Craniofacial Cleft: A Case of Tessier 10 Cleft With a Novel Method to Repair Large Bilateral Colobomas

Abstract

Objective: To describe a reliable method utilizing large, rotation flaps to reconstruct a number 10 Tessier cleft. Design: This is a descriptive clinical case report. Setting: Pediatric teaching hospital affiliated with a university. Patients, Participants: One participant in this clinical case report. Interventions: Full-thickness excision of the clefted eyelid, brow, and forehead tissue was performed bilaterally to develop medial and lateral eyebrow and forehead flaps. Right: the forehead/brow flap was rotated caudally to reapproximate the eyebrow and an eyelid rotation flap was also used to reapproximate the lid margin. Left: forehead/brow rotation flap allowed realignment of the eyebrow and a series of Z-plasties were used in the eyelid to reapproximate the lid margin and to lengthen the eyelid. Main Outcome Measure(s): Develop and construct a reliable reconstruction with full-eyelid closure and minimal donor site morbidity. Results: Complete eyelid closure bilaterally was achieved intraoperatively, and was maintained at 6-month follow-up with no evidence of ocular pathology. Conclusions: Large, bilateral upper eyelid colobomas require repair to prevent blindness. Although free tarsomarginal grafts and lid-sharing procedures have been described, we demonstrate that large rotation flaps designed along the cleft margin can provide a reliable reconstruction and minimize donor-site morbidity.

Isolated Unilateral Tessier Cleft 10 with Anterior Staphyloma

“…The classification specifies numbers ranging from 0 to 14, to multiple axes passing through eyebrows, eyelids, maxilla and eventually entering the lips [ 1 ]. Cleft number 10 of the Tessier classification is an extremely rare occurrence and is typically characterized by the presence of a cleft in the superior orbit along with a concomitant coloboma involving the middle one-third of the upper eyelid [ 2 ]. It may also present as a complete absence of eyelids or ablepharia.…”

“…The treatment of a Tessier number 10 cleft mainly involves various surgical techniques with the basic logic to provide corneal cover by reconstructing a cosmetically acceptable upper eyelid. Removal of the aberrant hairs can be accomplished using lasers, including a ruby laser, alexandrite laser, long pulsed Nd: YAG (neodymium-doped yttrium aluminum garnet) laser and intense pulse light treatment [ 2 ].…”