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Manajemen jalan napas pasien hidrosephalus non komunikan dengan celah wajah transversal bilateral nonsindromik : laporan kasus

  • Aninda Tanggono ,
  • Tjahya Aryasa ,
  • Made Wiryana ,

Abstract

Background: Asyndromic bilateral transverse facial cleft are a very rare clefts and an atypical facial anomaly, occuring alone or associated with other anomalies. The incidence of atypical cleft has not been reported widely, but it was estimated from 1 in 50,000 births to 1 in 175,000 live births. The severity may vary from mild to severe, described as a cleft that stretches back to the ear. It increases the risk of airway difficulties. Advanced airway management equipments are provided as an alternative for anesthesiologists, thus they are expected to manage the airway difficulties more safely. This case report aims to present an alternative airway management in patient with asyndromic bilateral transverse facial cleft associated with other anomalies, such as noncommunicating hydrocephalus.

Case: A 7-months-old patient with noncommunicating hydrosephalus accompanied by asyndromic bilateral transverse facial cleft had VP-shunt cito surgery and was posted for correction of facial deformity. In this case, a larger mask was used to cover the cleft, following sevoflurane inhalation. Laryngoscopy was done to assist intubation. The intubation procedure necessitated a tongue spatula which is placed between the upper corners of the lips with the lower border of the nose to restrict the opening of the oral cavity while on the procedure.

 

Latar belakang: Celah wajah transversal bilateral nonsindromik merupakan kelainan celah wajah yang sangat jarang terjadi dan atipikal, dapat terjadi secara tunggal atau bersamaan dengan deformitas lainnya. Insiden celah wajah atipikal tidak diketahui secara luas, namun beberapa data memperkirakan 1 dari 50.000 sampai 1 dari 175.000 kelahiran hidup. Tingkat keparahan bervariasi, dari ringan hingga keparahan yang ditandai dengan celah yang membentang kembali ke telinga. Hal ini menjadi penyulit dalam manajemen jalan napas. Perangkat pengelolaan jalan napas alternatif semakin tersedia bagi ahli anestesi, dan diharapkan ahli anestesi akan memiliki keterampilan yang diperlukan untuk mengelola jalan napas dengan aman. Tujuan dari laporan kasus ini adalah untuk mengetahui anestesi yang digunakan pada manajemen jalan napas pasien celah wajah transversal bilateral nonsindromik yang disertai kelainan kongenital lainnya.

Kasus: Pasien berusia 7 bulan dengan hidrosefalus non komunikan disertai dengan celah wajah transversal bilateral nonsindromik telah menjalankan prosedur VP-shunt cito dan rekontruksi wajah. Pada kasus ini, masker berukuran lebih besar digunakan untuk menutupi celah wajah, sehingga memungkinkan untuk dilakukannya pembiusan dengan inhalasi sevoflurane. Laringoskopi dilakukan untuk memperlancar proses intubasi, dan dengan bantuan spatula lidah yang diletakkan diantara sudut atas bibir dengan batas bawah hidung, untuk membantu limitasi pembukaan rongga mulut.

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How to Cite

Tanggono, A., Aryasa, T., & Wiryana, M. (2019). Manajemen jalan napas pasien hidrosephalus non komunikan dengan celah wajah transversal bilateral nonsindromik : laporan kasus. Medicina, 50(3). https://doi.org/10.15562/medicina.v50i3.773

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