Formatting the surgical management of Tessier cleft types 3 and 4

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.

Anthropometrically-Based Surgical Technique for Tessier 3 Cleft Reconstruction

“…A reconstructive algorithm based on soft tissue and bony involvement has been proposed. 14 Other clinical reports involving unilateral, incomplete clefts have good results over the documented time of follow-up, 15,16 but have similar criticisms as the above.…”

Bilateral Tessier Cleft 3: A Case Report

“…3 is a well-known entity. (1,2,5) It is also defined as naso-ocular cleft, nasomaxillary dysplasia and Oblique facial (2) cleft by various authors. The cleft lies along the region of the union of medial and lateral nasal processes with the maxillary process.…”

“…An incision was made along the junction of the lower eyelid and the cheek with a small back cut to raise the lower eyelid with the punctum to the medial canthal region. (5) . A triangular flap (5) raised from the medial side of upper eyelid and lateral wall of nose was transposed to cover the defect thus produced.…”

“…(5) . A triangular flap (5) raised from the medial side of upper eyelid and lateral wall of nose was transposed to cover the defect thus produced. The soft tissue of the cheek and malar area was undermined and advanced medially.…”

“…A vermillion turn-down flap from the lateral lip element was used to form the prolabial vermillion. (5) A similar procedure was performed in the right side after three months. However, there was complete dehiscence of the lip repair in the right side with partial dehiscence of the canthopexies.…”