Presurgical nasoalveolar molding modifikasi Hotz-Kogo dengan single nasal stent untuk perawatan pra-bedah bayi celah bibir dan langit-langit unilateral komplit

Hotz-Kogo modified presurgical nasalveolar molding with single nasal stent for pre-surgical treatment of complete unilateral cleft lip and palate infant

Gian Nur Alamsyah, Lisda Damayanti, Taufik Sumarsongko

Abstract


ABSTRAK

Pendahuluan: Defek kongenital pada daerah kraniofasial yang sering terjadi adalah celah bibir dan langit-langit (CBL). Bayi dengan CBL unilateral memiliki ciri khas pada sisi bercelah, premaksila akan berotasi dan terproyeksi ke luar, filtrum dan columella akan memendek pada satu sisi, dan miring ke arah sisi tidak bercelah. Segmen minor maksila akan mengalami hipoplastik dan retroposisi. Presurgical nasoalveolar molding (PNAM) merupakan plat ortopedik yang dapat mereposisi secara pasif segmen alveolar dan kartilago nasal sebelum labioplasty. Desain PNAM dengan modifikasi desain Hotz-Kogo yaitu perpaduan dari plat Hotz yang menutupi segmen alveolar kemudian memanjang ke posterior hingga uvula dipadukan desain plat Kogo dengan peninggian 2 mm di posterior plat yang berperan sebagai close box akan menambah retensi pada plat. Nasal stent memiliki kelebihan mengoreksi kartilago hidung yang immature dan mempertahankan pada posisi yang normal. Tujuan laporan kasus untuk menjelaskan tahapan dan hasil perawatan bayi pra bedah dengan PNAM desain modifikasi Hotz-Kogo dengan single nasal stent bayi celah bibir dan langit-langit unilateral komplit sinistra. Laporan kasus: Diagnosis laporan kasus ini labiognatopalatoschizis unilateral complete sinistra dirawat dengan menggunakan PNAM desain modifikasi Hotz-Kogo dan strapping ekstraoral. Nasal stent kemudian dipasang untuk membentuk kartilago nasal. Posisi premaksila dikoreksi dengan melakukan penyesuaian berkala pada permukaan anatomi PNAM. Hasil perawatan didapat posisi premaksila lebih baik dan celah menyempit, serta morfologi nasal yang lebih simetris antara sisi bercelah dan tidak bercelah. Simpulan: Penanganan pra bedah dengan pembuatan PNAM modifikasi Hotz-Kogo dengan single nasal stent pada bayi CBL unilateral komplit, dapat mengkoreksi posisi premaksila dan memperkecil jarak celah sebelum tindakan labioplasty. 

Kata kunci: presurgical nasoalveolar molding; nasal stent; celah bibir dan langit-langit.

 

ABSTRACT

Introduction: Congenital defects in the craniofacial area, amongst others, are cleft lip and palate (CLP). Infants with unilateral CLP have a characteristic on the cleft side. The premaxilla will rotate and project outward; the philtrum and columella will shorten on one side and tilt toward the non-cleft side. The minor maxillary segment is hypoplastic and retroposition. Presurgical nasalveolar moulding (PNAM) is an orthopaedic plate that can passively reposition the alveolar and nasal cartilage segments before labioplasty. The PNAM with a modified Hotz-Kogo design combines the Hotz plate that covers the alveolar segment and extends posteriorly to the uvula combined with the Kogo plate design with a 2 mm elevation on the posterior plate, which acts as a close box will increase the retention of the plate. Nasal stents can correct the immature nasal cartilage and maintain it in its normal position. This case report presented the stages and outcomes of presurgical treatment with Hotz-Kogo modified PNAM design with a single nasal stent for infants with unilateral complete left cleft lip and palate. Case report: Diagnosis in this case report was unilateral complete left labiognatopalatoschizis, treated with Hotz-Kogo modified design PNAM and extraoral strapping. A nasal stent was then placed to form the nasal cartilage. The premaxillary position was corrected by making periodic adjustments to the anatomic surface of the PNAM. The treatment results obtained a better premaxillary position, narrowed slits, and a more symmetrical nasal morphology between cleft and non-slit sides. Conclusion: Presurgical treatment with Hotz-Kogo modified PNAM with a single nasal stent in complete unilateral CBL infants can correct the premaxillary position and reduce the gap before labioplasty.

Keywords: presurgical nasoalveolar moulding; nasal stent; cleft lip and palate.


Keywords


presurgical nasoalveolar molding; nasal stent; celah bibir dan langit-langit

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References


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DOI: https://doi.org/10.24198/jkg.v33i3.30906

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