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All Journal Medical Journal of Indonesia Jurnal Plastik Rekonstruksi

Kreshanti, Prasetyanugraheni

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Distraction Osteogenesis for Micrognathia in Cipto Mangunkusumo Hospital : A Case Series Boaz, Grace; Kreshanti, Prasetyanugraheni; Handayani, Siti; Bangun, kristaninta
Jurnal Plastik Rekonstruksi Vol. 2 No. 1 (2013): Jurnal Plastik Rekonstruksi
Publisher : Lingkar Studi Bedah Plastik Foundation

Background: Micrognathia is usually associated with genetic syndromes, characterized by mandibular hypoplasia causing a receding chin. The overall incidence of micrognathia was 1 per 1600 births, makes it a rare case. Severe micrognathia can be a neonatal emergency due to airway obstruction by the tongue in the small oral cavity. One method for correcting micrognathia is distraction osteogenesis. Lack of experience due to rare incidence of case, expensive cost of distraction device and technical complexity of the operation can be obstacles to this management. Patient and Method: We report two cases of micrognathia corrected with distraction osteogenesis conducted in Cipto Mangunkusumo Hospital from 2011-2012. The method consists of implantation of bilateral distraction device to the inferior border of the mandibular body. The patients then followed postoperatively. Result: Mandibular lengthening by gradual distraction is a proper method for young patients with micrognathia. Despite our minimal experience and intricate kind of method, we are trying to improve our skill in the future. Summary: Distraction osteogenesis is one method for correcting congenital mandibular hypoplasia.

Lip And Palate Reconstruction On Median Cerebrofacial Malformation Patient Anindhawati, Nur; Kreshanti, Prasetyanugraheni; Handayani, Siti; Bangun, Kristaninta
Jurnal Plastik Rekonstruksi Vol. 2 No. 2 (2013): Jurnal Plastik Rekonstruksi
Publisher : Lingkar Studi Bedah Plastik Foundation

Background: Median cerebrofacial malformations are developmental anomalies of the midline brain and facial structures. The clinical manifestations ranges from holoprosencephaly with agenesis of central facial structures, to those seen in median facial dysplasia. Patients who survive are usually born with severe functional limitation and die during infancy. Nowadays, with improved perinatal care, patient with severe midline craniofacial abnormalities can be expected to live longer. The purpose of this paper is to show how reconstruction of the lip and palate on patient with median cerebrofacial malformation is done. Patient and Method: Reporting 2 cases of child with cleft median cerebrofacial malformations. First case was a 2 year-old child with complete median cleft lip and palate. Clinical examinations and CT scan revealed a holoprosencephaly. She was also diagnosed with laryngomalacia. The second case was a 4 month-old patient with median cleft lip and palate also microcephaly. We performed labioplasty in both patients and did the palatoplasty in the first patient. Result: Both cases showed no sign of complication after the operation. They both discharged one day after the operation. The first patient reported dead 1 week after the surgery at home. The cause was unknown. Discussion: Disturbed maxillary growth is postulated to be caused by the manipulation and suturing of the maxillary vomer, and scarring of the dentoalveoli post-surgery. Another contributing factor is the intrinsic tissue deficiency. Summary: With proper perinatal care and holistic teamwork that expand the survival rate we expect those with the best prognosis deserve to appear as normal as possible. Keywords: Holoprosencephaly, median facial dysplasia, median cleft lip and palate

Revision of Bilateral Celft Lip Deformity Using Abbe Flap Djaprie, Shelly M; Kreshanti, Prasetyanugraheni; Handayani, Siti; Bangun, Kristaninta
Jurnal Plastik Rekonstruksi Vol. 2 No. 2 (2013): Jurnal Plastik Rekonstruksi
Publisher : Lingkar Studi Bedah Plastik Foundation

Background: Most primary repair of bilateral complete cleft lip does not show satisfying result due to several deformities caused by inappropriate use of the hypoplastic prolabial tissue, failure to advance the lateral lip elements to the midline for primary repair of the orbicularis, and scarring. The Abbe flap is the accepted procedure for the correction of severe secondary deformity of a bilateral cleft lip. By introducing an adequate amount of lip tissue, it relieves the tightness of the upper lip and also corrects the depressions of the tip of the nose. Symmetry between the two lip is also achieved Patient and Method: Three patients with tight lip deformity underwent this procedure. The Abbe flap, which was taken from the central portion of the lower lip vermilion, was designed to repair the vermilion tubercle and the Cupid’s bow. A tiny portion of skin was included to facilitate closure of the donor site. The pedicle was divided 3 weeks after operation. Results: Each patients showed a more natural contour of the vermilion tubercle and the Cupid’s bow. The scarring of the donor site was inconspicuous. Summary: The Abbe flap can be considered as a choice for revision of bilateral cleft lip deformity. The disadvantages of this flap include patient’s discomfort and the need for multiple procedures.

Efficacy of Intralesional Alcohol Injection as Preoperative Treatment of Upper Lip Arteriovenous Malformation Kreshanti, Prasetyanugraheni; Sudjatmiko, Gentur; Anindhawati, Nur
Jurnal Plastik Rekonstruksi Vol. 1 No. 1 (2012): Jurnal Plastik Rekonstruksi
Publisher : Lingkar Studi Bedah Plastik Foundation

Management of vascular malformation remains a major challenge because treatment carries a substantial risk of morbidity and recurrence of the fundamental problem. Intra-lesional 96% alcohol injection as a combination with other treatment modalities has good-to-excellent results. Six-year old female with a 5-year history of arteriovenous malformation on her upper lip underwent intralesional alcohol injection under general anesthesia. Afterward we performed excision of the lesion. During the surgery we used Satinsky intestinal clamp to control the bleeding by compressing the artery. The follow up period was 9 months; there were no complications and no signs of relapse. Aesthetically, the result perceived as acceptable to the parents and other viewers. In cases of arteriovenous malformation involving the lip the technique of injecting alcohol 96% intralesional in conjuct with reducing blood loss by using Satinsky intestinal clamps had an acceptable result aesthetically.

Computer Aided Volume Measurement Using Osirix, A Free 3D-Rendering Software, In Preplanned Correction Of Enophthalmos With Diced Cartilage Graft Kreshanti, Prasetyanugraheni; Bangun, Kristaninta
Jurnal Plastik Rekonstruksi Vol. 1 No. 1 (2012): Jurnal Plastik Rekonstruksi
Publisher : Lingkar Studi Bedah Plastik Foundation

Autologous costal diced cartilage graft is an option for replenishment of the volume deficit in residual enophthalmos following orbito-zygomatic trauma. However, in published journals referring this treatment option, quantitative volume measurement of the graft needed has not been established. Two patients with orbito-zygomatic fractures resulted from motorcycle accidents, presented with dystopia, entrapment of the eyeball, diplopia, and depressed malar eminence on the affected side. CT scans demonstrated orbital-floor disruption and herniation of the intra-orbital content into the maxillary sinus. Using OsiriX®, a free and open source medical imaging software, we calculated the volume discrepancy of the affected orbit. On coronal slices, the segmentation of the bony orbital region of interest of each single slice was performed and grouped to compute the volume. At surgery, diced cartilage grafts were inserted to the orbital cavity according to the calculated volume, to promote forwards shift of the eye globe position after releasing the entrapment and replacing the orbital floor. In both patients, good position of the eye globe was achieved. The aesthetic appearance was perceived as quite acceptable to the patients and other viewers. Transient diplopia settled within 3 months. We considered OsiriX® as a reliable tool for accurate quantitative measurement of diced cartilage graft volume in enophthalmos correction.

Tetrapod Fracture: Surgical Anatomy Revisited As A Guide For 3D Reduction Using Carroll Girard T-Bar Screw Kreshanti, Prasetyanugraheni; Gianni, Livia Faranita
Jurnal Plastik Rekonstruksi Vol. 4 No. 1 (2017): Jurnal Plastik Rekonstruksi
Publisher : Lingkar Studi Bedah Plastik Foundation

Background: Zygomaticomaxillary complex plays a key role in the structure, function, and aesthetic appearance of the facial skeleton. Using Carroll Girard T-bar screw allows easy manipulation of the zygomaticomaxillary complex fracture. The goal of the treatment is three dimensional (3-D) restoration of the disturbed anatomy. Methods: After exposing the fracture sites using technique such as lower eyelid, Dingman (lateral brow) or maxillary vestibular approach, the Carroll Girard T-bar screw is then attached to the lateral aspect of the malar eminence to freely move the zygoma according to the x,y, and z axis. Zygomaticosphenoid suture acts as the anatomical landmark for adequate reduction. Conclusion: Open reduction and internal fixation is the principle of management in displaced ZMC fractures, aided by the use of Carroll Girard T-bar screw which allows easy manipulation and rotation for the zygomatic bone using the reference axis x, y and z.

Lip Symmetry Evaluation Of The Gentur's Method Compared To Fisher Techniques For Unilateral Cleft Lip Repair Kreshanti, Prasetyanugraheni; Kiat, Muhammad Irsyad
Jurnal Plastik Rekonstruksi Vol. 4 No. 1 (2017): Jurnal Plastik Rekonstruksi
Publisher : Lingkar Studi Bedah Plastik Foundation

Background : Cleft lip and palate are the most common congenital anomalies that were found in plastic surgery. There are so many techniques for unilateral cleft lip repair. Rotation-advancement method by Gentur based on Millard technique has become the most widely used in unilateral cleft lip repair in RSCM. The Fisher technique repair is a modified technique based on approximation of anatomical subunit of the lip. The purpose of this study is to objectively compare and evaluate the lip symmetry of these two techniques. Method : Two senior board-certified plastic surgeons will perform different surgical techniques for the unilateral cleft lip: rotation-advancement technique by Gentur and Fisher technique. This study prospectively analyzed preoperative and postoperative of randomized single blinded patients who underwent unilateral cleft lip repair performed by each surgeon in 2016. Using caliper, facial points on the cleft and non-cleft sides were measured, including height and symmetry of Cupid’s bow, width and height of the nasal vestibule, height of the vermilion, and alar base position. Ratios of cleft side to non cleft side measurements were calculated to standardize comparisons between patients. Result : From July-October 2016, 14 patients performed surgery as preliminary data, showed that there are statistically difference in length of design and surgery time. Preoperative, comparable of cupid’s bow and vermillion showed statistically difference. Although, we found no statistically difference in postoperative ratio. Conclusion : Lip symmetry outcomes after cheiloplasty procedure are same between Gentur method and Fisher technique.

Use of Resorbable Plate and Screws in Pediatric Craniofacial Reconstructive Surgery Kreshanti, Prasetyanugraheni; Handayani, Siti; Bangun, Kristaninta; Tiza, Melina
Jurnal Plastik Rekonstruksi Vol. 2 No. 3 (2013): Jurnal Plastik Rekonstruksi
Publisher : Lingkar Studi Bedah Plastik Foundation

Background: To evaluate two pediatric patients with syndromic craniofacial anomaly that underwent craniofacial reconstructive surgery using resorbable plate-screw systems which have been claimed as biodegradable fixation materials and used in craniofacial reconstructive procedures owing to their advantages such as adequate biomechanical resistance, longer dwelling time, elimination through physiological routes without causing any foreign body reaction and/or significant sequale. Patient and Method: Resorbable plate-screw systems used in 2 patiens for craniofacial reconstructive procedures such as bilateral fronto-orbital advancement and segmental right orbita (four wall box) osteotomy were evaluated as for their efficacy. Result: Adequate fixation was obtained in both patient, but Infection complication was seen in segmental right orbita osteotomy patient that appear localized abcess formation on subciliary incision and fronto medial insicion. After drainage insicion and antibiotic administration for 1 week, the infection was relieved. Summary: Owing to resorbable copolymer which contain a polyester derivate of L- lactidc and glycolic acid are ideal fixation materials used favourably in pediatric craniofacial reconstructive surgery and have further advantages such as adequate biomechanical resistance against distraction and compression forces in the early postoperative period, longer dwelling time and elimination from the body through physiological routes without causing any foreign body reaction.

Speech Outcome Evaluation Of Cleft Palate Patients Underwent Palatoplasty In Plastic Surgery Division Cipto Mangunkusumo Hospital Indonesia Kreshanti, Prasetyanugraheni; Sari, Vania Aramita; Wangge, Grace; Wahyuni, Luh Karunia
Jurnal Plastik Rekonstruksi Vol. 5 No. 1 (2018): Jurnal Plastik Rekonstruksi
Publisher : Lingkar Studi Bedah Plastik Foundation

Background: Speech is the primary goal of palatoplasty, however, there is no current data available about the long term speech evaluation after palatoplasty in our hospital which is the national referral hospital that has the only cleft craniofacial center in Indonesia. The initial data of speech outcome is required for further research which assessment should be standardized and applicable to Indonesian children that mostly speak bahasa. This study aims to get initial data by evaluating speech outcome of patients that underwent palatoplasty with adapted perceptual assessment words in Indonesian language, and describe factors influencing speech. Method: This research is a cross-sectional study to evaluate speech outcome of patients underwent palatoplasty in Cipto Mangunkusumo Hospital from October 2010–December 2012 conducted from December 2017 – July 2018. Result: Total 23 samples were measured for articulation rating where 17 (74%) patients had normal production of majority of phonemes, while there were 6 (26%) patients had predominantly distortion of phonemes. The hypernasality rating were normal in 12 (52%) patients, mild in 5 (22%) patients and moderate in 6 (26%) patients. The speech intelligibility rating were dominantly normal which all speech is understood in 17 (74%) patients and the rest of 6 (26%) patients were listeners attention needed. The velopharyngeal competence were good in 16 (70%) patients, fair in 1 (4%) patients and poor in 6 (26%) patients. Conclusion: Management of cleft palate patients will be achieved by well integrated services including speech pathologist and orthodontist. By giving the long term follow up to the patients, the optimal outcomes will be achieved. This research can be used as a reference for speech outcome evaluation in cleft palate patients in Indonesia.

Long Term Evaluation Of Maxillary Growth After ‘The Non Denuded Palatoplasty’ Technique Kreshanti, Prasetyanugraheni; Handayani, Siti; Rachmasari, Maulina; Pancawati, Julieta; Susanto, Amila Jeni; Wangge, Grace; Indania, Alita
Jurnal Plastik Rekonstruksi Vol. 5 No. 2 (2018): Jurnal Plastik Rekonstruksi
Publisher : Lingkar Studi Bedah Plastik Foundation

Background : Conventional Two Flap Palatoplasty technique will produce lateral defects without any periosteal coverage. These denuded lateral defects are prone to contamination and infection. These will result in wound contraction, scar formation and maxillary growth impairment. In 2011, we studied “The Non Denuded Palatoplasty” technique. This technique precipitated the epithelialization process of the lateral defects. Faster epithelialization is expected to decrease wound contraction and good maxillary growth. Method : This is a case control study to compare the maxillary growth of 2 groups consists of unilateral cleft lip and palate patients repaired with “The Non Denuded Palatoplasty” technique and Conventional Two Flap Palatoplasty. The outcome will be evaluated from cephalometry and the dental cast for each patient is evaluated using GOSLON YARDSTICK method. Data will be analyzed using SPSS version 20. Result : A total of 4 patients in The Non Denuded Palatoplasty group and 10 in the Conventional Two Flap Palatoplasty. The cephalometric SNA, SNB and ANB point showed Class III skeletal jaw relationship or deficient maxilla. Meanwhile the GOSLON yardstick type III are the most common GOSLON on both group with good inter-ratter reliability (p=0.839) based on Mann Whitney test. In these study, there was no correlation between cephalometric variables with GOSLON score. Conclusion: Our results showed that modification (The Non Denuded Palatoplasty) technique made no statistically significant difference to the maxillary growth. However this study has several limitations, one of which being the small sample size due to family, social and other factors that are beyond the control of the investigating team. Also the evaluation was conducted in patients aged 7-9 years, hence the result of this study is not the final outcome. Keywords: maxillary growth evaluation, cephalometry, Goslon Yardstick, two flap palatoplasty

Co-Authors Anindhawati, Nur Aria Kekalih Atmaja, Tessa Miranda Bambang Pontjo Priosoeryanto Bangun, Kristaninta Boaz, Grace Deni Noviana Djaprie, Shelly M Fortuna, Forry Fortuna, Fory Gianni, Livia Faranita Grace Wangge, Grace Hakim, Intan Friscilla Harsono, Anastasia Dessy Hatibie, Mendy Juniaty Indania, Alita Kiat, Muhammad Irsyad Luh Karunia Wahyuni, Luh Karunia Margareta Lumbuun, Ruth Fitri Martina, Nungki Ratna Maulina Rachmasari, Maulina Mulyadi Mulyadi Pancawati, Julieta Putri, Nandita Melati Rahyussalim Sari, Vania Aramita Siti Handayani Sudjatmiko, Gentur Sugeng Supriadi, Sugeng Sukasah, Chaula Luthfia Susanto, Amila Jeni Syamsul Rizal Tiza, Melina Tunjung, Narottama Yulia Rosa Saharman

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