Tessier cleft numbers 3 and 4: Presentation of soft tissue and bony deformities in a select South African population

Abstract

BackgroundTessier cleft numbers 3 and 4 are rare congenital craniofacial malformations. Tessier cleft number 3 runs from the philtrum of the superior lip, traverses the ala of the nose and ends at the medial canthus of the eye. Tessier cleft number 4 commences between the philtrum and oral commissure in the superior lip, and ascends into the orbit, remaining medial to the infraorbital foramen. The associated clinical manifestation of each cleft type varies amongst patients. This study documented the soft tissue and bony deformities of Tessier cleft numbers 3 and 4 in a select South African population. MethodsThe study group was selected from retrospectively reviewed computed tomography (CT) scan records, which were made available via the repository of the Department of Clinical Anatomy at higher education institution in South Africa. Seven out of fifty CT scans that met the inclusion criteria were assessed and analysed. The patient records associated with the selected scans were reviewed. The soft tissue and bony deformities characteristic of Tessier cleft numbers 3 and 4 were documented [Ethical approval number: BE363/19]. Descriptive statistics were used to summarise the results. ResultsThe bony deformities presented in the cases of this study included alveolar clefts, nasal septum deviation, hypertelorism and maxillary bone defects. The soft tissue deformities included cleft lip, nasolacrimal abnormalities, eye dystopia, anophthalmia and nasal ala defects. ConclusionsThe extent of the associated deformities of each case varied; however, the primarily affected regions remained constant i.e., the orbital, nasal and oral regions. The variation in soft tissue and bony presentation warranted the need to document these clefts. This study will contribute to the anatomical interpretation of Tessier cleft numbers 3 and 4 in South Africa, and aid medical professionals in the evaluation, differentiation, and treatment of such clefts.