S13-01 SESSION 13: HYPERTELORISM / CRANIOFACIAL CLEFTS LOCAL FLAPS FOR FACIAL CLEFT TESSIER 3 AND 4 RECONSTRUCTION

Abstract

Introduction: Facial Cleft Tessier no. 3 and 4 are complex and challenging craniofacial malformations, and sometimes presented with severe disfiguring face. Reconstruction of facial clefts Tessier no. 3,4 always needs flaps for soft tissue coverage and for creating functional eyelids, lips, nose, and also performance of face aesthetically. This article is to describe about 30 cases of this malformation during 10 years experience, 2008–2018. Methods: Some demographic data, clinical features, and reconstructive results were evaluated retrospectively. These patients have been treated in Yayasan Citra Baru, craniofacial foundation, and 90% operated by 1 surgeon. Follow-up of varying times with mean 3 years. Results: Sex distribution showed a female prevalence (60%). The age of initial treatment was below 1 year old (50%), 1–5 years old (28%). Facial Cleft Tessier 3 characterized by inferior displacement of the medial canthus, superior displacement of the alar base, cleft lip and palate, coloboma of lower eyelids, nasolacrimal abnormalities, cleft of the inferomedial orbital wall, and teleorbitism. . Lower eyelid coloboma and medial canthus dystopia was seen in almost every case of Tessier 4. Surgical repair was individualized to each patient. Aiming the soft tissue reconstruction due to absence of tissue, reposition of medial canthus rotated upward and the ala rotated downward were evaluated using the contralateral side as the reference. Mostly patients had 1 or 2 operation. Commonly procedures include cheek flap, glabelar flap, tarsoconjuctival flap for medial lower lid coloboma. Learning curves gained from surgical experience allowed the surgeon to modify some technical procedures, which have improved aesthetic results, concealing scars into natural folds and anatomical units, without compromising functional outcomes. Conclusion: Tessier number 3 and/or 4 cleft is one of the most difficult and challenging malformations to correct. The great majority of Tessier no. 3 and 4 facial clefts can be appropriately treated using local flaps. Classic techniques and its modification is useful, and staged procedures are necessary for better result long-term.