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Das D, Modaboyina S, Agrawal S, Pushker N, Meel R, Bajaj MS. Tessier cranio-facial clefts presenting to a tertiary eye care center in Northern India: Ophthalmic features and a review of management. Indian J Ophthalmol 2022; 70:2552-2558. [PMID: 35791155 PMCID: PMC9426171 DOI: 10.4103/ijo.ijo_86_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Purpose Tessier classification is used to classify congenital facial cleft disorders utilizing the anatomical location of the cleft and its extension. The orbital and ocular morbidities associated with the birth disorder are numerous. The authors decided to perform a retrospective analysis of the clinical features of the patients who presented to a tertiary care hospital with orbito-cranial clefts. Methods The authors retrospectively evaluated the records of patients with craniofacial clefts who had presented to a tertiary eye care hospital in northern India in the last 2 years (January 2019-December 2020). The clinical features were studied, entered in MS Excel, and the data were evaluated. Results The data of 40 patients with Tessier cleft were found. The majority of the patients were male and presented in the pediatric age group. Unilateral involvement was more common, with maxillary hypoplasia being the most common facial anomaly associated. Eyelid coloboma and euryblepharon was the most common periocular finding; lateral epibulbar dermoid and corneal opacity were the most common ocular surface anomaly. The majority of patients had presented for cosmetic correction. The syndromic association was with Goldenhar syndrome (n = 13), Fraser (n = 2), and one each of Treacher Collins, blepharocheilodontic, organoid nevus, and oculo-dento-digital syndrome. Combined clefts were also seen. Conclusion Tessier cleft classification is a useful tool to classify cranio-facial left anomalies. Multitudes of ocular and orbital anomalies can be associated with their different forms. Better knowledge and understanding of the classification will aid immensely in predicting the ocular defects and planning their management.
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Affiliation(s)
- Deepsekhar Das
- Oculoplasty and Orbital Tumor Services, Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| | - Sujeeth Modaboyina
- Oculoplasty and Orbital Tumor Services, Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| | - Sahil Agrawal
- Oculoplasty and Orbital Tumor Services, Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| | - Neelam Pushker
- Oculoplasty and Orbital Tumor Services, Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| | - Rachna Meel
- Oculoplasty and Orbital Tumor Services, Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| | - Mandeep S Bajaj
- Oculoplasty and Orbital Tumor Services, Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
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Budihardja AS, Lutfianto B, Liman NP, Hiesmantjaja H, Wolff KD. Rare Facial Cleft: Surgical Treatment and Middle-Term Follow-up During Charity Operation. Craniomaxillofac Trauma Reconstr 2020; 13:138-142. [PMID: 32642046 DOI: 10.1177/1943387520904210] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
Abstract
Facial cleft is a rare and challenging craniofacial malformation. Treatment of rare facial cleft is complex, and the evaluation of its long-term results is challenging because of the low incidence. In this article, we would like to present middle-term follow-up of 6 patients with facial cleft Tessier number 4, number 5, and number 7 who were treated in our center during charity surgical mission. We will discuss surgical option, difficulties, and complication that may arise in this surgery.
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Affiliation(s)
- Andi Setiawan Budihardja
- Department of Oral and Maxillofacial Surgery, Siloam Hospital Lippo Village, University of Pelita Harapan, Jakarta, Indonesia
| | - Bakhrul Lutfianto
- Department of Oral and Maxillofacial Surgery, Sardjito Hospital, Yogyakarta, Indonesia
| | | | | | - Klaus-Dietrich Wolff
- Department of Oral and Maxillofacial Surgery, Technische Universität, München, Germany
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Introducing A Family With Tens of Rare Craniofacial Clefts. J Craniofac Surg 2019; 30:e395-e397. [PMID: 31299789 DOI: 10.1097/scs.0000000000005269] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Craniofacial clefts are one of the rarest congenital malformations. When it comes to genetic inheritance patterns of craniofacial clefts, there are few studies on this subject due to the rarity and sporadic nature. In this study an extended family whose members have multiple craniofacial clefts has been introduced. METHODS The authors haphazardly found a family whose members have craniofacial clefts, either Tessier no. 0 or both Tessier nos. 0 and 14, and, consequently, they were categorized into 3 groups based on the severity of clefts. RESULTS Forty-two craniofacial clefts were noticed within the family. Twenty-two (52.3%) of patients were females and 20 (47.6%) were males. Twenty-three (54.8%) members had isolated Tessier no. 0 cleft, whereas 19 (45.2%) members had both Tessier nos. 0 and 14. Of all 42 patients, 18 (42.8%), 3 (7.1%), and 21 (50%) patients had severe, intermediate, and mild clefts, respectively. CONCLUSION The present study reveals that in some patients genetic background is likely to be the cause of clefts.
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Hendriks TCC, Botman M, Rahmee CNS, Ket JCF, Mullender MG, Gerretsen B, Nuwass EQ, Marck KW, Winters HAH. Impact of short-term reconstructive surgical missions: a systematic review. BMJ Glob Health 2019; 4:e001176. [PMID: 31139438 PMCID: PMC6509599 DOI: 10.1136/bmjgh-2018-001176] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2018] [Revised: 01/19/2019] [Accepted: 01/25/2019] [Indexed: 01/04/2023] Open
Abstract
Introduction Short-term missions providing patients in low-income countries with reconstructive surgery are often criticised because evidence of their value is lacking. This study aims to assess the effectiveness of short-term reconstructive surgical missions in low-income and middle-income countries. Methods A systematic review was conducted according to PRISMA guidelines. We searched five medical databases from inception up to 2 July 2018. Original studies of short-term reconstructive surgical missions were included, which reported data on patient safety measurements, health gains of individual patients and sustainability. Data were combined to generate overall outcomes, including overall complication rates. Results Of 1662 identified studies, 41 met full inclusion criteria, which included 48 546 patients. The overall study quality according to Oxford CEBM and GRADE was low. Ten studies reported a minimum of 6 months’ follow-up, showing a follow-up rate of 56.0% and a complication rate of 22.3%. Twelve studies that did not report on duration or follow-up rate reported a complication rate of 1.2%. Fifteen out of 20 studies (75%) that reported on follow-up also reported on sustainable characteristics. Conclusions Evidence on the patient outcomes of reconstructive surgical missions is scarce and of limited quality. Higher complication rates were reported in studies which explicitly mentioned the duration and rate of follow-up. Studies with a low follow-up quality might be under-reporting complication rates and overestimating the positive impact of missions. This review indicates that missions should develop towards sustainable partnerships. These partnerships should provide quality aftercare, perform outcome research and build the surgical capacity of local healthcare systems. PROSPERO registration number CRD42018099285.
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Affiliation(s)
- Thom C C Hendriks
- Plastic, Reconstructive and Hand Surgery, VU Medisch Centrum, Amsterdam, The Netherlands.,Global Surgery Amsterdam, Amsterdam, The Netherlands
| | - Matthijs Botman
- Plastic, Reconstructive and Hand Surgery, VU Medisch Centrum, Amsterdam, The Netherlands.,Global Surgery Amsterdam, Amsterdam, The Netherlands
| | - Charissa N S Rahmee
- Plastic, Reconstructive and Hand Surgery, VU Medisch Centrum, Amsterdam, The Netherlands.,Global Surgery Amsterdam, Amsterdam, The Netherlands
| | | | - Margriet G Mullender
- Plastic, Reconstructive and Hand Surgery, VU Medisch Centrum, Amsterdam, The Netherlands
| | | | - Emanuel Q Nuwass
- Department of Surgery, Haydom Lutheran Hospital, Haydom, Tanzania
| | - Klaas W Marck
- Department of Plastic Surgery, Medisch Centrum Leeuwarden, Leeuwarden, The Netherlands
| | - Henri A H Winters
- Plastic, Reconstructive and Hand Surgery, VU Medisch Centrum, Amsterdam, The Netherlands.,Global Surgery Amsterdam, Amsterdam, The Netherlands
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Management of Rare Craniofacial Anomalies With Soft Tissue Reconstruction on Humanitarian Missions. J Craniofac Surg 2018; 29:452-456. [PMID: 29509173 DOI: 10.1097/scs.0000000000004146] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
In poor communities, patients may suffer from health problems requiring special management that cannot be provided locally because of lack of equipment and/or expertise. Children with craniofacial anomalies represent one of these challenging problems. Visiting medical missionary teams have attempted to address these issues for a long time. This article highlights healthcare difficulties in one of the third-world countries with personally based trials for providing free surgeries in tough situation and with hardly available diagnostic and therapeutic facilities. During 15 years, >5000 surgeries were performed in repeated missionary visits. The majority of operations were to correct post-burn complications or to repair cleft lip and/or palate. Of 33 cases of rare craniofacial anomalies, 14 patients were treated with simple soft tissue reconstruction without interference in the underlying bone deformities. This may not be optimal; however, it can give good results even with the limited resources.
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Racz C, Dakpé S, Kadlub N, Testelin S, Devauchelle B, Rachwalski M, Picard A. Phenotypic spectrum of Tessier facial cleft number 5. J Craniomaxillofac Surg 2017; 46:22-27. [PMID: 29239768 DOI: 10.1016/j.jcms.2017.10.012] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2017] [Revised: 09/12/2017] [Accepted: 10/09/2017] [Indexed: 11/26/2022] Open
Abstract
INTRODUCTION Craniofacial clefts belong to the most disfiguring and rare congenital malformations of the face and among these, orbito-facial clefts constitute approximately 0.22 % of the cases with Tessier cleft number 5 being the least common. Our aim was to define the phenotypic spectrum for this subgroup to improve clinical management. METHODS Our study group consisted of four patients which were treated at two different cleft centers. Retrospective chart review and anatomical analysis were conducted for each patient based on clinical evaluation and imaging studies. Morphological anomalies including soft tissue, bone and oral components were recorded. RESULTS Based on our analysis and literature review, we could define two subtypes of Tessier facial cleft number 5. (1) Medial clefts are the more severe subtype, creating a significant soft tissue and bone defect that runs vertically, through the eyelid, infraorbital rim, maxillary sinus and cheek. They have the poorer esthetic and functional prognosis, due to orbital dystopia and absence of lower eyelid. (2) Lateral clefts are a less severe subtype characterized by the presence of a vertical furrow of the cheek running laterally to the maxillary sinus. CONCLUSIONS We identified two subtypes of facial cleft number 5 which require an individualized surgical management.
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Affiliation(s)
- Caroline Racz
- Department of Maxillofacial Surgery, University Hospital Center, Place Victor Pauchet, 80054, Amiens Cedex 1, France; University of Picardie Jules Verne, Pôle santé 3, Rue des Louvels, 80036, Amiens Cedex 1, France.
| | - Stéphanie Dakpé
- Department of Maxillofacial Surgery, University Hospital Center, Place Victor Pauchet, 80054, Amiens Cedex 1, France; Facing Faces Institute, Amiens University Hospital Center, Place Victor Pauchet, 80054, Amiens Cedex 1, France
| | - Natacha Kadlub
- Department of Maxillofacial and Plastic Surgery, National Reference Center for Cleft Lip and Palate, Hôpital Universitaire Necker-Enfants Malades, 149 rue de Sèvres, 75015, Paris, France; University Paris Descartes, 12 rue de l'Ecole de Médecine, 75006 Paris, France
| | - Sylvie Testelin
- Department of Maxillofacial Surgery, University Hospital Center, Place Victor Pauchet, 80054, Amiens Cedex 1, France; University of Picardie Jules Verne, Pôle santé 3, Rue des Louvels, 80036, Amiens Cedex 1, France; Facing Faces Institute, Amiens University Hospital Center, Place Victor Pauchet, 80054, Amiens Cedex 1, France
| | - Bernard Devauchelle
- Department of Maxillofacial Surgery, University Hospital Center, Place Victor Pauchet, 80054, Amiens Cedex 1, France; University of Picardie Jules Verne, Pôle santé 3, Rue des Louvels, 80036, Amiens Cedex 1, France; Facing Faces Institute, Amiens University Hospital Center, Place Victor Pauchet, 80054, Amiens Cedex 1, France
| | - Martin Rachwalski
- Department of Maxillofacial and Plastic Surgery, National Reference Center for Cleft Lip and Palate, Hôpital Universitaire Necker-Enfants Malades, 149 rue de Sèvres, 75015, Paris, France; Department of Pediatric Neurosurgery, National Reference Center for Craniofacial Malformations, Hôpital Universitaire Necker-Enfants Malades, 149 rue de Sèvres, 75015, Paris, France
| | - Arnaud Picard
- Department of Maxillofacial and Plastic Surgery, National Reference Center for Cleft Lip and Palate, Hôpital Universitaire Necker-Enfants Malades, 149 rue de Sèvres, 75015, Paris, France; University Paris Descartes, 12 rue de l'Ecole de Médecine, 75006 Paris, France
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Adeosun OO, Ogah SA. Rare craniofacial cleft in a dark-skinned African population. Niger Med J 2017; 58:21-25. [PMID: 29238124 PMCID: PMC5715562 DOI: 10.4103/0300-1652.218415] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Background: Craniofacial clefts are congenital anomalies which pose a management challenge to cleft surgeons, especially in developing countries. The aim of this study is to share our experience regarding the management of these atypical facial clefts. Patients and Methods: This prospective study was carried out from May 2009 to May 2014 at Federal Medical Centre, Nguru, Nigeria. Diagnosis was based on clinical examination and Tessier classification was used to describe these clefts. Results: A total of seven patients with rare facial clefts were seen. There were four cases of midline clefts, two cases of bilateral clefts, and one case of multiple facial clefts. All cases were surgically treated, except one case of premaxillary agenesis type holoprosencephaly. Conclusion: To achieve an optimal management of patients with rare facial cleft, a well-equipped craniofacial center must be established which is still lacking in low-resource centers
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Affiliation(s)
- O Olalekan Adeosun
- Department of Dental and Maxillofacial Surgery, Federal Medical Centre, Lokoja, Nigeria
| | - Stephen Agbomhekhe Ogah
- Department of Surgery, Ear, Nose and Throat Division, Federal Medical Centre, Lokoja, Nigeria
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9
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An Evaluation of the Value of Plastic Surgery Mission Trips in Resident Education by Attending Physicians. J Craniofac Surg 2015; 26:1091-4. [DOI: 10.1097/scs.0000000000001554] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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Abstract
Short-term medical service trips (MSTs) aim to address unmet health care needs of low- and middle-income countries. The lack of critically reviewed empirical evidence of activities and outcomes is a concern. Developing evidence-based recommendations for health care delivery requires systematic research review. I focused on MST publications with empirical results. Searches in May 2013 identified 67 studies published since 1993, only 6% of the published articles on the topic in the past 20 years. Nearly 80% reported on surgical trips. Although the MST field is growing, its medical literature lags behind, with nearly all of the scholarly publications lacking significant data collection. By incorporating data collection into service trips, groups can validate practices and provide information about areas needing improvement.
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Affiliation(s)
- Kevin J Sykes
- Kevin J. Sykes is with the Department of Health Policy and Management in the School of Medicine at the University of Kansas Medical Center, Kansas City
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Wu D, Wang G, Yang Y, Chen Y, Wan T. Severe bilateral Tessier 3 clefts in a Uighur girl: the significance and surgical repair. J Craniomaxillofac Surg 2013; 41:598-602. [PMID: 23402731 DOI: 10.1016/j.jcms.2012.11.040] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2012] [Revised: 11/16/2012] [Accepted: 11/20/2012] [Indexed: 12/01/2022] Open
Abstract
The Tessier 3 cleft is one of the rarest congenital craniofacial clefts, which often extends through the upper lip, the alar groove and the medial canthus. Only a few cases have been reported. There is no standardized method for the surgical treatment for this condition in the literature, and to obtain an acceptable outcome is difficult. A Uighur girl with severe bilateral Tessier 3 clefts and associated orofacial deformities is described here, and a novel protocol for clefts of this severity and rarity is presented. This study focuses particularly on describing the surgical procedures and techniques. Further treatments required for the cleft-associated deformities during later growth and developmental stages are also discussed in detail.
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Affiliation(s)
- Dandan Wu
- Center for Cleft Lip and Palate, Department of Oral & Cranio-Maxillofacial Science, Ninth People's Hospital, Shanghai Jiao Tong University, School of Medicine, PR China; Shanghai Key Laboratory of Stomatology, Shanghai 200011, PR China
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Bilateral Tessier number 5 facial cleft with limb constriction ring: The first case report with an update of literature review. JOURNAL OF ORAL AND MAXILLOFACIAL SURGERY, MEDICINE, AND PATHOLOGY 2013. [DOI: 10.1016/j.ajoms.2011.12.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
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13
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Hachach-Haram N, Benyon SL, Eccles SJ, Kirkpatrick WNA, Kelly M, Waterhouse N. Facing the World: audit of activity 2002-2010. J Plast Reconstr Aesthet Surg 2012; 65:1312-24. [PMID: 22704823 DOI: 10.1016/j.bjps.2012.04.029] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2011] [Revised: 02/21/2012] [Accepted: 04/26/2012] [Indexed: 11/17/2022]
Abstract
BACKGROUND Craniofacial anomalies, although uncommon, can have considerable effects on the individual, their family and society.(1-4) They carry with them a large morbidity and require a highly specialized, multidisciplinary approach to treatment.(5) Facing the World (FTW), was founded in 2002, to offer facial reconstructive surgery to children with complex, craniofacial anomalies with no prospect of local treatment, from developing countries anywhere in the world. METHODS We present an 8-year audit of the cases treated by FTW, where children are brought from their own countries to the UK for treatment. Patient selection takes place prior to their arrival in the UK by a multidisciplinary team. Specifically the condition has to be correctable to a degree that justifies the risks involved with the surgery, and the disruption to the child and their family. RESULTS Since inception, FTW has evaluated more than 300 cases and provided treatment in the UK for over 24 cases from 18 different countries. We present our range of cases and complications. We discuss our complication rate of 28% and mortality rate of 4% (1 case). CONCLUSIONS Key to the sustainability of FTW is the development of local healthcare infrastructure within the developing countries to facilitate eventual local management of the more straightforward cases and follow up of these patients by well-trained medical staff. By establishing these programs, FTW aims to not only change these children's lives but to raise awareness, and help to expand the global craniofacial network whereby in the future, satellite partners will be present to help manage these conditions locally. LEVEL OF EVIDENCE III.
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Sesenna E, Anghinoni ML, Modugno AC, Magri AS. Tessier 3 cleft with bilateral anophthalmia: case report and surgical treatment. J Craniomaxillofac Surg 2012; 40:690-3. [PMID: 22266226 DOI: 10.1016/j.jcms.2011.12.007] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2011] [Revised: 12/22/2011] [Accepted: 12/22/2011] [Indexed: 11/17/2022] Open
Abstract
Tessier clefts type 3 and 4 are rare. In this paper the authors report on the management of a wide Tessier 3 cleft. There is no standardized protocol or timing of the surgical procedures in this rare disfiguring condition. Generally speaking, the aim is to preserve the function of important anatomical structures (e.g., a seeing eye.) and reconstruct, as best as possible, harmonic facial features. The authors present a "step by step" solution of the malformation pointing out the limitations of the surgical procedures they used and the goals they wanted to obtain. Despite of the uniqueness and the complexity of the pathology, the authors think they obtained reasonable results both in term of function and aesthetics, permitting the patient to be accepted in the social environment.
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Affiliation(s)
- Enrico Sesenna
- Maxillo-Facial Surgery Division, Head and Neck Department, University and Hospital of Parma, Parma, Italy
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Mishra RK, Purwar R. Formatting the surgical management of Tessier cleft types 3 and 4. Indian J Plast Surg 2011; 42 Suppl:S174-83. [PMID: 19884673 PMCID: PMC2825067 DOI: 10.4103/0970-0358.57192] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Tessier cleft types 3 and 4 are rare entities even among what are considered other rare craniofacial clefts. Very few cases have been reported worldwide, especially in the bilateral form. In the absence of any well-laid guidelines for management of such rare cases, plastic surgeons operate on such cases due to the inherent complexities in technique. To overcome this problem and provide a ground rule for surgical management of such cases, we propose an easier format with a ‘split approach’ of the affected areas. In our proposed formatting, we have divided the affected areas of the cleft into three components: 1. Lid component; 2. Lip component; and 3. Nasomalar component. Any person skilled in the plastic surgical art would appreciate that individual management of the aforesaid demarcated areas is easy as compared to the surgery of the entire craniofacial cleft, that too with the contemporary approach. We have evaluated this formatting technique with a ‘split approach’ in seven cases and found the results more convincing compared to those of classical methods. We invite the surgical fraternity to validate the surgical formatting in their settings and provide us with feedback on the same to consolidate these results.
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Affiliation(s)
- R K Mishra
- Plastic Surgery Unit, Sushrut Institute of Plastic Surgery, 29, Shahmeena Road, Lucknow-3, U.P, India
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16
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van den Elzen MEP, Versnel SL, Wolvius EB, van Veelen MLC, Vaandrager JM, van der Meulen JC, Mathijssen IMJ. Long-term results after 40 years experience with treatment of rare facial clefts: Part 2--Symmetrical median clefts. J Plast Reconstr Aesthet Surg 2011; 64:1344-52. [PMID: 21616735 DOI: 10.1016/j.bjps.2011.04.023] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2011] [Revised: 04/19/2011] [Accepted: 04/22/2011] [Indexed: 11/17/2022]
Abstract
BACKGROUND Median facial clefts are reconstructive challenges, requiring multiple operations throughout life. Long-term results are often still far from ideal and could be improved. Due to surgical intervention and diminished intrinsic growth potential, surgical results may change from initially good into a progressively disappointing outcome. If, however, the ideal timing and type of surgery are known, in combination with the intrinsic growth potential, the results can be ameliorated. A guideline for surgical treatment is given. METHODS Twenty patients with a pure symmetrical median cleft were evaluated on intermediate and long-term surgical results. The final result was scored based on severity of the initial and the remaining facial deformities, and the need for revisional surgery. RESULTS The long-term surgical outcome was initially good for each of the affected facial parts and the face in general, but worsened over time, especially in the zone of the nose. An adequate and stable result of hypertelorism correction was observed for both the orbital box osteotomy and medial faciotomy, even when performed at a young age. CONCLUSIONS The intrinsic growth restriction is mainly localised in the central midface. This leads to a complex and often unpredictable growth of the maturing face. It makes it difficult to achieve perfect reconstructions. Caution with surgical interventions of the nose at a young age is required. Once the face has matured, a midface advancement and secondary nose correction should be considered for satisfactory projection. Early referral to a specialised centre is essential.
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Affiliation(s)
- Marijke E P van den Elzen
- Department of Plastic and Reconstructive Surgery, Erasmus Medical Centre, Rotterdam, The Netherlands.
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Abstract
PURPOSE To describe a patient with Tessier cleft number 5 and 9 and review the literature on the ocular impairment and management of this extremely rare anomaly. METHODS Interventional case report and literature review. RESULTS The literature review showed that the present patient is the second case with clefts 5/9. The ophthalmic consequences of this rare association are virtually unreported. Our case demonstrates that the presence of cleft number 9 adds a cicatricial component on the upper eyelid that severely impairs the dynamics of this lid. The corneal status of the patient was successfully managed with simultaneous upper eyelid lengthening and facial reconstruction. CONCLUSION In order to avoid corneal perforation, simultaneous upper and lower eyelid reconstruction is mandatory in cases of cleft 5/9. The affected patients should be continuously followed in order to prevent amblyopia.
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Abstract
Bifid nose is a rare congenital anomaly and is also called double or cleft nose. The mode of appearance varies: from a simple groove at the nasal apex to a maxillary cleft. Neither surgical procedures nor the best time of surgery has been established. In this study, we performed dermal graft using an open approach via the nasal dorsum in patients with bifid nose and obtained good results. In the operation, a surplus skin of the nasal dorsum was resected through the nasal dorsum as a spindle graft and stored. The resected skin was denuded and the dermal graft applied on the nasal apex. For external nose plasty, it remains controversial which of 2 procedures, open or closed approach, should be selected. We have used the open approach to obtain a good surgical field. Nasal cartilage displacement could be confirmed under direct vision, facilitating cartilage correction. Furthermore, we could use the surplus skin component that is routinely abandoned and achieve a favorable nasal apex shape without adding supplemental invasiveness.
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