Presentation and Management of Atypical Orofacial Clefts: A Single-Institution Experience for 13 Year Period

Abstract

This study reviews the craniofacial clefts that presented at a Nigerian tertiary health facility, highlighting our experience with the pattern of presentation and surgical care of these patients. A retrospective review of the smile train database and medical records of all individuals who had been diagnosed with any of the Tessier craniofacial clefts and managed between 1st January 2007 and 31st December 2020 was done. The data were presented as numbers and percentages of cases. The cleft clinic of a tertiary health facility and a major cleft referral center in South-West Nigeria. Forty-five patients with craniofacial clefts were managed over the study period. 15.6% had associated syndromes, 2.2% had a family history of similar craniofacial cleft and 11% had a history of a possible teratogen. There were 21 (46.7%) middle clefts, 14(31.1%) lateral clefts and 10(22.2%) oblique clefts. The most common type of cleft was Tessier 0 while the Tessier 6 was the least common type. The median age at surgery was 10 months for male and 5months for female subjects, 15.3% complication rate was found in this study. Four patients had revision surgeries to correct residual deformities in this study. The diverse presentations and occurrence of the rare craniofacial clefts present complex aesthetic and functional problems that require individualized often multidisciplinary care. The execution of a properly planned treatment will reduce complications and the need for revision surgeries.

Midline cleft of the upper lip associated with a microform unilateral cleft and a proboscis-like structure: a case report

“…The curvilinear edge of the philtral flap allowed us to make a curvilinear repair, ensuring that the resulting scar simulates the philtral ridge. This technique for median cleft repair is similar to the one advocated by Millard and Williams 1 and used by James et al 17 . The excess tissue, including the proboscis-like structure 7 , was excised to allow the cleft edges to approximate a linear or curvilinear shape 1 , 17 .…”

“…This technique for median cleft repair is similar to the one advocated by Millard and Williams 1 and used by James et al 17 . The excess tissue, including the proboscis-like structure 7 , was excised to allow the cleft edges to approximate a linear or curvilinear shape 1 , 17 . A technique involving wide and extensive dissection of nasal cartilage and the incorporation of z-plasty near the vermilion in a median cleft that looked like the one presented in this report was described by Kolker et al 19 .…”

“…James et al 17 found craniofacial clefts to be commoner on the right sides and in male persons. In line with this, the right-sided microform cleft lip and the presence of a coloboma of the right eye in this case suggest that the cleft on the right is a craniofacial cleft.…”