REFERAT
PEMERIKSAAN TULANG UNTUK IDENTIFIKASI UMUR DAN JENIS KELAMIN
DISUSUN OLEH : Bagus Anggoro
G6A 002 00
La!"#a$ E%" Nur&a'&"
G6A 002 0*+
Nur Asr"
G6A 002 ,0
(u&)arna"n Pra)oso
G6A 002 ,,
RESIDEN PEMBIMBING : -r. In!arn"a!" N
DOSEN PEMBIMBING : -r. Ba/ang Pra/'ng S1.F
BAGIAN ILMU KEDOKTERAN FORENSIK DAN MEDIKOLEGAL FAKULT AKULTAS KEDOKTERAN KE DOKTERAN UNIERSITAS DIPONEGORO DIPONEG ORO SEMARANG 2003
1
DAFTAR ISI
DAFTAR ISI.................................................................................................................1 KATA KATA PENGANTAR PEN GANTAR ...................................................................................................2 ...................................................................................................2 BAB I PENDAHULUAN.............................................................................................3
A. LAT LATAR BELAKANG................................ BELAKANG........................................................ .................................................... ............................ .......3 ....... 3 B. MASALAH..................................... MASALAH............................................................ ...................................................................... ............................................... 3 C. TUJUAN...................................... TUJUAN............................................................. .............................................. ...................................................3 ............................3 D. MANFAA MANFAAT..................... T............................................ .............................................. .............................................. ......................................... ..................4 4 BAB II TINJAUAN PUSTAKA..................................................................................5
A. BIOLOGI TULANG MANUSIA.................................... MANUSIA.............................................................. .......................... ........... 5 1. Anatom T!"an#...................................... T!"an#............................................................. ...........................................................5 ....................................5 2. St$!%t!$ Mo"&%!"&$ T!"an#.................................................... T!"an#................................................................................' ............................' 3. H(to"o# )an M&ta*o"(m& T!"an#...................................................................' 4. +&$t!m*!,an T!"an#......................................................... T!"an#............................................................................... ...................... .................... B. +ENENTUAN JENIS KELAMIN BERDASAR +EMERIKSAAN TULANG... 1. I)&nt/%a( B&$)a(a$%an T!"an#0T!"an# K$an!m........................................... 2. I)&nt/%a( B&$)a(a$%an T!"an#0T!"an# +o(t0K$an!m.................................14 C. +ENENTUAN UMUR BERDASARKAN +EMERIKSAAN TULANG..........21 1. +&n&nt!an Um!$ B&$)a(a$%an Mo$/o"o# Symphysis Pubis............................. Pubis............................. 2. +&n&nt!an Um!$ )&n#an M!"a B&$(at!na Epiphysis B&$(at!na Epiphysis )&n#an diaphysis........ diaphysis........ 3. +&n&nt!an Um!$ )&n#an +&n!t!an S!t!$a a)a K$ana................................. 4. +&n&nt!an Um!$ )&n#an G#............................................. G#........................................................................... .............................. BAB III KESIMPULAN ............................................................................................2
DAFTAR DAFTAR +USTAKA..................... +USTAKA............................................ .............................................. .......................................................2................................2-
2
DAFTAR ISI
DAFTAR ISI.................................................................................................................1 KATA KATA PENGANTAR PEN GANTAR ...................................................................................................2 ...................................................................................................2 BAB I PENDAHULUAN.............................................................................................3
A. LAT LATAR BELAKANG................................ BELAKANG........................................................ .................................................... ............................ .......3 ....... 3 B. MASALAH..................................... MASALAH............................................................ ...................................................................... ............................................... 3 C. TUJUAN...................................... TUJUAN............................................................. .............................................. ...................................................3 ............................3 D. MANFAA MANFAAT..................... T............................................ .............................................. .............................................. ......................................... ..................4 4 BAB II TINJAUAN PUSTAKA..................................................................................5
A. BIOLOGI TULANG MANUSIA.................................... MANUSIA.............................................................. .......................... ........... 5 1. Anatom T!"an#...................................... T!"an#............................................................. ...........................................................5 ....................................5 2. St$!%t!$ Mo"&%!"&$ T!"an#.................................................... T!"an#................................................................................' ............................' 3. H(to"o# )an M&ta*o"(m& T!"an#...................................................................' 4. +&$t!m*!,an T!"an#......................................................... T!"an#............................................................................... ...................... .................... B. +ENENTUAN JENIS KELAMIN BERDASAR +EMERIKSAAN TULANG... 1. I)&nt/%a( B&$)a(a$%an T!"an#0T!"an# K$an!m........................................... 2. I)&nt/%a( B&$)a(a$%an T!"an#0T!"an# +o(t0K$an!m.................................14 C. +ENENTUAN UMUR BERDASARKAN +EMERIKSAAN TULANG..........21 1. +&n&nt!an Um!$ B&$)a(a$%an Mo$/o"o# Symphysis Pubis............................. Pubis............................. 2. +&n&nt!an Um!$ )&n#an M!"a B&$(at!na Epiphysis B&$(at!na Epiphysis )&n#an diaphysis........ diaphysis........ 3. +&n&nt!an Um!$ )&n#an +&n!t!an S!t!$a a)a K$ana................................. 4. +&n&nt!an Um!$ )&n#an G#............................................. G#........................................................................... .............................. BAB III KESIMPULAN ............................................................................................2
DAFTAR DAFTAR +USTAKA..................... +USTAKA............................................ .............................................. .......................................................2................................2-
2
KATA KATA PENGANTAR PEN GANTAR
+! (!%!$ %am anat%an %&a)a T!,an an# Ma,a E(a ata( Ra,mat )an Ka$!naNa6 Ka$!naNa6 (&,n##a %am )aat m&n&"&(a%an m&n&"&(a%an $&/&$at an# *&$!)!" 7+&m&$%(aan 7+&m&$%(aan T!"an# Unt!% I)&nt/%a( Um!$ )an J&n( K&"amn7 n. R&/&$ R&/&$at at n n )(!(! )(!(!n n (&*a#a (&*a#a (a"a, (a"a, (at! (at! (a$a (a$att an# an# ,a$!( ,a$!( )&n )&n!, !, )a"am )a"am m&n&"&( m&n&"&(a%a a%an n $o#$am $o#$am &n)) &n))%an %an $o/&( $o/&( )o%t&$ )o%t&$ a)a *a#an *a#an I"m! I"m! K&)o%t&$ K&)o%t&$an an Fo$&n( Fo$&n(% % )an )an M&)% M&)%o"& o"&#a" #a" Fa%!" Fa%!"ta( ta( K&)o% K&)o%t& t&$an $an Un8& Un8&$( $(ta ta(( Do Don&# n&#o$ o$o. o. Kam Kam m&n#!9a%an t&$ma%a(, %&a)a an# t&$,o$mat : 1. D$. D$. L. L. Bam*a Bam*an# n# +$am +$am&n# &n# N.6 S.F S.F 2. D$. D$. Inta Inta$n $na at t N. R. an# t&"a, t&"a, m&m*&$ m&m*&$%an %an *m*n# *m*n#an an (&$ta (&$ta m&"!an# m&"!an#%an %an ;a%t!na ;a%t!na *a# %am %am (&m!a (&m!a (&,n##a $&/&$at n t&$(&"&(a%an. S&mo S&mo#a #a $&/&$a $&/&$att n )aat )aat m&nam m&nam*a, *a, ;a;a ;a;a(an (an (&$ta (&$ta n/o$ n/o$ma ma( ( t&nta t&ntan# n# 7+&m&$% 7+&m&$%(aan (aan T!"an# !"an# Unt!% Unt!% I)&nt/ I)&nt/%a( %a( Um!$ Um!$ )an J&n( J&n( K&"am K&"amn7 n7 )a"am )a"am I"m! I"m! K&)o%t&$an Fo$&n(% *a# &m*a9a )an &n!"(. S&ma$an#6
O%to*&$ 2<<
+&n!(!n
2
BAB I PENDAHULUAN
A. LATAR BELAKANG
I)&nt/%a( /o$&n(% m&$!a%an !aa an# )"a%!%an )&n#an t!!an m&m*ant! &n)% !nt!% m&n&nt!%an )&ntta( (&(&o$an#.1 T&ta a)a%a"ana %o$*an an# )t&m!%an ,ana *&$!a oton#an t!*!, ata! *a,%an ,ana *&$!a %&$an#%a. J%a )&m%an ma%a $o(&( )&nt/%a( a%an "&*, (!"t. M&(%!n )&m%an )a$ %&$an#%a t&$(&*!t %ta ma(, )aat m&m&$o"&, n/o$ma( an# *&$%atan )&n#an )&ntta( (&(&o$an# (&&$t $a(6 &n( %&"amn6 !m!$6 )an &$%$aan tn## *a)an )a$ &m"% $an#%a t&$(&*!t. Ca*an# "m! )a$ /o$&n(% an# *&$%atan )&n#an $o(&( )&nt/%a( a)a"a, ant$oo"o# /o$&n(%. D&/n( )a$ ant$oo"o# /o$&n(% t! (&n)$ a)a"a, )&nt/%a( )a$ ((a ,aat man!(a an# a$n#an "!na%na t&"a, ,"an# (&*a#an ata! (&"!$!,na (&,n##a tn##a" %&$an#%a6 )a"am %ont&%( ,!%!m.2 Da"am ant$oo"o# /o$&n(%6 $o(&( )&nt/%a( $an#%a man!(a )m!"a )&n#an )&nt/%a( $a(6 "a"! )"an!t%an )&n#an )&nt/%a( &n( %&"amn %&m!)an )&nt/%a( !m!$ )an )a%,$ )&n#an )&nt/%a( tn## *a)an.2 Da"am $&/&$at n6 %am a%an m&m*a,a( "&*, "an!t m&n#&na )&nt/%a( !m!$ )an &n( %&"amn *&$)a(a$%an &m&$%(aan t!"an#.
B. MASALAH
1. Ba#amana%a, 9a$a m&n&nt!%an !m!$ )an &n( %&"amn *&$)a(a$%an &m&$%(aan t!"an#= 2. T!"an# aa (aa an# )aat )#!na%an !nt!% )&nt/%a( !m!$ )an &n( %&"amn=
4. TUJUAN
T!!an )a$ &n!"(an $&/&$at n a)a"a, a#a$ ma,a((;a )aat m&n#&ta,! 9a$a09a$a )an t!"an# aa (aa an# )aat )a)%an (&*a#a to"o% !%!$ )a"am )&nt/%a( !m!$ )an &n( %&"amn. 3
D. MANFAAT
Man/aat )a$ &n!"(an $&/&$at n a)a"a, !nt!% m&nam*a, n/o$ma( m&n#&na &n&nt!an !m!$ )an &n( %&"amn *&$)a(a$%an &m&$%(aan t!"an#.
4
BAB II TINJAUAN PUSTAKA
A. BIOLOGI TULANG MANUSIA
T!"an# man!(a *&$*&)a )&n#an t!"an# ,&;an )a"am ,a" (t$!%t!$6 %&t&*a"an6 !%!$an )an !m!$ &n!"an#an >o(/%a(?. S&ta man!(a m&m"% 1< t!"an#6 )an t!"an# n )*&)a%an m&na) t!"an# anan#6 &n)&%6 , )an t)a% t&$at!$. T!"an# anan# %ta )aat a)a tan#an )an %a% (&&$t humerus, radius, ulna, femur, tibia )an fibula. T!"an# &n)&% m&"!t t!"an# *&"%at@%"a8%!"a6 metacarpal 6 )an metatarsal >a$ tan#an )an %a%?. T!"an# , t&$)aat a)a t!"an#0t!"an# ata t&n#%o$a% (&&$t frontal, parietal, dan occipital . T!"an# t)a% t&$at!$ a)a"a, t!"an# vertebra dan basis cranii.2
. Ana!o/" Tu&ang
S&9a$a !m!m6 $an#%a o$an# )&;a(a m&m"% )!a %omon&n (t$!%t!$ an# m&n)a(a$ at! t!"an# (on#o(a )an %oma%ta@%o$t%a". St$!%t!$ %oma% ta"%o$t%a" t&$)aat a)a *a#an t& t!"an# anan# m&"!t &$m!%aan &%(t&$na". +a)a *a#an nt&$na" t!"an#6 t&$)aat (t$!%t!$ (on#o(a (&&$t a"a a"a (&)an#%an *a#an t&n#a, t!"an# anan# %o(on# ata! )(&*!t cavitas medullaris !nt!% t&mat (!m(!m t!"an#.2 +a)a &$(&n)an6 t!"an# %oma%ta )t!t! o"&, %a$t"a#o@t!"an# $a;an (&anan# ,)! an# )(&*!t t!"an# (!*9,on)$a". T!"an# subchondral a)a &$(&n)an n "&*, ,a"!( )an m&n#%"a )*an)n# t!"an# %oma%ta an# t)a% t&$"&ta% a)a &$(&n)an. Conto,na a)a"a, a)a *a#an )(ta" ,!m&$!( ata! (%!. S&"an t!6 t!"an# subchondral a)a (&n) !#a t)a% $&m"% %ana" Ha8&$(.2 +a)a t!"an# 8&$t&*$a6 (t$!%t!$na o$!( )an )nama%an t!"an# t$a0 *&9!"a$ ata! 9an9&""o!(. Da&$a, t!"an# t$a*&%!"a$ a)a $an#%a an# (&)an# t!m*!, m&m"% t&mat0t&mat (!m(!m m&$a,6 a$n#an &m*!at )a$a, ata! hemopoietic an# m&m$o)!%( (&"0(&" )a$a, m&$a,6 !t, )an "at&"&t. S!m(!m %!nn# *&$/!n#( t&$!tama (&*a#a &nman (&"0(&" "&ma% ) %a8ta( m&)!""a$( a)a t!"an# anan#6 )%&""n# o"&, t!"an# %oma%ta.
5
S&"ama &$t!m*!,an6 (!m(!m m&$a, )#ant%an (&9a$a $o#$&(/ o"&, (!m(!m %!nn# ) (&*a#an *&(a$ t!"an# anan#.2 Ba#an0*a#an t!"an# anan# an# anan# )an ("n)$( )(&*!t diaphysis6 (&)an# !!n# $o%(ma" )an )(ta"na t&$)aat epiphysis )an metaphysis. Ja)6 diaphysis a)a"a, *atan# t!"an# anan#6 epiphysis a)a"a, !!n# a%,$ t!"an# anan# (&)an#%an metaphysis a)a"a, !!n# t!"an# anan# an# m&"&*a$ %& (amn#. S&ma(a ,)!6 *a#an &%(t&$na" t!"an# an# t)a% *&$%a$t"a#o )"a( o"&, periosteum. Periosteum a)a"a, m&m*$an )&n#an 8a(%!"a$(a( an# m&m*&$ n!t$( a)a t!"an#. Ba#an nt&$na" t!"an# )"a( o"&, &n)o(t&!m@m&m*$an (&"!"&$. Ba% periosteum ma!!n endosteum a)a"a, a$n#an o(t&o#&n% an# *&$( (&"0(&" &m*&nt!% t!"an#. +a)a &$o(t&!m an# m&n#a"am t$a!ma6 (&"0(&" &m*&nt!% t!"an# !n"a,na *&$tam*a,. +a)a &$o(tt(@t$a!ma a)a &$o(t&!m )tan)a )&n#an &m*&nt!%an t!"an# *a$! ) &$m!%aan &%(t&$na" t!"an# an# nama% (&&$t a"a@t$a*&%!"a$.
2. S!ru)!ur Mo&')u&'r Tu&ang
T!"an# man!(a )an ,&;an (ama0(ama t&$)$ ata( %o"a#&n6 mo"&%!" $ot&n an# *&(a$6 an# m&$!a%an < &"&m&n o$#an% t!"an#. Mo"&%!"0 mo"&%!" %o"a#&n m&m*&nt!% (&$a*!t0(&$a*!t &"a(t% a)a t!"an# ta a)a t!"an#
)&;a(a6
%o"a#&n
m&n#&$a(
%a$&na
t&$(
*a,an
ano$#an%
hydroxyapatite. K$(ta"0%$(ta" mn&$a" n )a"am *&nt!% 9a"9!m ,o(,at& m&n#( mat$%( %o"a#&n. S&$a*!t0(&$a*!t $ot&n )an mn&$a" n m&m*!at t!"an# m&m"% )!a (/at: m&"!na% (&&$t %a$&t *"a mn&$a" ano$#an%na $!(a% ata! m&n#&$a( >*"a )$&n)am )a"am "a$!tan a(am? ata! $&ta% )an ,an9!$ *"a %o"a#&n@o$#an%na $!(a% >*"a )$&*!(@)ana(?.2
5. H"s!o&og" -an M'!ao&"s/' Tu&ang
H(to"o# a)a"a, (t!) a$n#an a)a tn#%at m%$o(%o%. T!"an# mat!$ )an mat&$ *&$*&)a (t$!%t!ma. T!"an# mat!$ "&*, $mt/ )a"am (t"a, &8o"!( ,"o#&n&t%na6 *&$!a a$n#an %at an# %a(a$)an (&&$t a"a %o"a#&n6 o"ana $an)om )an t)a% t&$at!$ o$&nta(na. T!"an# mat!$ "&*, *ana% m&m"% osteocyte6 *a(ana t&$)aat a)a t!"an# an# m&n)&$ta t!mo$6 a)a &n&m*!,an /$a%t!$ )an a)a $an#%a &m*$on%.2
'
T!"an# %oma%ta t)a% *(a )*&$ n!t$( m&"a"! )/!( &$m!%aan &m*!"!,0&m*!"!, )a$a,6 (&,n##a m&m&$"!%an ((t&m Ha8&$(. T!"an# t$a*&%!"a$ "&*, o$&( )an m&n&$ma n!t$( )a$ &m*!"!, )a$a, ) (&%ta$ $!an# (!m(!m. T!"an# )&;a(a *a% an# %oma%ta ma!!n t$a*&%!"a$ (&9a$a ,(to"o#( a)a"a, t!"an# lamela.2 +&m&$%(aan m%$o(%o% oton#an m&"ntan# t!"an# %oma%ta !m!mna m&n!n!%%an 4 (ama )&n#an - 9n9n %on(&nt$( an# )nama%an lamella haversi. +&m&$%(aan (&ta "am&""a m&n!n!%%an t!m!%an a$a"&" (&$a*!t %o"a#&n. S&$a*!t %o"a#&n a)a lamella *&$%!tna *&$o$&nta( %& a$a, an# *&$*&)a. +&$*&)aan a$a, (&$a*!t0(&$a*!t %o"a#&n n m&nam*a, %&%!atan (t$!%t!$ t!"an#. 2 S&ta *atan# oton#an m&"ntan# t!"an# %oma%ta "am&"a$ )(&*!t ((t&m Ha8&$( ata! o(t&on *&$!%!$an <63 mm )am&t&$na )an 305 mm anan#na. Int ((t&m ,a8&$( a)a"a, %ana" ,a8&$( )mana )a$a,6 "m/& )an (&$a*!t (a$a/ "&;at. Kana"0%ana" %&9" tam*a,an )(&*!t %ana"0%ana" Volkmann m&m*&"a, a$n#an t!"an# (&9a$a oblique a)a (!)!t $!n9n# ) &$m!%aan periosteal )an endosteal !nt!% m&n#,!*!n#%an %ana" %ana" Ha8&$(6 m&m*&nt!% a$n#an an# m&n(!"a )a$a, )an "m/& %& (&"0(&" t!"an# anan#. 2 L!*an#0"!*an# %&9" ) )a"am (&ta lamella )(&*!t lacunae. S&ta lacunae m&m!na (&"0(&" t!"an# )(&*!t osteocyte. N!t$( )t$an(o$t %& (&"0 (&" n m&"a"! %ana"%!". Osteoblast a)a"a, (&"0(&" t!"an# an# *&$/!n#( !nt!% m&m*&nt!%6 (nt&((6 )an )&o(t mat&$ t!"an#6 *a(ana t&$%on(&nt$a( ) *a;a, periosteum. Osteoblast m&m*!at osteoid mat$%( o$#an% ta% t&$%a"(/%a(
an#
%aa
%o"a#&n.
Ka"(/%a(
t!"an#
t&$a) (&*a#a %$(ta"0%$(ta" hydroatapatite 6 %omon&n ano$#an%. t!"an# K&t%a osteoblast )%&""n# mat$%( t!"an#6 )(&*!t osteocyte6 (&"0(&" an# t&$"&ta% ) )a"am lacunae )an *&$tan##!n# a;a* m&m&",a$a t!"an#. O(t&o%"a(
*&$t!#a(
remodelling t!"an#
m&$&(o$*( t&$a)
a)a
t!"an#. tn#%at
+&m*&nt!%an (&"!"&$
)
%&m*a" mana
o(t&o%"a(
m&$&(o$( a$n#an t!"an# )an osteoblast m&m*an#!n a$n#an t!"an#. 2
ata!
. P'r!u/u$an Tu&ang
O(t&o#&n&(( ata! o(/%a( t&$a) a)a )!a "o%a(: intramembraneous >9onto,na a)a t!"an# frontal )an parietal ? )an endochondral >9onto,na a)a t!"an# #a6 8&$t&*$a6 basis cranii6 t!"an# tan#an )an %a%?6 ) mana o(/%a(na m&"a"! /a(& %a$t"a#o. +&$t!m*!,an t!"an# m&"!a( )a$ "o%a( &n&t$a( a;a"6 an# m&na) /o$am&n n!t$(6 M&m*$ana t( *&mama perichondrium m&n#&""n# %a$t"a#o a)a t!"an# anan#. Osteoblast ) *a;a, perichondrium a)a t!"an# anan# /&t!( m!"a m&n)&o(t t!"an# ) (&%ta$ *a#an "!a$ *atan# %a$t"a#o. S&%a" ,a" n t&$a)6 m&m*$an n )(&*!t periosteum6 a$n#an %at *&$(&$a*!t an# m&n)&o(t t!"an# (&"a( )&m (&"a(. Dam&t&$ t!"an# anan# m&nn#%at6 )an o(t&o%"a( a)a &$m!%aan &n)o(t&a" m&$&(o$( t!"an# (&)an#%an o(t&o*"a( a)a periosteum m&n)&o(t t!"an#. +$o(&( &$t!m*!,an a)a t!"an# m&"&*a$ >)am&t$%? t!"an# anan# n )(&*!t &$t!m*!,an ao((ona". 2 +&$t!m*!,an
m&manan#
t!"an#
anan#
t&$a)
a)a
*)an#
epiphyseal o"&, %a$&nana "o%a( n )(&*!t *)an# &$t!m*!,an an# t&$"&ta% )anta$a metaphysis >!(at o(/%a( $m&$? )an epiphysis >!(at o(/%a( (&%!n)&$?. +&$t!m*!,an m&manan# n m&na!, *a#an t&n#a, t!"an# a%n m&n!! $o%(ma" )an m&n!! )(ta". +&$t!m*!,an m&manan# t!"an# anan# *&$,&nt %&t%a metaphysis m&nat! )&n#an epiphysis. 2 +a)a (&*&"a( mn##! (&*&"!m "a,$. *a(ana t&$)aat %!$an# "&*, -<< !(at o(/%a(. +a)a ;a%t! "a,$ t&$)aat 45< !(at o(/%a(. +!(at o(/%a( $m&$ m!n9!" (&*&"!m "a,$ )an !(at o(/%a( (&%!n)&$ m!n9!" (&(!)a, "a,$. S&t&"a, )&;a(a6 (&m!a !(at o(/%a( $m&$ )an (&%!n)&$ m&nat! )an !m"a, t!"an# m&na) 2<' &"&m&n. 2
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B. PENENTUAN JENIS KELAMIN BERDASAR PEMERIKSAAN TULANG
T!"an# man!(a )&;a(a m&n!n!%%an a)ana )mo$/(m& (&%(!a" (&,n##a "a%0"a% )an &$&m!an )aat )*&)a%an *&$)a(a$%an mo$/o"o#na.2 +&$"! )n#at *a,;a (&*&"!m )"a%!%an )&nt/%a( &n( %&"amn %ta (&*a%na t&$"&*, )a,!"! m&"a%!%an )&nt/%a( $a(6 ,a" n )%a$&na%an $a( t&$t&nt! m&m"% mo$/o"o# an# %,a( (&,n##a )aat m&n#a*!$%an )mo$/(m& (&%(!a" t! (&n)$. A%!$a( &n&nt!an &n( %&"amn )a$ t!"an# *&$8a$a( t&$,a)a !(a (!*&%6 )&$aat /$a#m&nta( t!"an# )an 8a$a( *o"o#(.3 S&"an t! K$o#mann !#a m&nm!"%an *a,;a a%!$a( n )&n#a$!, o"&, %&"&n#%aan %&$an#%a an# a)a at! %&t&atan &n&nt!an &n( %&"amn )&n#an &m&$%(aan $an#%a a)a"a, 1<< *"a (&"!$!, t!"an# t&$(&)a6 5 *"a ,ana &"8(6 2 *"a )&n#an t!"na# t&n#%o$a%6 - *"a )&n#an &"8( )an t!"an# t&n#%o$a%6 - *"a )&n#an &"8( )an t!"an# anan#6 (&$ta -< *"a ,ana )&n#an t!"an# anan#.163 n m&n#n)%a(%an %&&ntn#an $&"at/
*&$*a#a t!"an# )a"am &n&nt!an &n(
%&"amn.
. I-'n!"#")as" B'r-asar)an Tu&ang7Tu&ang Kran"u/.
I)&nt/%a( *&$)a(a$%an t!"an#0t!"an# %$an!m a)a )!a 9a$a. Ca$a an# &$tama at! )&n#an &n#amatan )an 9a$a an# %&)!a )&n#an &n#!%!$an. a. Ca$a &n#amatan T&$)aat )!a 9a$a &n#amatan )&nt/%a( &n( %&"amn )a$ t!"an# %$an!m6 at! m&n!$!t B!%(t$a )an M&"%& >1-5? (&$ta m&n!$!t K$o#mann >1-'?.
Ta'& . I-'n!"#")as" !u&ang )ran"u/ /'nuru! Bu")s!ra -an M"'&)' 8*+,9 Kara)!'r !u&ang K$an!m )an ;aa, Kaa(ta( %$an!m R# (!$ao$*ta"( Da,@/$onta"
Bata( t& ata o$*ta K$(ta t&mo$a"(6 nuchale6
La)"7&a)" S&9a$a !m!m "&*, *&(a$ C&n)&$!n# 145< 99 L&*, m&nono" M&n#a$a, %&*&"a%an#
P'r'/1uan S&9a$a !m!m "&*, %&9" C&n)&$!n# 13<< 99 L&*, ,a"!(6 )ata$ Ha"!(6 t&#a%6 )an
m&m*!"at T!m!" Taam #a$( L&*, *&$%&m*an# )an K!$an# *&$%&m*an#6
)an protuberentia
m&nono"
,a"!( )an "&*, )ata$
occipitalis eksterna K$(ta mastoideus, processus
L&*, *&(a$6 "&*, "&*a$ Ha"!(6 "&*, t&#a% )an
supramastoideus,
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processus
zygomaticus T!"an# #omat9!( Man)*!"a:
corpus6
m&m*!"at
L&*, *&(a$6 "&*, "&*a$ K&9"6
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symphisis )an condylus S!)!t gonion
%!at )an %a(a$ Taam6 %!at6
Da#!@ gnathion
9&n)&$!n# &8&$( C&n)&$!n# (&# &mat6 L&*, $!n9n#
%a(a$6 C&n)&$!n# 125
*&$$o&%( %&)&an
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Ta'& 2. I-'n!"#")as" !u&ang )ran"u/ /'nuru! Krog/ann 8*+69 ,
Kara)!'r !u&ang U%!$an (&9a$a !m!m R# (!$a o$*ta"( +$o99&(!( ma(to)&!( R&#o o99ta"
Emn&n(a /$onta"( Emn&n(a a$&ta" O$*ta Da, T!"an# +a"at! Con)"!( o99ta"( Man)*!"a B&nt!% )a#! S!)!t #ona" Gona" /"a$&
La)"7&a)"
*&(a$ L&*, m&nono" S&)an#0*&(a$ T&$)aat tan)a &$"&%atan otot K&9" K&9" +&$(&# )&n#an t& t!m!" M&m*&nt!% ("o&6 %!$an# m&m*!"at B&$at6 m&nono" %&"at&$a" B&(a$6 "&*a$6 *&nt!% U B&(a$ B&(a$6 (m,(( tn##6 $am!( "&*a$ B&nt!% U M&m*&nt!% (!)!t M&nono"
P'r'/1uan
K&9" L&*, ,a"!(6 )ata$ K&9"0(&)an# T)a% t&$)aat tan)a &$"&%atan otot B&(a$ B&(a$ B!"at )&n#an t& taam &$t9a" K&9"6 $amn# K&9"6 a$a*o"9 K&9" K&9"6 (m,(( $&n)a, )an $am!( "&*, %&9" B&nt!% &$t9a" Data$
Ga/ar. +&$*an)n#an anta$a t&n#%o$a% "a%0"a% )an &$&m!an >%$? )an &$*an)n#an
anta$a man)*!"a "a%0"a% )an &$&m!an >%anan?
*. Ca$a &n#!%!$an Ca$a )&nt/%a( )&n#an m&n##!na%an &n#!%!$an m&m"% a%!$a( -<0<. Stan)a$ &n#!%!$an an# )#!na%an a)a"a, &n#!%!$an Hooton >14'?. S&m*"an &n#!%!$an t&$(&*!t a)a"a, (&*a#a *&$%!t:2 11
1? +anan# glabelooccipital : anan# ma%(m!m %$ana6 )a$ tt% a"n# anterior t!"an# midfrontal t&n#a, %&tt% a"n# a!, ) midoccipital >GO? 2? L&*a$ ma%(m!m %$an!m: "&*a$ t&$*&(a$ %$an!m6 ),t!n# t&#a% "!$!( t&$,a)a *)an# midsagital 6 ,n)a$ %$(ta supramastoidea >LM? 3? Tn## basionbregma: tn## %$an!m )!%!$ )a$ basion >tt% t&n#a, a)a t& ant&$o$ foramen magnum %& bregma >tt% t&m! anta$a sutura coronalis )an sagitalis? >B0BR? 4? Dam&t&$ ma%(m!m bizygomatic: "&*a$ ma%(m!m anta$a &$m!%aan "at&$a" "&n#%!n# zygomatic %anan )an %$6 )!%!$ t&#a% "!$!( t&$,a)a *)an# midsagital >MD0B? 5? Tn## prosthionnasion: tt% t&$&n)a, a)a t& alveolar anta$a %&)!a incisivus &$tama ata(6 %& nasion >tt% t&n#a, sutura nasofrontalis? >+0N? '? !asionnasion: )a$ basion %& nasion >B0N? ? !asionprosthion: )a$ basion %&tt% a"n# anterior ) maksila a)a *)an# midsagital >B0+? -? L&*a$ &%(t&$na" palatum: "&*a$ ma%(m!m palatum6 )!%!$ )a$ *a#an "!a$ t& alveolar >+T? ? +anan# mastoid : )!%!$ t&#a% "!$!( t&$,a)a *)an# "rankfurt horizontal >t& *a;a, orbita )an t& ata( meatus acusticus externus? >MSL?
12
Ga/ar. 2 +anan# ma%(m!m %$ana >GO? )t!n!%%an )&n#an ana, ,tam.
Tn## %$an!m >B0BR? )t!n!%%an )&n#an ana, m&$a,6 prosthionnasion>+0N? )t!n!%%an )&n#an ana, m&$a, m!)a6 !asionnasion>B0N? ana, ,a!6 !asionprosthion>B0+? ana, *$!.
Ga/ar. 5 Dam&t&$ ma%(m!m bizygomatic >MD0B? )t!n!%%an )&n#an
ana, m&$a, L&*a$ ma%(m!m %$an!m>LM? )t!n!%%an )&n#an ana, *$!
G""&( )an E""ot >1'3? m&n#&m*an#%an m&to)o"o# &n&nt!an &n( %&"amn )&n#an ana"(a /!n#( )(%$mnan )&n#an m&n##!na%an (tan)a$ &n#!%!$an t&$(&*!t. Kta am*" 3 &$(amaan )a$ 21 /!n#( an# )%&m*an#%an: 1?
>GO 1.23'?0>LM 1.<MD0B 3.21?>MSL 1.52-?
2?
>GO 2.11?>LM 1.<MD0B 4.'3?>MSL -.<3?
3?
>GO 1.1'5?>B0N 1.'5?>MD0B 3.'?0>B0+ 1.<+0N 1.541?
Ta'& 5. P'rsa/aan G"&&'s -an E&&"o! 8*659 , P'rsa/aan 2
5
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Gna )an A"tn%% >2<<
A B
Ga/ar. Ja$0a$ a$&a /o$am&n ma#n!m >m(a": $? A B 2 2 A$&a /o$am&n ma#n!m 22 $
Rata P$ata )a&$a, /o$am&n ma#n!m a)a"a, <.1 12'.<2 mm a)a $a )an -1.<1 Q 11.24 mm20 a)a ;anta.'
2. I-'n!"#")as" B'r-asar)an Tu&ang7Tu&ang Pos!7Kran"u/
I)&nt/%a( &n( %&"amn *&$)a(a$%an t!"an#0t!"an# o(t09$ana" (&$n#%a" )o*(&$8a( *&$)a(a$%an )a$ !%!$an t!"an# )an t&%(t!$ t!"an#. T&ta ,a" n (&$n#%a" m&nm*!"%an %&(a"a,an %a$&na *ana% t&$a) t!man# tn), anta$a "a%0"a% )an ;anta *a% )anta$a o!"a( an# (ama ma!!n anta$ o!"a( an# *&$*&)a.5 +a)a !m!mna &m&$%(aan !nt!% &n&t!an &n( %&"amn *&$)a(a$%an t!"an# an##!"6 t!"an# )a)a )an t!"an# anan#. a. T!"an# an##!" 14
a(,*!$n )an K$o#mann >1'2? m&nata%an *a,;a ,ana )&n#an m&m&$%(a t!"an# an##!" tana &m&$%(aan "an (!)a, )aat )t&nt!%an &n( %&"amn a)a (&%ta$ < %a(!(.
a(,*!$n m&n&m!%an $!m!( I(9,o!*9 n)&%( at!: I(9,o!*9 n)&%( anan# o( !*( 1<< anan# o( (9,!m +&n#!%!$an ,a$!( )%&$a%an )&n#an ,at0,at6 anan# o( !*( )!%!$ )a$ )ata$an (m/(( (ama tt% a9!an ) a(&ta*!"!m anan# o( (9,!m )!%!$ )a$ t&mat an# (ama (ama ata( a"n# )(ta" )a$ o( (9,!m. Tt% a9!an an# )ma%(!) t&$"&ta% a)a t&mat *&$(at!na t#a *a#an t!"an# mat!$ nomnata6 *a(ana )tan)a )&n#an (&*!a, ta%% a)a &$m!%aan a$t%!"&$ )a$ a(&ta*!"!m >(9,!"t?.- J%a n)&%( (9o0 !*9 >a)a $a( %!"t !t,? %!$an# )a$ < ma%a a)a"a, &"8( $a %a "&*, )a$ 5 ma%a a)a"a, &"8( ;anta.
Ga/ar. , +&"8( "a%0"a% >%$? )an &"8( ;anta >%anan?. +anan# o( !*( )tan)a
)&n#an ana, *$! (&)an#%an anan# o( ( 9,!m )&n#an ana, m&$a,.
A(&ta*!"!m "&*, "!a( a)a $a6 )am&t&$ $ata $atana 52 mm )*an)n#%an $ata $ata )am&t&$ a(&ta*!"!m ;anta at! 4' mm. Man#%o% (&n) a)a $a !#a m&n#,a)a "&*, %&"at&$a" )*an)n#%an a)a ;anta. S&9a$a a"ama, !%!$an a(&ta*!"!m *&$,!*!n#an )&n#an 9a!t /&mo$(6 )mana a%an )*9a$a%an %&m!)an. Ta%% an##!" an# "&*, *&(a$ a)a"a, (&*!a, %$t&$a an# &ntn#6 (&mt )an )a"am a)a $a )an "&*a$ )an )an#%a" a)a ;anta. Ha$$(on )an H$)"9%a m&$a(a *a,;a (&ma%n *&(a$ ta%% an##!"na (&ma%n *a% )a"am &n&nt!an &n( %&"amn an# 15
*&$%!tna )%"am 5 tn#%at %&t&atanna ,ana )&n#an %$t&$a n. +a)a #am*a$. 5 )aat )",at 9a$a m&n#!%!$ )am&t&$ $ata0$ata a9&ta*!"!m.
Ga/ar. 6 Dam&t&$ $ata0$ata a9&ta*!"!m a
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Ga/ar. 3 +&"8( "a%0"a% > #am*a$. 'a? )an &"8( &$&m!an > #am*a$. '*? )",at )a$ ata(
a.
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Ga/ar +. +&"8( "a%0"a% > #am*a$. a? )an &"8( &$&m!an > #am*a$. *?
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Fo$am&n o*t!$ato$ a)a $a "&*, o8o) )an a)a ;anta *&$*&nt!% (&#t#a. S!"%!( $&a!$%!"a$( an# m&na) t&mat m&"&%atna "#am&nt!m (a9$o"a9a t&$"&ta% ) (&*&"a, "at&$a" (&n) (a9$o"a9a )an tama% &"a( a)a ;anta )an (&$n# t)a% ))aat%an a)a $a. +nt! *a;a, an##!" *"a )",at )a$ ata( tama% "&*, *!"at a)a ;anta )an a)a $a tama% ,&a$t (,a& (&*a#a a%*at )a$ $ot$!( (a9$!m %& o(t&$o$ >G$&!"9, )an T,oma(?. S&!m"a, n)&%( an##!" "anna t&"a,
1'
)t&m!%an o"&, *&*&$aa &n#a$an# (&&$t G$&!"9, )an T,oma( T!$n&$ C,a);&"" )an Mo""o (&$ta St$a!( )an D&$$. Sa9$!m (&9a$a /!n#(ona" a)a"a, *a#an )a$ &"8( )an !#a m&m"% &$*&)aan a)a %&)!a &n( %&"amn. Sa9$!m ;anta "&*, "&*a$ )an m&m"% 9&%!n#an )an#%a"6 (&%a" "a# ,a" n *&$,!*!n#an )&n#an 9ana"( &"89a"( an# "&*, "!a( !nt!% $o(&( m&"a,$%an. +a)a ;anta 9ana"( &"89a"( n "&*, &n)&% )an %&"&n#%!n#anna ,am$ (&"!$!,na (ama *a#an )(ta" )a$ &$t&n#a,an 8&$t&*$a (a9$a" %&t#a. Sa9$!m a)a $a )aat m&m"% "&*, )a$ "ma (&#m&n )mana ,a" n a$an# t&$a) a)a ;anta. K&"&n#%!n#an (a9$!m $a *&$"an!t (ama %& *a;a, (ama %&(&"!$!,an t!"an# )an m&m$o&%(%an o( 9o99 a#a% %&)&an. Fa;9&t m&m*an)n#%an )am&t&$ t$an8&$(a )a$ 8&$t&*$a (a9$a" &$tama >C? )&n#an )am&t&$ t$an8&$(a *a(( (a9$!m >B?. D&n#an $!m!( C 1<<@B ))aat%an a)a $a $ata $atana 456 )an a)a ;anta $ata $atana 4<. %m!$a t&"a, m&n#&m*an#%an *a(& ;n# n)& )mana "&*a$ $&"at/ )a$ (aa )an *a(( m&n&)a%an %o&/(&n /!n#( )(%$mnan !nt!% &n&nt!an &n( %&"amn.
Ga/ar. * +a)a #am*a$ n t&$",at &"a( *a,;a %&"&n#%!n#an (a9$!m $a *&$"an!t (ama
%& *a;a, (ama %&(&"!$!,an t!"an# (&,n##a $o&%( o( 9o99 a#a% %&)&an.
1
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(t&$n )an 9o$!( (t&$n m&n&nt!%an &n( %&"amn6 a)a ;anta man!*$!m (t&$n m&"&*, (&a$!, anan# 9o$!( (t&$n.3 St&;a$t )an M9 Co$m9% m&n##!na%an t&%n% $a)o"o# )an m&n&#a(%an tota" %&a%!$atanna &n#!%!$an t!"an# (t&$n!m (ama %!$an# )a$ 121 mm a)a &$&m!an )an "&*, )a$ 13 mm a)a $a. T!"an# (%a!"a t&"a, )&"aa$ "&*, )a"am t&ta "&*, &$at ,!*!n#anna t&$,a)a !m!$. T&$)aat (&)%t ,!*!n#an &n( %&"amn an# "&*, *&$8a$a( )a"am &n#!%!$an )am&t&$ 8&$t%a" a)a 9a8ta( #"&no). M&n!$!t D;#,t a)a $a 3' mm "&*, %&9" )*an)n#%an ;anta.3
9. T!"an# +anan# +$a a)a !m!mna m&m"% t!"an# an# "&*, anan#6 "&*, *&$at )an "&*, %a(a$ (&$ta &nono"anna "&*, *ana%.1 T!"an# anan# an# a"n# *&$#!na )a"am &n&nt!an &n( %&"amn a)a"a, o( /&m!$6 )mana anan# )an %&a)atanna &ntn#. K&t&atanna a)a o$an# )&;a(a (&%ta$ -<. S&&$t *a(a6 %a$a%t&$(t% &n( %&"amn a)a t!"an# anan# (an#at t!man# tn),6 t&ta &n&"tan (&$" B$a(, m&n!n!%an *a,;a anan# ma%(ma" >o*"%? a)a /&m!$ $a (&%ta$ 45 mm (&)an#%an a)a ;anta ,ana (&%ta$ 42' mm. ,a(" an# *&$*&)a ))aat%an o"&, +&a$(on )an B&"" at! $ata $ata 44 mm !nt!% "a% "a% )an )an 4< mm !nt!% &$&m!an. D&n#an m&n##!na%an anan# o*"% t$o%ant&$%a m&$&%a m&n#!(!"%an $an#& anta$a 3<04<5 mm !nt!% ;anta )an 43<045< mm !nt!% $a6 m&(%!n )aat t&$a) t!man# tn), )anta$a %&)!ana. Ra( )an (tat!( # >)mana *&$,!*!n#an )&n#an ;a%t! )an t&mat )mana (am&" ))aat%an? ,a$!( )&$tm*an#%an a)a (aat &n#!%!$an.5 U%!$an
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m&m*&)a%an &n( %&"amn an# "&*, *a%6 !%!$an )am&t&$ 8&$t%a" (&&$t an# )9ant!m%an o"&, &a$(on )an *&"" ,am$ "&*, *&(a$ )a$ 45 mm !nt!% "a%0"a% )an %!$an# 41 mm !nt!% &$&m!an 6 m&(%!n an# "&*, (&$n# )a%a a)a"a, !%!$an an# *&$%(a$ 43 mm. a)a $a !m!mna 4305' mm )an 304' mm a)a ;anta.5 U%!$an %a!t /&m!$ m&n!$!t &n&"tan +&a$(on )a"am F&m!$ m&n!$!t &n( %&"amn *&)a(a$%an &$,t!n#an mat&mat%a7 an# (&$n# 1
)ma(!%%an )a"am *&*&$aa 9a$a &n#!%!$an. D;#,t m&m&"aa$ !%!$an %a!t /&m!$ )an %a!t ,!m&$!( )an m&n&#a(%an *a,;a %&)!ana "&*, *&$#!na )a$a)a m&n#!%!$ anan# t!"an#.5 Sat! ,a" "a#6 &n##!naan m&to)& )&n#an m&"a%!%an (&!m"a, &n#!%!$an !nt!% m&n&nt!%an &$*&)aan a)a &n( %&"amn (!)a, *ana% )tn##a"%an. K&t&$an#an ,a" n "&*, "an!t )aat )%&ta,! )a$ M""&$ (,a8t(. S/at "an /&m!$ m&n!$!t &n( %&"amn a)a"a, a)a (!)!t an# )*!at *a)an t!"an# t&$,a)a #a$( 8&$t%a" %a$&na t!"an# &"8( a)a ;anta $&"at/ "&*, *&(a$6 *a)an t!"an# ,a$!( )m$n#%an a#a$ *&$t&m! a)a *a#an "!t!t6 (&,n##a 9on)"!( t&$"&ta% a)a *a#an a"n# *a;a, )a$ /&m!$ )a"am o(( ,o$(onta" a)a "&m&n# t*a. D&n#an )&m%an %&t%a t!"an# /&m!$ ;anta )"&ta%%an a)a &$m!%aan an# )ata$6 (!)!t an# t&$*&nt!% o"&, t!"an# )&n#an &$m!%aan ta) %!$an# "&*, '7 (&)an#%an a)a t!"an# $a (&)%t "&*, *&(a$ at! *&$%(a$ -<7. S!)!t a)a *a#an "&,&$ )a$ *a)an /&m!$ >(!)!t a)a 9o""!m )an )a/((? t&"a, )&"aa$ o"&, #o)9%6 ,a("na m&n#&m!%aan *a,;a t!"an# )&n#an (!)!t %!$an# )a$ 4
Ta'& ,. P'ran-"ngan 1anang r'&a!"%' !u&ang 1anang an!ara 1r"a -an 1'r'/1uan /'nuru! Krog/an Tu&ang
,
La)"7&a)"
P'r'/1uan
Ras"o &a)"7&a)"
Panang 8//9
Panang 8//9
-an 1'r'/1uan
2<
F&m!$ T*a F*!"a H!m&$!( Ra)!( U"na
41 4< 3-33' 255 2'
434 35 351 31 22< 23'
--65 --6< <65 465 -'64 -565
4. PENENTUAN UMUR BERDASARKAN PEMERIKSAAN TULANG 1. P'n'n!uan u/ur 'r-asar)an /or#o&og" symphysis pubis 8
A)a!n m&to)&0m&to)& an# (&$n# )#!na%an a)a"a, (&*a#a *&$%!t: a. M&to)& To)) >12<0121? B&$)a(a$%an &n&"tan ata( %&$an#%a man!(a 1-05< ta,!n6 To)) m&m*a# !m!$ )a"am 1< /a(& (&*a#a *&$%!t : 1? Fa(& a(%a a)o"o(&n &$tama > !m!$ 1-01 ta,!n ? +&$m!%aan (m/(( %a(a$6 t&$*a# o"&, tono"an m&"ntan# an# ) *ata( o"&, 9&%!n#an an# &"a(6 ta% )t&m!%an no)!"!( o((/%a( >&/(&a"? an# m&nat! )&n#an &$m!%aan6 t)a% )!ma t& an# *&$*ata( t&#a(6 t)a% )!ma *ata( &%t$&mta(. 2? Fa(& a(9a a)o"&(&n %&)!a >!m!$ 2<021 ta,!n? +&$m!%aan (m/(( ma(, %a(a$ )&n#an tono"an m&"ntan# )an 9&%!n#an )anta$ana6 t&ta 9&%!n#an m!"a *&$%!$an# )&%at *ata( )o$(a" %a$;&na t&$( o"&, t!"an# an# t&%(t!$na ,a"!(. Fo$ma( n m!"a m&nama$%an &%(t$&mta( n/&$o$ )a$ tono"an ,o$onta". No)!"!( o((/%a( >&/(&a"? m!n#%n *&$(at! )&n#an &$m!%aan (m/(( *a#an ata(6 *ata( t& )o$(a" m!"a t&$*&nt!%6 t)a% a)a *ata( &%t$&mta(6 *a#an )&an (ama$0(ama$ t&$,a)a "&$&n# 8&nt$a" >8&nt$a" *&8&"?.
3? Fa(& a(9a a)o"&(&n %&t#a >!m!$ 22024 ta,!n? +&$m!%aan (m/(( m&n!n!%an o*"t&$a( $o#$&((/ tono"an )an 9&%!n#. T&$*&nt!% "ato )o$(a"6 t&$)aat no)!"!( o((/%a(6 t& )o$(a" *&$ta,a ma%n a"a(6 t)a% )!m &m*at(an &%(t$&mta(. 4? Fa(& %&&mat >!m!$ 2502'?
21
+&nn#%atan
%&$a(
)a&$a, "&$n# 8&nt$a"6 *&$,!*!n#an
)&n#an
,"an#na tono"an )an 9&%!n#an6 *ata( t& )o$(a" (&m!$na a%*at t&$*&nt!%na "ato )o$(a"6 t&$)aat &m*ata(an &%t$&mta(. 5? Fa(& %&"ma >!m!$ 203< ta,!n? S&)%t ata! t)a% a)a &$!*a,an a)a &$m!%an (m/(( )an "ato )o$(a"6 %&9!a" )!ma a)ana !(a,a (o$a% )an $&ma! m*&t!%an tan##!" 8&nt$a" >8&nt$a" $ama$t?6 &%(t$&mta( *;a, &$t t& )o$(a"6 *aa(na ma%n *&$tam*a, &"a(6 &m*&nt!%an &%(t$&mta( ata( ata! tana *a;a, nt&$8&n( no)!"!( t!"an# >&/(&a"?. '? Fa(& %&&nam >!m!$ 3044 ta,!n? Bata( &%(t$&mta( ma%n &"a(6 &$%&m*an#an )an &n&m!$naan tan##!" 8&nt$a" t&$)aat #am*a$an #$an!"a$ a)a &$m!%aan (m/(( )an *a#an 8&nt$a" !*( t)a% )!ma **$ >"n#? a)a t& (m/((. ? Fa(& %&t!!, >!m!$ 3503 ta,!n? +&$!*a,an a)a &$m!%aan (m/(( )an *a#an 8&nt$a" !*( a%*at *&$%!$an#na a%t8ta(6 t&$a) &$t!m*!,an t!"an# a)a &"tWa%an t&n)on
)an
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t&$!tama
t&n)on
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(a%$ot!*&$o(!m. -? Fa(& %&)&"aan >3044 ta,!n? +&$m!%aan (m/(( !m!mna ,a"!( )an na%t/6 &$m!%aan 8&nt$a" !#a na%t/6 *ata( o8a" (&m!$na ata! ,am$ (&m!$na6 &%(t$&mta( (an#at &"a(6 t)a% )!ma *n#%a >$m? an# &"a a)a &$m!%aan (m/((6 t)a% )!ma **$ an# &"a( *a% a)a t& 8&nt$a" a!!n )o$(a". ? Fa(& %&(&m*"an >!m!$ 4505< ta,!n? +&$m!%aan (m/(( m&n!n!%an "&*, %!$an# *n#%a an# &"a(6 t& )o$(a" (m!ana *&$**$6 t& 8&nt$a" *&$**$ t)a% t&$at!$.
1!m!$ 5< ta,!n %&ata(? +&$m!%aan (m/(( m&n#a"am &$o( )an m&n!n!%an o(/%a( an# t)a% m&n&nt!6 t& 8&nt$a" "&*, %!$an# m!"a ,an9!$ )&n#an *&$tam*a,na !m!$.
22
*. M&to)& Han,a$a P S!!% A)a %omon&n an# )&$%(a6 at! : 1? Tono"an )an 9&%!n#an ,o$onta" Tono"an )an 9&%!n#an ,o$onta" n (an#at &"a( a)a an# *&$!m!$ 2< ta,!n : tono"an tn## )an 9&%!n#an taam (&$ta )a"am. +a)a !m!$ anta$a 2<023 ta,!n 9&%!n#an m&na) )an#%a" )an tono"an $&"at/ t!m!". +&n#%(an an# *&$"an!t (ama %$a0%$a !m!$ 2 ta,!n6 (&t&"a, !m!$ 2- ta,!n )&n#an (&)%t %&%&9!a"an #am*a$ n a%an ,"an# (&"!$!,na &$m!%aan (m/(( a%an m&na) )ata$. 2? T!*&$%!"!m !*%!m. +a)a t!"an#
!*(
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t!*&$%!"!mna m&"&%at m&"a"! t!"an# $a;an (&,n##a #a$( &/(a" ma(, t&$",at. S&t&"a, !m!$ 24 ta,!n t!*!$%!"!m a%an m&nat! )&n#an t!"an# a)a (&m!a o$an# tana %&9!a". 3? U!n# *a;a, S&*&"!m !m!$ 22 )an 23 ta,!n6 !!n# *a;a, &$m!%aan (m/(( ta% )aat )*&)a%an )a$ !!n# ata( $!m!( !*( n/&$o$. +a)a !m!$ 230 3< ta,!n6 *a#an *a;a, &$m!%aan (m/(( ) *ata( o"&, tono"an (&mt )an (&t&"a, 3< ta,!n6 tono"an t! m&"&*a$ )an *ana% %a(!( *&nt!%na m&na) (&#t#a m&nono". 4? T& )o$(a" Sama )&n#an !m!$ 1 ta,!n6 t)a% t&$)aat tono"an a)a *ata( )o$(a" a)a &$m!%aan (m/((. +a)a (&%ta$ 2< ta,!n (!at! tono"an (ama$0(ama$ m!n9!" a)a *ata( )o$(a" &$m!%aan. o$an# an# "&*, t!a )a$ 2 ta,!n m&n!n!%%an &m*&nt!%an tono"an an# ,am$ (&m!$na m&(%!n ma(, (&mt a)a (&"!$!, anan# t& )o$(a". +a)a (&a$!, %a(!( (&t&"a, 33 ata! 34 ta,!n6 ta ,a" n (an#at *&$8a$a(.
5? No)!"!( o(/%a( (!&$o$. +&m*&nt!%an no)!"!( t&$a) a)a &$m!%aan !*( *a#an ata( (&"ama ;a%t! an# t&$*ata(. Ta% )t&m!%anna no)!"!( *(a *&$a$t !m!$na )*a;a, 2< ta,!n )ata( 2 ta,!n. Ia &"a( t&$",at a)a !m!$ 2102 ta,!n. 23
'? L&$&n# 8&nt$a". Sama !m!$ 22 ta,!n %&ata(6 *ata( 8&nt$a" &$m!%aan (m/(( !*( *&$(at! )&n#an &$m!%aan 8&nt$a" &$m!%aan t!"an# !*(. +a)a !m!$ an# "&*, t!a t&$*&nt!% &$m!%aan (&mt )anta$a %&)!ana. Too)
m&n&*!t%an
"&$&n# 8&nt$a"
&$m!%aan
nt&$m&)a )an
m&n#an##ana (&*a#a #am*a$an an# *&$#!na !nt!% &$%$aan !m!$. Ia m!"a m!n9!" a)a !m!$ 23 ta,!n )an *a$! (&m!$na a)a !m!$ 2 ta,!n. Anta$a 2-033 ta,!n a t&"a, t&$*&nt!% (&m!$na (&anan# &$m!%aan (m/(( !*(. +a)a n)8)! an# a)a !m!$na "&*, t!a )a$ 33 ata! 34 ta,!n *a#an ata( "&$&n# 8&nt$a" m&n#,"an# ta a)a 8a$a( ,a" n (an#at *&(a$. ? Bn#%a (m/(( +a)a o$an# an# "&*, t!a6 &$m!%aan (m/(( %a)an#0%a)an# )*ata( o"&, *n#%a an# $&"at/ "&*a$ )an t!m!". Ha" n )aat )!ma a)a o$an# an# *&$!m!$ )ata( 3< ta,!n )an /$&%!&n(na m&nn#%at (&t&"a, !m!$ 34 ta,!n6 m&(%!n 8a$a(na !#a *&(a$. %a$&nana *"a )!ma *n#%a an# &"a( (&9a$a aman )aat )%ata%an *a,;a !m!$ 350an ata! "&*,6 t&ta n)8)! tana *n#%a m!n#%n t)a% (&"a"! m!)a,.
2. P'n'n!uan u/ur -'ngan /u&a" 'rsa!un;a epiphysis -'ngan diaphysis Ta'& 6. P'n'n!uan u/ur -'ngan /u&a" 'rsa!un;a epiphysis -'ngan diaphysis Epiphysis
U/ur saa! /u&a" 'rsa!un;a Epiphysis 8!a$un9 La)"7&a)" P'r'/1uan 1- P 22 1 P 21 14 P 22 13 P 2< 14 P 21 14 P 2< 2P4 2P4
K"a8%!"a6 medial S9a!"a: processus acromialis #umerus $ caput T!*&$%&" mao$ 24
%rochlea Epicondylus lateralis &adius$ caput distal 'lna, distal (lium $ K$(ta iliaca (schium$ pubis T!*&$o(ta( ischium "emur$ caput )istal T*a: proximal )istal "ibula $ proximal distal
11 P 15 11 P 1 14 P 1 1' P 2< 1- P 2< 1 P 2< P 1 P 22 15 P 114 P 1 15 P 1 14 P 114 P 2< 14 P 1-
P 13 1< P 14 13 P 1' 1' P 1 1' P 1 1 P 1 P 1' P 2< 13 P 1 14 P 1 14 P 1 14 P 1' 14 P 113 P 1'
3. P'n'n!uan u/ur -'ngan 1'nu!u1an su!ura 1a-a )ran"a. 2 Sa"a, (at! t&%n% an# )%&m*an#%an o"&, M&n)" )an Lo8&o >1-5? !nt!%
m&n&nt!%an !m!$ mat a)a"a, lateroanterior suture closure*, &n!t!an (!t!$a 9$ana" a)a )a&$a, lateral )an anterior+ S!t!$a0(!t!$a an# )&$%(a a)a"a,: a. idcoronal *. Pterion 9. Sphenofrontal$ tt% t&n#a, ). Sphenotemporal inferior &. Sphenotemporal superior 4. P'n'n!uan u/ur -'ngan 1'r!u/u$an g"g" K"a(/%a( )an &$!( ## t&$a) a)a !m!$ t&$t&nt!6 (&,n##a &n#&ta,!an
m&n#&na (aat ## m&n#a"am &$!( *(a )a%a (&*a#a a9!an &n&nt!an !m!$ n)8)! )a$ !m!$ nt$a!t&$n& (ama )&n#an )&;a(a. D%&na" t#a &$o)& &$t!m*!,an ##: a. +&$o)& ## (!"!n# >' *!"an P ' ta,!n? +ato%an ;a%t! &$t!m*!,an ## (!"!n#: 0 G# n9(8!( 1 : ' P - *!"an 0 G# n9(8!( 2 : - P 1< *!"an 0 G# 9ann!( : 1' P 2< *!"an 0 G# mo"a$ 1 : 1' P 2< *!"an 0 G# mo"a$ 2 : 2< P 3< *!"an *. +&$o)& ## &$#antan >' P 12 ta,!n? 9. +&$o)& ## t&ta > 12 ta,!n? Patokan waktu pertumbuhan gigi tetap:
0 0
In9(8!( 1 In9(8!( 2
Ra,an# Ata(
Ra,an# Ba;a,
P - ta,!n - P ta,!n
' P ta,!n P - ta,!n
25
0 0 0 0 0 0
Cann!( +$&mo"a$ 1 +$&mo"a$ 2 Mo"a$ 1 >' ta,!n? Mo"a$ 2 >12 ta,!n? Mo"a$ 3
11 P 13 ta,!n 1< P 11 ta,!n 12 P 13 ta,!n ' P ta,!n 11 P 13 ta,!n 1 P 21 ta,!n
2'
- P 1< ta,!n 1< P 11 ta,!n 11 P 12 ta,!n ' P ta,!n 11 P 13 ta,!n 1 P 21 ta,!n
BAB III KESIMPULAN
J&n( %&"amn )an !m!$ *(a )t&nt!%an )a$ &m&$%(aan t!"an#. S&9a$a #a$( *&(a$ &n&nt!an &n( %&"amn )a$ (&*!a, $an#%a )"a%!%an m&"a"! 2 9a$a6 at! 9a$a an# &$tama a)a"a, m&"a"! &n#amatan )a$ %a$a%t&$(t% t!"an#0t!"an# t&$t&nt! )an 9a$a an# %&)!a at! )&n#an 9a$a &n#!%!$an. T!"an#0t!"an# an# )aat )#!na%an (&*a#a *a,an )&nt/%a( &n( %&"amn )anta$ana a)a"a, t!"an# %$an!m6 t!"an# an##!"6 t!"an# )a)a6 )an t!"an# anan#. S&)an#%an &n&nt!an !m!$ *(a *&$)a(a$%an mo$/o"o# (m(( !*(6 m!"a *&$(at!na &/(( )an )a/((6 &n!t!an (!t!$a %$an!m6 )an &$!( ##.
2
DAFTAR PUSTAKA
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M6
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!*(.M&)an:Un8&$(ta( S!mat$a Uta$a D#ta" L*$a$.2<<4 . S!(ant. +&$t!m*!,an G#. Ba,an %!"a, ## )an m!"!t Ma,a((;a FK UNDI+.
2-
