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.

KEY WORDS

Tessier cleft types 3 and 4 - Surgical formatting - Split approach

• REFERENCES

• 1 Joos U, Anastassov E. Treatment of craniofacial midline clefts in association with hamartomas: Report of three cases. J Oral Maxillofac Surg 1998;56:383-92.
• 2 Ranta R, Rintala R. Oblique lateral oro-ocular facial cleft. J Oral Maxillofac Surg 1988;17:186-9.
• 3 Tessier P. Anatomical classification of facial, cranio-facial and latero-facial clefts. J Maxillofac Surg 1976;4:69-92.
• 4 Longaker MT, Lipschutz GS, Kawamoto HK. Reconstruction of Tessier No. 4 Clefts Revisited. Plast Reconstr Surg 1997;99: 1501-7.
• 5 Accessed from: http://www.odv.bo.it/2002-4//04-tessierIV.rtf
• 6 Resnick JI, Kawamoto HK Jr. Rare craniofacial clefts: Tessier no. 4 clefts. Plast Reconstr Surg 1990;85:843-9.
• 7 Aköz T, Erdoğan B, Görgü M, Kutlay R, Dağ F. Bilaterally involved Tessier No. 4 cleft: Case report. Cleft Palate Craniofac J 1996;33:252-4.
• 8 Kale SM, Pakhmode VK. Bilateral Tessier no. 4 facial cleft with left eye anophthalmos: A case report. J Indian Soc Pedod Prev Dent 2000;18:87-9.
• 9 Sieg P, Hakim SG, Jacobsen HC, Saka B, Hermes D. Rare facial clefts: Treatment during charity missions in developing countries. Plast Reconstr Surg 2004;114:640-7.
• 10 Wenbin Z, Hanjiang W, Xiaoli C, Zhonglin L. Tessier 3 cleft with clinical anophthalmia: Two case reports and a review of the literature. Cleft Palate Craniofac J 2007;44:102-5.
• 11 David DJ. New perspectives in the management of severe craniofacial deformity. Ann R Coll Surg Engl 1984;66:270-9.
• 12 David DJ, Moore MH, Cooter RD. Tessier clefts revisited with a third dimension. Cleft Palate J 1989;26:163-84.
• 13 Lodge M, Abbott A, David D, et al. Fronto-ethmoidal meningoencephalocele compared with rare facial clefts. In: Marchac D, editor. Craniofacial surgery. Proceedings of the VIth International Congress of the International Society of Cranio-facial Surgery. Bologna, Italy: Monduzzi Editore; 1995. p. 2966.
• 14 Kawamoto HK. Rare craniofacial clefts. In: McCarthy JG, editor. Plastic Surgery. Philadelphia: WB Saunders; 1990. p. 389-550.
• 15 Stricker M, van der Meulen J, Raphael B, et al. Editors. Surgery. Craniofacial malformations. Edinburgh: Churchill Livingstone; 1990. p. 389-550.
• 16 Menard RM, Moore MH, David DJ. Tissue expansion in the reconstruction of Tessier craniofacial clefts: A series of 17 patients. Plast Reconstr Surg 1999;103:779-86.