The growth and development of a child is very dependent on sleep because during sleep, brain cells are repaired and about 75% of growth hormones are produced. Sleep also has a major effect on mental, emotional and physical health as well as the body's immune system. Poor sleep patterns can result in brain abnormalities in children. 1 OSAS or Obstructive sleep apnea syndrome is a syndrome in which. episode apnea or hypopnea on moment Sleep. Prevalence OSAS in children is highest in preschool age and can occur in children with adenoid and tonsil hypertrophy, craniofacial structural abnormalities, obesity, abnormalities in the nasal area and neck circumference. Adenoid and tonsil hypertrophy are the most common conditions that cause OSAS in children. 1 OSAS on child different with mature Good from factor risk and also management. Clinical manifestations of OSAS in children are difficulty breathing during sleep, snoring, daytime sleepiness, and sometimes enuresis. At night, symptoms can appear such as children sleeping with their mouths open, snoring and often experiencing respiratory arrest so that children often wake up from their sleep because of difficulty breathing and lack of oxygen (hypoxia), then during the day they will experience symptoms such as often falling asleep in class, learning difficulties and other cognitive disorders so that there is a decrease in academic achievement. Long-term hypoxic conditions in children with OSAS with high apnea and hypopnea indices can cause cor-pulmonale , pulmonary hypertension and failure to thrive. 2 A number of House Sick use criteria snore Which different and the criteria for OSA in adults cannot be applied to children. The examinations that can be performed to confirm OSAS in children consist of subjective and objective examinations. Finding a history of snoring in children is a routine examination, so if a history of snoring is found, a detailed sleep history needs to be explored. In addition, a polysomnogram examination is needed in children suspected of suffering from OSAS. during sleep as a standard. If the polysomnogram shows an apnea index in a child > 1, then the child is suffering from OSAS. 3 Management of children with OSAS can be with medication, diet, continuous positive pressure ventilation (CPAP) and surgery. The choice of OSAS therapy in children must be in accordance with risk factors and indications. Good counseling and long-term monitoring are important for the success of OSAS therapy in children. 4,5,6

Labioschisis or cleft lip is a common congenital facial malformation of the head and neck region. 1-6 This abnormality is caused by the failure of the medial nasal process to fuse with the maxillary process during fetal development in the eighth week of embryology. 6-10 This disorder can be found in 1 in 700 births in the world. 6 Labioschisis can occur unilaterally or bilaterally. 7,11 Labioschisis can be associated with certain malformations or syndromes known as syndromic disorders, if this disorder is not associated with certain malformations or syndromes it is called nonsyndromic disorders. Approximately 70% of cases are nonsyndromic disorders and 30% of cases are syndromic disorders. 6,8 The aim of treating labioschizophrenia is to form perfect lips according to your needs. normal anatomy Where involving various disciplines sciences such as plastic surgery, pediatrics, nutrition and reconstructive facialists as a team. This is because it can cause quite complex problems for child with labioschis as well as person his parents And requires long-term care. 1- 5.1

Nose is senses sense of smell Which own various function, Among them are the olfactory function, respiratory function, phonetic function and as a nasal reflex. Nose consists of from nose part outside And nose part in. Nose formed in beginning time pregnancy on Sunday third And Sunday fourth And will become a complete nose after the sixth and seventh weeks. Many abnormalities can arise in the embryological period of the nose, one of the abnormalities that can occur is choanal atresia. 1-3 Atresia koana is closed Wrong One or second part posterior from the nasal cavity by an abnormal membrane or bone. This congenital obstruction occurs behind the nose (posterior choana), which connects the nose and nasopharynx. Choanal atresia occurs due to embryological failure of buconal membrane division before birth. This disorder can occur together with other congenital disorders, namely coloboma, heart defects, mental retardation, growth disorders, genital hypoplasia, ear deformities and deafness ( CHARGE syndrome) . In addition, it can also occur together with Crouzon syndrome, Pfeiffer syndrome and Antley-Bixler syndrome . 1,2 Atresia koana is case Which seldom happen. Number incident Choanal atresia is 1 case per 5,000 – 7,000 births. Unilateral choanal atresia occurs more frequently, reaching 75% compared to atresia koana bilateral. Women have incident rate two more times higher than men. Risk increased in multiple births. Chromosomal anomalies can also be found in 6% of cases of choanal atresia. 1-3 Clinical symptoms of choanal atresia vary between unilateral and bilateral types. Unilateral choanal atresia sufferers sometimes do not show typical symptoms at birth but will later cause unilateral chronic nasal drainage disorders. And obstruction nose, whereas sufferer with atresia koana bilateral usually will shows signs of increasing efforts to breathe moment closed mouth meeting, and retraction chest until followed by cyanosis. Cycle This ends when the sufferer cries. 1-5 The diagnosis of choanal atresia is based on alloanamnesis, physical examination physique as well as inspection support. Inspection physique can performed using a catheter to detect obstruction. 3 Once the diagnosis is established, especially in bilateral choanal atresia, treatment Which appropriate is done action surgery Because can There is cyanosis and asphyxia which threatens the life of the patient. 1-3

Cleft palate or palatoschisis is a condition where there is an abnormal gap in the roof of the oral cavity which occurs due to the failure of the fusion process. process facialist on time pregnancy. Gap palate can It stands alone or can be accompanied by a gap in the lip or labiopalatoschisis. Matter This can happen Because development embryology the palate Also along with development lips on time pregnancy. The existence of gap in palate can cause a number of problem, that is: disturbance on speech function, swallowing function, hearing, malposition of teeth, respiratory function, development face, And disturbance psychological from person old patient. Disorders breathing And disturbance swallow on patient child is a crucial problem because the blockage of food and drink when the patient eats/drinks can enter the palate and cause difficulty breathing. Required exercise And knowledge special for person old patient to be able to care for a child with a cleft palate. 1,2,3 The incidence of cleft palate in America is reported to be 0.1 – 1.1 cases per 1000 population. Whereas number incident labiopalatoschisis as big as 0.2 – 2.3 case by case 1000 population. Diagnosis prenatal gap patatum and/or gap lips, along with other developmental anomalies are more frequently found with the increasing use of prenatal screening with ultrasound. Diagnosis of orofacial defects on time prenatal very important for prepare person old so that can obtain appropriate genetic counseling, emotional support, and therapy planning. 1,2,3 The main treatment option for palatoschisis is surgery. There are various surgical techniques for cleft palate reconstruction. The choice of technique used is highly dependent on the patient's condition, the extent of the cleft palate, and the surgeon's expertise. However, the principle of palatoschisis surgery must remain a priority. The principle of palatoplasty is to close the gap, correct the position abnormal muscle on palate, reconstruction muscle slings , retroposition soft palate as best as possible, minimal raw area , tension-free suturing , and layered closure of the palate. 1,2

The nose is the most prominent part of the face and plays an important role both in terms of aesthetics and function. Nasal obstruction is a common complaint complained by patients who come to ENT-KL doctors. There are many causes of nasal obstruction including septal deviation, concha hypertrophy, nasal polyps, adenoid hypertrophy, and also those related to external nasal deformities such as nasal vestibule stenosis. 1 The nasal vestibule is located caudal to the nasal valve and posterior to the external nares. Although the nasal valve is the narrowest part of the nasal cavity, significant stenosis of the nasal vestibule can cause complaints of obstruction. 1 Vestibular stenosis is a nasal disorder that causes disturbance in a way anatomy and also physiology. Stenosis nasal vestibule is a narrowing of the nasal cavity in the vestibule. Causes include congenital abnormalities, nasal trauma, infection and iatrogenic. Stenosis of the nasal vestibule is a relatively rare deformity and if it occurs it can have a significant impact on aesthetics and function. patient. The treatment of choice for nasal vestibular stenosis is surgery. Election type procedure And technique surgery depends on location stenosis, thickness wall network Which experiencing obstruction, condition network around, degrees deformity external, and alanation conditions. Here is one case of nasal vestibule stenosis that underwent surgery with excision technique and stent placement will be reported in this case report.

Mucosal malignant is a rare form of melanoma malignant, representing 1% of melanoma cases, with a five-year survival rate of 25% in contrast to cutaneous melanoma where the survival rate is until 80%. Variants melanoma malignant This especially found on head and neck, followed by the anorectal and vulvovaginal mucosa, in order of prevalence. 1 Melanoma Malignant is a tumor that originates from the transformation of melanocytes in the basal layer of the mucosa. Melanoma Malignant has two types, skin melanoma and mucosal melanoma. The frequency of Melanoma Malignant tumors in the head and neck is more than 90% in the skin, 5% in the eyes, 2.2% of primary lesions are unknown and only 1.3% occur in the mucosa. 25–50% of mucosal melanoma cases This happen in area head neck. Place Which most general from mucosal melanoma primary head And neck is cavity nose (50%), area maxillofacial (20%), oral cavity (17%), followed by nasopharynx. 2 The main symptoms of Melanoma Malignant of the nasal mucosa include recurrent bleeding and impaired nasal patency. Macroscopically, Melanoma Malignant of the nasal mucosa Nasal Cavity appear as tumor polypoid with color start from white to gray, brown to black. Histopathological diagnosis is based on the detection of melanocyte markers: S-100, Melan-A, HMB-45, MITF-1 and vimentin. In ⅓ case, melanoma mucosa happen in form amelanotic. Factor etiology Not yet defined in a way right. 2 The etiological factors are still not known for certain. The prevalence of melanoma mucosa is said No related with radiation sun, papillomavirus or herpes simplex virus. Smoking may be a predisposing factor for oral melanoma, and exposure to formaldehyde may predispose to sinus melanoma. paranasal. Age patient moment diagnosed is between 60 And 80 year, with the highest frequency between 65 and 70 years. The average 5-year survival rate is about 12-44%. The problems with mucosal Melanoma Malignant are the late diagnosis and the aggressive nature of the cancer. About 20% of patients are found to have lymph node metastases at diagnosis, and 10% of patients experience metastasis Far (to lungs, heart, bone, brain, more seldom to adrenal glands). 2 There are many therapeutic modalities for Melanoma Malignant of the nasal mucosa, including surgery, radiotherapy, chemotherapy, and biological therapy. early melanoma mucosa that until now This is still an option is surgery, followed by additional radiotherapy. However, mucosal Melanoma Malignant , characterized by high variability of tumor characteristics, poor prognosis, complexity of treatment, and various new therapeutic targets. Therefore, complete surgical resection is not easy, some patients in advanced stages even lose the opportunity for surgery. In addition, biological treatments, as well as immunotherapy, have been increasingly developed over the last decade. Recent studies have shown that immunotherapy may provide survival benefits for patients with advanced stages of the disease. general prognosis melanoma malignant mucosa sinonasal bad, by Therefore, immediate diagnosis and management are very important. 1,3

Meniere's disease is the third most common cause of vertigo after benign paroxysmal positional vertigo (BPPV) and vestibular neuritis. Meniere's disease is also known as endolymphatic hydrops. Acute symptoms of Meniere's disease are characterized by the triad of vertigo, tinnitus, and hearing loss. Meniere's disease is a chronic disorder of the inner ear, not fatal but disrupting quality of life. 1,2 In the case of Meniere's disease, the anatomical structure of the ear that is affected is the entire labyrinth Which covering canal semicircular and cochlea. Meniere's disease was discovered by Meniere in 1861, at which time there was debate among experts that the disease was in the brain. Whereas Meniere believe that disease This is in the ear. 1,2,6 This opinion was later proven by Hallpike and Cairn in 1938, with the discovery of endolymphatic hydrops after examining the temporal bone of a patient with suspected Meniere's disease. 1,2 Meniere's disease is one of the most common causes of inner ear vertigo. In most cases, Meniere's disease is unilateral and about 10-20% of cases are bilateral. The incidence reaches 0.5-7.5: 1000 in the UK and Sweden. 2,3 The typical attack symptoms of Meniere's disease are preceded by a feeling of fullness on One ear. Disturbance hearing Which nature fluctuating and may be accompanied by tinnitus. One episode of an attack of the disease Meniere's in general involving vertigo, disturbance balance, nauseous, And vomiting. An episode of Meniere's disease lasts on average two minutes to four hours. After the attack Which critical, most Patients complain of fatigue and need to sleep for several hours. There is some variability in the duration of symptoms. Some patients experience brief attacks while others may experience persistent imbalance. 3

The process of listening is very important for the development of speech and language skills. This will affect a child's ability to communicate in life. Hearing on children's age must always evaluated so that the child can be an individual in the midst of an adequate society where oral communication is more dominant. Disorders hearing can result in disturbance Language And cognitive Which more slow, intellectual and socio-cultural, thus hearing loss should be detected as early as possible so that language and social functions can develop well and normally. 1,2 Speech delay is a delay in a child's speech process compared to the speech process of children of the same age. Speech delay is one of the most common causes of developmental disorders found in children. Speech and language disorders are very common problems at the age of 3-5 years. Every day this disorder seems to be increasing rapidly. The prevalence of speech disorders in the form of language delays with an expressive vocabulary of less than 50 words and/or no word combinations is estimated to occur in 15% of children aged 24-29 months. 2 Some reports state that the incidence of speech and language delay ranges from 5-10% in school children. Speech delay is a major problem that is mostly caused by by disturbance hearing. The more early We detect abnormality or the disorder, the better the recovery from the disorder. 2 The prevalence of speech and language delay has been reported across a wide range. A recent Cochrane review summarized prevalence data on speech delay, language delay and combined delay in children reported number prevalence range between 5-8% and study of delay speak from 2.3% until 19%. Prevalence delay development speak in Indonesia Not yet has been studied extensively. Data from the Department of Medical Rehabilitation of RSCM in 2006, from 1125 total patient visits, 10.13% of children were diagnosed with speech delay and Language. 3 Wahyuni's 1998 research in one of the sub-districts in Central Jakarta found a prevalence delay Language as big as 9.3% from 214 child Which aged under three years. 4 Hearing loss associated with speech delay may be conductive. or sensorineural. Conductive deafness can be caused by otitis media with effusion. If this happens thus so lost hearing the nature temporary, average between 15-20 dB. Disturbance hearing on baby neonate Which treated stay in NICU For time more than two days increases the likelihood of hearing loss up to 10 times. 2 One of the examinations used for hearing loss is the Brainstem Evoked Response Audiometry (BERA) examination. BERA is a neurodiagnostic examination to evaluate the integrity of the auditory nerve pathway to assess lesions in the auditory nerve and brainstem. 3 Early detection of hearing loss by referring to therapy program experts medical And rehabilitation if Already obtained suspicion disturbance hearing. The joint committee of infant hearing (JCIH) recommends that children with hearing loss be identified through universal hearing screening at discharge from the hospital or within the first month of life. If the screening test is positive, children should be referred to respective medical experts and speech therapists. 2 The development of universal hearing screening has grown rapidly due to JCIH recommendations, one of which is BERA. BERA can also be used to diagnose changes in hearing thresholds, characterize the type of hearing loss, identify retrochochlear and assess the maturity of the central auditory system in neonates. 2 Besides For evaluation hearing, application main other from BERA is as diagnostic tool and tool for identifying neurological abnormalities. BERA can detect lesions in the eighth nerve, such as schwanoma of the eighth nerve, as well as lesions in the brain stem. In addition, BERA examination can also detect demyelinating diseases such as multiple sclerosis. Other uses of BERA include intraoperative monitoring and also as monitoring of neurological status in comatose patients in intensive care. 1-3