterior dental loss thus overcoming the malocclusion. Satisfying functional and aesthetic outcome was achieved. Summary: Rehabilitation of maxillopalatal defect has been well defined for prosthodontists and surgeons. A successful prosthetic design for functional restoration of the palatal defect utilizes the remaining palate and dentition to maximize the support, stability and appearance. In this case,prosthodontist and dentition prosthesis was used as modalities that offer simple solution to close the palatal defect compared to a more complicated surgical intervention.

The Eficiency in The Management of Facial Fracture Patients in Developing Country by Using OsiriX®, A Free 3D-Rendering Software Kreshanti, Prasetyanugraheni; Bangun, Kristaninta
Jurnal Plastik Rekonstruksi Vol. 1 No. 6 (2012): Jurnal Plastik Rekonstruksi
Publisher : Lingkar Studi Bedah Plastik Foundation

Background: Being a developing country with a GNI (Gross National Income) per capita of US$3,830, the cost for managing patients with facial fractures was often unaffordable. The use of a free 3D-rendering software presumably would decrease cost. With OsiriX, a free and open source 3D-rendering software, complex images manipulations and real-time 3D image visualization is easily accessible anytime and anywhere from the surgeon’s personal computer, making diagnosis and preoperative planning more convenient for the surgeons. Patients and methods: From December 2009 to January 2010, 14 patients with facial fracture were admitted to our unit. Seven of them underwent surgery. Preoperatively, diagnosis & surgery plan was developed using OsiriX. Results: By using OsiriX, more accurate diagnosis was made at a lower cost. Patients could save up to 48.1% from total diagnostic cost (19.2% from monthly income). OsiriX provided easier access to multidimensional navigation and visualization tools in personal computers, making easier planning possible for surgical steps and materials needed. Summary: OsiriX being free and open source is bene!cial from !nancial point of view, which is an important point for patients in a developing country. It is user friendly and ef!cient in developing treatment plan for facial fracture patients.

Changing of Condylar Fracture Approach in Cipto Mangunkusumo Hospital Susanto, Imam; Bangun, Kristaninta; Handayani, Siti; Kreshanti, Prasetyanugrahni; Hapsari, Nathania Pudya
Jurnal Plastik Rekonstruksi Vol. 1 No. 6 (2012): Jurnal Plastik Rekonstruksi
Publisher : Lingkar Studi Bedah Plastik Foundation

Management of condylar fracture draws controversy for over three decades. Previously, closed reduction with intermaxillary !xation (IMF) had been predominant for many surgeons, considering shorter length of procedure, ability to achieve preinjury occlusion with acceptable adjustment, and low cost of procedure. Introduction of osteosynthesis material rigid internal !xation (RIF) and adaptive miniplate !xation marked technology development in condylar fracture management and became popular in term of the applicability and outcome results. Over period time, several studies proposed vary classi!cation system and selection patient criteria for surgical treatment on the basis of age, location of fracture, degree of communition, direction of proximal fragment displacement, location of condylar head, concomitant medical illness or associated trauma, and patient’s preferences to achieve optimum goal. This review focuses on the shifting of condylar fracture management at Cipto Mangunkusumo Hospital from 2004-2012.

Reconstruction of Traumatic Partial Ear Amputations Using Two-Stage Skin Flap Pocket Technique Hakim, Intan Friscilla; Kreshanti, Prasetyanugraheni; Handayani, Siti; Bangun, Kristaninta
Jurnal Plastik Rekonstruksi Vol. 2 No. 1 (2013): Jurnal Plastik Rekonstruksi
Publisher : Lingkar Studi Bedah Plastik Foundation

Background: Various reconstructive techniques for partial traumatic ear amputations have been reported. The choice of technique is based on the missing ear components and the availability of tissue for defect coverage. The goal is to obtain an aesthetically acceptable ear. The authors report a two-stage skin flap pocket technique for the reconstruction of traumatic ear amputations. Patient and Method: Three cases of partial traumatic ear amputation due to bite is reported. After sufficient debridement, skin flap pocket was created on the retroauriculomastoid area. Conchal cartilage graft was used to replace cartilage defect in one case. The other 2 cases utilized their amputated cartilage graft, deepithelialized and then resutured to the remaining cartilage. All three cases underwent second stage surgeries for flap division, three weeks after the pocketing. Result: In 2 months follow-up, all of 3 cases showed no signs of infection. Normal dimension of the ears were achieved and aesthetic appearances were perceived as acceptable to the patients and other viewers. One case was able to be followed one year post surgery with acceptable aesthetics, and no sign of cartilage resorption. Summary: The technique used in these cases provided acceptable results in reconstructing the size and shape of the partially amputated ears. Cartilage grafts implanted in the pockets retained their shape with no infection or resorption.

Pericranial Hinged Flap for Congenital Posterior Meningoencephalocele Closure Atmaja, Tessa Miranda; Kreshanti, Prasetyanugraheni; Handayani, Siti; Bangun, Kristaninta
Jurnal Plastik Rekonstruksi Vol. 2 No. 1 (2013): Jurnal Plastik Rekonstruksi
Publisher : Lingkar Studi Bedah Plastik Foundation

Background: Posterior meningoencephalocele is a complicated case that requires adequate method for closure of the defect. Congenital meningoencephalocele is a rare incidence estimated at 1:3000 to 10000 live births; with occipital encephaloceles are the most common. The method for closure should prevent leakage of cerebrospinal fluid (CSF) and coverage for the calvarial bone. Meningoencephalocele are treated by excising the non-functional brain tissue and closed the defect using thick connective tissue graft, alloplastic material and local flaps. The problems with closure are continuous leakage of cerebrospinal fluid and infection, especially when alloplastic material is used. In this case report, a pericranial flap is used to close the dura. Patient and Method: A neonate with occipital meningoencephalocele was consulted to the Plastic Surgery Department with wound dehiscence and recurrent herniation of brain tissue after undergoing first surgery by the neurosurgery team. On the second operation, a premilene mesh was placed which was later infected and causing wound dehiscence. We then close the defect using pericranial hinged flap and primary closure of the skin and subcutaneous tissue. Result: After the closure using pericranial hinged flap, there were no signs of infection and no CSF leakage. In 4 month follow up, the defect has completely healed. Summary: Closure of calvarial bone defect with pericranial-hinged flap provides a tight closure of the intracranial space, without increased risk of infection. Pericranial hinged flap should be considered as a method of choice for closure of intracranial defect, preventing leakage of cerebrospinal fluid and reducing risk of infection.

The Versatility of Temporalis Muscle Flap in Reconstruction of Maxillofacial Region Harsono, Anastasia Dessy; Kreshanti, Prasetyanugraheni; Handayani, Siti; Bangun, Kristaninta
Jurnal Plastik Rekonstruksi Vol. 2 No. 1 (2013): Jurnal Plastik Rekonstruksi
Publisher : Lingkar Studi Bedah Plastik Foundation

Background: The temporalis muscle !ap (TMF) is a very versatile and valuable axial flap, which could be used in various reconstructive procedures in and around the maxillofacial region. The surgical anatomy, vascular pattern and technique of elevation of the flap are described, associated with our experience in different reconstructive situations. Patient and Method: There were two patients, one case of TMJ ankylosis and one case of facial paralysis. The TMF was used as an interpositional arthroplasty for TMJ ankylosis, as a dynamic facial reanimation for facial paralysis. Result: In the first patient, he was able to open his mouth 4 cm in 2 weeks following the surgery. There was no pain or other complication complained. In second patient, in two weeks follow up after the surgery, we found the edema was decrease gradually. The contraction on the right nasolabial sulcus was slightly seen. Summary: These report described the reliability, versatility and reproducibility of temporalis muscle flap. The rich vascularized tissue and its proximity to the reconstruction site make this flap reliable. TMF should be taken into consideration before deciding on more extensive reconstructive procedures.

Incomplete Cleft Palate in Cornelia de Lange Syndrome Fortuna, Fory; Kreshanti, Prasetyanugraheni; Handayani, Siti; Bangun, Kristaninta
Jurnal Plastik Rekonstruksi Vol. 2 No. 1 (2013): Jurnal Plastik Rekonstruksi
Publisher : Lingkar Studi Bedah Plastik Foundation

Background: Cornelia de Lange Syndrome (CdLS) is a rare congenital anomaly inheritance syndrome. The prevalence is 1.6-2.2/100.000 of 8,558,346 births in Europe. Cleft palate is less frequent malformation of this syndrome (21,7%) than other associated malformations. The diagnosis can be obtained clinically based on CdLS diagnostic criteria by USA CdLS Foundation. This is the first case in our hospital. Patient and Method: A case of a 4-year-old girl who came to our attention at Cleft and Craniofacial Center Cipto Mangunkusumo National General Hospital for incomplete cleft palate. Parents’ major concerns was feeding problem. The clinical investigations showed that the child met diagnostic criteria for CdLS as described in literatures. We manage this case in collaboration with paediatric department and other related specialists, including radiologist and craniofacial orthodontist. We performed Veau-Wardill-Kilner’s palataoplasty for the incomplete cleft palate. Paediatric department arranged provision of dietary. Result: This patient with incomplete cleft palate whom we treated by palatoplasty was moderately involved by CdLS (severity score 17). After 3 weeks follow-up, we have overcome feeding problem and body weight gained. Summary: Patient with CdLS needs early multidisciplinary team approach management for maximum outcome, because variety of associated malformations may present and life-threatening. Diagnostic criteria by USA CdLS Foundation assist health care personnel recognize this syndrome early.

Co-Authors A., Nur Agatha Novell Harsanto, Agatha Novell Amaliah, Rizky Anindhawati, Nur Arvin Pramudita, Arvin Atmaja, Tessa Miranda Atmodiwirjo, Parintosa Basuki, Adi Boaz, Grace Chen, Zung Chung Diah, Enrina Djamaloeddin, Chaula Djaprie, Shelly M Djoenaedi, Intania Evie Lamtiur Pakpahan Evie Lamtiur, Evie Fortuna, Fory Hakim, Intan Friscilla Halim, Jessica Hapsari, Nathania Pudya Harsono, Anastasia Dessy Imam Susanto Irwansyah, Denny Jesica Putri Sudarman Kamayana, Jenisa Amanda Sandiarini Kesuma, Ayu Diah Kreshanti, Prasetyanugraheni Kreshanti, Prasetyanugrahni Kusumastuti, Nadia Lestari, Puri Ambar Luh Karunia Wahyuni, Luh Karunia Mahandaru, Danu Martina, Nungki Ratna Maulana, Muhammad Iqbal Mendy Hatibie Menna, Clara Mulyadi Mulyadi Nahdiyat, Nur Eulis Pujiastuti Nangingtuari, Irinawati Nindita, Eliza Olivia, Andria Pancawati, Julieta Permana, Lucky Prawoto, Pujisriyani Primadian, Akmal Putra, Teuku Nanda Putri, Nandita Melati Rayeni, Natasha Ratna Sandhi, Afriyanti Sastrasupena, Aditya Herwandar Simamora, Huntal Siti Handayani Soetjipto Soepodo, Fernita Leo Sudjatmiko, Gentur Sudjatmiko, Gentur Sukasah, Chaula Luthfia Syamsul Rizal Tania, Vika Teuku Fadli Nazwan Sani Tiza, Melina Vityadewi, Nurardhilah Widayanti, Nurina

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