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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]"

"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."

"Latar Belakang: Pergeseran dominasi antara laki-laki dan perempuan pada dunia kedokteran terjadi dari waktu ke waktu di berbagai belahan dunia, termasuk di bidang bedah plastik di Indonesia. Profesi yang semula didominasi oleh laki-laki, saat ini didominasi perempuan. Pergeseran dominasi perempuan ini memungkinkan terjadinya masalah-masalah yang berpengaruh pada pendidikan dan pelayanan bedah plastik. Penelitian ini bertujuan untuk mengeksplorasi fenomena dominasi perempuan pada pendidikan spesialis di Indonesia. Metode: Penelitian ini bersifat kualitatif berupa studi fenomenologi. Penelitian dilakukan pada 3 program pendidikan dokter spesialis bedah plastik rekonstruksi dan estetik di Indonesia. Penelitian dimulai pada bulan Januari 2020. Populasi penelitian terdiri dari 4 kelompok, yaitu peserta didik, dosen, pengelola program studi, dan pengguna lulusan. Responden penelitian dipilih menggunakan metode maximum variation sampling. Setiap responden mendapatkan informed consent, seluruh informasi yang diberikan sifatnya rahasia dan tidak memengaruhi proses pendidikan responden. Metode pengumpulan data berupa studi dokumen, Focus Group Discussion (FGD), dan In-Depth Interview. Data penelitian yang diperoleh dari berbagai metode diatas, kemudian dianalisis dan diolah lebih dalam secara tematik. Hasil: Peneliti membagi tema berdasarkan garis waktu proses pendidikan, yaitu: prapendidikan, intra-pendidikan, dan pascapendidikan. Masing-masing proses memiliki tema yang saling memengaruhi proses pendidikan. Pada masa prapendidikan terdapat karakter personal yang dipengaruhi oleh persepsi positif maupun negatif dari masyarakat. Sedangkan iklim lingkungan kerja, dampak dominasi perempuan, dan dimensi budaya memengaruhi kelancaran intra-pendidikan. Pasca pendidikan dan memasuki dunia kerja, peserta didik menginginkan suatu kondisi lingkungan kerja yang ideal dan terdapat preferensi tempat bekerja tertentu untuk mencapai kondisi well-being. Kesimpulan: Dampak dominasi perempuan selama pendidikan hanya akan berpengaruh pada dinamika kehidupan antar peserta didik dan antara peserta didik dengan dosen sebagai mentor. Namun dominasi ini tidak akan memengaruhi kualitas pendidikan dan beban kerja yang diberikan. Pada penelitian ini juga didapatkan fenomena kesenjangan kepemimpinan tidak terjadi selama pendidikan tetapi terjadi pada pascapendidikan. Namun kesenjangan kepemimpinan bukanlah akibat tekanan dalam komunitas, melainkan kecenderungan dari pribadi perempuan pada umumnya di kelompok masyarakat feminim.

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Introduction: Shifting in gender dominance between men and women in the medical field has occurred from time to time globally, including in Indonesia’s plastic surgery. The profession, which was initially dominated by men, is currently dominated by women. This shift in female dominance might allow problems that affect the education and clinical settings of plastic surgery. This study aims to explore the phenomenon of women's dominance in medical residency education in Indonesia. Method: This study is a qualitative study of phenomenology. It was conducted on 3 medical residency programs specializing in reconstructive and aesthetic plastic surgery in Indonesia. The study began in January 2020. The research population consisted of 4 groups, namely students, lecturers, study program managers, and graduate users. Research subjects were selected using the maximum variation sampling method. Each respondent was provided with informed consent, all information given was confidential and did not affect the educational process of the respondent. Data collection methods include document study, Focus Group Discussion (FGD), and In-Depth Interview. Research data obtained from various methods above was analyzed and processed thematically. Results: The themes were categorized based on the educational process timeline, namely: pre-education, intra-education, and post-education. Each timeline had several themes which mutually influenced the educational process. During pre-education there were personal characters which were affected by positive and negative perceptions from society. Whereas the work environment atmosphere, the impact of women's dominance, and the cultural dimension affected the intra-educational process. After graduating from residency program and entering the career life, students expected an ideal working environment and had certain workplace preferences to achieve their well-being. Conclusion: The impact of women's dominance during education affected the daily dynamics among students and their interaction with lecturers as mentors. However, this dominance did not affect the quality of education and workload. We also found that the phenomenon of leadership disparity did not occur during education but occurred in post-education setting. This leadership disparity was not resulted by pressure in the community, but due to the tendency of the women’s personality in general among the feminine community."

"Background: Pada program pelatihan residensi bedah Plastik, pengukiran framework untuk telinga luar pada prosedur mikrotia masih terbatas pada sistem magang. Menurut model berbasis simulasi, residen dapat dilatih sebelum menghadapi pasien sebenarnya. Penelitian ini akan menilai efisiensi dari program pelatihan pengukiran framework telinga luar untuk residen Bedah Plastik Rekonstruksi dan Estetik.Materials and Methods: 14 residen bedah plastik masuk dalam penelitian ini, terbagi menjadi dua grup. Grup I, terdiri dari residen yang pernah mengikuti prosedur mikrotia lebih dari 1 kali sebagai asisten atau pengukir sementara grup II beum pernah. Grup II akan mendapat program pelatihan yang terdiri dari kuliah dan video, dilanjutkan dengan pengukiran dengan subtitusi kartilago dalam bimbingan. Hasil akhir akan dinilai oleh 2 orang konsultan ahli bedah Mikrotia dalam hal presisi anatomi dan ukuran serta kecepatan pengukiran.Result: Penelitian menunjukkan terdapat peningkatan bermakna dalam hal kecepatan pengukiran dengan p=0.003 (p<0.005) antara 2 grup. Sementara dalam presisi anatomi, terdapat peningkatan bermakna pada tinggi tragus dengan p=0.003 (p<0.005) serta penurunann tinggi antitragus dengan p=0.000 (p<0.0005), dan pada nilai lain tidak terdapat perbedaaan yang signifikan diantara 2 grup. Conclusion: Dari penelitian ini, dapat disimpulkan bahwa kecuali tinggi anti tragus, hasil ini menunjukkan efektivitas program pelatihan antara mereka yang belum pernah mengikuti operasi mikrotia dengan mereka yang sudah berpengalaman.

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Background: In Plastic Surgery residency training program, cartilage carving of external ear reconstruction for Microtia's procedure was limited to traditional apprenticeship model. Under simulation based training, resident could be groomed before facing the real patient. This study will be evaluate the efficacy training program for cartilage carving of external ear framework for resident of Aesthetic Reconstructive Plastic Surgery.Materials and Methods: 14 plastic surgery resident will be enrolled in this study, separated into two group. Group I, consisted of resident had experience in Microtia's procedure more than once asisstant or carver meanwhile group II hadn't. Group II will had training program comprised of lecture and video then carving of cartilage substitute under guidance. A week later, both group would carve external ear cartilage framework without guidance. The final result will be assesed by two consultant of Microtia's surgeon in term of anatomical, size appearance of external ear and speed of carving.Result: Study showed that there was improvement in term of speed of carving with p = 0.003 (p<0.005) between both group. Meanwhile, in term of anatomical precision, there was improvement in tragal height with p=0.003 (p<0.005) and decline antitragal height with p=0.000 (p<0.0005), though in other points there was no significant differences between both team. Conclusion: From study, we concluded that except for antitragal height point, this result successfully demonstrated the effectiveness of the training program between those who had never experienced microtia's procedure before than those who had."

"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."

"ABSTRAKSkripsi ini membahas tentang inspanningverbintenis dan resultaatverbintenis dalam praktik bedah plastik serta kaitannya dengan tanggung jawab hukum dokter yang melakukan praktik diluar kompetensinya. Pembahasan dilakukan melalui studi kasus pada putusan No.1207/Pid.S/1992/PN.SBY dan No. 944/Pid.Sus/2015/PN.JKT.SEL, serta wawancara dengan ahli bidang hukum kesehatan. Penelitian ini adalah penelitian kualitatif dengan bentuk penelitian yuridis normatif. Hasil penelitian ini menyimpulkan bahwa antara inspanningverbintenis dan resultaatverbintenis, keduanya dapat diterapkan dalam praktik bedah plastik. Inspanningverbintenis dapat diterapkan pada bedah plastik rekonstruksi, sedangkan resultaatverbintenis dapat diterapkan pada bedah plastik estetik. Tindakan bedah plastik haruslah dilakukan oleh dokter yang kompeten di bidangnya, apabila seorang dokter terbukti melakukan pelanggaran disiplin profesi, maka dapat dikenakan sanksi disiplin.

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ABSTRACTThis thesis discusses inspanningverbintenis and resultaatverbintenis in the practice of plastic surgery and its relation to the legal responsibility of doctors who practice outside of its competence. The study was conducted through case studies on the decision number 1207 Pid.S 1992 PN.SBY and number 944 Pid.Sus 2015 PN. JKT.SEL, as well as interviews with the experts in the field of medical law. This research is a qualitative research in the form of normative juridical study. The results of this study concluded that between inspanningverbintenis and resultaatverbintenis, both of which can be applied in the practice of plastic surgery. Inspanningverbintenis can be applied to reconstructive plastic surgery, while resultaatverbintenis can be applied to aesthetic plastic surgery. Plastic surgery should be performed by doctors who are competent in their fields, if a doctor was guilty of violation of professional discipline, he or she could be subjected to the disciplinary sanctions."

"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"