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.
Highlights
C raniofacial dysrraphia, orbitomaxillary, and lateral facial clefts grouped under rare craniofacial clefts, are rare congenital anomalies in comparison to the more commonly seen cleft lip and palate.[1]
Tessier cleft types 3 and 4; Surgical formatting; Split approach raniofacial dysrraphia, orbitomaxillary, and lateral facial clefts grouped under rare craniofacial clefts, are rare congenital anomalies in comparison to the more commonly seen cleft lip and palate.[1]
Surgical management becomes more challenging as the classical surgical plan and markings used currently and described in literature are complex and confusing
Summary
C raniofacial dysrraphia, orbitomaxillary, and lateral facial clefts grouped under rare craniofacial clefts, are rare congenital anomalies in comparison to the more commonly seen cleft lip and palate.[1]. Tessier cleft 3 and 4 absence of any well laid, practically adaptable guideline, the surgeon is either hesitant to attempt the surgery or dissatisfied with the ultimate postoperative results. The proposed ‘split approach’ to ease the plan of surgery assures a single-stage repair and provides better results in terms of aesthetics. We present here the management of seven cases of Tessier cleft types 3 and 4 in the unilateral and bilateral forms, outlining the surgical management in detail with the aim to lay down certain ground rules towards planning and execution of surgery in these complex deformities
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