A classification and construction of congenital lateral facial clefts

Abstract

SUMMARY. Background: The repair of the lateral or transverse facial cleft is a surgical challenge on the account of the abnormal positioning and appearance of the cleft. Materials and methods: Over a twenty-seven year period, 22 lateral facial cleft cases were evaluated at a cleft lip (CL) and palate clinic and seven children underwent reconstruction of the lateral CL. Results: Twenty-two of 3187 (0.69%) cases presented with a lateral CL. Five of these 22 cases (23%) had a bilateral, eight (36%) had a right-sided and nine (41%) had a left-sided cleft. The evaluation of these cases resulted in a new classification (namely an extension of the Tessier 7 cleft) classification for the cutaneous and muscle involvement: a superior (T7.1), middle (T7.2), inferior (T7.3) and agenetic (T7.4) lateral CL. The altered surgical construction: an internal mucosal straight-line closure, a curved cutaneousemucosal red-lip/vermilion-lined flap for the lip commissure, muscle reconstruction at the modiolus and a positional cutaneous z-plasty for the rare lateral cutaneous cleft. Conclusion: The paper introduced a new classification for the lateral CL, as well as an altered surgical reconstructive technique for the most natural functioning of the lateral part of the face. Ó 2010 European Association for Cranio-Maxillo-Facial Surgery

Bilateral macrostomia as a sole entity

“…Macrostomia is a rare congenital deformity [1][2][3][4][5], in which a soft tissue cleavage extends from the oral commissure laterally and superiorly across the cheek toward the tragus [4]. The cleft is mostly partial and rarely complete [6] and most commonly it extends up to the anterior border of the masseter muscle [1,2,4].…”

“…Many techniques of macrostomia repair such as straight-line closure, W-plasty, Z-plasty, double reverse Z-plasty, skin musclevermilion flap and triangular flaps are suggested in the literature [2,[4][5][6]10]. However, the objectives in the repair of macrostomia include symmetry of lips, normal function of the orbicularis oris muscle, accurate positioning and natural look of the oral commissure with prevention of its lateral displacement due to scar contraction, and ultimately, cutaneous closure with minimum scar formation [6].…”

“…However, the objectives in the repair of macrostomia include symmetry of lips, normal function of the orbicularis oris muscle, accurate positioning and natural look of the oral commissure with prevention of its lateral displacement due to scar contraction, and ultimately, cutaneous closure with minimum scar formation [6]. In addition, creation of a naturally neutral or smiling appearance of the face is equally important [5]. However, the key point in the repair of macrostomia remains the reconstruction of a muscular commissure [4].…”

“…Macrostomia is more commonly seen in males than females, and unilateral form is more common than the bilateral one [2]. The incidence of macrostomia is 0.3-1% of the total facial clefts and 0.02% of the live births [5]. In this paper we report a rare case of asyndromic bilateral macrostomia in a 7-year-old male which was repaired by Pfeifer wave line incision technique.…”

Tessier Cleft No. 7: Report of 12 Cases

“…(2) Various classifications have been proposed, but the Tessier classification founded on the basis of clinical observation, is accepted widely. (4,5) The associated anomalies include pre-auricular skin tag, microtia, absence of temporomandibular joint, zygomatic arch, eye lids, accessory maxilla, (3) polydactyly and cardiac anomalies.…”