ACHMAD MAULUDIN

Pembimbing :

DR. NUSKAH SUDJANA, Drg., SpBM(K)

Introduction

Treatment planning in cleft lip and palate rehabilitation is contingent upon understanding the natural history of the palatal cleft defect and the face in which it exists.

Orofacial cleft are produced by incompletely understood mechanisms, both genetic and environmental

Normal anatomy The elements of the normal lips are composed of the central

philtrum, demarcated laterally by philtrum collums, inferiorly by cupid’s bow and tubercle

Above the junction of vermilion cutaneous border is a mucocutaneous ridge / white skin roll

Within the red vermilion of the lip is a junction demarcating the dry and wet vermillion

Anatomy The primary muscle of the lip : orbicularis oris

Arterial Blood Supply

Normal

Cleft Lip

Nerve InnervationsSensory nerve

Motoric nerve

The Z-PlastyPrinciples

Z-plasty is a plastic surgery technique that is used to improve the functional and cosmetic appearance of defects or scars.

With this technique it is possible to redirect a defect into better alignment with a natural skin fold or the lines of least skin tension.

Z-plasty involves the creation of two triangular flaps of equal dimension that are then transposed.

Z Plasty Procedures The basic 60-degree z-plasty technique

to the lines of least skin tension. The defect length (AB) is 2.5 cm.

Tension on the wound healing eventually widens and thickens the scar.

Incisions are made vertically through the skin using a no. 11 scalpel blade.

The triangular flaps and the surrounding skin are undermined. When tip F is pulled toward C, and tip E toward D, the flaps E and F are transposed.

A few anchoring stitches are placed in the new centerline. The two flap tips are then approximated using interrupted

Additional simple interrupted sutures are placed to close the diagonal lines.

Z-PLASTY, ANGLES, AND THEORETICAL GAIN

Complications of Z-Plasty

flap necrosis, hematoma, wound infection, sloughing of the flap caused by high

wound tension, and the trapdoor effect (elevation of

central tissue resulting from a downward contraction of a surrounding scar).

Z-Plasty Technique Applied

Orbicularis Muscle Management

CONCLUSION

Z-plasty is a plastic surgery technique that is used to improve the functional and cosmetic appearance of defects or scars.

Routine wound care instructions are given to the patient, and prophylactic antibiotics may be considered for use in patients with diabetes and in other immunocompromised patients.

Thank You