hemiparese n.fasialis pada neonatus dana akalasia esofagus

8/18/2019 hemiparese n.fasialis pada neonatus dana akalasia esofagus

1/50

SMF/Lab Ilmu Kesehatan Anak Tutorial Respirologi

Fakultas Kedokteran Umum

Universitas Mulawarman

AR!S! "!R#US FASIALIS $A" AKALASIA !S%FA&US

Disusun Oleh:

Radhi'ana utri ()(**+,*)-

$esire . alada ()(**+,*0-

Pembimbing:

dr 12Sukartini3 SpA

$ibawakan $alam Rangka Tugas Kepaniteraan Klinik

SMF/Lab Ilmu Kesehatan Anak

Fakultas Kedokteran Umum

Universitas Mulawarman

+*(-


2/50

$AFTAR ISI

BAB 1 PENDAHULUAN.......................................................................................1

BAB 2 STATUS PASIEN........................................................................................5

BAB 3 TINJAUAN PUSTAA.............................................................................22

BAB ! PE"BAHASAN........................................................................................!!

BAB 5 PENUTUP.................................................................................................52

DA#TA$ PUSTAA.............................................................................................53


3/50

.A. (

!"$A1ULUA"

(( Latar .elakang

elum%uh&n '%&(ese) ne(*us +&si&lis me(u%&,&n ,elum%uh&n -&ng

meli%ui //0// &&h. P&(ese ne(*us +&si&lis &%& e(&i sen(&l &n %e(i+e(.

Ne(*us +&si&lis memili,i &n&/mi -&ng s&ng& ,/m%le, &n e(i(i &(i 4 se(&

m&sing0m&sing be(+ungsi memb&& im%uls lis(i, ,e //0// &&h. In+/(m&si

-&ng is&m%&i,&n &,&n menimbul,&n e,s%(esi +&si&l se%e(i e(&&6 men&ngis6

e(sen-um &n be(b&g&i e,s%(esi +&si&l l&inn-&. Ne(*us +&si&l i&, h&n-&

memb&& im%uls ,e //0// &&h e&%i ug& ,e gl&nul& l&,(im&l6 gl&nul&

s&li*&6 &n ,e // e,& ul&ng %eneng&(&n 's&%es) se(& mens(&nsmisi,&n (&s&

&(i b&gi&n e%&n li&h. Oleh ,&(en& iu6 bil& e(&i ,e(us&,&n seeng&h &&u lebih

&(i se(&0se(& s&(&+ ini m&,& &,&n imbul ge&l& lum%uh &&u %&(&l-sis %&&

&&h6 ,e,e(ing&n %&& m&& &&u mulu6 g&nggu&n &l&m %enge7&%&n.16263

#/ese( mel&%/(,&n b&h& ,e(us&,&n ne(*us +&si&lis seb&n-&, 12 &(i

384 ,&sus '39) &(i selu(uh (&um& ,e%&l& s&& Pe(&ng Duni& I. #(iem&n &n

"e(i menemu,&n se,i&( 4 &(i !3 ,&sus (&um& ,e%&l&. A&%un %&(ese ne(*us+&si&lis -&ng i&, i,e&hui %en-eb&bn-& 'Bells P&ls-) se,i&( 203 ,&sus %e(

1. %enuu, %e(&hun6 se,i&( ;0459 &(i semu& ,&sus me(u%&,&n

%&(&l-sis ne(*us +&si&lis unil&e(&l. Insien %&& l&,i0l&,i &n %e(em%u&n s&m&6

n&mun (&&0(&& mun7ul %&& usi& ! &hun mes,i%un %en-&,i ini &%& imbul i

semu& umu(. Insien e(en&h &&l&h %&& &n&, i b&&h 1 &hun6 mening,&

%&& umu( i &&s 4 &hun. #(e,uensi %&(ese ne(*us +&si&lis ,&n&n &n ,i(i s&m&.

&us& um/( me(u%&,&n h&l -&ng &(&ng6 h&n-& se,i&( 59 &(i semu& ,&sus

%&(ese ne(*us +&si&lis.3

P&(ese ne(*us +&si&lis membe(i,&n &m%&, -&ng bes&( b&gi ,ehiu%&n

sese/(&ng im&n& %&sien i&, &%& &&u ,u(&ng &%& mengge(&,,&n // &&h

sehingg& &m%&, &&h %&sien i&, sime(is. D&l&m mengge(&,,&n // ,ei,&

menggembung,&n %i%i &n menge(u,&n &hi &,&n &m%&, se,&li &&h %&sien

i&, sime(is. H&l ini menimbul,&n su&u e+/(mi&s ,/smei, &n +ungsi/n&l

-&ng be(&.1

2

`


4/50

Pen-eb&bn-& &%& be(u%& ,el&i&n ,/ngeni&l6 in+e,si6 (&um&6 um/(6

ii/%&i,6 &n %en-&,i0%en-&,i e(enu se%e(i D"6 hi%e(ensi be(&6 &n in+e,si

eling& eng&h. Pen&ng&n&n %&sien eng&n %&(ese ne(*us +&si&lis se7&(& ini6 b&i,

/%e(&i+ m&u%un se7&(& ,/nse(*&i+ &,&n menenu,&n ,ebe(h&sil&n &l&m

%eng/b&&n.1

A,&l&si& es/+&gus me(u%&,&n su&u g&nggu&n m/ili&s %(ime( es/+&gus

-&ng i&n&i /leh ,eg&g&l&n s+inge( es/+&gus b&gi&n is&l -&ng hi%e(/ni,

unu, be(el&,s&si %&& &,u menel&n m&,&n&n &n hil&ngn-& %e(is&lsis

es/+&gus. Se7&(& ,linis6 &,&l&si& mul&i i,en&l /leh Th/m&s


5/50

(+ Tu2uan enulisan

Tuu&n &(i %enulis&n ini &&l&h &g&( /,e( mu& m&m%u mem&h&mi

e+inisi6 e%iemi/l/gi6 ei/l/gi6 +&,/( (isi,/6 %&/genesis6 i&gn/sis &n

%en&&l&,s&n&&n &(i %&(ese ne(*us +&si&lis &n &,&l&si& es/%h&gus %&& ne/n&us.

!

`


6/50

.A. +

STATUS ASI!"

Identitas pasien

0 N&m& : B-. N-. J

0 Jenis ,el&min : L&,i0l&,i

0 L&hi( : 2 "&(e 21;

0 Al&m& : Jl. .H.


7/50

"un&h i&l&mi se&, 1 minggu S"$S. Ibu %&sien meng&,u6 %&sien mun&h

sei&% ,&li seel&h meminum ASI. Isi mun&h&n be(u%& ASI -&ng iminum

Bi&s&n-& ibu %&sien membe(i,&n ASI sei&% 2 &m eng&n l&m& %embe(i&n ASI

sel&m& 3 meni. Sel&m& 1 h&(i %e(&m& ,ehiu%&n %&sien6 ibu meng&,u %&sien

i&, meng&l&mi mun&h sel&m& minum ASI. Ibu %&sien meng&,u6 %&sien i&,

meng&l&mi mun&h hi&u. B&n-&,n-& i&% ,&li mun&h gel&s &Cu&. "un&h

-&ng i&l&mi i&, men-em%(/. P&sien meng&l&mi mun&h &n%& i&hului b&u,.

P&sien i&, meng&l&mi ses&,6 em&m6 m&u%un b&u,. BAB i&% 2 h&(i se,&li.

BA &l&m b&&s n/(m&l.

Sel&in iu6 Ibu %&sien mengeluh,&n &&h %&sien sebel&h ,&n&n -&ng mi(ing

s&& %&sien men&ngis. Ibu %&sien meng&,u m&& ,&n&n %&sien e(bu,& sebel&h &n

bibi( %&sien sebel&h ,&n&n mi(ing s&& %&sien men&ngis. Se&ng,&n m&& ,i(i &n

bibi( sebel&h ,i(i %&sien n/(m&l. Ibu meng&,u h&l ini el&h e(&i se&, %&sien

l&hi(. P&sien i&, %e(n&h meng&l&mi ,e&ng sebelumn-&6 (i&-& (&um& l&hi(

is&ng,&l.

Riwa'at en'akit $ahulu

P&sien i&, %e(n&h meng&l&mi ,eluh&n be(u%& mun&h sebelumn-&. P&sien i&,

meng&l&mi ,e&ng sebelumn-&. $i& &le(gi &n &sm& is&ng,&l.

Riwa'at en'akit Keluarga

0 Ti&, && ,elu&(g& -&ng memili,i ,eluh&n se(u%& eng&n %&sien

0 $i&-& &le(gi is&ng,&l.

0 $i&-& Hi%e(ensi6 D"6 &n %en-&,i &nung is&ng,&l.

Riwa'at Ibu 4

H&mil ini &&l&h h&mil ,eig& &(i ibu %&sien. An&, %e(&m& l&hi( %&& &hun

21. Sel&m& ,eh&mil&n ibu (uin ,/n(/l ,e %(&,e, bi&n s&s&6 i&, &&

%en-&,i -&ng i&l&mi sel&m& ,eh&mil&n. N&mun ibu %&sien meng&,u %&& u&

,eh&mil&n sebelumn-&6 ibu meng&l&mi e,&n&n &(&h inggi. Ibu meng&,u be(&

b&&n sel&m& h&mil n&i, se,i&( 1 ,g. sel&m& h&mil /b&0/b& -&ng i,/nsumsi

h&n-& *i&min %en&mb&h &(&h. P&sien me(u%&,&n &n&, ,eig&6 l&hi( eng&n

/%e(&si se,si/ ses&(e& ,&(en& ibu %&sien be,&s il&,u,&n /%e(&si se,si/ ses&(e&

;

`


8/50

%&& u& ,eh&mil&n sebelumn-& i $SUD A< S&h(&nie i/l/ng /leh D/,e(

s%esi&lis ,&nung&n. P&sien l&hi( 7u,u% bul&n eng&n BB 3 g(&m &n PB !=

7m.

Riwa'at ersalinan Sekarang 4

B&-i l&hi( %&& &ngg&l 2 "&(e 21; %u,ul 1;.35 eng&n /%e(&si se,si/

ses&(e& %&& usi& ,eh&mil&n 38 minggu eng&n enis ,el&min l&,i0l&,i. B&-i l&hi(

l&ngsung men&ngis ,u&.

Riwa'at Kelahiran 'ang Lalu4

An&, %e(&m& l&hi( %&& &hun 21 eng&n /%e(&si se,si/ ses&(e& &&s

ini,&si e,&n&n &(&h inggi &l&m ,eh&mil&n6 be(& b&&n l&hi( 32 g( eng&n

enis ,el&min %e(em%u&n. An&, ,eu& l&hi( %&& &hun 213 eng&n /%e(&si

se,si/s ses&(e& &&s ini,&si e,&n&n &(&h inggi &l&m ,eh&mil&n6 be(& b&&n

l&hi( 2.8 g(&m eng&n enis ,el&min l&,i0l&,i. N&mun &n&, ,eu& el&h

meningg&l s&& usi& ; bul&n ,&(en& ,e&ng &n ,emui&n meng&l&mi %enu(un&n

,es&&(&n.

Resume ersalinan

Usi& ,eh&mil&n : 38 minggu

Le&, b&-i : P(esen&si ,e%&l&


9/50

1amil

ke5

Kondisi

saat lahir

6enis

persalinan

Usia Sehat/tidak Usia

meninggal

1 Ae(m S%/n&n ; &hun Seh& 0

2 Ae(m S%/n&n 0 0 ; bul&n ,&(en&

,e&ng

P&sien Ae(m S%/n&n 1 bul&n 11

h&(i

Seh&

ertumbuhan dan erkembangan Anak

Be(& b&&n l&hi( : 3 g(

P&n&ng b&&n l&hi( : != 7m

Be(& b&&n se,&(&ng : 35 g(

Tinggi b&&n se,&(&ng : !87m

igi ,elu&( : 0

Te(sen-um : 0

"i(ing : 0

Teng,u(&% : 0

Duu, : 0

"e(&ng,&, : 0

Be(i(i : 0

Be(&l&n : 0

Be(bi7&(& 2 ,&& : 0

Makan dan Minum Anak

ASI : Se&, l&hi( &n m&sih meminum ASI

hingg& se,&(&ng

Susu +/(mul&>s&%i : 0

emeriksaan renatal

Pe(i,s& i : P(&,e, Bi&n S&s&

=

`


10/50

Pen-&,i ,eh&mil&n : 0

Ob&0/b& -&ng se(ing iminum : i&min %en&mb&h &(&h

Riwa'at Kelahiran

L&hi( i : $S

Di/l/ng /leh : D/,e( s%esi&lis ,&nung&n

Usi& &l&m ,&nung&n : 8 bul&n

Jenis %&(us : S? &.i be,&s S? 2 ,&li

$i&-& ,el&hi(&n : B&-i l&ngsung men&ngis ,u&

Keluarga .eren7ana

elu&(g& Be(en7&n& : F&

"em&,&i sisem : Se(il

Riwa'at Imunisasi

Imunis&si Usi& s&& imunis&si

I II III I B//se( I B//se( II

B? '0) >>>>>>>>>>>> >>>>>>>>>>>> >>>>>>>>>>>> >>>>>>>>>>>> >>>>>>>>>>>>

P/li/ 'G) '0) '0) '0) 0 0

?&m%&, 0 0 >>>>>>>>>>>> >>>>>>>>>>>> >>>>>>>>>>>> >>>>>>>>>>>>

DPT '0) '0) '0) >>>>>>>>>>>> 0 0

He%&iis B 'G) '0) '0) >>>>>>>>>> 0 0

!M!RIKSAA" FISIK

Dil&,u,&n %&& &ngg&l = A%(il 21;

es&n umum : &m%&, s&,i se&ng

es&&(&n : ?/m%/smenis

Tanda Vital

• #(e,uensi N&i : 1!4 >meni

• #(e,uensi N&%&s : 3; >meni

8

`


11/50

• Tem%e(&u( : 3464/ ? %e( &i&l

• S%2 : 84 9

Antropometri

Be(& b&&n : 3.5 g(

P&n&ng B&&n : !8 7m

Ling,&( ,e%&l& : 32 7m

Ling,&( Leng&n A&s : =62 7m

S&us i@i :

BB>U ;; 9 &&u 03 SD s&m%&i 2 SD 'i@i u(&ng be(&s&(,&n K0 S7/(e)

TB>U : 02 SD s&m%&i 2 SD ' i@i B&i, be(&s&(,&n K0 S7/(e )

1

`


12/50

e%&l&

$&mbu :


13/50

Ins%e,si : I,us 7/(is i&, &m%&,

P&l%&si : I,us 7/(is e(&b& i I?S le+ %&(&se(n&l line

Pe(,usi : B&&s &nung

&n&n : I?S III (igh %&(&se(n&l line

i(i : I?S le+ mi7l&*i7ul&( line

Aus,ul&si : S16S2 ungg&l (egule(6 g&ll/% '0)6 mu(mu( '0)

Ab/men

Ins%e,si : isene '0)6 e(&%& ,&s& be,&s /% 'G)6 &(&h '0)

P&l%&si : S/e+l6 ,embung '0)6 isene '0)6 n-e(i e,&n 'G)6

he%&/meg&li '0)6 s%len/meg&li '0)6 u(g/( ,uli b&i,.

Pe(,usi : Tim%&ni

Aus,ul&si : Bising usus 'G) ,es&n n/(m&l

E,s(emi&s : A,(&l h&ng& 'G)6 /eem '0)

Status "eurologis

es&&(&n

?S E!5";

o "eninge&l Sign

&,u ,uu, '0)

e(nig sign '0)

L&seCue '0)

B(uin@,- I '0)

B(u@ins,- II '0)

Peme(i,s&&n S&(&+ (&ni&lis

Peme(i,s&&n S&(&+ (&ni&lis Nil&i

O,ul/m//(ius 'III)

Sel& m&&

Pe(ge(&,&n m&& ,e&(&h su%e(i/(6

mei&l6 in+e(i/(

S(&bismus

$e+le,s %u%il e(h&&% sin&(

SDE

SDE

'0)

'G>G) i&mee( 2mm>2mm

12

`


14/50

T(/,le&(is 'I)

Pe(ge(&,&n m&& /(si su%e(i/( SDE

T(igeminus ')

"embu,& mulu

"engun-&h

"enggigi

N/(m&l

N/(m&l

SDE

Abusens 'I)

Pe(ge(&,&n m&& ,e l&e(&l N/(m&l

#&si&lis 'II)

"enuu% m&&

"em%e(lih&,&n gigi

Suu bibi(

'0>G)

SDE

N/n Sime(is '%&(ese De)

esibul/,/,le&(is 'III)

#ungsi %eneng&(&n 'Sube,i+) N/(m&l

&gus ')

Bi7&(&

"enel&n

SDE

N/(m&l

Asses/(ius 'I)

"em&ling,&n ,e%&l& SDE

Hi%/gl/ssus 'II)

Pe(ge(&,&n li&h SDE

Angg/& e(&, A&s

Angg/& e(&, A&s &n&n i(i

"//(i,

Pe(ge(&,&n

e,u&&n

G

5

G

5

$e+le,s +isi/l/gis

Bise%s

T(i7e%s

SDE

SDE

SDE

SDE

$e+le,s %&/l/gis

T(/mne(

H/++m&n

'0)

'0)

'0)

'0)

13

`


15/50

• Angg/& e(&, B&&h

Angg/& e(&, B&&h &n&n i(i

"//(i,

Pe(ge(&,&n

e,u&&n

G

5

G

5

$e+le,s +isi/l/gis

P&ell&

A7hilles

SDE

SDE

SDE

SDE$e+le,s %&/l/gis

B&bins,i

?h&/7,

'0)

'0)

'0)

'0)

!M!RIKSAA" !"U"6A"&

Peme(i,s&&n L&b/(&/(ium

+0/*)/+*(-

Leukosit (+8**

1b 1!64

17t !!6!

lt )9:***

&$S ;;

"a 13;

K ;6!

;l 1=

+,/*)/+*(-

Leukosit =.85

1b 126=17t 3863

lt 3!2.

&$S 4=

"a 1!!

K 562

;l 11;

Ureum 26

Kreatinin 64

0/0/+*(-

Leukosit 11.!

1!

`


16/50

1b 116;

17t 346!

lt 22=.

S&%T 32

S&T 21Albumin 361

-/)/+*(-

Albumin 26;

8/)/+*(-

Leukosit (-)9*

1b 1262

1t 3565

lt +8,***

emeriksaanRadiologis

Foto %M$


17/50

• T&m%&, %en-em%i&n lumen is&l es/+&gus

Kesan 4 en'empitan lumen distal esophagus ingter

distal esophagus=

;T S7an Kepalatgl )*/)/+*(-

Interpretasi 4

• T&m%&, g&mb&(&n hi%/ens i %&(ie/ em%/(&l sinis(&6 7u(ig& ,(/mi,

subu(&l hem&/m&

• Sisem *en(i,el men-em%i6 /eem se(eb(i

$iagnosis Utama : A,&l&si& Es/+&gus

Di&gn/sis l&in : #&(ese N. #&7i&lis e,s(& G Eem& 7e(eb(i

Di&gn/sis /m%li,&si : i@i u(&ng

!"ATALAKSA"AA" 4

0 In+. AEN !A G D!9 1 +l&sh !5 77>2! &m

0 In. $&niiin 2 3mg

0 In+. Amin/se(il ;9 5 77 >2! &m

0 In+. I*eli% 29 2 77>2! &m

1;

`


18/50

0 Pu&s&

0 /nsul be&h &n&,

0 #// b&(ium me&l

0 P&s&ng OT &n D?

rognosa : & "&l&m

14

`


19/50

Follow Up Ruangan

T&ngg&l S O A P

2!03021;

'h&(i )

$u&ng

B&-i

Usi& :

2! h&(i

"un&h sei&%ibe(i,&n ASI6

,embung '0)6

em&m '0)6 ses&, '0)

?S : E!5";

H$. 1!3 >meni6 $$. 3= >meni

>L : Ane '0>0)6 i, '0>0)6 $? 'G>G)6 #&(ese

N. +&si&l e(&

Th/(& : S1S2 ungg&l (egule(

*esi,ule('G>G)6h@'0>0)6(h/n,i'0>0)

Ab:s/e+l6isene'0)6 Bu'G)N

E,s:&,(&l h&ng&

Obse(*&si*/miing e7

Obs(u,si

seinggi

g&s(i7 /ule

/bs(u,si G

Hi%e(,&lemi&

G %&(ese N.

+&7i&l D

0 In+. AEN !A G D!9 1 +l&sh

!5 77>2! &m

0 In. $&niiin 2 3mg

0 In+ Amin/se(il ;9 5 77 >2! &m

0 #// b&(ium me&l

0 P&s&ng OT &n D?

2=03021;

'h&(i! )

$u&ng

B&-i

P(/u,si OT

hi&u'G)6 em&m

'0)6 ses&, '0)

?S : E!5";

H$. 1! >meni6 $$. !2 >meni

>L : Ane '0>0)6 i, '0>0)6 $? 'G>G)6 P&(ese

N. #&7i&lis D

Obse(*&si

*/miing e7Obs(u,si

seinggi

g&s(i7 /ule

/bs(u,si G

Hi%e(,&lemi&

0 In+. AEN !A 5 77>2! &m

0 In+ Amin/se(il ;9 2 77 >2! &m

0 In. Am%isilin 2 15 mg

0 In+. I*eli% 29 2 77>2! &m

1=

`


20/50

Usi& :

2= h&(i


*esi,ule('G>G)6 h@'0>0)6 (h/n,i'0>0)

Ab : s/e+l6 isene'0)6 Bu'G)N

E,s : &,(&l h&ng&

G #&(ese N.

+&7i&lis D

0 Pu&s&

20!021;

'h&(i =)

$u&ng

B&-i

"un&h '0)6 BAB

'G)6 ,embung '0)6

,e&ng '0)

?S : E!5";

H$. 12= >meni6 $$. != >meni

>L : Ane '0>0)6 i, '0>0)6 $? 'G>G)6 P&(ese

N. #&7i&lis D


*esi,ule('G>G)6h@'0>0)6(h/n,i'0>0)

Ab:s/e+l6isene'0)6 Bu'G)N

E,s:&,(&l h&ng&

A,&l&si& G

P&(ese N.

#&7i&lis D G

Eem&

7e(eb(i

0 In+. AEN !A 5 77>2! &m

0 In+ Amin/se(il ;9 2 77 >2! &m

0 In. Am%isilin 2 15 mg

0 In+. I*eli% 29 2 77>2! &m

0 ASI ; 1 77

0 P(/ m-//mi Helle( $&bu ;>!>21;

;0!021;

'h&(i12)

PI?U

Lu,& %/s /% 'G)6

mun&h '0)6 em&m

'0)6 ,embung '0)6

NT : (eensi

7&i(&n e(nih

?S : E!5";

H$. 13! >meni6 $$. 52 >meni

>L : Ane '0>0)6 i, '0>0)6 $? 'G>G)6 P&(ese

N. +&7i&lis D

P/s /%m-//mi

helle( &>I

A,&l&si& H0

G P&(ese N.

#&si&lis D G

0 In+. D1 1>5 NS 2= 77>2! &m

0 I*eli% 29 465 77> 2! &m

0 Amin/+usi 59 ; 77>2! &m

0 ?l 46!9 ; 77>2! &m

18

`


21/50

minim&l Th/(& : S1S2 ungg&l (egule(

*esi,ule('G>G)6h@'0>0)6(h/n,i'0>0)

Ab:lu,& %/s /% 'G)6 s/e+l6isene'0)6

Bu'G)N

E,s:&,(&l h&ng&

Eem&

7e(eb(i

0 ?e+/&iem 2 15 mg

0 P&(&7e&m/l 3 3mg

0 Albumin 29 2 177

;0!021;

'h&(i 12)

PI?U

Lu,& %/s /% 'G)6

mun&h '0)6 em&m

'0)6 ,embung '0)

?S : E3!";

H$. 13! >meni6 $$. 52 >meni

>L : Ane '0>0)6 i, '0>0)6 $? 'G>G)6 P&(ese

N. +&si&lis D


*esi,ule('G>G)6h@'0>0)6(h/n,i'0>0)


Bu'G)N

E,s:&,(&l h&ng&

P/s /%

m-//mi

helle( &>i

A,&l&si& H01

G P&(ese N.

#&7i&lis D G

Eem&

7e(eb(i

0 In+. D1 61= NS 2= 77>2! &m

0 I*eli% 29 465 77> 2! &m

0 Amin/+usin 59 ; 77>2! &m

0 ?l 46!9 ; 77>2! &m

0 ?e+/&iem 2 15 mg

0 P&(&7e&m/l 3 3mg

0 Albumin 29 2 177

=0!021;

'h&(i1!)

Lu,& %/s /% 'G)6

mun&h '0)6 em&m

'0)6 ,embung '0)

?S : E!5";

H$. 11; >meni6 $$. != >meni

>L : Ane '0>0)6 i, '0>0)6 $? 'G>G)6 P&(ese

P/s /%

m-//mi

helle( &>i

A,&l&si& H02

0 In+. D1 61= NS 225 77>2! &m

0 In+. I*eli% 29 15 77> 2! &m

2

`


22/50

PI?U N. +&7i&lis D


*esi,ule('G>G)6h@'0>0)6(h/n,i'0>0)


Bu'G)N

E,s:&,(&l h&ng&

G P&(ese N.

+&7is&lis D G

Eem&

7e(eb(i

0 In+. Amin/+usin 59 ; 77>2! &m

0 In. ?e+/&iem 2 15 mg

0 P&(&7e&m/l 3 3mg

0 Albumin 29 2 177 'H02)

0 Die ASI = 577 'OT)

21

`


23/50

.A. )

TI"6AUA" USTAKA

)( AR!S! "!R#US FA;IALIS

)(( $e>inisi

elum%uh&n s&(&+ +&si&lis 'N II) me(u%&,&n ,elum%uh&n //0// &&h

im&n& %&sien i&, &&u ,u(&ng &%& mengge(&,,&n // &&h6 sehingg& &&h

%&sien i&, sime(is. H&l ini &m%&, se,&li ,ei,& %&sien imin& unu,

menggembung,&n %i%i &n menge(u,&n &hi.1

)(+ !pidemiologi

#/ese( mel&%/(,&n b&h& ,e(us&,&n s&(&+ +&si&lis seb&n-&, 12 &(i

384 ,&sus '39) &(i selu(uh (&um& ,e%&l& s&& Pe(&ng Duni& I. #(iem&n &n

"e(i menemu,&n se,i&( 4 &(i !3 ,&sus (&um& ,e%&l&. A&%un ,elum%uh&n

s&(&+ +&si&lis -&ng i&, i,e&hui %en-eb&bn-& 'Bells P&ls-) se,i&( 203 ,&sus

%e( 1. %enuu, %e(&hun6 se,i&( ;0459 &(i semu& ,&sus me(u%&,&n

%&(&l-sis ne(*us +&si&lis unil&e(&l.3

Insien %&& l&,i0l&,i &n %e(em%u&n s&m&6 n&mun (&&0(&& mun7ul %&&

usi& ! &hun mes,i%un %en-&,i ini &%& imbul i semu& umu(. Insien e(en&h&&l&h %&& &n&, i b&&h 1 &hun6 mening,& %&& umu( i &&s 4 &hun.

#(e,uensi ,elum%uh&n s&(&+ +&si&lis ,&n&n &n ,i(i s&m&. &us& um/( me(u%&,&n

h&l -&ng &(&ng6 h&n-& se,i&( 59 &(i semu& ,&sus ,elum%uh&n s&(&+ +&si&lis. 3

)() !tiologi

Pen-eb&b ,elum%uh&n s&(&+ +&si&lis bis& iseb&b,&n /leh ,el&in&n

7/ngeni&l6 in+e,si6 um/(6 (&um&6 g&nggu&n %embuluh &(&h6 ii/%&i,6 &n

%en-&,i0%en-&,i e(enu.163

( Kongenital

elum%uh&n -&ng i&%& se&, l&hi( ' 7/ngeni&l ) be(si+& i((e*e(sible

&n e(&%& be(s&m&&n eng&n &n/m&l- %&& eling& &n ul&ng %eneng&(&n. 1

P&& ,elum%uh&n s&(&+ +&si&lis bil&e(&l &%& e(&i ,&(en& &&n-& g&nggu&n

%e(,emb&ng&n s&(&+ +&si&lis &n se(ing,&li be(s&m&&n eng&n ,elem&h&n /,ul&(

'sin(/m "/ibeus).3

+ In>eksi

22

`


24/50

P(/ses in+e,si i in(&7(&ni&l &&u in+e,si eling& eng&h &%&

men-eb&b,&n ,elum%uh&n s&(&+ +&si&lis. In+e,si in(&7(&ni&l -&ng men-eb&b,&n

,elum%uh&n ini se%e(i %&& Sin(/m $&ms&-0Hun6 He(%es /i,us. In+e,si

Teling& eng&h -&ng &%& menimbul,&n ,elum%uh&n s&(&+ +&si&lis &&l&h /iis

mei& su%u(&i+ ,(/ni, ' O"S ) -&ng el&h me(us&, &n&l #&ll/%i.1

) Tumor

Tum/( -&ng be(me&s&sis ,e ul&ng em%/(&l me(u%&,&n %en-eb&b -&ng

%&ling se(ing iemu,&n. Bi&s&n-& be(&s&l &(i um/( %&-u&(&6 %&(u0%&(u6 &n

%(/s&. Jug& il&%/(,&n b&h& %en-eb&(&n l&ngsung &(i um/( (egi/n&l &n sel

s7h&nn6 ,is& &n um/( g&n&s m&u%un in&, &(i ,elen&( %&(/is bis&

mengin*&si 7&b&ng &,hi( &(i s&(&+ +&si&lis -&ng be(&m%&, seb&g&i be(m&7&m0

m&7&m ing,& ,elum%uh&n. P&& ,&sus -&ng s&ng& &(&ng6 ,&(en& %eleb&(&n

&neu(ism& &(e(i ,&(/is &%& mengg&nggu +ungsi m//(i, s&(&+ +&si&lis se7&(&

i%sil&e(&l.2

0 Trauma

elum%uh&n s&(&+ +&si&lis bis& e(&i ,&(en& (&um& ,e%&l&6 e(u&m& i,&

e(&i +(&,u( b&sis 7(&nii6 ,hususn-& bil& e(&i +(&,u( l/ngiuin&l. Sel&in iu

lu,& usu,6 lu,& emb&, se(& %ene,&n&n +/(se% s&& l&hi( ug& bis& men&i

%en-eb&b. S&(&+ +&si&lis %un &%& 7ee(& %&& /%e(&si m&s/i6 /%e(&si neu(/m&

&,usi,>neu(&lgi& (igemin&l &n /%e(&si ,elen&( %&(/is.2

9 &angguan embuluh $arah

&nggu&n %embuluh &(&h -&ng &%& men-eb&b,&n ,elum%uh&n s&(&+

+&si&lis i&n&(&n-& h(/mb/sis &(e(i ,&(/is6 &(e(i m&,sil&(is &n &(e(i se(eb(i

mei&.1

- Idiopatik


25/50

elum%uh&n +&si&lis %e(i+e( &%& e(&i %&& %en-&,i0%en-&,i e(enu6

mis&ln-& D"6 he%e(ensi be(&6 &nesesi l/7&l %&& %en7&bu&n gigi6 in+e,si

eling& eng&h6 sin(/m uilli&n B&((e.3

)(0 Mani>estasi Klinis

O/0// b&gi&n &&s &&h men&%& %e(s&(&+&n &(i 2 sisi. &(en& iu6

e(&%& %e(be&&n &n&(& ge&l& ,elum%uh&n s&(&+ II enis sen(&l &n %e(i+e(.

P&& g&nggu&n sen(&l6 se,i&( m&& &n &hi -&ng men&%& %e(s&(&+&n &(i 2

sisi6 i&, lum%uh M -&ng lum%uh i&l&h b&gi&n b&&h &(i &&h. P&& g&nggu&n

N II enis %e(i+e( 'g&nggu&n be(&& i ini &&u i se(&bu s&(&+) m&,& semu& //

sesisi &&h lum%uh &n mung,in ug& e(m&su, 7&b&ng s&(&+ -&ng mengu(us

%enge7&%&n &n se,(esi lu&h -&ng be(&l&n be(s&m& N. #&si&lis.;

B&gi&n ini m//(i, -&ng mengu(us &&h b&gi&n b&&h men&%&

%e(s&(&+&n &(i ,/(e,s m//(i, ,/n(&l&e(&l6 se&ng,&n -&ng mengu(us &&h

b&gi&n &&s men&%& %e(s&(&+&n &(i ,eu& sisi ,/(e,s m//(i, 'bil&e(&l)

'g&mb&( 1). &(en&n-& ,e(us&,&n sesisi %&& u%%e( m//( neu(/n &(i s&(&+ II

'lesi %&& (&,us %i(&mi&lis &&u ,/(e,s m//(i,) &,&n meng&,ib&,&n

,elum%uh&n %&& //0// &&h b&gi&n b&&h6 se&ng,&n b&gi&n &&sn-& i&,.

Pene(i&n-& m&sih &%& meng&ng,& &lis6 menge(u,&n &hi &n menuu% m&&

'%e(s&(&+&n bil&e(&l) M e&%i %&sien ,u(&ng &%& meng&ng,& suu mulu

'men-e(ing&i6 mem%e(lih&,&n gigi geligi) %&& sisi -&ng lum%uh bil& isu(uh.

/n(&,si in*/lune( m&sih &%& e(&i6 bil& %ene(i& e(&& se7&(& s%/n&n6

m&,& suu mulu &%& e(&ng,&.;

P&& lesi m//( neu(/n6 semu& ge(&,&n // &&h6 b&i, -&ng */lune(

m&u%un -&ng in*/lune(6 lum%uh. Lesi su%(&nu,li( 'u%%e( m//( neu(/n) s&(&+ IIse(ing me(u%&,&n b&gi&n &(i hemi%legi&. H&l ini &%& ium%&i %&& s(/, &n

lesi0buuh0(u&ng 's%&7e /77u%-ing lesi/n) -&ng mengen&i ,/(e,s m//(i,6

,&%sul& ine(n&6 &l&mus6 mesense+&l/n &n %/ns i &&s ini s&(&+ II. D&l&m h&l

emi,i&n %enge7&%&n &n s&li*&si i&, e(g&nggu. elum%uh&n s&(&+ II

su%(&nu,li( %&& ,eu& sisi &%& ium%&i %&& %&(&lisis %seu/bulbe(. ;

2!

`


26/50

&mb&( 1 Pe(s&(&+&n O/


27/50

he(%es @/se( i g&ngli/n geni,ul&um. T&n&0&n&n-& &&l&h he(%es @/se(

/i,us 6 eng&n n-e(i &n %embenu,&n *esi,el &l&m ,&n&lis &ui/(ius &n

ibel&,&ng &u(i,el 's&(&+ &u(i,ul&(is %/se(i/()6 e(&i inius6 ,eg&g&l&n

%eneng&(&n6 g&nggu&n %enge7&%&n6 %engelu&(&n &i( m&& &n s&li*&si.

9 Lesi di meatus akustikus internus

e&l& &n &n& ,lini, se%e(i i&&s i&mb&h eng&n uli &,ib&

e(lib&n-& ne(*us &,usi,us.

- Lesi ditempat keluarn'a sara> >asialis dari pons.

e&l& &n &n& ,lini, s&m& eng&n i&&s6 ise(&i ge&l& &n &n&

e(lib&n-& s&(&+ (igeminus6 s&(&+ &,usi,us &n ,&&ng ,&&ng ug& s&(&+

&busen6 s&(&+ &,ses/(ius &n s&(&+ hi%/gl/ssus.

&mb&( 2. ,/m%/nen se(& s&(&+ +&si&lis &n ine(meie &n &n&0&n&

,e(us&,&n segmen ini*iu&ln-&

)(9 Klasi>ikasi Kelumpuhan Fasialis

&mb&(&n &(i is+ungsi m//(i, +&si&l ini s&ng& lu&s &n ,&(&,e(isi,

&(i ,elum%uh&n ini s&ng& suli. Bebe(&%& sisem el&h usul,&n e&%i semen&,

%e(eng&h&n 18= sisem H/use0B(&7,m&nn -&ng sel&lu &&u s&ng& i&nu(,&n .

%&& ,l&si+i,&si ini g(&e 1 me(u%&,&n +ungsi -&ng n/(m&l &n g(&e ;

2;

`


28/50

me(u%&,&n ,elum%uh&n -&ng ,/m%li. Pe(eng&h&n g(&e ini sisem be(be&

%en-esu&i&n &(i +ungsi ini %&& isi(&h& &n eng&n ,egi&&n. Ini i(ing,&s

&l&m &bel:=

T&bel 1. l&si+i,&si H/use0B(&7,m&nn

(&e Penel&s&n &(&,e(isi,

I N/(m&l #ungsi +&si&l n/(m&l

II Dis+ungsi (ing&n elem&h&n -&ng sei,i -&ng e(lih& %&& ins%e,si

e,&6 bis& && sei,i sin,inesis.

P&& isi(&h& sime(i &n sel&(&s.

Pe(ge(&,&n &hi se&ng s&m%&i b&i,

"enuu% m&& eng&n us&h& -&ng minim&l

Te(&%& sei,i &sime(is %&& mulu i,& mel&,u,&n

%e(ge(&,&n

III Dis+ungsi

se&ng

Te(lih& &%i i&, &m%&, &&n-& %e(be&&n &n&(&

,eu& sisi

A&n-& sin,inesis (ing&n

D&%& iemu,&m s%&sme &&u ,/n(&,u( hemi+&si&l

P&& isi(&h& sime(is &n sel&(&s

Pe(ge(&,&n &hi (ing&n s&m%&i se&ng

"enuu% m&& eng&n us&h&

"ulu sei,i lem&h eng&n %e(ge(&,&n -&ng

m&,simum

I Dis+ungsi

se&ng be(&

T&m%&, ,elem&h&n b&gi&n &&h -&ng el&s &n

&sime(i

em&m%u&n mengge(&,,&n &hi i&, &&

Ti&, &%& menuu% m&& eng&n sem%u(n&

"ulu &m%&, &sime(is &n suli ige(&,,&n.

Dis+ungsi be(&


29/50

)(- U2i $iagnostik

Di&gn/sis ieg&,,&n eng&n mel&,u,&n %eme(i,s&&n +ungsi s&(&+ +&si&lis. Tuu&n

%eme(i,s&&n +ungsi s&(&+ +&si&lis &&l&h unu, menenu,&n le&, lesi &n

menenu,&n e(&& ,elum%uh&nn-&.1

( emeriksaan >ungsi sara> motorik

Te(&%& 1 //0// u&m& &&h -&ng be(&nggung &&b unu,

e(7i%&n-& mimi, &n e,s%(esi &&h sese/(&ng. A&%un u(u&n ,e01 //0//

e(sebu &(i sisi su%e(i/( &&l&h seb&g&i be(i,u :

&. ". #(/n&lis : i%e(i,s& eng&n 7&(& meng&ng,& &lis ,e &&s. b. ". S/u(7ilie( : i%e(i,s& eng&n 7&(& menge(u,&n &lis

7. ". Pi(&mi&lis : i%e(i,s& eng&n 7&(& meng&ng,& &n

menge(u,&n hiung ,e &&s

. ". O(bi,ul&(is O,uli : i%e(i,s& eng&n 7&(& meme&m,&n ,eu& m&&

,u&0,u&

e. ". Kig/m&i,us : i%e(i,s& eng&n 7&(& e(&& leb&( s&mbil

mem%e(lih&,&n gigi

+. ". $ele*e( /munis : i%e(i,s& eng&n 7&(& mem/n7/ng,&n mulu

,ee%&n s&mbil mem%e(lih&,&n gigig. ". Busin&/( : i%e(i,s& eng&n 7&(& menggembung,&n ,eu& %i%i

h. ". O(bi,ul&(is O(is : i%e(i,s& eng&n 7&(& men-u(uh %ene(i& be(siul

i. ". T(i&ngul&(is : i%e(i,s& eng&n 7&(& men&(i, ,eu& suu bibi( ,e

b&&h

. ". "en&lis : i%e(i,s& eng&n 7&(& mem/n7/ng,&n mulu -&ng

e(uu% (&%& ,e e%&n

P&& i&% ge(&,&n &(i ,e 1 // e(sebu6 ,i& b&ning,&n &n&(& ,&n&n &n ,i(i :

&. Unu, ge(&,&n -&ng n/(m&l &n sime(is inil&i eng&n &ng,& ig& ' 3 )

b. Sei,i && ge(&,&n inil&i eng&n &ng,& s&u ' 1 )7. Di&n&(&n-& inil&i eng&n &ng,& u& ' 2 )

. Ti&, && ge(&,&n s&m& se,&li inil&i eng&n &ng,& n/l ' )

Selu(uh // e,s%(esi i&% sisi mu,& &l&m ,e&&&n n/(m&l &,&n

mem%un-&i nil&i ig& %uluh ' 3 ).1

+ Tonus

P&& ,e&&&n isi(&h& &n%& ,/n(&,si m&,& /nus // menenu,&n

e(h&&% ,esem%u(n&&n mimi7 > e,s%(esi mu,&. #(e-ss meng&ngg&% %ening &,&n

+ungsi /nus sehingg& meng&&,&n %enil&i&n %&& sei&% ing,&&n ,el/m%/, //

2=

`


30/50

mu,&6 bu,&n %&& sei&% //. ?&h/(ne mengemu,&,&n b&h& /nus -&ng ele,

membe(i,&n g&mb&(&n %(/gn/sis -&ng ele,. Penil&i&n /nus selu(uhn-&

be(uml&h lim& bel&s '15) -&iu selu(uhn-& e(&%& lim& ing,&&n i,&li,&n ig&

unu, sei&% ing,&&n. A%&bil& e(&%& hi%//nus m&,& nil&i e(sebu i,u(&ngi

s&u '01) s&m%&i minus u& '02) %&& sei&% ing,&&n e(g&nung &(i g(&&sin-&.1

) &ustometri

Sisem %enge7&%&n %&& 2>3 &ne(i/( li&h i%e(s&(&+i /leh n. /(&

im%&ni6 s&l&h s&u 7&b&ng s&(&+ +&si&lis.1 e(us&,&n %&& N II sebelum

%e(7&b&ng&n ,/(& im%&ni &%& men-eb&b,&n &geusi 'hil&ngn-& %enge7&%&n).2

Peme(i,s&&n il&,u,&n eng&n 7&(& %ene(i& isu(uh menulu(,&n li&h6

,emui&n %eme(i,s& men&(uh bubu, gul&6 ,in&6 &s&m si(& &&u g&(&m %&& li&h

%ene(i&. H&li ini il&,u,&n se7&(& be(gili(&n &n iselingi isi(&h&. Bil& bubu,

i&(uh6 %ene(i& i&, b/leh men&(i, li&hn-& ,e &l&m mulu6 seb&b bubu,

&,&n e(seb&( mel&lui lu&h ,e sisis li&h l&inn-& &&u ,e b&gi&n bel&,&ng li&h

-&ng %e(s&(&+&nn-& iu(us /leh s&(&+ l&in. Pene(i& isu(uh unu, men-&&,&n

%enge7&%&n -&ng i(&s&,&nn-& eng&n is-&(&6 mis&ln-& 1 unu, (&s& m&nis6 2

unu, (&s& %&hi6 3 unu, (&s& &sin6 &n ! unu, (&s& &s&m.2

P&& %eme(i,s&&n +ungsi ,/(& im%&ni &&l&h %e(be&&n &mb&ng

(&ngs&ng &n&(& ,&n&n &n ,i(i. #(e-ss mene&%,&n b&h& be& 59 &n&(& ,eu&

sisi &&l&h %&/l/gis.1

0 Salivasi

Peme(i,s&&n ui s&li*&si &%& il&,u,&n eng&n mel&,u,&n ,&nul&si

,elen&( subm&nibul&(is. ?&(&n-& eng&n men-eli%,&n &bung %/lieilen n/ 5

,e&l&m u,us


31/50

su%e(+isi&lis m&-/( seinggi g&ngli/n geni,ul&um. e(us&,&n %&& &&u i &&s

s&(&+ %e(/sus m&-/( &%& men-eb&b,&n be(,u(&ngn-& %(/u,si &i( m&&.162

Tes S7hime( il&,u,&n unu, menil&i +ungsi l&,(im&si &(i m&&. ?&(&

%eme(i,s&&n eng&n mele&,,&n ,e(&s his&% &&u l&,mus leb&( 65 7m %&n&ng 50

1 7m %&& &s&( ,/nungi*&. Seel&h ig& meni6 %&n&ng &(i b&gi&n s(i% -&ng

men&i b&s&h ib&ning,&n eng&n sisi s&un-&. #(e-s men-&&,&n b&h& ,&l&u

&& be& ,&n&n &n ,i(i lebih &&u s&m& eng&n 59 i&ngg&% %&/l/gis.162

- Re>leks Stapedius

Unu, menil&i (e+le s&%eius igun&,&n ele,/&,usi, im%e&ns mee(6

-&iu eng&n 7&(& membe(i,&n (&ns&ng&n %&& mus,ulus s&%eius -&ng be(uu&n

unu, menge&hui +ungsi N. s&%eius 7&b&ng N.II.1

8 U2i audiologik

Sei&% %&sien -&ng mene(i& %&(&lisis s&(&+ +&si&lis %e(lu men&l&ni

%eme(i,s&&n &ui/g(&m leng,&%. Pengui&n e(m&su, h&n&(&n u&(& &n h&n&(&n

ul&ng6 im%&n/me(i &n (e+le s&%es. #ungsi s&(&+ 7(&ni&l ,eel&%&n &%&

inil&i eng&n menggun&,&n ui (es%/n &ui/(i, -&ng ib&ng,i,&n &(i b&&ng

/&,. Ui ini be(m&n+&& &l&m menee,si %&/l/gi ,&n&lis &,usi,us ine(nus.

Su&u uli ,/nu,i+ &%& membe(i,&n ,es&n su&u ,el&in&n &l&m eling& eng&h6

&n eng&n mem&n&ng s-&(&+ +&si&lis -&ng e(%&%&( %&& &e(&h ini6 %e(lu

i%e(imb&ng,&n su&u sumbe( in+e,si. Ji,& e(&i ,elum%uh&n s&(&+ ,euuh %&&

&,u /iis mei& &,u6 m&,& mung,in g&nggu&n s&(&+ %&& eling& eng&h.

Pengui&n (e+le, &%& il&,u,&n %&& eling& i%sil&e(&l &&u ,/n(&l&e(&l eng&n

menggun&,&n su&u n&& -&ng ,e(&s6 -&ng &,&n memb&ng,i,&n (es%/n su&u

ge(&,&n (e+le, &(i // s&%eius. e(&,&n ini mengub&h eg&ng&n memb(&ne

im%&ni &n men-eb&b,&n %e(ub&h&n im%e&nsi (&n&i /si,ul&(. Ji,& n&& e(sebui%e(eng&(,&n %&& bel&h&n eling& -&ng n/(m&l6 &n (e+le, ini %&&

%e(&ngs&ng&n ,eu& eling& menges&n,&n su&u ,el&in&n %&& b&gi&n &+e(en s&(&+

,(&ni&lis.2

: Sinkinesis

Sin,inesis meneu,&n su&u ,/m%li,&si &(i ,elum%uh&n s&(&+ +&si&lis

-&ng se(ing ,i& um%&i. ?&(& menge&hui && i&,n-& sin,inesis &&l&h seb&g&i

be(i,u :1

3

`


32/50

&. Pene(i& imin& unu, memen&m,&n m&& ,u&0,u& ,emui&n ,i&

melih& %e(ge(&,&n //0// %&& &e(&h suu bibi( &&s. &l&u

%e(ge(&,&n n/(m&l %&& ,eu& sisi inil&i eng&n &ng,& u& '2). &l&u

%e(ge(&,&n %&& sisi %&(esis lebih 'hi%e() ib&ning,&n eng&n sisi n/(m&l

nil&in-& i,u(&ngi s&u '01) &&u u& '02)6 e(g&nung &(i g(&&sin-&.

b. Pene(i& imin& unu, e(&& leb&( s&mbil mem%e(lih&,&n gigi6

,emui&n ,i& melih& %e(ge(&,&n //0// %&& suu m&& b&&h.

Penil&i&n se%e(i %&& '&).

7. Sin,inesis ug& &%& ilih& %&& &,u %ene(i& be(bi7&(& 'ge(&,&n

em/si) eng&n mem%e(h&i,&n %e(ge(&,&n //0// se,i&( mulu. Nil&i

s&u '1) ,&l&u %e(ge(&,&n n/(m&l. Nil&i n/l ') ,&l&u %e(ge(&,&n i&,

sime(is.

, 1emispasme

Hemis%&sme me(u%&,&n su&u ,/m%li,&si -&ng se(ing ium%&i %&&

%en-embuh&n ,elum%uh&n +&si&lis -&ng be(&. Di%e(i,s& eng&n 7&(& %ene(i&

imin& unu, mel&,u,&n ge(&,&n0ge(&,&n be(s&h&-& se%e(i mengei%0ngei%,&n

m&& be(ul&ng0ul&ng m&,& bibi( &,&n el&s &m%&, ge(&,&n //0// %&& suu

bibi( b&&h &&u suu m&& b&&h. P&& %ene(i& -&ng be(& ,&&ng0,&&ng

//0// %l&ism& i &e(&h lehe( ug& i,u be(ge(&,. Unu, sei&% ge(&,&n

hemis%&sme inil&i eng&n &ng,& '01).1

#ungsi m//(i, //0// i&% sisi &&h /(&ng n/(m&l selu(uhn-&

be(uml&h lim& %uluh '5) &&u 19. (&&si %&(esis +&si&lis ib&ning,&n

eng&n nil&i e(sebu i,&li,&n u& unu, %e(sen&sen-&.1

)(8 emeriksaan enun2ang

S&l&h s&u %eme(i,s&&n %enun&ng -&ng &%& il&,u,&n unu, menge&hui

,elum%uh&n s&(&+ +&si&lis &&l&h eng&n ui +ungsi s&(&+. Te(&%& bebe(&%& ui

+ungsi s&(&+ -&ng e(sei& &n&(& l&in Ele,(/mig(&+i 'E")6 Ele,(/neu(/n/g(&+i

'ENO)6 &n ui simul&si m&,sim&l.2

1. Ele,(/mi/g(&+i 'E")

E" se(ing ,&li il&,u,&n /leh b&gi&n neu(/l/gi. Peme(i,s&&n ini

be(m&n+&& unu, menenu,&n %e(&l&n&n (es%/ns (eine(*&si %&sien. P/l& E"

&%& i,l&si+i,&si,&n seb&g&i (es%/n n/(m&l6 %/l& ene(*&si6 %/l& +ib(il&si6 &&u

31

`


33/50

su&u %/l& -&ng ,&7&u -&ng menges&n,&n su&u mi/%&i &&u neu(/%&i. N&mun6

nil&i su&u E" s&ng& e(b&&s ,u(&ng &(i 21 h&(i seel&h %&(&lisis &,u.

Sebelum 21 h&(i6 i,& &&h i&, be(ge(&,6 E" &,&n mem%e(lih&,&n %/ensi&l

ene(*&si. P/ensi&l +ib(il&si me(u%&,&n su&u &n& %/sii+ -&ng menunu,,&n

,e%ulih&n seb&gi&n se(&bu. P/ensi&l ini e(lih& sebelum 21 h&(i.2

2. Ele,(/neu(/n/g(&+i 'ENO)

ENO membe(i in+/(m&si lebih &&l ib&ning,&n eng&n E". ENO

mel&,u,&n simul&si %&& s&u ii, &n %engu,u(&n E" %&& s&u ii, -&ng

lebih is&l &(i s&(&+. e7e%&&n h&n&(&n s&(&+ &%& i%e(hiung,&n. Bil&

e(&%& (eu,si 89 %&& ENO bil& ib&ning,&n eng&n sisi l&inn-& &l&m

se%uluh h&(i6 m&,& ,emung,in&n sembuh ug& be(,u(&ng se7&(& be(m&,n&. #is7h

Eselin mel&%/(,&n b&h& su&u %enu(un&n sebes&( 25 %e(sen be(&,ib&

%en-embuh&n i&, leng,&% %&& == %e(sen %&sien me(e,&6 semen&(& 44 %e(sen

%&sien -&ng m&m%u mem%e(&h&n,&n (es%/ns i &&s &ng,& e(sebu meng&l&mi

%en-embuh&n n/(m&l s&(&+ +&si&lis.2

3. Ui Simul&si "&,sim&l

Ui simul&si me(u%&,&n su&u ui eng&n mele&,,&n s/ne ie,&n,&n

%&& &&h i &e(&h s&(&+ +&si&lis. A(us ,emui&n in&i,,&n %e(l&h&n0l&h&n

hingg& 5 m&6 &&u s&m%&i %&sien me(&s& i&, n-&m&n. D&hi6 &lis6 &e(&h

%e(i/(bi&l6 %i%i6 &l& n&si6 &n bibi( b&&h iui eng&n men-&%u,&n ele,(/&

se7&(& %e(l&h&n. Ti&% ge(&,&n i &e(&h0&e(&h ini menunu,,&n su&u (es%/ns

n/(m&l. Pe(be&&n (es%/ns -&ng ,e7il &n&(& sisi -&ng n/(m&l eng&n sisi -&ng

lum%uh i&ngg&% seb&g&i su&u &n& ,esembuh&n. Penu(un&n -&ng n-&& &&l&h

&%&bil& e(&i ,eu&n %&& sisi -&ng lum%uh eng&n bes&( &(us h&n-& 25 %e(sen

&(i &(us -&ng igun&,&n %&& sisi -&ng n/(m&l. Bil& ib&ning,&n seel&h 1h&(i6 82 %e(sen %ene(i& Bells P&ls- ,emb&li &%& mel&,u,&n bebe(&%& +ungsi.

Bil& (es%/n ele,(is hil&ng6 m&,& 1 %e(sen &,&n meng&l&mi %emulih&n +ungsi

-&ng i&, leng,&%. S&isi, meng&nu(,&n b&h& benu, %engui&n -&ng %&ling

&%& i&n&l,&n &&l&h ui +ungsi s&(&+ se7&(& l&ngsung.2

32

`


34/50

&mb&( 3 E,s%(esi >asialis

A #isi/e(&%i

1. Heat Theraphy, Face Massage, Facial Excercise

B&s&h,&n h&nu, eng&n &i( %&n&s6 seel&h iu h&nu, i%e(&s &n

ile&,,&n imu,& hingg& h&nu, meningin. emui&n %&sien imin& unu,

mem&s&se //0// &&h -&ng lum%uh e(u&m& &e(&h se,i&( m&&6 mulu &n

&e(&h eng&h &&h."&s&se il&,u,&n eng&n menggun&,&n ,(im &&h &n

ie&ln-& ug& eng&n menggun&,&n &l& %engge&( lis(i,. Seel&h iu %&sien

imin& unu, be(i(i ie%&n 7e(min &n mel&,u,&n bebe(&%& l&ih&n &&h

se%e(i meng&ng,& &lis m&&6 meme&m,&n ,eu& m&& ,u&0,u&6 meng&ng,&

&n menge(u,&n hiung6 be(siul6 menggembung,&n %i%i &n

men-e(ing&i.368egi&&n ini il&,u,&n sel&m& 5 meni 2 ,&li seh&(i.3

. Electrical !tim"lation

Simul&si ene(gi lis(i, eng&n &li(&n g&l*&ni7 be(ene(gi lem&h.2 Tin&,&n

ini be(uu&n unu, memi7u ,/n(&,si bu&&n %&& //0// -&ng lum%uh &n ug&

be(+ungsi unu, mem%e(&h&n,&n &li(&n &(&h se(& /nus //.8

. #&(m&,/l/gi

Ob&0/b&&n -&ng &%& ibe(i,&n &l&m %en&&l&,s&n&&n ,elum%uh&n

s&(&+ +&si&lis &n&(& l&in8:

33

`


35/50

1. As&m Ni,/ini,

P&& ,elum%uh&n s&(&+ +&si&lis -&ng i,&(en&,&n is,emi&As&m ni,/ini,

&n /b&0/b&&n -&ng be,e(& mengh&mb& g&ngli/n sim%&i, se(*i,&l igun&,&n

unu, memi7u *&s/il&&si sehingg& &%& mening,&,&n su%l&i &(&h ,e s&(&+

+&si&lis.

2. &s/,/ns(i,/(6 Animi,(/b&

Ob& ini ibe(i,&n %&& ,elum%uh&n s&(&+ +&si&lis -&ng iseb&b,&n /leh

,/m%(esi s&(&+ +&si&lis %&& ,&n&l +&l/%i. Ob& ini be,e(& mengu(&ngi benung&n6

%embeng,&,,&n6 &n in+l&m&si %&& ,e&&&n i&&s.

3. Se(/i

Ob& ini ibe(i,&n unu, mengu(&ngi %(/ses in+l&m&si -&ng men-eb&b,&n

Bell’s Palsy.

!. S/ium (/m/gli,&

Dibe(i,&n %&& ,elum%uh&n s&(&+ +&si&lis i,& i%i,i(,&n &&n-& (e&,si

&le(gi.

5. Ani*i(us

B&(u0b&(u ini &ni*i(us ibe(i,&n eng&n &&u &n%& %enggun&&n

%(enis/ne se7&(& simul&n.

; Peng/b&&n Psi,/+isi,&l

A,u%unu(6 #io$eed#ac% 6 &n electromyographic $eed#ac% il&%/(,&n

&%& memb&nu %en-embuh&n Bell’s Palsy.8

+ engobatan Sekuele < &e2ala Sisa =Peng/b&&n e(h&&% ge&l& sis& -&ng &%& il&,u,&n &n&(& l&in 8:

A. De%(esi

P&sien eng&n ,elum%uh&n s&(&+ +&si&lis memili,i ,e&,u&n b&h&

me(e,& memili,i %en-&,i -&ng meng&n7&m i& &&u%un %en-&,i -&ng

melib&,&n %embuluh &(&h /&,. /nseling &n e(&%i ,el/m%/, -&ng

melib&,&n %ene(i& eng&n usi& -&ng s&m& e(bu,i e+e,i+ unu, meng&&si

e%(esi e(sebu.

3!

`


36/50

B. N-e(i

Seb&gi&n %&sien eng&n Bell’s Palsy &n h&m%i( selu(uh %&sien eng&n

He(%es K//se( ?e%h&li7 me(&s&,&n n-e(i. N-e(i ini &%& i&&si eng&n

&n&lgesi7 n/n0n&(,/i,. D&%& ibe(i,&n se(/i eng&n /sis &&l 1 mg> ,g BB>

h&(i &n &%e(ing /++ seel&h 1 h&(i %enggun&&n.

?. Pe(&&&n "&&

Se7&(& umum6 Pe(&&&n m&& iuu,&n unu, men&g& ,elemb&b&n m&&

&g&( i&, e(&i ,e(&iis &n ,e(us&,&n ,/(ne&. P&sien imin& unu,

mengei%,&n m&& 2 s&m%&i ! ,&li %e(meni is&m%ing %enggun&&n /b& ees

m&&.

) Indikasi Untuk %perasi

P&& ,&sus eng&n g&nggu&n h&n&(&n be(& &&u su&h e(&i ene(*&si

/&l6 in&,&n /%e(&i+ sege(& h&(us il&,u,&n eng&n e,ni, e,/m%(esi s&(&+

+&si&lis (&nsm&s/i.1

)(, Komplikasi

Seel&h ,elum%uh&n +&si&l %e(i+e(6 (egene(&si s&(&+ -&ng (us&,6 e(u&m&

se(& //n/m &%& seb&gi&n &&u %&& &(&h -&ng s&l&h. Se(& -&ng e(linung

mung,in membe(i,&n &,s/n b&(u -&ng umbuh ,e &l&m b&gi&n -&ng (us&,.

Pe(s&(&+&n b&(u -&ng &bn/(m&l ini6 &%& menel&s,&n ,/n(&,u( &&u sin,inesis

'ge(&,&n -&ng be(hubung&n) &l&m //0// mimi, &&h;.

Sin(/m &i( m&& bu&-& '(e+le,s g&s(/l&,(im&lis %&(&/,si,&l) &m%&,n-&

i&s&(,&n /leh %e(s&(&+&n b&(u -&ng s&l&h. Di %e(,i(&,&n b&h& se(& se,(e/(is

unu, ,elen&( &i( liu( umbuh ,e &l&m selubung S7h&nn &(i se(& -&ng 7ee(&

-&ng be(egene(&si &n %&& &s&ln-& se(& e(sebu be(&nggung &&b unu, gl&nul& l&,(im&lis4.

)+ AKALASIA !S%FA&US

)+( $e>inisi

A,&l&si& &&l&h g&nggu&n m/ili&s be(u%& hil&ngn-& %e(is&lis es/+&gus

&n g&g&ln-& s+inge( es/+&g/,&(i& be(el&,s&si sehingg& m&,&n&n e(&h&n i

35

`


37/50

es/+&gus. A,ib&n-&6 e(&i h&mb&&n m&su,n-& m&,&n&n ,e &l&m l&mbung

sehingg& es/+&gus be(il&&si membenu, meg&es/+&gus !.

A,&l&si& -&ng ,u& '&igoro"s achalasia) e(lih& %&& %&sien -&ng

mem%e(lih&,&n is+&gi&. P&& %&sien ini6 LES &&l&h hi%e(ensi+ &n g&g&l unu,

(el&6seb&g&im&n& e(lih& &l&m &7h&l&si&. Te(lebih l&gi6 ,/n(&,si 7/(%us

es/+&gus be(l&nu unu, men&i simul&n &n n/n0%e(is&li,. "es,i%un

emi,i&n6 &m%liu/ &(i ,/n(&,si &l&m (es%/n menel&n &&l&h n/(m&l &&u

inggi6 -&ng m&n& in,/nsisen eng&n &7h&l&si& ,l&si,. H&l e(sebu in-&&,&n

b&h&& %&sien %&& %e(,emb&ng&n &&l &7h&l&si& mung,in i&, memili,i

,el&in&n &l&n 7/(%us es/+&gus -&ng e(lih& %&& &h&% sel&nun-& &(i %en-&,i.

P&sien -&ng mem%e(lih&,&n &igoro"s achalasia &%& be(&& %&& +&se &&l &n

&,&n be(l&nu unu, mengemb&ng,&n ,/n(&,si 7/(%us es/+&gus 5.

A,&l&si& ug& i,e&hui men&i ,/nisi -&ng premalignant &(i es/+&gus.

Lebih &(i %(i/e 2 &hun6 se/(&ng %&sien &,&n memili,i s&m%&i =9 %elu&ng

unu, be(,emb&ngn-& 7&(7in/m&. !'"amo"s cell carcinoma &&l&h i%e -&ng

umum e(ieni+i,&si %&ling b&n-&, &n i%i,i(,&n men&i &,ib& &(i long(

standing air $l"id le&els &l&m 7/(%us es/+&gus6 -&ng men-eb&b,&n i(i&si mu,/s&

&n menginu,si me&%l&si&. A7en/7&(7in/m& 7ene(ung unu, mun7ul &l&m

se%e(ig& eng&h &(i es/+&gus6 ib&&h air($l"id le&el im&n& i(i&si mu,/s&

&&l&h -&ng %&ling bes&(. Ti&, && %(/g(&m %eng&&s&n -&ng s%esi+i, el&h

imul&i %&& %&sien eng&n &7h&l&si& -&ng e(/b&i 5.

)++ !tiologiD&s&( %en-eb&b &,&l&si& &&l&h i&, e+e,i+n-& %e(is&lsis es/+&gus

b&gi&n is&l se(& g&g&ln-& (el&,s&si s+inge( b&&h. Penelii&n menunu,,&n

&&n-& ,el&in&n %e(s&(&+&n %&(&sim%&is be(u%& hil&ngn-& sel g&ngli/n i &l&m

%leus Aue(b&7h6 -&ng isebu ug& %le,sus miene(i,us6 -&ng iug& e(&i

&,ib& %(/ses &u/imun &&u in+e,si ,(/nis !.

)+) atogenesis

3;

`


38/50

Segmen es/+&gus b&gi&n b&&h -&ng %&n&ngn-& be(,is&( &n&(& 2= 7m

men-em%i &ni&, m&m%u be(el&,s&si. Es/+&gus b&gi&n %(/,sim&l &(i

%en-em%i&n e(sebu meng&l&mi il&&si &n %em&n&ng&n sehingg& &,hi(n-&

men&i meg&es/+&gus-&ng be(,el/,0,el/,. Benu, es/+&gus ini s&ng&

be(g&nung %&& l&m&n-& %(/ses6 &%& be(benu, b//l6 +usi+/(m6 s&m%&i

be(benu, sigm/i eng&n hi%e((/+i &(ing&n // si(,ule( &n l/ngiuin&l.

"u,/s& mung,in meng&l&mi %e(&&ng&n &,ib& (&ngs&ng&n (eensi m&,&n&n !.

A,&l&si& &&l&h s&l&h s&u +&,/( (isi,/ e(&in-& ,&(sin/m& e%ie(m/i.

&(sin/m& &%& e(&i %&& 59 %&sien -&ng i&, men&%& e(&%i6 (&&0(&& 2

&hun &(i s&& e(i&gn/sis. Ji,& su&h e(&i ,&(sin/m&6 %(/gn/sisn-& lebih

bu(u, ib&ning,&n eng&n ,&(sin/m& es/+&gus -&ng bu,&n be(&s&l &(i &,&l&si&.

H&l ini iug& ,&(en& ge&l&n-& s&ng& mi(i% eng&n &,&l&si& sehingg&

menimbul,&n ,ee(l&mb&&n i&gn/sis !.

P&/genesis &(i &,&l&si& iug& e(&i egene(&si neu(/geni,6 -&ng m&n&

ii/%&i, &&u ,&(en& in+e,si. P&& bin&&ng e,s%e(imen6 %en-&,i ini el&h

i(e%(/u,si /leh es(u,si nu7leus &mbiguus &n nu7leus m//( /(s&lis &(i

ne(*us *&gus. P&& %&sien eng&n %en-&,i ini6 %e(ub&h&n egene(&i+ el&h

iunu,,&n /leh ne(*us *&gus &n %&& g&ngli& &l&m %le,sus miene(i,us &(i

es/+&gus iu seni(i. Degene(&si ini meng&,ib&,&n hi%e(ensi &(i LES 'lo)er

esophageal sphincter )6 sebu&h ,eg&g&l&n s+inge( unu, me(el&,s&si,&n

%enel&n&n6 %ening,&&n &(i e,&n&n es/+&gus in(&lumin&l6 il&&si es/+&gus6 &n

,ehil&ng&n be(i,un-& &(i %e(is&lsis -&ng %(/g(esi+ %&& 7/(%us es/+&gus.

Dil&&si es/+&gus meng&,ib&,&n ,/mbin&si &(i s+inge( -&ng i&, be(el&,s&si6

-&ng m&n& men-eb&b,&n %e(ub&h&n &n&/mis -&ng e(lih& %&& sui (&i/g(&+is6

se%e(i seb&g&i sebu&h es/+&gus -&ng e(il&&si eng&n benu,&n l/n/ng>l&n7i%6 %en-em%i&n se%e(i #ird’s #ea% %&& &,hi( is&l. A& ing,& air $l"id le&el

%&& es/+&gus &(i m&,&n&n &n s&li*& -&ng e(enensi6 ,einggi&n -&ng m&n&

me(e+le,si,&n e(&& (esisensi -&ng i%&,s&,&n /leh s+inge( -&ng i&,

(el&,s&si. Seb&g&i %(/g(es &(i %en-&,i6 es/+&gus men&i e(il&&si &n

be(,el/,0,el/, se7&(& m&si+ 1.

)+0 &ambaran Klinis

34

`


39/50

A,&l&si& bi&s&n-& imul&i %&& e&s& mu& &l&u%un && ug& -&ng

iemu,&n %&& b&-i &n s&ng& &(&ng %&& usi& l&nu. e&l& u&m& &,&l&si&

&&l&h is+&gi&6 (egu(gi&si6 (&s& n-e(i &&u i&, en&, i bel&,&ng se(num &n

be(& b&&n menu(un. L&m& imbuln-& ge&l& s&ng& be(*&(i&si6 &(i bebe(&%& h&(i

s&m%&i be(&hun0&hun6 &n ge&l& l&mb& l&un sem&,in be(& !.

T(i&s ,l&si, &(i ge&l&0ge&l& -&ng &m%&, e(i(i &&s is+&gi&6

(egu(gi&si6 &n %enu(un&n be(& b&&n. "es,i%un emi,i&n6 heart#"rn6 e(se&,

seel&h m&,&n ' postprandial cho%ing )6 &n b&u, n/,u(n&l &&l&h umum e(lih&.

Dis+&gi& -&ng %&sien &l&mi mul&i eng&n 7&i(&n &n be(l&nu ,e %&&.

eb&n-&,&n %&sien mengg&mb&(,&n m&,&n seb&g&i sebu&h %(/ses -&ng

membuuh,&n b&n-&, en&g&. "e(e,& m&,&n se7&(& %e(l&h&n &n menggun&,&n

*/lume &i( -&ng bes&( unu, memb&nu menghem%&s,&n m&,&n&n ,e b&&h

&l&m l&mbung. S&& &i( mem%e(,u& e,&n&n6 n-e(i && (e(/se(n&l i&l&mi &n

&%& membe(& s&m%&i LES e(bu,&6 -&ng m&n& membe(i,& (&s& leg& -&ng 7e%&.

$egu(gu&si m&,&n&n0m&,&n&n -&ng &, e(7e(n&6 &n be(b&u busu, &&l&h umum

&n eng&n %(/g(esi+n-& %en-&,i6 &s%i(&si &%& men&i meng&n7&m i&.

Pneum/ni&6 &bs7ess %&(u6 &n b(/n7hie7&sis se(ing me(u%&,&n h&sil &(i long

standing achalasia. Dis+&gi& be(l&nu se7&(& %e(l&h&n be(&hun0&hun &n %&sien

be(&&%&si %&& %/l& hiu%n-& unu, meng&,/m/&si ,ei&,n-&m&n&n -&ng

men-e(&i %en-&,i ini. P&sien se(ing i&, men7&(i %e(h&i&n meis s&m%&i

ge&l&0ge&l& me(e,& be(l&nu &n &,&n h&i( eng&n %e(eg&ng&n -&ng n-&& &(i

es/+&gus5.

Dis+&gi& &&l&h ge&l& u&m& -&ng mul&0mul& i(&s&,&n seb&g&i (&s&

%enuh &&u (&s& mengg&n&l i &e(&h es/+&gus is&l6 hil&ng imbul6 &n sem&,in

l&m& sem&,in be(&. P&sien &,&n m&,&n se7&(& %e(l&h&n0l&h&n &n sel&lu ise(&iminum -&ng b&n-&,. $egu(gi&si e(&i bil& %en-&,i su&h l&nu &n su&h

e(&i il&&si es/+&gus b&gi&n %(/,sim&l. $egu(gi&si bi&s&n-& i(&s&,&n %&&

&,u m&l&m sehingg& %&sien e(b&ngun &(i iu(n-&. "&,&n&n -&ng meng&li(

b&li, belum i7e(n&6 i&, &s&m6l&n b&un-& m&nis ,&(en& %eng&(uh lu&h.

e&&&n ini be(b&h&-& ,&(en& &%& menimbul,&n %neum/ni& &s%i(&si. eluh&n

n-e(i umumn-& i&, /min&n. "ul&0mul& ,e&&&n gi@i b&i, &n b&(u menu(un

%&& &h&% l&nu !.

3=

`


40/50

)+9 $iagnosis

P&& %eme(i,s&&n +isi, i&, iemu,&n ,el&in&n -&ng be(&(i. Deng&n

&n&mnesis sebeuln-& su&h &%& iug& &&n-& &,&l&si&6 &l&u%un emi,i&n

e&% h&(us i%i,i(,&n i&gn/sis b&ning %en-&,i ,eg&n&s&n6 sen/sis6 &&u ben&

&sing es/+&gus !.

P&& es/+&g/g(&+i e(&%& %en-em%i&n &e(&h b&&s es/+&g/g&se( &n

il&&si b&gi&n %(/,sim&ln-&. Ji,& %(/ses &,&l&si& su&h l&m&6 benu, es/+&gus

be(ub&h men&i be(,el/, &n &,hi(n-& be(benu, hu(u+ S. Deng&n %eme(i,s&&n

es/+&g/s,/%i &%& ising,i(,&n ,el&in&n %en-em%i&n ,&(en& s(i,u( &&u

,eg&n&s&n. P&& &,&l&si&6 e(&%& g&nggu&n ,/n(&,si ining es/+&gus sehingg&

%engu,u(&n e,&n&n i &l&m lumen es/+&gus eng&n m&n/me(i s&ng&

menenu,&n i&gn/sis. Te,&n&n i &l&m s+inge( es/+&g/g&se( meninggi &n

e,&n&n i &l&m lumen es/+&gus lebih inggi &(i%&& e,&n&n i &l&m l&mbung

!.

Di&gn/sis &(i &7h&l&si& bi&s&n-& ibu& &(i es/+&g/g(&m &n sui

m/ili&s. Penemu&n e(sebu &%& be(&ne,& (&g&m6 e(g&nung %&& si+& &l&mi

-&ng be(,el&nu&n &(i %en-&,i. Es/+&g/g(&m &,&n menunu,,&n es/+&gus -&ng

be(il&&si eng&n %en-em%i&n is&l -&ng isebu seb&g&i g&mb&(&n %&(uh

bu(ung ,l&si, 'classic #ird’s #ea% ) &(i es/+&gus -&ng e(isi b&(ium 5.

Peme(i,s&&n es/+&g/g(&+i menggun&,&n ,/n(&s %&& ,u(&ng lebih 89 %&sien

-&ng i7u(ig&i mene(i& &,&l&si& menunu,,&n &&n-& %eleb&(&n es/+&gus &n

benu, ,l&si, g&mb&(&n %&(uh bu(ung. Te&%i %&& %&sien -&ng men&l&ni

%eme(i,s&&n ini6 h&n-& 505=9 %&sien menunu,,&n &&n-& g&mb&(&n (&i/l/gis

-&ng menu,ung i&gn/sis &,&l&si&6 semen&(& sis&n-& %e(lu men&l&ni %eme(i,s&&n m&n/me(i unu, meneg&,,&n i&gn/sis. J&i6 es/+&g/g(&+i eng&n

,/n(&s ,u(&ng sensii+ seb&g&i %eme(i,s&&n %enun&ng ungg&l unu, ,&sus

&,&l&si& !. S%&sme s+inge( &n %eng/s/ng&n -&ng e(un& mel&lui LES6 seb&i,

il&&si &(i 7/(%us es/+&gus i/bse(*&si. u(&ngn-& gel/mb&ng %e(is&li, %&&

7/(%us &n ,eg&g&l&n (el&,s&si &(i LES h&(us i%e(h&i,&n. u(&ngn-&

gelembung u&(& l&mbung me(u%&,&n %enemu&n -&ng umum b&gi&n -&ng eg&,

lu(us &(i es/+&g/g(&m &n me(u%&,&n h&sil &(i LES -&ng e(& -&ng i&,

38

`


41/50

mengiin,&n u&(& unu, mele&i eng&n mu&h ,e &l&m l&mbung. P&& &h&%

-&ng lebih l&nu &(i %en-&,i6 il&&si es/+&gus -&ng m&si+6 ,el/,&n6 &n

es/+&gus sigm/i&l 'megaesophag"s) e(lih& 5

&mb&( ! : Penel&n&n B&(ium -&ng "enunu,,&n &mb&(&n husus ' Bird’s

Bea% ) %&& A,&l&si& Es/+&gus

#// $/engen && memili,i sensii*i&s &n s%esi+isi&s -&ng (en&h

&l&m meneg&,,&n i&gn/sis &,&l&si&6 sehingg& %e(lu il&,u,&n ,/n+i(m&si es

(&i/g(&+i, l&inn-& se%e(i +lu/(/s,/%i ,/n(&s b&(ium6 en/s,/%i6 &n

m&n/me(i. Bebe(&%& %en-&,i &%& membe(i,&n g&mb&(&n men-e(u%&i &,&l&si&

%&& +// $/engen && m&u%un b&(ium ,/n(&s6 se%e(i &en/,&(sin/m&6

,eg&n&s&n es/+&gus6 ,eg&n&s&n l&mbung6 ,eg&n&s&n %&(u n/n0sel ,e7il6

s,le(/e(m&6 &mil/i/sis6 %en-&,i ,/l&gen *&s,ul&(6 &n lim+/m& !.

En/s,/%i ,/n*ensi/n&l6 m&n/me(i6 &n +// ,/n(&s es/+&gus &%&

membe&,&n &,&l&si& &(i %seu/&,&l&si&. Penggun&&n ul(&s/n/g(&+i memili,i

,eh&n&l&n -&ng b&i,6 -&,ni se,i&( =2019 &l&m membe&,&n &n&(& &,&l&si&

mu(ni &n %su/&,&l&si& !.

"&n/me(i me(u%&,&n ui b&,u em&s ' gold standard ) unu, i&gn/sis &n

&,&n memb&nu mengelimin&si g&nggu&n m/ili&s es/+&gus -&ng %/ensi&l

l&inn-&. D&l&m &,&l&si& i%i,&l6 %enelusu(&n m&n/me(i menunu,,&n lim&

%enemu&n ,l&si,6 u& ,el&in&n &(i LES6 &n ig& &(i 7/(%us es/+&gus. LES &,&n

men&i hi%e(ensi+6 eng&n e,&n&n -&ng bi&s&n-& lebih inggi &(i 35 mmHg

!

`


42/50

e&%i6 lebih %ening l&gi6 &,&n g&g&l unu, (el&,s&si eng&n egluisi 'menel&n).

?/(%us es/+&gus &,&n memili,i e,&n&n i&&s &s&( '%ene,&n&n %&& es/+&gus)

&(i e*&,u&si un&(& -&ng i&, sem%u(n&6 sim"ltaneo"s mirrored contraction

eng&n i&, && bu,i &(i %e(is&lsis -&ng %(/g(esi+6 &n benu, gel/mb&ng

be(&m%liu/ (en&h mengini,&si,&n ,u(&ngn-& /nus //. Lim& %enemu&n ini

membe(i,&n i&gn/sis &,&l&si&. En/s,/%i il&,u,&n unu, menge*&lu&si

mu,/s& seb&g&i bu,i &(i es/+&gus &&u ,&n,e(. Ji,& i&, en/s,/%i &,&n

be(,/n(ibusi ,e7il %&& i&gn/sis &,&l&si& 5.

)+- enatalaksanaan

A& %ilih&n %eng/b&&n be&h &n n/n be&h unu, %&sien eng&n

&,&l&si&M semu& i&(&h,&n %&& %enu(un&n /bs(u,si -&ng iseb&b,&n /leh LES.

&(en& i&, &(i me(e,& men-&&,&n h&sil &(i %enu(un&n m/ili&s %&& 7/(%us

es/+&gus6 me(e,& selu(uhn-& me(u%&,&n %eng/b&&n %&li&i+ 5.

Die &n /b&0/b&&n unu, menghil&ng,&n &&u mengu(&ngi ,/n(&,si

s+inge( es/+&gus &n // %/l/s ining es/+&gus i&nu(,&n %&& &h&% &&l

%en-&,i. Tin&,&n ini bi&s&n-& ise(&i eng&n il&&si -&ng be(uu&n membu&

s+inge( es/+&gus b&gi&n b&&h e(bu,& sehingg& //0//n-& (us&,!

. Pilih&n

%eng/b&&n n/n be&h meli%ui /b&0/b&&n &n ine(*ensi en/s,/%i e&%i

bi&s&n-& h&n-& me(u%&,&n s/lusi &ng,& %ene, unu, sebu&h m&s&l&h -&ng

&b&i. P&& &h&% &&l &(i %en-&,i6 %eng/b&&n meis eng&n ni(/glise(in

sublingu&l6 ni(&6 &&u calci"m channel #loc%ers '??B) &%& men&&(,&n

be(&m0&m %engu(&ng&n e,&n&n && sebelum &&u seel&h m&,&n. Bo"gie

dilation s&m%&i 5! #( &%& men&&(,&n bebe(&%& bul&n seb&g&i %e(e& e&%i

meme(lu,&n il&&si be(ul&ng unu, &%& be(&h&n

5

.Ine,si b/ulinum /in 'B//) se7&(& l&ngsung ,e &l&m LES mengebl/,

%ele%&s&n &seil,/lin6 men7eg&h ,/n(&,si // h&lus6 &n se7&(& e+e,i+

me(el&,s&si,&n LES. Deng&n %eng/b&&n be(ul&ng6 B// &%& men&&(,&n

%e(e& ge&l& sel&m& be(&hun0&hun6 e&%i ge&l&0ge&l& imbul l&gi lebih &(i

59 &l&m &,u en&m bul&n 5. T/,sin b/ulinum -&ng isuni,,&n eng&n

b&nu&n en/s,/% &&l&h /,sin -&ng be,e(& mengh&mb& %engelu&(&n

&seil,/lin i %(&sin&%s %&& se(&bu s-&(&+ sehingg& &%& menu(un,&n /nus

!1

`


43/50

s+inge( es/+&gus. "es,i%un emi,i&n6 e(&%i ini h&n-& be(h&sil %&& u& %e(ig&

%&sien. Sel&in iu %ul&6 b/-ulinum h&n-& e+e,i+ unu, &ng,& %ene, sehingg&

h&(us il&,u,&n %en-uni,&n ul&ng !.

Dil&&si eng&n *r"nt+ig(type #alloon '*/lume e(b&&s6 ,/n(/l e,&n&n)

&&l&h e+e,i+ %&& ;9 %&sien &n memili,i sebu&h (isi,/ %e(+/(&si ,u(&ng &(i

!9M mes,i%un emi,i&n6 %e(+/(&si meng&n7&m i& &n h&(us iii,be(&,&n

se7&(& h&i0h&i %&& %&sien -&ng i&, seh& 5.Dil&&si -&ng il&,u,&n eng&n

il&/( -&ng e(i(i &&s s/ne eng&n b&l/n -&ng &%& iisi eng&n u&(& &&u &i(

be(e,&n&n inggi sehingg& // si(,ule( e(eg&ng &n (/be,. Dil&&si ini h&(us

iul&ng se&,u imbul ge&l& ,emb&li. Ang,& ,ebe(h&sil&n 7&(& il&&si 49

eng&n ,/m%li,&si %e(+/(&si 1.!9 &n ,em&i&n .39. m&ss&l&h -&ng se(ing

imbul &&l&h (e+lu,s6 -&ng e(&i %&& 229 ,&sus !.

Be&h es/+&g//mi e(i(i &&s mem//ng // es/+&gus %&& &(&h sumbu

es/+&gus se%&n&ng s+inge( b&&h6 i lu&( mu,/s&. Tin&,&n ini &%& i,e(&,&n

se7&(& e(bu,& '/(&,//mi &&u l&%&(//mi)6 /(&,/s,/%i,6 &&u l&%&(/s,/%i,.

H&sil /%e(&si ini 7u,u% memu&s,&n. Ting,& ,ebe(h&sil&nn-& i,&&,&n men7&%&i

=0896 be(g&nung %&& ,ee(&m%il&n /%e(&/(. Bu,i %enelii&n -&ng ,u&

men-im%ul,&n b&h& ini,&si es/+&g/mi//mi &&l&h %&sien -&ng '1) m&sih

be(usi& mu&6 '2) meng&l&mi ,eg&g&l&n e(&%i +&(m&,/l/gis &&u il&&si b&l/n6

'3) be(isi,/ inggi meng&l&mi %e(+/(&si %&& e,ni, il&&si6 -&iu %&sien eng&n

es/+&gus -&ng be(,el/,0,el/, &&u i*e(i,ul&6 &&u el&h men&l&ni %embe&h&n

unu, ,el&in&n l&in sebelumn-&6 &n '!) ingin menghin&(i %(/seu( e(&%i

be(ul&ng. Es/+&g/mi//mi membe(i,&n h&sil -&ng memu&s,&n %&& 859 ,&sus6

eng&n l&m& %e(&&&n (um&h s&,i h&n-& ig& h&(i bil& i,e(&,&n se7&(&

l&%&(/s,/%i,

!

.Be&h es/+&g//mi men&&(,&n h&sil -&ng su%e(i/( &n ,u(&ng membu&

(&um& &(i%&& il&&si b&l/n. Te,ni, s&& ini me(u%&,&n m/i+i,&si &(i Heller

myotomy -&ng ig&mb&(,&n se7&(& /(igin&l /leh sebu&h l&%&(//mi %&& 1813.

Pe(ub&h&n -&ng be(*&(i&si el&h ibu& unu, %(/seu( e(sebu e&%i modi$ied

laparoscopic Heller myotomy me(u%&,&n %ilih&n /%e(&si s&& ini. H&l e(sebu

i,e(&,&n &&u eng&n *ie/ &&u b&nu&n (/b/. e%uus&n unu, mel&,u,&n

sebu&h %(/seu( &ni(e+lu,s men-is&,&n ,/n(/*e(si. eb&n-&,&n %&sien -&ng

!2

`


44/50

el&h men&l&ni sebu&h m-//mi &,&n meng&l&mi bebe(&%& ge&l&0ge&l& (e+lu,s.

T&mb&h&n %(/seu( &ni(e+lu,s %&(si&l6 se%e(i To"pet &&u or $"ndoplication6

&,&n mengemb&li,&n %e(linung&n e(h&&% (e+lu,s &n menu(un,&n ge&l&0ge&l&

%/s/%e(&i+. Ini ,hususn-& n-&& %&& %&sien -&ng be(sih&n es/+&gusn-&

'esophageal clearance) i(us&, eng&n heb& 5.

Es/+&g//mi i%e(imb&ng,&n &l&m bebe(&%& %&sien sim%/m&is eng&n

es/+&gus -&ng be(,el/,0,el/, 'meg&es/+&gus)6 es/+&gus sigm/i6 ,eg&g&l&n lebih

&(i s&u m-//mi6 &&u sebu&h s(i,u( (e+lu,s -&ng i&, &%& be(il&&si. Lebih

sei,i &(i ;9 %&sien -&ng men&l&ni ,eunggul&n m-//mi be(ul&ng &(i

/%e(&si6 &n +un/%li,&si unu, %eng/b&&n s(i,u( (e+lu,s b&h,&n memili,i h&sil

-&ng lebih bu(u,. Te(lebih l&gi unu, meng/b&i se7&(& e%& &,&l&si& &h&% &,hi(6

(ese,si es/+&gus ug& mengelimin&si (isi,/ unu, ,&(sin/m&. Sebu&h transhiatal

esophagotomy eng&n &&u &n%& %emelih&(&&n ne(*us *&gus men&&(,&n h&sil

&ng,& %&n&ng -&ng b&i, 5.

!3

`


45/50

.A. 0

!M.A1ASA"

T!%RI KASUS

A"AM"!SIS

• arese " Fa7ialis $

0 &&l&h elum%uh&n // &&h

im&n& %&sien i&, &&u

,u(&ng &%& mengge(&,,&n

// &&h sehingg& &&h

%&sien i&, sime(is.

0 #&,/( %en-eb&b %&(ese N.II :

/ngeni&l6 in+e,si6 um/(6

g&nggu&n %embuluh &(&h6

(&um&6 ii/%&i,6 %en-&,i

%en-&,i e(enu 'uilli&n

B&((e6 D"6 HT be(&)0 eluh&n -&ng bi&s& i&l&mi

-&,ni // // &&h lum%uh

e(g&nung lesi -&ng i&l&mi

-&,ni %e(i+e( '/&l %&(ese)

m&u%un sen(&l ',elum%uh&n

%&& &&h b&gi&n b&&h).

• P&sien &&ng eng&n ,eluh&n :

1. Se%eng&,u&n ibu %&sien6 sei&%

&n&, men&ngis6 m&& sebel&h

,&n&n e&% e(bu,& &n suu

bibi( sebel&h ,&n&n mi(ing

-&ng i&l&mi se&, l&hi(

2. $i. e&ng is&ng,&l6

(i&-& (&um& l&hi( is&ng,&l.

3. P&sien &&ng eng&n ,eluh&n

mun&h 1 minggu S"$S

sei&% minum ASI.

0 Sesak


46/50

&%& men-eb&b,&n ,el&in&n

%e(s&(&+&n %&(&sim%&is '%leus

mesen(i,us).

0 eluh&n -&ng se(ing i&l&mi :

T(i&s : is+&gi&6 (egu(gi&si6

%enu(un&n BB

He&(bu(n6 e(se&, s&& m&,&n6

&n mun&h

!M!RIKSAA" FISIK

• P&(ese N. #&si&lis :

Diui eng&n %eme(i,s&&n N. #&si&lis :

0 Peme(i,s&&n +ungsi s&(&+ m//(i, ". T(i&ngul&(is : meng&ng,&

hemiparese n.fasialis pada neonatus dana akalasia esofagus

Documents