Facial Plast Surg 2018; 34(03): 335-336
DOI: 10.1055/s-0038-1653985
Letter to the Editor
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Bilateral Tessier Type 3 Cleft—Repairment in a Single Session

Ilker Uyar
1   Department of Plastic, Reconstructive and Aesthetic Surgery, Meram Medical Faculty, Necmettin Erbakan University, Konya, Turkey
,
Sibel Burçak Şahin Uyar
2   Department of Pediatrics, Konya Education and Training Hospital, Health Sciences University, Konya, Turkey
,
Zeynep Altuntas
1   Department of Plastic, Reconstructive and Aesthetic Surgery, Meram Medical Faculty, Necmettin Erbakan University, Konya, Turkey
› Author Affiliations
Further Information

Publication History

Publication Date:
01 June 2018 (online)

Craniofacial clefts and face slits are rare congenital malformations classified using the Tesssier scale (between 0–14). Maternal infections in the intrauterine period and drugs often constitute the etiology. The Tessier type 3 cleft is medially placed in comparison with oblique face clefts.

A 15-month-old infant presented to our clinic with a Tessier type 3 craniofacial cleft. There were bilateral orbitomaxillary cleft, microopthalmy in both eyes, hypertelorism, complete cleft palate, and severe macrocephaly. Both facial clefts extend to the lower eyelids, covering the lips, alveoli, palate, and maxilla. Rudimentary premaxillary segment, prolabium, and short lower lateral nasal cartilage were seen in the midline parts ([Fig. 1]). There were no relevant factors in the family history. Maternal infection, drug use, and radiation exposure were not identified as predisposing factors.

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Fig. 1 Preoperative appearance of the patient.

First, a nasoalveolar mold was applied to the patient by our orthodontics department, and our department started to follow up the patient. Cleft palate repairment was performed in the 15th month, following that facial reconstruction was performed in a single operation in the 17th month.

Regarding the surgical technique, the left ala nasi was received from the lateral canthus level to the inferior part of the nose via a single z-plasty method ([Fig. 2]). Markings were made showing a modification of the Millard rotation-advancement technique to repair the facial cleft. After elevating the prolabial flap, wide-based rectangular skin flaps were prepared from the lateral lip elements. These flaps were widely dissected to the midcheek area, and an upper back cut incision was made along the infraorbital rim. The mucosal layer from both lateral lips was advanced and sutured below the premaxilla, and the rectangular advancement flaps were sutured to the prolabial flap. The postoperative clinical outcome demonstrated good aesthetic results ([Fig. 3]).

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Fig. 2 The plan of the operation.
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Fig. 3 Postoperative appearance of the patient.

Tessier type 3 cleft is a well-identified facial cleft. The cheek advancement flap method was first described by Van der Mulen. Broad midline defects can be corrected during the same operation with the help of flaps that are dissected up to the lateral canthus. Midline defects can be covered without tension using rectangle flaps that are dissected in a large volume and well designated, as for our patient, and the premaxilla setback can be used in cases where there is tension. The z-plasty technique may play a role in setting the distance between the ala nasi and medial canthus. The z-plasty procedure may be beneficial, as shown in this patient. Bordoloi reported that he was able to correct a bilateral facial cleft in two phases—the larger portion of the defect was covered and then after 3 months the other parts were corrected. In our patient, the midline defects were corrected in a single phase using rectangle advancement flaps. Through this approach, the abnormally high ala nasi was brought into its normal position.

In conclusion, bilateral Tessier type 3 cleft is a rare congenital anomaly that can be repaired in a single, well-planned session and good cosmetic outcomes can be achieved.