1
|
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 DOI: 10.1097/moo.0000000000000985] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [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.
Collapse
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
| |
Collapse
|
2
|
Agarwal A, Ali MJ, Bothra N. Post-traumatic canalicular fistula: description and review of literature - SALDO update study (SUP) - paper II. Orbit 2024; 43:85-89. [PMID: 37191177 DOI: 10.1080/01676830.2023.2207201] [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] [Received: 03/21/2023] [Accepted: 04/22/2023] [Indexed: 05/17/2023]
Abstract
PURPOSE To discuss the clinical spectrum and management strategies in patients with post-traumatic canalicular fistula (PTCF). METHODS Retrospective, interventional case series of consecutive patients diagnosed with PTCF over a 6-year study period between June 2016 and June 2022. The demographics, mode of injury, location, and communication of the canalicular fistula were noted. The outcomes of several management modalities including dacryocystorhinostomy, lacrimal gland therapies, and conservative approaches were assessed. RESULTS Eleven cases with PTCF over the study period were included. The mean age at presentation was 23.5 years (range: 6-71 years), with male: female ratio of 8:3. The median time interval between trauma to presentation at the Dacryology clinic was 3 years (range: 1 week to 12 years). Seven had iatrogenic trauma and four had the canalicular fistula following primary trauma. Management modalities pursued include conservative approach for minimal symptoms, and dacryocystorhinostomy, dacryocystectomy, and lacrimal gland botulinum toxin injection. The mean follow-up period was 30 months (range: 3-months-6 years). CONCLUSION PTCF is a complex lacrimal condition and the management of the PTCF needs a tailored approach guided by its nature and location and patient symptomatology.
Collapse
Affiliation(s)
- Ayushi Agarwal
- Govindram Seksaria Institute of Dacryology, Ophthalmic Plastic Surgery Services, L.V. Prasad Eye Institute, Hyderabad, India
| | - Mohammad Javed Ali
- Govindram Seksaria Institute of Dacryology, Ophthalmic Plastic Surgery Services, L.V. Prasad Eye Institute, Hyderabad, India
| | - Nandini Bothra
- Govindram Seksaria Institute of Dacryology, Ophthalmic Plastic Surgery Services, L.V. Prasad Eye Institute, Hyderabad, India
| |
Collapse
|
3
|
The Anatomical Subunit Approach to Managing Tessier Numbers 3 and 4 Craniofacial Clefts. Plast Reconstr Surg Glob Open 2022; 10:e4553. [PMID: 36187274 PMCID: PMC9521789 DOI: 10.1097/gox.0000000000004553] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2022] [Accepted: 08/03/2022] [Indexed: 11/26/2022]
Abstract
Patients with atypical facial clefts are rare, and there is a paucity of literature outlining the surgical approach to managing these patients. The anatomical subunit approach to the surgical correction of the cleft lip has revolutionized cleft care. Here, we outline our approach and operative technique to treating Tessier clefts 3 and 4 using a novel technique based on the anatomical subunit approach. Methods All cases of Tessier facial clefts 3 and 4 between 2019 and 2021 from the senior author's practice were reviewed retrospectively. Patient demographics, clinical presentation, procedure details, and complications are reported. The senior author's technique is described in detail. Results Five patients underwent treatment by the senior author during the study period. One patient had bilateral Tessier 4 clefts, one patient had bilateral Tessier 3 clefts, two patients had a unilateral Tessier 4 cleft, and one patient had a unilateral Tessier 3 cleft. Two of the patients had their clefts treated as secondary procedures. The surgical complication profile was a lost nasal stent in one patient. Treatment principles of the senior author's technique are presented. Conclusions The anatomical subunit approach to managing atypical facial clefts provides a structured approach to a complex problem for the cleft and craniofacial surgeon. The technique of repair presented here can assist surgeons attempting to treat patients with Tessier 3 and 4 clefts.
Collapse
|
4
|
Tonello C, Martins DANDP, Baptista MAFDB, Mondelli F, Kokitsu Nakata NM, Feitosa LB, Alonso N. Tessier 3 and 4 Clefts and Choanal Atresia: An Unusual Association? Cleft Palate Craniofac J 2021; 59:1228-1232. [PMID: 34514882 DOI: 10.1177/10556656211042172] [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: 11/16/2022] Open
Abstract
INTRODUCTION Craniofacial clefts are rare congenital anomalies that might involve both soft tissue and skeletal components. The association of Tessier cleft number 3 and 4 with choanal atresia appears to be unusual and only few clinical cases have been reported in published literature. OBJECTIVES Report a series of 13 cases of choanal atresia in patients with Tessier numbers 3 or 4 clefts and the literature review on this topic. METHODS A literature review was undertaken via PUBMED database before April 2020 addressing the association between Tessier numbers 3 or 4 clefts and choanal atresia. Retrospective chart review of patients diagnosed with both comorbidities at a tertiary hospital expertised in craniofacial anomalies. RESULTS Literature review yielded 10 studies describing the relationship between choanal atresia and Tessier 3 and 4 facial clefts. We identified 98 patients diagnosed with medial oro-ocular facial clefts (Tessier 3 and 4) and 119 with choanal atresia at our institution over a 20 years time period. Altogether, 13 individuals were diagnosed with both malformations, 3 patients with number 3 cleft, and 10 patients with number 4 cleft. It represents 13.26% of the cases. CONCLUSION This study highlights the features of Tessier 3 and 4 facial clefts associated with choanal atresia. Although the publications regarding this association are very scarce, the authors present the largest series of cases of Tessier number 3 and 4 clefts with choanal atresia showing that association between these conditions could be not so unusual.
Collapse
|
5
|
Omodan A, Pillay P, Lazarus L, Satyapal K, Madaree A. Tessier Number 3 and 4 Clefts: Clinical Presentation and Associated Clefts in a South African Population. Cleft Palate Craniofac J 2021; 59:1299-1305. [PMID: 34414809 DOI: 10.1177/10556656211036306] [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: 11/15/2022] Open
Abstract
INTRODUCTION The defects found in Tessier clefts number 3 and number 4 come in various forms in different patients. These variations have to a great extent affected not only documentation of these craniofacial defects but invariably their treatment and communication amongst craniofacial researchers. This study has not only documented the clinical presentation of these clefts in a South African population but has also incorporated the clinical presentation of Tessier clefts number 3 and 4 from different regions of the world. METHODS The records of 8 patients, who had been treated for either Tessier clefts number 3 or 4, were reviewed and compared with 16 studies pulled from the literature systematically. The defects recorded as well as associated clefts and other congenital malformations were documented, and findings were compared. RESULTS The anatomical and clinical presentation of the patients was compared to the reviewed literature and the different parameters were documented. In addition, associated clefts were also recorded in the study-it was noted that the association pattern recorded in Tessier cleft number 4 in this study did not conform to its traditional counterpart. CONCLUSION This study concluded that the clinical presentations of these clefts, however variable, seem to have a similar presentation worldwide. Additionally, associated clefts do not conform to the original Tessier classification system and therefore it is imperative for these patterns to be clearly mapped out.
Collapse
Affiliation(s)
- Abiola Omodan
- Department of Clinical Anatomy, School of Laboratory Medicine and Medical Sciences, 72753University of KwaZulu-Natal, Durban, South Africa
| | - Pamela Pillay
- Department of Clinical Anatomy, School of Laboratory Medicine and Medical Sciences, 72753University of KwaZulu-Natal, Durban, South Africa
| | - Lelika Lazarus
- Department of Clinical Anatomy, School of Laboratory Medicine and Medical Sciences, 72753University of KwaZulu-Natal, Durban, South Africa
| | - Kapil Satyapal
- Department of Clinical Anatomy, School of Laboratory Medicine and Medical Sciences, 72753University of KwaZulu-Natal, Durban, South Africa
| | - Anil Madaree
- Department of Plastic and Reconstructive Surgery, University of KwaZulu- Natal, Durban, South Africa
| |
Collapse
|
6
|
Tonello C, Paula RG, Paula IP, Nunes RB, Kokitsu-Nakata NM, Alonso N. Eyeball Preservation With Purse-String Conjunctival Closure for Melting Corneal Ulcer in Rare Facial Cleft. Cleft Palate Craniofac J 2020; 58:1195-1200. [PMID: 33349028 DOI: 10.1177/1055665620980632] [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: 11/15/2022] Open
Abstract
Rare facial clefts are characterized by facial involvement that is not restricted to the lip, palate, and alveolus as in traditional cleft lip and palate. The craniofacial skeleton and the orbital structures are frequently affected in these conditions. Exposure of the eyeball, when not early treated, puts the function and the preservation of the eye at risk. We report the case of a 2-month-old boy admitted to our service with an extensive oral-ocular cleft and exposure of the eyeball with melting corneal ulcer treated with a conjunctival closure with a purse-string suture.
Collapse
Affiliation(s)
- Cristiano Tonello
- Hospital for Rehabilitation of Craniofacial Anomalies, University of São Paulo, São Paulo, Brazil
| | - Raul G Paula
- Hospital for Rehabilitation of Craniofacial Anomalies, University of São Paulo, São Paulo, Brazil
| | - Isabella P Paula
- Hospital for Rehabilitation of Craniofacial Anomalies, University of São Paulo, São Paulo, Brazil
| | - Rodrigo B Nunes
- Hospital for Rehabilitation of Craniofacial Anomalies, University of São Paulo, São Paulo, Brazil
| | - Nancy M Kokitsu-Nakata
- Hospital for Rehabilitation of Craniofacial Anomalies, University of São Paulo, São Paulo, Brazil
| | - Nivaldo Alonso
- Hospital for Rehabilitation of Craniofacial Anomalies and Hospital of Clinics of Medicine Faculty, University of São Paulo, São Paulo, Brazil
| |
Collapse
|
7
|
Omodan A, Pillay P, Lazarus L, Madaree A, Satyapal K. Scoping review of the morphology and anthropometry of Tessier craniofacial clefts numbers 3 and 4. Syst Rev 2019; 8:42. [PMID: 30717789 PMCID: PMC6360760 DOI: 10.1186/s13643-019-0951-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2018] [Accepted: 01/14/2019] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND In 2016, WHO reported a death rate of 303,000 newborns before 4 weeks of age due to congenital anomalies. Those that survive congenital anomalies may have long-term disabilities which may have significant impacts on the individual, their families, the healthcare system, and societies. Tessier craniofacial clefts numbers 3 and 4 are congenital anomalies that result in a partial or total defect of craniofacial tissues thereby seriously influencing the patient's appearance and impair normal functioning. Therefore, understanding these defects is paramount to relieving the burden caused by this disability. The objective of this review was to examine the literature on the understanding of the knowledge of morphology and anthropometry of Tessier craniofacial clefts numbers 3 and 4 so that areas yet to be fully understood by research can be mapped out for future research. METHODS AND ANALYSIS A scoping review for literature on patients who have Tessier craniofacial clefts numbers 3 and 4 was conducted. Relevant studies from 1976 to the present were identified. The following databases were searched for peer-reviewed literature viz., PubMed, MEDLINE, EBSCOhost, Google Scholar, and the Cochrane library. The study selection was guided by the eligibility criteria. A data table was designed to extract information from the literature. The result of this study was reported using the Preferred Reporting Items for Systematic reviews and Meta-analyses (PRISMA). The quality of the included studies was assessed using the Mixed Method Appraisal Tool (MMAT). RESULT Thirty-three studies met the inclusion criteria. The majority of the studies included were conducted in middle-income countries (54.5%) and some in high-income countries (45.5%); none was recorded from low-income countries. The total available sample size from the studies was 120 with a dominant male population of 67 (55.8%) and female 53 (44.2%). The majority (97%) of the studies reported on the knowledge of morphology while 12.1% of the included studies reported on anthropometry. Of the 33 included studies, 32 scored the highest quality (76-100%) from the quality assessment. DISCUSSION The findings from this review show evidence of the knowledge of morphology and the knowledge of anthropometry of Tessier craniofacial clefts numbers 3 and 4. However, these knowledges have not translated to universally recognized ways of repairing and documenting these clefts due to the sparse amount of studies on Tessier craniofacial clefts numbers 3 and 4.
Collapse
Affiliation(s)
- Abiola Omodan
- Department of Clinical Anatomy, School of Laboratory Medicine and Medical Sciences, University of KwaZulu-Natal, Durban, South Africa
| | - Pamela Pillay
- Department of Clinical Anatomy, School of Laboratory Medicine and Medical Sciences, University of KwaZulu-Natal, Durban, South Africa
| | - Lelika Lazarus
- Department of Clinical Anatomy, School of Laboratory Medicine and Medical Sciences, University of KwaZulu-Natal, Durban, South Africa
| | - Anil Madaree
- Department of Plastic and Reconstructive Surgery, University of KwaZulu-Natal, Durban, South Africa
| | - Kapil Satyapal
- Department of Clinical Anatomy, School of Laboratory Medicine and Medical Sciences, University of KwaZulu-Natal, Durban, South Africa
| |
Collapse
|
8
|
The Arkansas Tessier Number 3 Cleft Experience: Soft Tissue and Skeletal Findings With Primary Surgical Management: Four-Step Approach. J Craniofac Surg 2018; 29:1834-1841. [PMID: 29877978 DOI: 10.1097/scs.0000000000004634] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Tessier No 3 facial cleft (oro-nasal-ocular clefts) is the rarest and most challenging of all the Tessier clefts. Reports on Tessier No 3 clinical findings, surgical techniques, and outcomes are varied due to the scarcity of patients and the wide range of phenotypic findings. The authors present our experience of 2 children born with Tessier No 3 clefts who were both managed at the Arkansas Children's Hospital. Our purpose is to add knowledge on this rare craniofacial cleft by providing detailed soft tissue findings, skeletal findings, operative techniques, early postoperative outcome, and suggestions of a treatment protocol.Both were born at 38 weeks gestation and had multiple associated anomalies including: syndactyly, limb anomalies, cardiac defects, and encephalocele in Patient 1 and hydrocephalus and dysphagia in Patient 2. While both patients had a bilateral cleft lip and palate, Patient 1 had a severe left-sided cleft and Patient 2 had a right-sided incomplete cleft. A multidisciplinary team of specialists in Plastic Surgery, Otolaryngology, and Oculoplastics were assembled to devise a top-down approach for repair. In brief, our surgical sequence for both infants was a dorsal nasal Reiger flap to level the ala, cheek advancement flap along with medial canthal repositioning, and more traditional bilateral cleft lip repair using a modified Millard technique. Postoperatively, Patient 1 experienced some early scarring, medial canthal rounding, lagophthalmos, and cicatricial retraction of the lower lid and patient 2 demonstrated under-correction of the displaced ala but had satisfactory medial canthal position.Future evaluations will include serial photography and annual 3-dimensional computed tomography scans to evaluate the soft tissue and bony growth. After these initial procedures, both infants will be followed for routine cleft clinical and surgical care.
Collapse
|
9
|
Anthropometrically-Based Surgical Technique for Tessier 3 Cleft Reconstruction. J Craniofac Surg 2018; 27:e785-e787. [PMID: 28005824 DOI: 10.1097/scs.0000000000003129] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Craniofacial clefts are rare entities, with an incidence reported as 1.43 to 4.85 per 100,000 births. The Tessier number 3 cleft, the most medial of the oblique clefts, can manifest as clefting of the lip between the canine and lateral incisors, colobomas of the nasal ala and lower eyelid, and inferior displacement of the medial canthus-frequently disrupting the lacrimal system with extreme variability in expressivity (Eppley).Literature on cleft lip repair is extensive and has evolved to incorporate anthropometric techniques, based on identifiable landmarks and anthropometric measurements that are compared with contralateral unaffected anatomy or population means and tracked over time to assess impact on growth. Recent focus has been placed on "subunit" repair that repairs "like with like." These approaches have resulted in a remarkable reproducibility of methods and outcomes.Facial cleft surgery publications are sparse due to the rarity of the disorders, and consensus has yet to develop on standardized landmarks, reference measurements, and principles of repair. The authors describe a method of correcting incomplete unilateral Tessier 3 cleft based on the principles described above. Intraoperative photographs, including secondary revisions, as well as immediate and long-term postoperative results are presented.
Collapse
|
10
|
Aleman RM, Martinez MG. Tessier 3 Cleft in a Pre-Hispanic Anthropomorphic Figurine in El Salvador, Central America. Cleft Palate Craniofac J 2017; 54:227-230. [DOI: 10.1597/15-260] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
In 1976, Paul Tessier provided a numerical classification system for rare facial clefts, numbered from 0 to 14. The Tessier 3 cleft is a rare facial cleft extending from the philtrum of the upper lip through the wing of the nostril, and reaches the medial canthus of the eye. The aim of this document was to describe a pre-Hispanic anthropomorphic figurine dating from the classic period (200 A.D.–900 A.D.), which has a Tessier 3 cleft. We also discuss the documented pre-Hispanic beliefs about facial clefts.
Collapse
Affiliation(s)
- Ramon Manuel Aleman
- Department of Maxillofacial Surgery, Evangelical University of El Salvador, Staff of Department of Maxillofacial Surgery, Dr. Juan Jose Fernandez National Hospital of El Salvador, and Chief of Clinica Aleman, Cleft Lip and Palate Center, San Salvador, El Salvador
| | | |
Collapse
|
11
|
|
12
|
Frontal Encephalocele Associated With a Bilateral Tessier Number Three Cleft and Fraser Syndrome. J Craniofac Surg 2015; 26:1947-50. [DOI: 10.1097/scs.0000000000001986] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
|
13
|
Esenlik E, Aydın MA, Spolyar JL. Serial Presurgical Orthopedics for Eye Repositioning and Optimization of Soft-Tissue Repair in an Infant With Tessier No. 4 Cleft. Cleft Palate Craniofac J 2015; 53:481-90. [PMID: 26120884 DOI: 10.1597/15-031] [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: 11/22/2022] Open
Abstract
OBJECTIVE A male patient with Tessier No. 4 cleft (unilateral left) presented at 20 days of age. The cleft defect beginning between the cupid bow and oral commissure extended to the ipsilateral orbital floor, skirting the nose and lacrimal duct while passing through the cheek medial to the infraorbital nerve. With the lesser segment disposed 16 mm transversely, the wide gap included an absence of orbital floor and lower eyelid. A deficient midfacial platform caused a severe inferior globe dystopia, superiorly displaced left ala base, and severe vertical shortening between ala-canthus and ala-globe. INTERVENTION A modified Latham device applied directional orthopedics to contract the cleft gap and with an eye part added to elevate the dystopic globe. Two different Latham devices used in succession were each applied for 4 weeks. Lastly, a removable plate further repositioned the eye. Each appliance was designed to differentially move the noncleft and cleft segments of the maxilla. Presurgical orthopedics began at 3 weeks lasted 14 weeks. Intraoperatively at 17 weeks, the inferior globe dystopia was effectively reduced, and the cleft gaps were nearly closed and aligned at the orbital floor, cheek, and the alveolus. Respecting the aesthetic units of face became possible with the soft-tissue repair yet were tight enough in the malar region to retract the lower lid. CONCLUSION The presurgical directional orthopedic and eye-globe mechanics were sufficient to enable medial canthal repositioning, sustainable correction of orbital distopia, and optimized primary soft-tissue repair. Early result suggests that surgery with presurgical orthopedics is superior to surgery alone.
Collapse
|
14
|
Tessier No. 3 and No. 4 clefts: Sequential treatment in infancy by pre-surgical orthopedic skeletal contraction, comprehensive reconstruction, and novel surgical lengthening of the ala base-canthal distance. J Craniomaxillofac Surg 2015; 43:1261-8. [PMID: 26170000 DOI: 10.1016/j.jcms.2015.06.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2014] [Revised: 06/02/2015] [Accepted: 06/02/2015] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Repair of facial clefts implies wide tissue mobilization with multi-stage surgical treatment. Authors propose pre-surgical orthopedic correction for naso-oro-ocular clefts and a novel surgical option for Tessier No. 3 cleft. METHODS Two male infants, a Tessier No. 3 cleft (age 7 months) and another Tessier No. 4 (age 3 months), were treated with a modified orthopedic Latham device with additional septo-premaxillary molding and observed to age four years. Tessier No. 3 orthopedic measurements were obtained by image corrected cephalometric analysis. Subsequent repair included tissue expansion on Tessier No. 4 and naso-frontal Rieger flap combined with myocutaneous upper lid flap on Tessier No. 3. RESULTS Orthopedic movements ranged from 18.5 mm in bi-planar to 33 mm in oblique analyses. Tissue margins became aligned with platform normalization. Tissue expansion on Tessier No. 4 improved distances from ala base-lower lid and subalar base-lip. The naso-frontal flap combined with myocutaneous upper lid flap on Tessier No. 3 had similar achievement, but also sufficiently lengthened ala base-canthal distance. CONCLUSIONS Repairs were facilitated by pre-surgical orthopedic correction. The naso-frontal flap combined with an upper lid myocutaneous flap seems viable as a single-stage option to lengthen ala base-canthal distance to advance repair achievement in unilateral Tessier No. 3.
Collapse
|
15
|
The Tessier number 3 cleft: A report of 10 cases and review of literature. J Plast Reconstr Aesthet Surg 2014; 67:1055-62. [DOI: 10.1016/j.bjps.2014.04.020] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2013] [Revised: 02/19/2014] [Accepted: 04/22/2014] [Indexed: 11/19/2022]
|
16
|
Chamney S, Willoughby CE, McLoone E. Amniotic band syndrome associated with an atypical iris and optic nerve defect. J AAPOS 2013; 17:539-41. [PMID: 24054035 DOI: 10.1016/j.jaapos.2013.05.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2013] [Revised: 05/02/2013] [Accepted: 05/04/2013] [Indexed: 10/26/2022]
Abstract
We report the case of an 8-year-old boy who presented with right cleft lip and palate, left Tessier number 3 and 11 clefts, and limb abnormalities because of amniotic band syndrome. He was found to have an atypical iris and optic disk nasal defect and a right-sided ptosis, which have not been previously reported with amniotic band syndrome.
Collapse
Affiliation(s)
- Sarah Chamney
- Department of Ophthalmology, Royal Victoria Hospital, Belfast, Northern Ireland, United Kingdom.
| | | | | |
Collapse
|
17
|
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.
Collapse
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
| | | | | | | | | |
Collapse
|
18
|
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.
Collapse
Affiliation(s)
- Enrico Sesenna
- Maxillo-Facial Surgery Division, Head and Neck Department, University and Hospital of Parma, Parma, Italy
| | | | | | | |
Collapse
|