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"[Latar belakang: Tujuan studi ini adalah untuk menilai persepsi masyarakat terhadap hasil operasi hidung pada pasien cleft menggunakan tehnik semi-open modified Tajima. Mengingat banyak tehnik operasi yang digunakan dengan berbagai kelebihan masing – masing, kami ingin mengetahui apakah tehnik yang sederhana, mudah dikerjakan dengan morbiditas yg rendah hasilnya akan mendapatkan apresiasi yang berbeda oleh orang tua dan para profesional medis.Metode: Studi cross sectional menggunakan questionnaire dengan menilai 25 foto dari hasil operasi hidung pada pasien cleft dengan tehnik semi-open modified Tajima. Duapuluh lima orang tua dan 25 orang pelaku medis dalam hal ini residen bedah plastik akan di perlihatkan foto, dan kemudian mereka akan menilai hasil operasi tersebut dengan menggunakan VAS score, yaitu berupa tanda disepanjang garis berukuran 100 mm. Data kemudian dianalisa dengan tes Chi-square. Dan korelasi antara profesional medis dan orang tua akan dianalisa menggunakan Spearman correlation.Results: Dari penelitian didapatkan perbedaan yang significant dari persepsi orangtua mengenai hasil operasi dengan professional medis sebesar -0.38 yang berarti persepsi mereka cenderung bertolak belakang. Dan terdapat korelasi lemah antara orangtua dan medis sebesar 0. 045(lebih rendah dari 0.05).Kesimpulan: Persepsi estetik antara profesional medis dan orangtua ternyata berbeda. Dan korelasi antara persepsi yang satu dengan yang lainnya ternyata lemah. Sebagai orang terdekat dan yang bertanggung jawab terhadap pasien, memang sudah sewajarnya kita mendengarkan dan menelaah apa sebenarnya keinginan dan harapan mereka. , Background: There are many technique of cleft rhinoplasty has been used worldwide. Each of it came with their advantage and disadvantage. Technique that has been known with simple, easy and less morbidity are semi – open modified Tajima technique, but it always judged as a second class compare to the open rhinoplasty, despite the higher morbidity of the open rhinoplasty. But actually no one ever try to find if result of the semi –open rhinoplasty modified Tajima technique are really dislike by the community. Are the medical professional communities whom prefer sophisticated technique with exquisite result or the parents also share the same interest? The different perception between medical profesional and parents are the thing we like to observe. Methods: A cross sectional research on a 25 consecutive sample for each grouup. Twenty-five photograph of a patient that has been through rhinoplasty using semi – open modified Tajima technique are shown to 25 parents and 25 medical professional (plastic surgery resident). After observe the photograph, parents and residents are giving their judgment on a questionnaire using VAS score. They put a mark on a 100 mm ruler base on their judgments. After that the result was analyzed using chi square, and correlation between parents and residents are analyzed using Spearman correlation. Results: The result shown that there are 12 poor perception and 13 good perception from medical professional, while there are 13 poor perception and 12 good perception from parents. There 6 poor perceptions by both medical professional and parents, and 6 good perceptions by booth parents and medical professional. A kappa value from this research is – 0.38, which means the two observers classify Background: There are many technique of cleft rhinoplasty has been used worldwide. Each of it came with their advantage and disadvantage. Technique that has been known with simple, easy and less morbidity are semi – open modified Tajima technique, but it always judged as a second class compare to the open rhinoplasty, despite the higher morbidity of the open rhinoplasty. But actually no one ever try to find if result of the semi –open rhinoplasty modified Tajima technique are really dislike by the community. Are the medical professional communities whom prefer sophisticated technique with exquisite result or the parents also share the same interest? The different perception between medical profesional and parents are the thing we like to observe. Methods: A cross sectional research on a 25 consecutive sample for each grouup. Twenty-five photograph of a patient that has been through rhinoplasty using semi – open modified Tajima technique are shown to 25 parents and 25 medical professional (plastic surgery resident). After observe the photograph, parents and residents are giving their judgment on a questionnaire using VAS score. They put a mark on a 100 mm ruler base on their judgments. After that the result was analyzed using chi square, and correlation between parents and residents are analyzed using Spearman correlation. Results: The result shown that there are 12 poor perception and 13 good perception from medical professional, while there are 13 poor perception and 12 good perception from parents. There 6 poor perceptions by both medical professional and parents, and 6 good perceptions by booth parents and medical professional. A kappa value from this research is – 0.38, which means the two observers classify ]"

"ABSTRAKRinoplasti adalah prosedur estetik yang banyak diminati di seluruh dunia dan merupakan prosedur menantang bagi seorang ahli bedah estetik karena memiliki satu tujuan yaitu kepuasan. Kepuasan ini tidak hanya untuk pasien, tapi juga bagi ahli bedah yang terlibat. Banyak faktor yang dapat mempengaruhi suatu kepuasan. Kepuasan yang ingin dicapai dapat dilihat dari segi estetik tanpa melupakan fungsinya. Penelitian ini menggunakan kuesioner rhinoplasty outcomes evaluation untuk menilai tingkat kepuasan pasien setelah menjalani prosedur rinoplasti. Segala jenis prosedur operasi, kususnya dibidang estetik, kunci keberhasilan adalah ketepatan pemilihan pasien, sehingga mengetahui psikologi pasien dapat menjadi garis depan dalam pengambilan keputusan pemilihan pasien. Prosedur ini memiliki risiko potensial tinggi terutama pada pasien dengan gangguan psikopatologi, sehingga penilaian psikologi pasien perlu dilakukan, dimana digunakan penilaian dengan skala kecemasan pada penelitian ini untuk mengetahui hal tersebut. Hal lain yang dapat mengurangi tingkat kepuasan pasien adalah keluhan sumbatan hidung setelah operasi, oleh karena itu penilaian aliran udara hidung sebelum dan sesudah operasi perlu dilakukan untuk memaksimalkan target kepuasan yang ingin dicapai. Oleh karena itu pada penelitian ini menggunakan kuesioner NOSE dan ESS, serta pemeriksaan PNIF untuk menilai aliran udara hidung sebelum dan sesudah operasi.

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ABSTRACTRhinoplasty is an aesthetic procedure that is in great demand throughout the world and is a challenging procedure for an aesthetic surgeon because it has one goal, satisfaction. This satisfaction is not only for patients, but also for the surgeons involved. Many factors can influence satisfaction. Satisfaction to be achieved can be seen in terms of aesthetics without forgetting its function. This study used a rhinoplasty outcomes evaluation questionnaire to assess the level of patient satisfaction after undergoing a rhinoplasty procedure. All types of surgical procedures, especially in the aesthetic field, the key to success is the accuracy of patient selection, so knowing the psychology of patients can be the front line in making patient selection decisions. This procedure has a high potential risk especially in patients with psychopathological disorders, so assessment of patient psychology needs to be done, which is used to assess the neurotic scale in this study to find out this. Another thing that can reduce the level of patient satisfaction is a complaint of nasal obstruction after surgery, therefore an assessment of nasal air flow before and after surgery needs to be done to maximize the target of satisfaction to be achieved. Therefore in this study using the NOSE and ESS questionnaire, and PNIF examination to assess nasal air flow before and after surgery.

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"[ABSTRAKPendahuluan :Fraktur Midface merupakan fraktur yang sering terjadi dapat dapat memberikan efek baik dari segi estetik dan fungsi. Fraktur Midface yang tidak ditangani dengan baik akan merubah bentuk wajah menjadi tidak proporsional, salah satunya wajah yang menjadi lebih lebar dan panjang, terdapat depresi malar. Tata laksana dengan reposisi segmen fraktur dan fiksasi interna merupakan pilihan utama.Metode :Data yang diambil dari status estetik dengan menggunakan studi cross sectional pada pasien dengan fraktur midface sebelum operasi ORIF didapatkan di rekam medis, dan data setelah opeasi ORIF didapatkan dari follow up (4 years), kemudian dilakukan pengukuran dari proyeksi vertical, horizontal dan warm?s view .Hasil :Berdasarkan analisis fotografi dari proyeksi vertikal didapatkan 3 pasien memiliki proporsi muka yang baik, 3 pasien memiliki proporsi wajah yang baik dikarenakan perbedaan rata-rata. Berdasarkan analisis fotografi dari proyeksi horizontal didapatkan 3 pasien memiliki panjang muka yang berbeda, 2 pasien memiliki dystopia, 1 pasien memiliki enophtalmus. Berdasarkan analisi fotografi dari proyeksi worm?s eye didapatkan 4 pasien memiliki depresi malar eminensMengenai hasil estetika, didapatkan 4 pasien (66,6 %) puas dengan simetrisitas wajah setelah operasi. 2 pasien (33,3 %) mengeluhkan tidak puas dengan penampilan akhir setelah operasiKesimpulan :Untuk dapat mengevaluasi hasil operasi ORIF di Divisi Bedah Plastik Rumah Sakit Ciptomangunkusumo. Tidak hanya dibutuhkan registrasi data awal yang baik, tetapi juga dibutuhkan sarana dan fasilitas untuk mendapatkan evaluasi jangka panjang pada pasien terutama lokasi pasien yang jaraknya jauh dari lokasi rumah sakit.

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ABSTRACTBackground :Midface fracture is a fracture that often occurs may be able to give a good effect in terms of aesthetics and functionality. Midface fracture that is not handled properly will change the shape of the face become disproportionate, one of which face becomes wider and longer, there is a malar depression. The management of the segment repositioning fracture and internal fixation is the main option.Methods:Data taken from the status aesthetic using cross sectional study in patients with fractures midface before surgery ORIF obtained in medical records, and the data after opeasi ORIF obtained from follow-up (4 years), then the measurement of the projected vertical, horizontal and warm's view.Result:Based on the photographic analysis of the vertical projection obtained 3 patients have a good proportion of the face, 3 patients had good facial proportions due to differences in average. Based on the photographic analysis of horizontal projection obtained 3 patients had a different face long, 2 patients had a dystopia, 1 patient had enophtalmus. Based on the photographic analysis of the worm's eye projection obtained 4 patients had a malar depression eminens.Regarding the aesthetic results, obtained four patients (66.6%) are satisfied with simetrisitas face after surgery. 2 patients (33.3%) complained of is not satisfied with the final appearance after surgeryConclusions:To be able to evaluate the results of ORIF surgery in the Division of Plastic Surgery Hospital Ciptomangunkusumo. Not only the data registration needed a good start, but also the infrastructure and facilities needed to obtain a long-term evaluation of the patients, especially the location of patients that were located far from the location of the hospital, Background :Midface fracture is a fracture that often occurs may be able to give a good effect in terms of aesthetics and functionality. Midface fracture that is not handled properly will change the shape of the face become disproportionate, one of which face becomes wider and longer, there is a malar depression. The management of the segment repositioning fracture and internal fixation is the main option.Methods:Data taken from the status aesthetic using cross sectional study in patients with fractures midface before surgery ORIF obtained in medical records, and the data after opeasi ORIF obtained from follow-up (4 years), then the measurement of the projected vertical, horizontal and warm's view.Result:Based on the photographic analysis of the vertical projection obtained 3 patients have a good proportion of the face, 3 patients had good facial proportions due to differences in average. Based on the photographic analysis of horizontal projection obtained 3 patients had a different face long, 2 patients had a dystopia, 1 patient had enophtalmus. Based on the photographic analysis of the worm's eye projection obtained 4 patients had a malar depression eminens.Regarding the aesthetic results, obtained four patients (66.6%) are satisfied with simetrisitas face after surgery. 2 patients (33.3%) complained of is not satisfied with the final appearance after surgeryConclusions:To be able to evaluate the results of ORIF surgery in the Division of Plastic Surgery Hospital Ciptomangunkusumo. Not only the data registration needed a good start, but also the infrastructure and facilities needed to obtain a long-term evaluation of the patients, especially the location of patients that were located far from the location of the hospital]"

"Latar Belakang: Rekonstruksi pada defek tulang kritikal masih merupakan tantangan yang besar untuk seorang ahli bedah plastik rekonstruksi. Selama ini, baku emas untuk menangani kasus defek tulang tersebut adalah menggunakan autologous bone graft, namun terdapat beberapa kekurangannya seperti morbiditas pada lokasi donor, pemanjangan waktu operasi, donor yang terbatas, dan pemajangan waktu rawat. Mencoba mengatasi kekurangan tadi, muncullah rekayasa jaringan tulang yang memberikan hasil yang menjanjikan dalam regenerasi jaringan tulang biologis yang baru. Beberapa penelitian hewan sebelum, menunjukkan bahwa implantasi secara ortotopik dan ektopik dapat memberikan hasil yang cukup baik dalam regenerasi tulangMetode: Telaah sistematis dilakukan pada Pubmed/MEDLINE, Cochrane Library, dan WHO ICTRP, termasuk semua studi dengan data primer untuk rekayasa jaringan tulang menggunakan kalsium fosfat sebagai bahan rangka, studi pada defek tulang kritikal, baik uji klinis acak terkontrol maupun tidak pada manusia dan hewan. Luaran yang dinilai adalah pembentukan tulang baru yang membandingkan implantasi secara ortotopik (intraperiosteum) dan ektopik (intramuskular). Studi ini menggunakan SYRCLE’s tools untuk menilai risiko bias studi pada hewan.Hasil: Didapatkan lima studi hewan yang memenuhi kriteria eligibilitas dari total 80 studi yang diinklusi pada telaah ini. Dicantumkan karakteristik demografis dari masing-masing studi. Studi yang memiliki luaran klinis yang sama (% area tulang dan % kontak) dibandingan antara implantasi ortotopik dan ektopik. 2 studi menunjukkan bahwa implantasi secara intramuskular menggunakan kerangka yang sudah ditambahkan BMSC memberikan hasil yang baik pada pembentukan jaringan tulang baru. Kerangka kosong tidak menunjukkan adanya pembentukan tulang. Penambahan BMP-2 sebagai factor pertumbuhan dapat meningkatkan osteogenisitas baik pada implantasi ortotopik maupun ektopik.Kesimpulan: Implantasi ortotopik dapat menginduksi pembentukan tulang baru lebih baik daripada implantasi ektopik. Menggunakan kerangka yang ditambahkan BMSC serta BMP-2 pada implantasi intramuskular memberikan hasil yang baik untuk pembentukan tulang baru. Rekayasa jaringan tulang memungkinkan untuk dilakukan dengan implantasi secara ortotopik maupun ektopik

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Background: Critical bone defect reconstruction remains a major challenge in plastic reconstructive surgery. While autologous bone graft is still considered as the gold standard for treating critical bone defects, there are disadvantages like donor site morbidity long operative time, donor limitation, and extended hospital stay. In order to resolve them, bone tissue engineering has emerged in reconstruction medical studies, for they give promising result in regenerating new biological bone tissue. Previous animal studies have shown that implantating orthotopically and ectopically gave promising result in bone regeneration.

Methods: A systematic search was done on PubMed/MEDLINE, Cochrane Library, and WHO ICTRP, including all studies with primary data for bone tissue engineering using calcium phosphate as scaffold materials, studies in critical bone defects, RCT or non RCT in human studies or animal studies. Studies with outcome of new bone formation comparing orthotopic (intraperiosteum) implantation and ectopic (intramusculuar) implantation. We used SYRCLE’s tools for assessing risk of bias of animal studies.

Results: Five animal studies meet the eligibility criteria from a total of 80 studies are included for this review. Characteristics demography of each study are stated. Studies with the same outcome (bone area% and contact%) are compared in orthotopic and ectopic implantation. Two studies showed that intramuscular implantation using BMSC-seeded scaffold give promising result of new bone formation. However empty scaffold did not show any bone formation. Adding BMP-2 for growth factor can improved osteogenecity both in orthotopic implantation and ectopic implantation

Conclusion: Orthotopic implantation can induced new bone formation better than ectopic implantations. Using BMSC-seeded and addition of BMP-2 for intramuscular implantation give good result of new bone formation. Both orthotopic and ectopic (intramuscular) implantation are possible for bone tissue engineering"

"Objective : To measure sensitivity and specificity diagnostic finding of convensional radiography in midfacial fractur performed at the Emergency room of Cipto Hospital and to evaluate its quality.

Design and Main Outcome Measures: In this diagnostic testing 35 patients with clinical signs of midfacial fracture were investigated. All patient underwent radiography examination at the Emergency room (Anteroposterior, Lateral and reverse Waters view). X ray photo were expertised by a plastic surgeon and a radiologist, both of them without knowing the clinical conditions, and by the residen who received the patient at the ER. Then we compare radiographic and intraoperative findings as goal standard, The results were analyzed by statistical testing (for sensitivity, specificity, positive, negative predictive value).

Results: The result showed that sensitivity and specificity varied between plastic surgeon, radiologist and residen but still high, and we noted that clinical examinations revealed to be very helpful in the assessment of an inadequate imaging fracture.

Conclusion: Conventional radiography performe at the Emergency Room of Cipto hospital has high specificity although the quality is considered substandard. Clinical findings is still very important to distinguished uncertain fracture."

"ABSTRAKPendahuluan. Perkembangan analisis wajah pada bedah rekonstruksi wajah sangatlah pesat, sejalan dengan perkembangan teknologi pencitraan dan komputerisasi. Program perangkat lunak yang tersedia pada saat ini, seperti Rhinobase, hanya dapat mengukur daerah hidung, tidak seluruh wajah. Oleh sebab itu dibutuhkan suatu program perangkat lunak yang lebih lengkap, dapat menyimpan data medis, mengukur dan menganalisis foto (fotogrametri dan analisis fotografi) guna merencanakan tindakan operasi rekonstruksi wajah secara keseluruhan. Pengakat lunak ini diharapkan dapat digunakan sebagai alat ukur dan menjadi panduan untuk melakukan tindakan bedah rekonstruksi wajah (reaksilofasial)."

"Salah satu pergeseran paradigma terbesar dalam dunia kedokteran saat ini adalah pergeseran model pelayanan kesehatan dari disease-centric care menjadi patient-centric care. Bedah plastik rekonstruksi dan estetik menjadi spesialis kedokteran yang membutuhkan implementasi model tersebut, didorong oleh rendahnya tingkat konversi pasien di tahap pre-operatif, teknik operasi tanpa panduan di tahap intra-operatif, dan masih tingginya tingkat permintaan revisi operasi di tahap pasca-operatif. Saat ini, implementasi patient-centric care melalui penggunaan model spesifik-pasien, yaitu replika anatomis bagian wajah atau tubuh pasien yang dapat digunakan dokter sebagai simulator bedah dan alat visualisasi pasien, menjadi instrumen paling efektif dalam memecahkan masalah tersebut. Namun, model spesifik-pasien yang ada di pasaran saat ini masih menggunakan modalitas pemindai yang rumit, mahal, dan model spesifik-pasien masih sulit diakses khususnya untuk negara berkembang. Oleh karena itu, dalam skripsi ini penulis mengusulkan sebuah rancang bangun model spesifik-pasien yang dikhususkan pada bagian maxillofacial untuk pemandu operasi dengan metode pemindaian 3D berbasis smartphone dengan sensor TrueDepth™ dan pemodelan 3D berbasis Growing Neural Gas yang jauh lebih sederhana, murah, dan terjangkau. Akurasi model spesifik-pasien yang dirancang diukur nilai indeks similaritasnya sebesar 0,2101 terhadap topologi wajah subjek asli yang dinilai cukup akurat.

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One of the biggest paradigm shifts in medicine today is the shift in health care models from “disease-centric care” to “patient-centric care”. Plastic and aesthetic surgery become one of the medical field who urgently need this model implementation, driven by the low conversion rates of patients in pre-surgery phase, unguided surgery technique encountered in intra-operative phase, and high surgery revision demand in postoperative phase. Currently, patient-centric care implemented through patient-specific models, which is an anatomical replica of the patient's face or body which surgeons can use as a surgical simulator and patient visualization tool, this instrument proven to be the most effective in solving those mentioned problems. However, patient-specific models on the market today still use complex and expensive scanning modalities and the patient-specific models that are still difficult to access, especially in developing countries. Therefore, in this research the author propose a patient-specific model prototype for surgical guidance in maxillofacial region with 3D scanning methodology which utilized smartphone with TrueDepth™ sensor and Growing Neural Gas-based 3D modelling methodology which more simple, low-cost, and accessible. The accuracy of patient-specific model measured in similarity index against the subject’s real face topology resulted in the amount of 0,2101 which sufficiently accurate."

"Latar belakang: Manusia sering mendeteksi asimetri wajah yang minimal. Koreksi bedah diindikasikan bila  distopia orbital ≥ 5 mm dan/ atau disertai dengan disfungsi visual seperti diplopia. Penelitian ini bertujuan untuk menginvestigasi batas untuk koreksi distopia orbital vertikal dengan penilaian subyektif visual.Metode: Penelitian ini merupakan studi preliminary dengan desain potong-lintang analitik. Empat puluh delapan residen bedah plastic  diminta untuk mengevaluasi secara subjektif pada 60 foto yang dimanipulasi dan diacak secara digital yang memperlihatkan distopia orbital 0 hingga 5 mm. Jawaban dimasukkan pada formulir skala Likert. Data diproses dan dianalisis menggunakan SPSS 22.0.Hasil: Sebanyak 48 residen dari dua pusat pendidikan bedah plastic (Rumah Sakit Hasan Sadikin dan Ciptomangunkusumo) terdaftar dalam penelitian. Berdasarkan kurva ROC, batas distopia yang dapat dideteksi secara subjektif adalah 2.5 milimeter. Indikasi koreksi berdasarkan penilaian subjektif secara visual pada respondent, 46.3% setuju dilakukan bila disropia <5 mm, sementara 69.9% menjawab setuju dilakukan bila dystopia ³5 mm.Kesimpulan: Batas dystopia yang dapat dideteksi secara subjektif adalah 2.5 milimeter. Responden yang menjawab setuju dilakukan koreksi yaitu sebanyak 46.3% untuk dystopia <5 mm dan 69.9% untuk dystopia ³ 5 mm. Walaupun persentase jawaban setuju dilakukan koreksi pada distpia <5 mm lebih sedikit dibanding dystopia ³ 5 mm, namun angka ini dapat menjadi acuan pertimbangan untuk dilakukan koreksi pada dystopia. Penelitian lebih lanjut dibutuhkan dengan subjek yang lebih bervariasi dan lebih banyak.Keywords: orbital dystopia, subjective assessment, aesthetic

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Background: People can detect even a subtle facial asymmetry. Surgical correction is indicated if orbital dystopia is 5 mm and more and/or along with visual disfunction such as diplopia. This study aims to investigate the cut off point for correction of vertical orbital dystopia by visual subjective assessment.

Methods: This is a preliminary analytic cross-sectional study. Forty-eight plastic surgery residents were asked to subjectively evaluate 60 digitally manipulated photographs showing 0 to 5-millimeter orbital dystopia using Likert scale form. Data was processed and analyzed using SPSS 22.0.

Result: A total of 48 plastic surgery residents from two centres (Hasan Sadikin and Ciptomangunkusumo Hospital) were enrolled. According to the ROC curve, the cut-off point of dystopia that can be detected subjectively is 2.5 millimetre. Regarding indication for corrective surgery, 46.3% respondents agreed for correction on dystopia <5 mm, while 69.9% agreed for correction on dystopia ³5 mm.

Conclusion: The cut-off point of dystopia that can be detected by visual subjective perception is 2.5 millimetres. Respondents who agree for correction of dystopia <5 mm and ³5 mm were 46.3% and 69.9%, respectively. Although there were fewer respondents agreeing for correction on dystopia <5 mm, it can still be used as consideration for subjective criterion in correcting dystopia correction. Further study with more varied and larger sample is needed.

Keywords: orbital dystopia, subjective assessment, aesthetic"