GROUP I Abidin Ahmad saukani Aditya chandra Fauzi alwi yannor Hengki hanggara H.Muammad safi.

DEFINITION
Labioskizis or cleft lip is a condition in which the presence of a gap in the upper lip between the mouth and nose. This disorder can be a small notch in the lip to a reddish color on complete separation of one or two sided lip extending from the lip to the nose.
Palatoskisis is a midline fissure on the palate which occurs due to the failure of the 2 sides together because embriotik development. so of the two definition above it can be concluded Labioskizis and labiopalatoskizis is a deformity of the mouth slit or cleft or less perfect formation during embryonic development in which the lip on the right side and the left side did not grow up together.

Classification of labioschizis

Countinue.
1. Slit one side / Unilateral Cleft Lip / Labioschizis unilateral was subdivided into two

a. Slit one side full / Complete unilateral cleft lip / Labioschizis unilateral complete

b. Slit one side incomplete / Incomplete Unilateral Cleft lip / Labioschizis

Unilateral incomplete.
2. Two side slit / Bilateral Cleft Lip / Bilateral Labioschizis is further divided into:

a. Two side slit full / Complete bilateral cleft lip / Labioschizis Bilateral Complete b. Cracks two-sided incomplete / Incompete bilateral cleft lip / labioscjis bilateral

incomplete
c. Gap two sides with one side complete, the other is incomplete

Etiology labioschizis and Palatoskisis

Abnormalities labioschizis and Palatoskisis is a congenital

defect. The cause multiple factors such as genetic disorders, trauma during pregnancy, use of drugs, environmental pollution

countinue

a. Genetic or hereditary factors

Where is the genetic material in the chromosomes that influence. Which can occur due to gene mutations or chromosomal abnormalities. In any normal cell has 46 chromosomes consisting of 22 pairs of non-sex chromosomes (chromosome 1 s / d 22) and 1 pair of sex chromosomes (X and Y chromosomes) that determines gender. In patients with cleft lip occurs Trisomy 13 or Patau syndrome, where there are three strands of chromosome 13 in every cell of the patient, so that the total number of chromosomes in each cell is 47. If there is anything like this in addition to causing cleft lip will cause severe disruption in the development of the brain, heart, and kidneys. However, this disorder is very rare with a frequency of one of the babies born 8000-10000.

Countinue.
a. Less Nutrition, sample Zn deficiency and B6, vitamin C during pregnancy, folic acid deficiency. b. Trauma occurs in the first trimester of pregnancy. c. Infection of the mother can affect the fetus for example like rubella infection and syphilis, toxoplasmosis and chlamydia. d. Effect of teratogenic medications, including herbs and hormonal contraceptives, due to toxicity during pregnancy, such as alcoholism, penitonin therapy.

e. Multifaktoral and genetic mutations.

f. Diplasia ektodermal. g. Radiation.

pathophysiology
In general labioschizis and Palatoskisis, occurs because:

a. Unification failure or development of soft tissue and bone

during or trimester embryonic phase I.

b. Or the parting of the lips and nose due to the failure of the

maxillary process and medial Nasal to converge occurs during pregnancy 6-8 weeks.
c. Palatoskisis is the gap in the middle of the line caused by the

failure palato pooling arrangement palato at 7-12 weeks gestation.

d. Complete Merger midline upper lip between 7-8 weeks of

pregnancy.

Countinue.
classification

1. Based on the organ involved in labioschizis disoder

a. Cleft lip (labioskizis) b. Cracks in the gums (gnatoskizis) c. Cracks in the sky (cleft palate

Sign and symptoms

some symptoms of cleft Lips / labioschisis and

Palatoskisis, are: a. Lips separation occurs.

b. Weight does not increase.

c. Nasal regurgitation occurs in infants when breastfeeding is the milk out of the nose.

d. Difficulty in sucking / eating

e. Distortion of the nose seems partly or both g. The gap in the Lips

treatment
Treatment for cleft lip is by surgery. This operation is

done after the baby is was 2 months, the baby's weight increases, minimum of 10 pounds, and free from oral infections and systemic respiratory tract. and, levels of Hb

10 g%, and a minimum age of 10 weeks and a minimum

10.000/ui leukocyte levels.

Diagnostic examination
1. 2.

Hearing tests, speech and evaluation. Laboratory preparation for surgery; hemoglobin, hematocrit,

leukocytes, BT, CT scan.

3. 4.

Photo Rontgen. Evaluation ortodental and prostontal of starting position of the teeth and changes in the structure of orkumaxilaris.

5.

consultation with doctor spesialist Plastic surgery, ENT, ortodentisist, spech therapy.

6.

MRI (magnetic resonance imaging) for evaluation of

abnormal.

Prognosis
Babies whose cleft lip will be malfunctioning sucking difficulty breastfeeding,

especially if the disorder reaches the palate. If so, have pumped breast milk from mothers first and then given a perforated spoon or with a large bottle in the baby's body position upheld. The upright position of the baby's milk is very helpful entry to the esophagus. If not straight, so possible the milk will enter the airway reflexes considering epiglottis valve opening (valve connecting the mouth to the esophagus) should be stimulated to move the tongue, palate and salivary glands.
Cleft lip also cause simple infections in the nasal cavity, throat and tuba

eustachius (channels connecting the ear and throat) due to ease any irritation caused by the milk or water entering the nasal cavity of the cleft gap.
For parents who have children with this disorder will cause shock. For the child

will experience an interruption in speaking, chewing and swallowing disorders resulting aesthetic psychological and social disorders. Children become difficult to get along with the environment that interfere with the development of his soul. Therefore we need to help children with this disorder.

Complications.
Difficulty eating, experienced in patients with cleft

Lips with cleft palate if followed.

Ear infections are not functioning properly because

the tube that connects the middle ear to the throat and if not addressed then it will lose hearing
Difficulty speak. because muscles to speak decreased

function by a gap. It can disrupt the pattern can even speak him down.
Dental problems. In cleft Lips teeth grow abnormally

or did not even grow

Nursing diagnosis
nutritional needs are less than the needs associated

with swallowing disorders. Aspiration risk associated with the inability to spontaneously secretion. The risk of infection associated with the incision after the surgery. Impaired skin integrity related to the incision after surgery. The changes family processes related to abnormal physical conditions in children.

REFERENCES
EW Nelson. , 2005. Health Sciences children (Nelson textbook of pediatrics) Ed.15 Vol.2. Jakarta: EGC Yamada T.2003. Gastroenterology 4th Ed. Vol.1. Philadelphia: Lippincott William & Wilkins
A.Aziz Hengki Hidayat, 2006, Pengantar Ilmu

Keperawatan Anak, Jakarta, Salemba Medika

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