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"ABSTRAKLatar Belakang: Operasi orthognatik merupakan tahapan akhir dari perawatan fungsional dan rehabilitasi pada penderita celah bibir dan langit-langit, disebabkan karena tingginya prevalensi dari rahang atas yang mengalami hipoplasi, sehingga banyak penderita yang memerlukan osteotomi maksila. Tujuan: Mengetahui kebutuhan operasi orthognatik pada penderita celah bibir dan langit - langit usia pasca perawatan orthodontik konvensional usia 18–25 tahun pada RSAB Harapan Kita Unit Celah Bibir dan Langit-langit. Metode: Analisis antropometri dengan mengukur besar sudut nasolabial dan facial contour, analisis sefalometri dengan mengukur besar sudut ANB dan jarak Wits Appraisal, analisis model studi dengan mengukur jarak inter insisal dan inter molar. Hasil perbandingan antar kelompok dianalisa menggunakan uji T – Test tidak berpasangan .Hasil: Kebutuhan bedah orthognatik usia 18–25 tahun cukup tinggi dibandingkan yang dapat dirawat dengan perawatan orthodontik konvensional. Kesimpulan: Untuk meningkatkan pelayanan di unit CLP RSAB Harapan Kita pasien celah bibir dan langit-langit harus diedukasi ke arah bedah orthognatik untuk mendapat hasil akhir yang lebih baik.

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ABSTRACTBackground: Orthognathic surgery is the final stage of treatment and functional rehabilitation in patients with cleft lip and palate, due to the high prevalence of maxillary hipoplasia that require osteotomy. Purpose: Measure the need for orthognathic surgery in 18-25 years old patients with cleft lip and palate after orthodontic treatment at Harapan Kita Hospital. Method: Anthropometric analysis with a large measure the nasolabial angle and facial contour, cephalometric analysis with a large measure ANB angle and Wits appraisal distance, analytical study of the model by measuring the inter-incisal distance and inter molar. The results of comparisons between groups were analyzed using T test - Test. Result: Surgical needs orthognatik age 18-25 years is quite high compared to that can be treated with conventional orthodontic treatment. Conclusion: To improve services in the CLP unit RSAB Harapan Kita patients cleft lip and sky - the sky should be educated towards orthognatik surgery to get a better end result."

"Latar belakang: Kehilangan darah memiliki pengaruh terhadap kejadian komplikasi pasca operasi. Kehilangan darah intraoperatif berfungsi sebagai penanda keberhasilan operasi dan prognosis bagi pasien. Prosedur bedah seperti bedah ortognatik termasuk bedah mayor dengan resiko kehilangan darah intraoperatif yang banyak. Kehilangan darah setelah bedah ortognatik sangat bervariasi, dan terkadang diperlukan transfusi. Ahli bedah perlu mengevaluasi faktor yang mempengaruhi kehilangan darah intraoperatif dan menilai tingkat transfusi sehingga dapat mengurangi resiko komplikasi kehilangan darah dan menghindari penggunaan transfusi berlebihan.Tujuan: Studi ini bertujuan untuk menganalisis hubungan lama operasi, jenis bedah ortognatik dan indeks massa tubuh terhadap jumlah kehilangan darah intraoperatif pada bedah ortognatik. Metode: Studi ini menggunakan metode analitik observasional dengan desain penelitian retrospektif. Hasil: Terdapat hubungan yang signifikan antara jenis bedah ortognatik dan lama operasi dengan kehilangan darah intraoperatif pada pasien bedah ortognatik. Double jaw surgery dan Lefort I osteotomy serta faktor lama operasi menunjukkan adanya korelasi yang kuat terhadap jumlah kehilangan darah intraoperatif pada pasien bedah ortognatik. Indeks massa tubuh tidak menunjukkan hubungan yang signifikan terhadap jumlah kehilangan darah intraoperatif pada pasien bedah ortognatik. Kesimpulan: Jenis bedah ortognatik double jaw surgery dan Lefort I osteotomy serta lama operasi lebih dari 5 jam mempengaruhi jumlah kehilangan darah intraoperatif yang signifikan pada pasien bedah ortognatik.

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Background: Blood loss has an influence on the incidence of postoperative complications. Intraoperative blood loss can be serves as a marker of successful surgery and prognosis for patients. Surgical procedures such as orthognathic surgery is one of major surgery with a high risk of intraoperative blood loss. Blood loss after orthognathic surgery varies greatly, and sometimes transfusion is needed. Surgeons need to evaluate factors that affect intraoperative blood loss and assess transfusion rates so as to reduce the risk of blood loss complications and avoid excessive transfusion use.

Objective: This study aims to analyze the relationship between duration of surgery, type of orthognathic surgery and body mass index to the amount of intraoperative blood loss in orthognathic surgery.

Method: This study uses observational analytic methods with a retrospective research design.

Results: There is a significant relationship between the type of orthognathic surgery and the length of surgery with intraoperative blood loss in orthognathic surgery patients. Double jaw surgery and Lefort I osteotomy as well as the duration of surgery showed a strong correlation with the amount of intraoperative blood loss in orthognathic surgery patients. Body mass index did not show a significant relationship to the amount of intraoperative blood loss in orthognathic surgical patients.

Conclusion: The type of orthognathic double jaw surgery and Lefort I osteotomy as well as the operating duration of more than 5 hours affect the amount of significant intraoperative blood loss in orthognathic surgery patients."

"Latar belakang: Pasien celah bibir dan langit-langit (CLP) memiliki karakteristik ukuran maksila dan mandibula yang lebih kecil, posisi maksila dan mandibula yang retrognati, dimensi faring yang lebih kecil, dan posisi tulang hyoid yang lebih inferior. Gangguan pada struktur wajah dan jalan napas ini meningkatkan risiko gangguan napas saat tidur terutama Obstructive Sleep Apnea (OSA). OSA merupakan gangguan tidur berupa episode berulang sumbatan jalan napas baik parsial dan total. OSA pada anak berakibat gangguan perkembangan, gangguan kognitif, kelelahan di siang hari, gangguan perilaku, dan komplikasi kardiovaskular. Walaupun memiliki banyak dampak negatif, OSA pada anak-anak terutama pada pasien CLP kurang menjadi perhatian. Tujuan: Penelitian ini bertujuan untuk melihat hubungan struktur wajah dan jalan napas secara sefalometri terhadap risiko terjadinya OSA pada pasien CLP. Metode: Sefalometri lateral dari 18 pasien celah bibir dan langit-langit pasca labioplasti dan palatoplasti baik unilateral maupun bilateral dengan usia 6 sampai 8 tahun di poli CLP RSAB Harapan Kita di-tracing. Orang tua atau wali pasien mengisi kuesioner uji tapis OSA Brouillette dan Pediatric Sleep Questionnaire. Hasil tracing dan kuesioner dilakukan uji korelasi Spearman dan Kendall. Hasil: Pasien CLP memiliki dimensi faring yang lebih kecil, maksilomandibular retrognati, ukuran maksila dan mandibular yang pendek, posisi hyoid yang lebih anterior dan adenoid yang besar. Dari kuesioner Brouillette tidak didapatkan risiko OSA pada pasien CLP. Satu pasien CLP memiliki risiko tinggi OSA dari hasil kuesioner PSQ. Semua variabel sefalometri tidak memiliki korelasi bermakna dengan risiko OSA (p>0,05). Kesimpulan: Penelitian ini tidak mendapatkan adanya korelasi antara variabel-variabel sefalometri dengan risiko OSA walaupun hasil analisis sefalometri mendukung terjadinya OSA.

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Background: Cleft lip and palate (CLP) patients have characteristic of smaller maxilla and mandible, bimaxillary retruded, smaller pharyngeal dimension, and inferiorly position hyoid. Facial structural and airway abnormalities increase sleep-disordered breathing especially obstructive Sleep Apnea (OSA). OSA is a sleep disturbance characterized by repeated episodes of total or partial upper airway obstruction. OSA in children results in developmental disorders, cognitive impairments, daytime fatigue, behavioral disorders, and cardiovascular complications. Although it has many detrimental effects, OSA in children especially in CLP patients is underrecognized.

Objective: This study aims to determine the relationship between cephalometric facial and airway structures and the risk of OSA in CLP patients.

Methods: Lateral cephalometry of 18 patients with cleft lip and palate which had undergone labioplasty and palatoplasty according to treatment protocol, both unilateral and bilateral, aged 6 to 8 years in cleft lip and palate clinic, Harapan Kita Hospital were traced. Patient’s parent were asked to fill out Brouillette's questionnaire and the Pediatric Sleep Questionnaire. Spearman and Kendall correlation test were used to asses the colleration cephalometric analysis and questionnaires’ result.

Results: CLP patients have smaller pharyngeal dimensions, bimaxillary retruded, shortened maxillary and mandibular length, anteriorly positioned hyoid and relatively large adenoids. Brouillette failed to demonstrate OSA risk in CLP patients. One CLP patient has a high risk of OSA from the results of the PSQ questionnaire. All cephalometric variables did not have a significant correlation with OSA risk (p> 0.05).

Conclusion: This study did not show any correlation between cephalometric variables and OSA risk, although the results of cephalometric analysis supported the occurrence of OSA."

"ABSTRAKTujuanPenelitian mengenai penggunaan analisis faktor risiko dan mortalitas pada operasijantung masih menjadi perdebatan dan merupakan area yang sedang berkembang.Analisis faktor risiko dalam penilaian suatu hasil pembedahan jantung merupakan halyang tidak dapat dihindari. Ahli bedah dan rumah sakit memerlukan suatu hasilpenilaian faktor risiko terhadap risiko kejadian mortalitas perioperasi agar dapatmenentukan keputusan klinis. Tujuan penelitian ini adalah untuk membandingkanParsonnet dan European System for Cardiac Operative Risk Evaluation (EuroSCORE)pada pasien yang menjalani perbaikan katup mitral dan memperkirakan faktor-faktorrisiko apa saja yang dapat mempengaruhi mortalitas perioperatif.Pasien dan MetodeDari bulan Januari 2010 sampai dengan bulan Desember 2012, 96 pasien terpilih yangtelah menjalani operasi perbaikan katup mitral menggunakan mesin jantung paru dantelah dilakukan analisis faktor risiko berdasarkan Parsonnet score and EuroSCORE .seluruh faktor risiko dianalisis dengan analisis deskriptif, tabulasi silang, Pearson ChiSquare, dan uji Anova, keduanya juga dianalisis dengan kurva ROCHasilAngka mortalitas riil sebesar 5,2 %. Berdasarkan Parsonnet score, nilai prediksimortalitas sebesar 18,26 % sementara pada EuroSCORE nilai prediksi mortalitassebesar 3,68 %. Hasil keduanya signifikan secara statistik. Nilai prediksi EuroSCORElebih mendekati angka kematian riil bila dibandingkan Parsonnet score .KesimpulanEuroSCORE lebih unggul dibandingkan dengan Parsonnet score .Nilai prediksiEuroSCORE lebih mendekati angka kematian riil . EuroSCORE merupakan alat ukuryang baik dalam analisis faktor risiko dan mortalitas pada operasi perbaikan katupmitral

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ABSTRACTObjectiveThe use of risk stratified mortality studies for analyzing surgical outcome in cardiacsurgery is obviously a developing area. Unfortunately, outcomes research in valverepair surgery has been relatively limited. The risk stratification in the assessment ofcardiac surgical results is inevitable. Surgeons and hospitals need availability of riskassessment result which may influence decision-making. Without risk stratification,surgeons and hospitals treating high-risk patients will appear to have worse resultsthan others. Our purpose was to compare the performance of risk stratification models,Parsonnet and European System for Cardiac Operative Risk Evaluation (EuroSCORE)in our patients undergoing mitral valve repair (MVr) and predict the risk factors thatinfluence inhospital mortality .Patient and methodsFrom January 2010 to December 2012, 96 consecutive patients have undergone MVrusing cardiopulmonary bypass and scored according to Parsonnet score andEuroSCORE algorithm. All risk factors were analyzed by descriptive analytic, crosstabulation, Pearson Chi Square, and Anova test, both scores analyzed by ROC curve.ResultsOverall hospital mortality was 5,2 %. In Parsonnet model, predicted mortality was18,26 % while in the EuroSCORE model, predicted mortality was 3,68 %. and it wasstatistically significant for the Parsonnet score and EURO score . Parsonnet Score hasa higher sensitivity compared to the EuroSCORE. From the ROC curve, AUC forParsonnet score (0,905) higher than AUC for EuroSCORE (0,892). Problems with theParsonnet score of subjectivity, inclusion of many items not associated with mortality,and the overprediction of mortality have been highlighted. Pre operative NYHA class,age, ejection fraction , complication, etiology, EuroSCORE, and Parsonnet scoreduring mitral valve repair were statistically significant for affecting inhospitalmortality risk.ConclusionsThe EuroSCORE is more reasonable overall predictor of hospital mortality in ourpatients undergoing MVr compared to Parsonnet score."

"Latar belakang : Deformitas nasal pada pasien dengan celah bibir disebabkan oleh deviasi septum nasal, distorsi tulang rawan alar, dan ketidaksejajaran maksila dan tulang alveolar yang disebabkan oleh bidang palatum yang melebar. Penambahan rinoplasti pada teknik labioplasti menjadi solusi pada pengelolaan pasien UCLP dengan tujuan untuk mendapatkan kesimetrisan nostril. Penelitian ini bertujuan membandingkan ukuran dan kesimetrisan nostril sisi celah dan non celah pasca kombinasi Labioplasti teknik Cronin dengan Rinoplasti teknik Tajima.Metode : Penilaian kesimetrisan nostril berdasarkan skala antropometri dari data fotograf wajah, yaitu ukuran tinggi nostril, lebar nostril, tinggi ¼ medial nostril, dan luas nostril pada 35 pasien UCLP pasca kombinasi Labioplasti teknik Cronin dengan Rinoplasti teknik Tajima.Hasil : Dari hasil statistik didapatkan P<0,05 pada lebar dan tinggi ¼ medial nostril. Sedangkan pada tinggi dan luas nostril didapatkan P>0,05 . Hal ini menunjukkan tidak terdapat perbedaan bermakna pada tinggi dan luas nostril antara sisi non celah dengan sisi celah pada pasien pasca labioplasti Teknik Cronin dan Rinoplasti teknik Tajima, sedangkan pada lebar dan tinggi ¼ medial nostril terdapat perbedaan yang bermakna.Kesimpulan: Tidak terdapat perbedaan pada tinggi dan luas nostril pasca labioplasti teknik Cronin dan rinoplasti teknik Tajima pada pasien UCLP. Sedangkan pada lebar dan tinggi ¼ medial nostril terdapat perbedaan antara sisi celah dan non celah.

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Background: Nasal Deformity in cleft lip patient is caused by nasal septum deviation, alar cartilage distortion, and unparallel maxilla and alveolar bone which caused by widening of palate. Additional rhinoplasty in labioplasty method becomes a solution in management of UCLP patient in order to achieve nostril symmetrically. The aim of this experiment is to compare nostril size and symmetry between cleft side with non cleft side post labioplasty Cronin method and Rhinoplasty Tajima method.

Methods: Evaluation of Nostril symmetrical according to anthropometry scale from profile photograph, which are nostril height, nostril width, ¼ medial nostril height, and nostril area in 35 UCLP patients post labioplasty with combination of Cronin and rhinoplasty method.

Result: Based on statistic, the result showed P<0,05 within width and ¼ medial nostril height. On the other side, height and nostril area result showed p>0,05. This shows that there is no significant difference between height and nostril area between non cleft side with cleft side in patient post labioplasty Cronin method and Tajima method Rhinoplasty. On the other side, there is significant different between width and ¼ medial nostril height.

Conclusion: There is no significant different between height and nostril area post labioplasty Cronin method and Tajima method Rhinoplasty in UCLP patient. On the other side, there is significant difference between width and ¼ medial nostril height between cleft side and noncleft side."

"This manual of spine surgery has become necessary as a consequence of the rapid expansion of instrumented spine surgery using different minimally invasive and non-fusion techniques. To do justice to this development, the manual aims to present the different techniques to spinal surgeons (orthopaedic and neurosurgeons) in a clear and instructive way using detailed illustrations. The description of different open, less invasive or minimally invasive techniques will provide the spinal surgeon with useful guidelines for their use. The success of any spinal operation depends on good definition of the indications, consideration of the contraindications, technical and organisational factors, good operating technique and correct preoperative preparation and positioning of the patient. "

"Latar Belakang: Keseimbangan dan harmoni gambaran wajah merupakan tujuan utama dari penatalaksanaan bedah pada pasien dengan celah bibir. Berbagai metode operasi untuk celah bibir unilateral telah tersedia. Labioplasti metode Cronin pada pasien celah bibir dan langit-langit unilateral menghasilkan bibir yang simetris dengan jaringan parut seminimal mungkin.Tujuan: Evaluasi kesimetrisan bibir pada pasien celah bibir dan langit-langit unilateral pasca labioplasti metode Cronin sesuai protap yang berlaku di Unit Celah Bibir dan Langit-langit Rumah Sakit Anak dan Bunda Harapan Kita Jakarta.Metode: Pasien celah bibir dan langit-langit unilateral 2 minggu, 1 bulan, 3 bulan, 6 bulan, dan 1 tahun pasca labioplasti dengan metode Cronin sebanyak 36 orang dinilai kesimetrisan bibir secara antropometri dengan fotograf yang telah terstandarisasi dari 2 aspek, yaitu anterior dan lateral. Bibir pada sisi celah diukur dan dibandingkan dengan sisi non celah.Hasil: Tidak terdapat perbedaan bermakna pada jarak ac ke komisura ipsilateral (p = 0.387) dan jarak puncak cupid?s bow ke komisura ipsilateral (p = 0.933) pada sisi celah dan non celah. Terdapat perbedaan bermakna jarak sbal ke puncak cupid?s bow (p = 0.007) antara sisi celah dan non celah pada 2 minggu, 1 bulan, 3 bulan, dan 6 bulan pasca labioplasti.Kesimpulan: Kesimetrisan bibir pada sisi celah dan non celah pasca labioplasti dengan metode Cronin berdasarkan rasio pengukuran antropometri dengan fotograf yang telah terstandarisasi dapat dicapai sempurna pada 1 tahun pasca labioplasti.

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Background: Balance and harmony of facial features are the goal of surgical treatment for patients with cleft lip. Various methods of surgery for unilateral cleft lip had been provided. Labioplasty Cronin method in patients with unilateral cleft lip and palate produce symmetrical lips with minimal scarring.

Objective: Evaluation lip symmetry post labioplasty Cronin method in patients with unilateral cleft lip and palate based on standard operating procedure in Cleft Center Harapan Kita General Hospital.

Material and Methods: Thirty-six patients with unilateral cleft lip and palate after performing labioplasty Cronin method were photographed on anterior and lateral side by a standardized method 2 weeks, 1 month, 3 months, 6 months, and 1 year after surgery. Lips on the cleft side were measured and compared with the opposite side.

Results: There were no significant differences the length of ac to ipsilateral commissure (p = 0.387) and the distance of the peak cupid's bow to the ipsilateral commissure (p = 0.933) on cleft and norm side. There are significant differences the length of sbal to the Cupid's bow peak (p = 0.007) between cleft and norm side at 2 weeks, 1 month, 3 months, and 6 months post labioplasty.

Conclusion: Symmetrical lip post labioplasty with Cronin method at cleft and non cleft side based on the ratio of anthropometric measurements with standardized photographs can be accomplished perfectly in 1 year after labioplasty."