Cahyanita Dyah Prabawaningrum G99152033

Putu Putri Andiyani Dewi G99161013

Yassin Oki Purbayanto G99161103
Yanu Tomang S G99162007
Hega Fitri Nuraga G99162086
Sonya Elizabeth G99162165

Supervisor : dr. Amru Sungkar, Sp. B, Sp.BP-RE (K)

Periode : 22 - 28 June 2016

 Name : Child. S

Age : 1 year

Sex : Female

Address : Wonogiri, Jawa Tengah

Religion : Islam

No. RM : 01378087

Date of admission : 18 May 2017

Cleft in the soft palate
 Patient was brought to the hospital by his
parent with the main complain cleft in the
upper palate. She has those complain since she
was born. Cough (-), fever (-), vomittus (-).
The patient was difficult to take the breastmilk,
and often get a hiccup after breastmilk feeding.
 PREVIOUS HSITORY FAMILIY HISTORY

operation history (-) Same complain (-)

Trauma history (-)

Same complain (-)

Alergic history (-)

 Pregnancy history Birth History

ANC history: (+) in the Patient born

midwife spontaneusly and was
Illness history during helped by the midwife,
pregnancy: (-) 38 weeks. When the
patient was born, he
History of anti seizure
cried loudly.
pills usage: (-)
Weight: 3200 g
History of smoking
during pregnancy: (-) Height: 48 cm

History of drinking
alchohol during
pregnancy: (-)
 Eyes : normal
Ear : normal
Mouth : abnormality (+),
look local status
Respiration system : normal
Cardiovasculer system : normal
Gastrointestinal system : normal
Muskuloskeletal system : normal
Genitourinaria system : normal
 General status : Compos mentis, E4V5M6,
nutrition is enough
Vital sign :
N : 98 x/minute, regular, symetric
RR : 24 x/minute
T : 36.5o C per axillar
Head : mesocephal, lession (-)
Eyes : Anemic conjunctiva(-/-), icteric sclera (-/-), pupil
isokor (3mm/3mm), light reflex (+/+), hematom
periorbita (-/-)
Ear : mucous (-), blood (-), mastoid pain (-), Tragus
pain(-)
Nose : asymetric nose (-, mucus (-), blood (-)
Mouth : bleeding gum (-), lession (-), wet mucosa (+),
unstable maxilla (-), unstable mandibula (-), cleft
lip (-), cleft alveolar (-), cleft palate (+)
Neck : thyroid enlargement (-), lymphonode
enlargement (-), pain (-), JVP increase (-)
Thorax : normochest, symetric, symetric respiration
movement
Heart

Inspection : ictus cordis is not visible.

Palpation : ictus cordis normal.

Percusion : heart border normal

Auscultation : heart sound normal, regular,
abnormal sound(-)
Pulmo
Inspection : movement of hemithorax symetric
dextra sinistra
Palpation : fremitus tactil symetric dextra sinistra
Percusion : sonor/sonor.
Auscultation : vesicular (+/+) normal, additional
sound(-/-)
Abdomen
Inspection : distended (-)
Auscultation : Bowel Sound (+) normal
Percusion : tympanic.
Palpation : pain (-), defance muscular (-)
Genitourinaria : urination normal,
hematuria (-), pyuria(-),
dissuria (-)
Musculoskeletal : normal
Extremity :
Extremity Coldness Oedeme
- - - -
- - - -
Mouth Regio
Inspection : cleft palate (+),
Palpation : pain in palpation (-)
Cleft palate / soft palate complete
 Blood Examination

Nutrition

Consultation to Plastic Surgeon (Pro palatoplasty)

 Pemeriksaan Hasil Satuan Nilai Normal
Darah Rutin
Hemoglobin 11.4 g/dl 10.95 12.9
Hematokrit 38 % 33 41
Leukosit 9.6 ribu/ul 5,5 17.0
Trombosit 225 ribu/ul 150 450
Eritrosit 4.58 ribu/ul 4.10 5.30
PT 11.8 detik 10 15,0
APTT 23.1 detik 2040
INR 0.850
SGOT 56 u/l <31
SGPT 17 u/l <34
Albumin 4.9 g/dl 3.8 5.4
Creatinine 0.3 mg/dl 0.3 0.7
Ureum 21 mg/dl <48
Gula darah sewaktu 85 mg/dl 60 100
Natrium darah 135 mmol/L 132-145
Kalium darah 4.8 mmol/L 3.1-5.1
Chlorida darah 112 mmol/L 98-106
HBsAg Non reactive Non reactive
Palatoschisis Unilateral
Nutrition
Consultation to Plastic Surgeon (Pro
palatoplasty)
Cleft palate: Congenital abnormal space
in palate
3rd most common congenital
abnormalities

women (57%) > man (43%)

1) Phitral column, 2) Phitral groove, 3) Cupids
bow 4) White roll upper lip, 5) Tuberculum, 6)
Commissura, 7) Vermilion
 Prenatal Diagnosis
Prenatal ultrasound techniques are used to
display both the normal and the pathological
fetal lip and palate
MRI is used increasingly for evaluation of fetal
abnormalities that are difficult to identify on
sonography alone
Lactate dehydrogenase and creatine
phosphokinase detection is used for prenatal
diagnosis of unilateral cleft palate
 Post Natal Diagnosis
Could be detected after birth delivery
In particular condition, e.g. soft palate
(submucous cleft, an insidious form, can be
detected insidentally.
The Veau classification system
divides the cleft palate into 4 groups,
which are as follows and illustrated in
the image below:
Group I Defects of the soft palate
only
Group II Defects involving the
hard palate and soft palate
Group III Defects involving the
soft palate to the alveolus, usually
involving the lip
Group IV Complete bilateral clefts
 Oro-nasal communication
Feeding difficulties
Dental problem Malocclusion
Restriction of growth
Speech difficulties
Recurrent ear infection, otitis >50% children
with CLP
Airway obstruction may present in children
with a cleft palate, especially those with
mandibular hypoplasia
 Surgical techiques :
Von Langenbeck
Schweckendiek
2-flap
3-flap (V-to-Y)
Double reverse z-plasty (Furlow) palatoplasties.
Furlow procedure is the most common technique
for cleft palate closure
 Mucoparietal flaps
Flaps are advanced
medially to close the
palatal cleft
Advantage : simple,
less dissection
Disadvantages : Does
not increase the
length of the palate,
anterior fistulas
 The technique is
primarily used for repair
of incomplete clefts or
clefts of the secondary
palate
Osteotomy &
repositioning of greater
palatine foramen
Advantage : maintenance
of blood supply, useful in
wider clefts, adds length
Disadvantage : fistula
 This method is difficult to
perform in wide cefts but a
good method when the cleft
is narrow or if submucous
cleft exist
The technique involves
opposing z-plasties of the
mucosa and the
musculature of the soft
palate
The goal is to separate the
nonfunctioning attachments
to the posterior border of
the hard palate and to
displace the mucosa and
the musculature posteriorly
 Arch of cleft will
provide the
length needed
for closure
Combines intra-
velar veloplasty
 2 staged approach
Earlier soft palate later harf palate
Soft palate + lip = 4 to 6 months
Hard palate = 4-5 years
Earlier hard palate closure is proposed = 18-
24 months
 Intra operative
Hemorrhage
Flap tearing
Improper suturing

Post operative
Airway obstruction
Uncontrolled hemorrhage
fistula