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Civantos AM, Shakya P, Shaye DA. Atypical facial clefts: Tessier number 3 and 4 clefts. Curr Opin Otolaryngol Head Neck Surg 2024; 32:248-256. [PMID: 38900216 PMCID: PMC11338038 DOI: 10.1097/moo.0000000000000985] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/21/2024]
Abstract
PURPOSE OF REVIEW Tessier number 3 and 4 clefts result from failed fusion of facial processes during embryogenesis, and cause functional, psychosocial, and cosmetic morbidity. Given their rarity and heterogeneity, they present a unique challenge to the reconstructive surgeon, with limited literature for guidance. The purpose of this update is to summarize Tessier number 3 and 4 clefts with a focus on recent literature and expert opinion. RECENT FINDINGS The incidence of atypical facial clefts has been estimated between 1.4 and 4.9 per 100 000 live births. Several retrospective chart reviews have been published in recent years; however, the epidemiologic data remains limited. Surgical management must be individualized and guided by classic reconstructive principles. The goal of surgery is to return the three soft tissue components (lip, nasomalar, and eyelid) to their proper anatomical location. SUMMARY Tessier number 3 and 4 clefts are rare, demonstrate a wide spectrum of clinical presentation, and remain challenging to gain a breadth of experience for any single surgeon. They are classified based on their location along well defined anatomical axes. Component repair is performed with attention to the lip, nasomalar, and eyelid regions to restore facial symmetry and function.
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Affiliation(s)
- Alyssa M. Civantos
- Department of Otolaryngology-Head and Neck Surgery, University of California-San Francisco, San Francisco, California, USA
| | - Pramila Shakya
- Department of Burns, Plastic and Reconstructive Surgery, Kirtipur Hospital, Nepal
| | - David A. Shaye
- Department of Otolaryngology-Head & Neck Surgery, Massachusetts Eye & Ear, Harvard Medical School, Boston, Massachusetts, USA
- Department of Surgery, University Teaching Hospital Kigali, College of Medicine & Health Sciences, University of Rwanda, Kigali, Rwanda
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Borg TM, Solomon S, Alfarrouh R, Barazi W, Abu Sittah G, Sommerlad B, Ghanem A. Simulation Training Approach for Cleft Lip and Palate Repair in Low-Income Countries. Cleft Palate Craniofac J 2024; 61:706-711. [PMID: 36330704 DOI: 10.1177/10556656221136650] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/17/2024] Open
Abstract
BACKGROUND During periods of civil strife, the need for trauma care and lack of sufficient cleft surgeons causes an increase in children left untreated with cleft lip and palate deformities. During the Syrian war, some cleft care was provided through visiting charities, with surgeries performed both in Syria and neighboring countries. There is a need to increase the number of adequately trained cleft surgeons available in such regions so that care can be achieved beyond mission trips. METHODOLOGY Cleft lip and palate repair workshops were delivered to 50 doctors in Syria. Pre-workshop, trainees received supplementary learning material. During the workshop, attendees received didactic teaching followed by 2 simulation sessions. Pre- and post-workshop, attendees completed questionnaires regarding their confidence and ability to perform cleft lip and palate repair. RESULTS Pre-workshop, 96% of workshop attendees had never independently performed cleft lip repair while 100% of attendees had not previously performed cleft palate repair. The mean pre-workshop confidence score was 2.452. Post-workshop, the mean confidence score was 3.503. Confidence rating scores significantly improved (P < .001). CONCLUSION The workshop delivered in Syria, together with this cleft lip and palate simulator provides an effective training tool that may support surgical training globally, particularly those in low-income countries. Further support is needed by charity organizations to ensure the continued delivery of such training.
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Affiliation(s)
- Tiffanie-Marie Borg
- Department of Plastic and Reconstructive Surgery, James Cook University Hospital, Middlesbrough, UK
- Academic Plastic Surgery Group, Barts and the London School (QMUL), London, UK
| | - Sara Solomon
- Department of Surgery, Queen's Hospital, Romford, London, UK
| | - Rik Alfarrouh
- Academic Plastic Surgery Group, Barts and the London School (QMUL), London, UK
| | - Wael Barazi
- Academic Plastic Surgery Group, Barts and the London School (QMUL), London, UK
| | - Ghassan Abu Sittah
- Academic Plastic Surgery Group, Barts and the London School (QMUL), London, UK
| | | | - Ali Ghanem
- Academic Plastic Surgery Group, Barts and the London School (QMUL), London, UK
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Philipp K, Anja Q, Boris S, Johanna K, Susanne W, Adam S, Philipp MM, Henning S. Epidemiological and clinical evaluation of patients with a cleft in lower saxony Germany: a mono-center analysis. Clin Oral Investig 2023; 27:5661-5670. [PMID: 37542681 PMCID: PMC10492882 DOI: 10.1007/s00784-023-05187-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Accepted: 07/28/2023] [Indexed: 08/07/2023]
Abstract
OBJECTIVE The aim was to provide epidemiological and clinical data on patients with orofacial clefts in Lower Saxony in Germany. MATERIALS AND METHODS The records of 404 patients with orofacial clefts treated surgically at the University Medical Center Goettingen from 2001 to 2019 were analyzed in this retrospective study. Prevalence of orofacial clefts in general, orofacial clefts as manifestation of a syndrome, sex distribution, and prevalence of different cleft types was evaluated and associated with the need for corrective surgery, family history, pregnancy complications, and comorbidities. RESULTS The prevalence of orofacial clefts for Goettingen in Lower Saxony was 1:890. 231 patients were male and 173 were female. CLP was most common (39.1%) followed by CP (34.7%), CL (14.4%), CLA (9.9%), and facial clefts (2%). The left side was more frequently affected and unilateral cleft forms occurred more often than bilateral ones. Almost 10% of the population displayed syndromic CL/P. 10.9% of all patients had a positive family history regarding CL/P, predominantly from the maternal side. Pregnancy abnormalities were found in 11.4%, most often in the form of preterm birth. Comorbidities, especially of the cardiovascular system, were found in 30.2% of the sample. 2.2% of patients treated according to the University Medical Center Goettingen protocol corrective surgery was performed in form of a velopharyngoplasty or residual hole closure. CONCLUSIONS The epidemiological and clinical profile of the study population resembled the expected distributions in Western populations. The large number of syndromic CL/P and associated comorbidities supports the need for specialized cleft centers and interdisciplinary cleft care.
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Affiliation(s)
- Kauffmann Philipp
- Department of Oral and Maxillofacial Surgery, University Medical Center Göttingen, Georg-August-University Göttingen, Robert-Koch-Straße 40, D-37099, Göttingen, Germany.
| | - Quast Anja
- Department of Orthodontics, University Medical Center Göttingen, Göttingen, Germany
| | - Schminke Boris
- Department of Oral and Maxillofacial Surgery, University Medical Center Göttingen, Georg-August-University Göttingen, Robert-Koch-Straße 40, D-37099, Göttingen, Germany
| | - Kolle Johanna
- Department of Oral and Maxillofacial Surgery, University Medical Center Göttingen, Georg-August-University Göttingen, Robert-Koch-Straße 40, D-37099, Göttingen, Germany
| | - Wolfer Susanne
- Department of Oral and Maxillofacial Surgery, University Medical Center Göttingen, Georg-August-University Göttingen, Robert-Koch-Straße 40, D-37099, Göttingen, Germany
| | - Stepniewski Adam
- Trauma Surgery, Orthopedics and Plastic Surgery, University Medical Center of Göttingen, Göttingen, Germany
| | | | - Schliephake Henning
- Department of Oral and Maxillofacial Surgery, University Medical Center Göttingen, Georg-August-University Göttingen, Robert-Koch-Straße 40, D-37099, Göttingen, Germany
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Jorge PK, Ambrosio ECP, Mello-Peixoto YCT, Carrara CFC, Soares S, Almeida ALPFD, Machado MAAM, Oliveira TM. Current Perspectives on Cleft Lip and Palate and Children's Health. CHILDREN (BASEL, SWITZERLAND) 2023; 10:children10050857. [PMID: 37238405 DOI: 10.3390/children10050857] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Accepted: 05/06/2023] [Indexed: 05/28/2023]
Abstract
Orofacial clefts are the most prevalent craniofacial congenital anomalies, affecting the lip, with or without involvement of the palate, or solely the palate [...].
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Affiliation(s)
- Paula Karine Jorge
- Hospital for Rehabilitation of Craniofacial Anomalies, University of São Paulo, Rua Silvio Marchione 3-20, Bauru 17012-900, Brazil
| | - Eloá Cristina Passucci Ambrosio
- Hospital for Rehabilitation of Craniofacial Anomalies, University of São Paulo, Rua Silvio Marchione 3-20, Bauru 17012-900, Brazil
| | - Yana Cosendey Toledo Mello-Peixoto
- Department of Pediatric Dentistry, Orthodontics and Public Health, Bauru School of Dentistry, University of São Paulo, Alameda Dr. Octávio Pinheiro Brisolla 9-75, Bauru 17012-901, Brazil
| | - Cleide Felício Carvalho Carrara
- Hospital for Rehabilitation of Craniofacial Anomalies, University of São Paulo, Rua Silvio Marchione 3-20, Bauru 17012-900, Brazil
| | - Simone Soares
- Hospital for Rehabilitation of Craniofacial Anomalies, University of São Paulo, Rua Silvio Marchione 3-20, Bauru 17012-900, Brazil
- Department of Prosthodontics and Periodontology, Bauru School of Dentistry, University of São Paulo, Alameda Dr. Octávio Pinheiro Brisolla 9-75, Bauru 17012-901, Brazil
| | - Ana Lucia Pompeia Fraga de Almeida
- Hospital for Rehabilitation of Craniofacial Anomalies, University of São Paulo, Rua Silvio Marchione 3-20, Bauru 17012-900, Brazil
- Department of Prosthodontics and Periodontology, Bauru School of Dentistry, University of São Paulo, Alameda Dr. Octávio Pinheiro Brisolla 9-75, Bauru 17012-901, Brazil
| | - Maria Aparecida Andrade Moreira Machado
- Department of Pediatric Dentistry, Orthodontics and Public Health, Bauru School of Dentistry, University of São Paulo, Alameda Dr. Octávio Pinheiro Brisolla 9-75, Bauru 17012-901, Brazil
| | - Thais Marchini Oliveira
- Hospital for Rehabilitation of Craniofacial Anomalies, University of São Paulo, Rua Silvio Marchione 3-20, Bauru 17012-900, Brazil
- Department of Pediatric Dentistry, Orthodontics and Public Health, Bauru School of Dentistry, University of São Paulo, Alameda Dr. Octávio Pinheiro Brisolla 9-75, Bauru 17012-901, Brazil
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