Transverse Facial Cleft Research Articles

Prenatal Diagnosis of a Case of Asyndromic Tessier Class-7 Bilateral Complete Transverse Facial Cleft: Case Report with Review of Literature

AbstractTransverse or lateral facial clefts are atypical and rare forms of facial clefts identified as Tessier type 7 in the classification system for orofacial clefts. They have an overall incidence of 1 in 60,000 to 300,000 live births. We report a case diagnosed at 22 weeks of gestation. The two-dimensional (2D) ultrasound examination revealed a single live fetus with a persistently open mouth, failure of visualization of lateral commissures, and mild retrognathia. The three-dimensional (3D) surface rendering of the fetal face demonstrated a bilateral horizontal facial cleft that extended from the lateral commissures to the ears. No additional anomalies were identified. Fetal karyotype and whole exome sequencing reports did not reveal any genomic imbalances. The case highlights the importance of 2D oblique and 3D imaging of the fetal face when subtle findings are detected in routine 2D views. A review of the literature is provided to enhance the understanding of the entity.

Tessier 7– Facial Cleft with Macrostomia: A Rare Case Report

The literature rarely reports unilateral Tessier no. 7 clefts. Tessier no. 7 craniofacial clefts, also called temporozygomatic or transverse facial clefts, are the most laterally located type of craniofacial clefts. History of the patient, clinical presentation, and Computed tomography (CT)scan were considered as the diagnostic criteria. The hasty analysis and surgical correction of craniofacial defect is essential because it may disturb the facial development of the patient.

Evaluation of Long-Term Outcomes of Transverse Facial Cleft Repair.

To evaluate the long-term outcomes of linear commissuroplasty and linear skin closure with a focus on commissural migration. Retrospective study. Individuals who underwent transverse facial cleft repair at a single institution between 2004 and 2021. The disrupted orbicularis oris muscle was reoriented and sutured. A simple linear commissuroplasty technique was used, and the cheek skin was closed linearly without Z-plasty. The distances from Cupid's bow peak to the oral commissure were measured bilaterally, and the difference between the normal and cleft sides was obtained. Finally, its proportional value as a percentage of the total lip length was calculated from short- and long-term follow-up photographs. Cheek scarring and its effects on melolabial fold breakage were evaluated. Of the 18 patients who underwent transverse facial cleft repair, 12 were included in this study. The mean follow-up period based on medical photographs was 1773.5 days. The average proportional difference was 4.6%, demonstrating no observable commissural migration. There were no consistent trends in the direction of migration, either on the cleft or normal side. In patients with a transverse cleft crossing the melolabial fold, the folds appeared broken before and after the cleft repair surgery. No significant long-term commissural migration was observed after transverse facial cleft repair with simple linear commissuroplasty and linear skin closure. Deliberate positioning of the new oral commissure, proper myoplasty, and meticulous skin closure with minimal scar burden can be considered key procedures for successful transverse cleft repair.

Airway management under general anesthesia for infants and young children with the first and second branchial syndrome featuring unilateral mandibular dysplasia: A case series of 8 children

ObjectiveTo investigate and summarize the airway management methods for infants and young children of the first and second branchial syndrome featuring mandibular dysplasia, and to evaluate the auxiliary effect of direct laryngoscope and video laryngoscope during tracheal intubation. MethodsFrom March 2017 to March 2022, 8 cases with the first and second branchial syndrome featuring absent or hypoplastic mandibular ascending ramus that underwent cleft palate repair or transverse facial cleft repair under general anesthesia were retrospectively reviewed and summarized. The information such as demographic data, preoperative airway assessment, mask ventilation effect, anesthesia method, anesthesiologist's evaluation of laryngoscope exposure and intubation, operation method, operation time, and extubation time was collected. ResultsThe median age of the 8 children was 12 months; none of them had limitation of mouth opening, 4 had snoring during sleep, 2 had unilateral absence of the ascending ramus of the mandible, and 6 had partial absence. Of the 8 children, 3 underwent cleft palate repair, and 5 underwent transverse facial cleft repair. During anesthesia induction, 1 case of mask ventilation was graded as Grade 2, and the other 7 cases were graded as Grade 1; the Cormack-Lehane (C-L) grade of glottic exposure by direct laryngoscope was graded as Grade 3 (3 cases) and Grade 4 (5 cases), and the C-L grade by video laryngoscope was graded as Grade 1 (4 cases) and Grade 2 (4 cases). All the children completed video laryngoscope-assisted intubation successfully in one time. The extubation was completed smoothly, without complications related to anesthesia. The median operation time was 50 minutes, and the median time from end of operation to extubation was 240 seconds. ConclusionFor anesthesia of infants and children with the first and second branchial syndrome, especially those with hypoplasia of the mandible, a comprehensive preoperative assessment is needed, and direct laryngoscope may lead to difficulty in glottic exposure, and adequate planning for difficult airway management is necessary.

Bilateral Tessier no. 7 cleft with an accessory maxilla and osseous choristoma: a case report

Tessier no. 7 clefts are characterized by macrostomia, facial muscular diastasis and maxillary and zygomatic bone abnormalities. It is caused by a lack of ectomesenchyme formation or penetration of the maxillary and mandibular processes during the fourth and fifth weeks of development. A case of bilateral transverse facial cleft with an accessory maxilla and an osseous choristoma is presented. The diagnosis of accessory maxilla was based on clinical findings due to the inaccessibility of orthopantomography and computed tomography scan. Orbicularis oris muscle reconstruction, cheiloplasty and excision of accessory maxilla were done. Histopathological examination of the bony lesion showed an osseous choristoma. There were no postoperative complications or local recurrence of the lesion excised. This case report demonstrates the importance of early diagnosis and intervention in maxillofacial congenital anomalies. Cheiloplasty restores function and gives the patient a natural appearance. The excision of accessory bone prevents further complications in the child's growth.

Review of two cutaneous closure methods for Tessier 7 repair

Aim of the Study: The aim of this study is to retrospectively analyze the surgical outcomes of patients who were treated for Tessier 7 cleft deformity, over a period of 10 years and compare the two cutaneous closure methods used for the treatment of the same in our cleft center. Patients and Methods: This is a retrospective audit of all the patients who had undergone Tessier 7 cleft repair from 2010 to 2020 in our center. Relevant details from recorded case histories were extracted and the surgical technique (Straight-line closure or Z-plasty technique) used for the closure of each case was analyzed. The benefits and drawbacks of linear closure and geometric closure methods were also studied. The preoperative, postoperative, and follow-up records and photographs were assessed for the results. Results: Of the 40 patients, 23 patients had skin closure done using Z-plasty technique while 17 patients had the closure done using the straight-line method. The average age at repair was 10.6 months and the follow-up period was unto 1.5 years. Visual Analog Scale and Scar assessment scales revealed Z-plasty skin closure scars were more conspicuous than straight-line closure ones. Lateral migration of the commissure was not an evident finding. Conclusion: Z-plasty or W-plasty can be avoided in repair of transverse facial clefts. Closure of the orbicularis oris muscle is the critical step to provide a counterforce to the contraction of the cutaneous scar and no lateral migration or hypertrophic scarring is present after straight-line cutaneous closure.

Bilateral Isolated Transverse Facial Cleft Repaired by Straight Line Closure: About Two Cases

Transverse facial cleft or congenital macrosomia is a rare facial malformation. It is more common in men than in women. Unilateral form is the most frequent and appears to be associated in most cases with additional facial deformities. Bilateral form is rare and is more often isolated. The cosmetic damage it causes can be source of psychological stress. Sever form can cause oral functional disorders. These consequences justify early repair. We report two cases of isolated bilateral transverse facial cleft in a 6 month old girl and a 5 month old boy. The straight-line technique was used. Mucosal flaps from the lower lip were used to reduce the suture of the labial mucosa to 5 mm from the commissures on the upper lip. The aesthetic and functional outcomes were satisfactory.

Transverse Facial Cleft, Tessier number 7: Case Report of a Rare Congenital Anomaly

Transverse facial cleft (TFC), Tessier number 7, is a rare congenital anomaly commonly associated with other anomalies of the first and second branchial arch with varying severity. Risk factors such as alcohol abuse, folic acid deficiency, and ingestion of herbal concoctions in pregnancy have been implicated in this deformity. We report a case of a bilateral transverse facial cleft in a newborn and review the existing literature on the condition to increase awareness and knowledge.

Bilateral complete transverse facial cleft: A case report

Transverse facial cleft is rare congenital craniofacial anomalies, affecting the esthetics and function of the oral cavity. In the 1st and 2nd branchial arches, it occurs usually with different structural deformities. However, alone occurrence of bilateral facial clefts is rare. Embryonic procedure of mandibular and maxillary approaches of the primary arch of bronchi fails to fuse to form the mouth corner resulting in the development of this anomaly. Number of incidence is identified at birth, at the several times are identified prenatally. In given scenario, the case of complete facial cleft as a bilateral transverse detected by three-dimensional ultrasonography at 19 weeks and 6 days of gestational age in a 24-year-old pregnant patient. The ultrasound findings revealed a singleton intrauterine fetus with normal growth and polyhydramnios (mild). An abnormal fetal face was identified with complete transverse (two sided) facial cleft extended from the mouth through commissure up to both ears. This report illustrates the advantages of three-dimensional ultrasonography in the diagnosis of developmental anomalies prenatally.

Orbicularis oris muscle reconstruction and cheiloplasty with Z-plasty in a patient with a transverse facial cleft

BackgroundTransverse facial clefts are Tessier’s number 7 facial cleft among numbers 1–15 in Tessier’s classification of craniofacial malformations, which varies from a simple widening oral commissure to a complete fissure extending towards the external ear.Case presentationIn a patient with a transverse facial cleft, to functionally arrange the orbicularis oris muscle and form the oral commissure naturally, we performed a surgical procedure including orbicularis oris muscle reconstruction and cheiloplasty with Z-plasty.ConclusionWe achieved good results functionally and esthetically by orbicularis oris muscle reconstruction and cheiloplasty with Z-plasty. The surgical modality of our anatomical repair and 3 months follow-up results are presented.

Transverse facial cleft (macrostomia) repair: Modification of a traditional technique

Outcomes from surgical repair of transverse facial cleft (macrostomia) may not be very satisfactory when conventional methods are used to position the oral commissure to be repaired. To improve patient outcomes, we developed a modified oral commissure positioning and reconstruction method for transverse facial cleft repair. In the modified positioning method, the oral commissure at the abnormal side was positioned precisely and reconstructed by a combination of two conventional methods, namely, the distance measurement method and the anatomical charateristics method. The function of the orbicularis oris muscle was preserved. Postoperative surgical scar score and oral commissure symmetry score were determined and compared between patients and healthy controls. The scores ranged from one to five, with one representing the best and five indicating the worst results. Nine patients aged 4-31 months (7 girls) underwent the modified transverse facial cleft repair surgery. All the patients had unilateral transverse facial cleft with or without microsomia and/or complete cleft lip. The patients were followed up for one to five years. Although average surgical scar scores of patients (close-mouth: 1.8±0.8, range: 1.0-2.8; open-mouth: 1.8±0.9, range 1.0-3.6) remained significantly higher (P<0.05) than those of the healthy controls (N = 8, close-mouth 1.1±0.4, range: 1.0-1.4, open-mouth: 1.1±0.3, range: 1.0-1.2) 6 months after the surgery, their average close-mouth oral commissure symmetry score (1.9±0.7, range: 1.6-2.8) was similar (P = 0.381) to those of the healthy controls (1.8±0.8, range: 1.0-2.6). The modified procedure appears to lead to promising long-term benefit on restoring oral commissure symmetry.

Application of modified vermillion flap and orbicularoris oris bundle anastomosis in repair of transverse facial cleft

To improve the method of vermillion flap and orbicularis oris bundle anastomosis in repair of transverse facial cleft. Based on the precise fixed point, the modified vermillion flap was designed slender at the new corner of the upper lip, and was inserted into the lower lip after removing part tissue. The orbicularis oris was divided into two bands and cross-stitched. Fifteen patients with unilateral transverse facial cleft form the Children's Hospital of Zhejiang University during September 2016 and December 2018 were operated, and the position and shape of the commissure were almost normal. The cosmetic effect and oral function are satisfactory when the modified vermillion flap and bundle anastomosis of orbicularis oris is used to repair transverse facial cleft.

Surgical Treatment of a Goldenhar Syndrome Patient with Cleft Lip and Palate and Transverse Facial Cleft: Case Report

Surgical Treatment of a Goldenhar Syndrome Patient with Cleft Lip and Palate and Transverse Facial Cleft: Case Report

Surgical repair for transverse facial cleft: two flaps with a superiorly rotated single Z-plasty lateral to the commissure

Various techniques have been performed for repairing transverse facial clefts. This study aimed to investigate an optimal method for repairing transverse facial clefts. Twenty-seven patients from 2008 to 2017 were evaluated. Their mean age at repair was 6.7 months with a follow-up period of 6 months to 10 years. A method using an inferior lip-based triangular mucosa flap and a superior lip-based rectangular vermilion-mucosa flap was designed for transposition. The orbicularis oris was reconstructed by using everting mattress suture. The skin was sutured using linear cutaneous closure with a single superiorly rotated Z-plasty lateral to the commissure. A postoperative symmetrical commissure was obtained owing to complete contraction with the new commissure directed 2 or 3 mm medial to the symmetrical point on the lips individually for the 27 patients. Lateral displacement of the reconstructed commissure was not observed. The patients showed a plump and symmetrical cheek on the cleft side. Twenty-one patients with hemifacial microsomia achieved a prominent improvement compared with their preoperative appearance, although the postoperative cheeks still did not show fullness because of the lesser facial tissue on the cleft side. In the early follow-up period, most patients showed a minimal scar during movement. However, the scar became thinner and symmetrical oral movement was achieved over time. This method obtained a natural oral movement without a conspicuous scar and was reliable and remarkable for the postoperative appearance of commissural symmetry. We conclude that this is an optimal method to repair transverse facial clefts.

Reconstruction of the oral commissure in patients with unilateral transverse facial cleft

The normal commissure is not a simple joint of the upper and lower lip, but a triangular mucosal area. To reconstruct a symmetrical oral commissure in patients with a unilateral transverse facial cleft, we designed composite vermilion flaps, including triangular flaps. We retrospectively studied 17 patients with unilateral transverse facial clefts from 2013–2016. Three-dimensional images were obtained with a 3-dimensional photogrammetry system at the 1-year follow-up, and we used an anthropometric method to evaluate the postoperative symmetry of the commissure. No obvious deformity was found during the follow-up examination, and comparison of the cleft and non-cleft sides by the paired samples t test showed that in all cases both horizontally and vertically symmetrical commissures had been achieved.

Anatomic approximation approach to correction of transverse facial clefts

Transverse clefts of the oral cavity have significant impacts on both appearance and function. Many methods of repair have been described, but there is no consensus on optimal approach. In addition, dissatisfaction with scars, distortion of appearance, and recurrent deformity have led to complex surgical designs that are difficult to understand and reproduce. We describe a simple approach to repair that is based upon anatomic approximation of lip components and accurate repair of the muscle.Twenty patients underwent repair by the senior author, who devised the approach, and the corresponding author, who adopted it. Eight (62%) patients had right-sided clefts, three (23%) patients had left-sided clefts, and two (15%) patients had bilateral clefts. One patient had an associated branchial cleft remnant, two patients had multiple branchial cleft remnants and tragus deformities, one patient had craniofacial microsomia with microtia, and one patient had a contralateral Tessier 1 cleft. Mean age of the patients at repair was 23 months. All patients achieved normal oral competence, have favorable scars and commissure appearance, and have had no recurrent deformity. None of the patients have required revision.The described surgical approach is reproducible, easy to understand, and can produce favorable outcomes.

A Case of Bilateral Craniofacial Cleft From Amniotic Band Syndrome

Amniotic band syndrome [ABS] or amniotic disruption complex is defined as a destructive process of fetal damage in a random non symmetrical distribution, which is not attributable to aberrations in normal embryologic development processes .The mechanism has been considered to be initiated in rupture of the amnion, with the fetus then coming into contact with the chorionic surface of the amniotic membrane ,to which it adheres or becomes entwined by fibrous strands .As the fetus grows ,The tethered regions are progressively distorted, leading to constrictions, amputations ,Slash defects, and body wall or cranial defects .The severity varies from a single constrictive ring of a digit to lethal thoraco abdominal eviscerations or craniofacial distruction.ABS is a rare disorder in which bands of mesoderm that emanate from the chorionic side of the amnion and insert on the fetal body can lead to a wide variety of disfiguring and disabling malformations[1,2] . ABS results in the amputation of the fingers or limbs, associated with a wide spectrum of congenital anomalies usually involving the trunk and craniofacial regions including the skull. AbBS is in general sporadic and the incidence is approximately 1 in 15,000 live birth. Characterized by a destructive fetal process that is initiated by rupture of the amnion. Proposed as a sequel of intrauterine rupture of the amnion resulting in oligohydramnios and passage of fetus to chorionic cavity .The fetus subsequently becomes adherent to intertwined in, and tethered by fibrous mesodermic bands .As the fetus grows, its anatomy is distorted .This may lead to cranial or body wall defects or and although been reports of associated malformations of internal structures. [3, 4] ABS that involves craniofacial region may present as cleft lip or palate , oblique or transverse facial cleft .These craniofacial anomalies in ABS are typically often bizarre and frequently non-embryological .The exact cause of ABS is still unknown .This lack of direct evidence has led to the proposal of two main etiological theories. The extrinsic and the intrinsic 4. The extrinsic theory states that the band of ruptured amnion causes an extrinsic compression which then results in constriction rings and other deformities of the developing fetus, while the intrinsic theory holds that germ cell deficiencies result in the malformation of the affected parts [4]. Treatment is usually carried out after birth when plastic and reconstructive surgery is considered to treat the resulting deformities. [4, 5] (Ethiopian Journal of Reproductive Health 2016; 8:50-55)

Kaplan's commissuroplasty and myoplasty technique in the reconstruction of isolated bilateral transverse facial clefts

Bilateral transverse facial clefts are a rarity and are often isolated without other craniofacial deformities. The goals of surgery are to reestablish function and an esthetically pleasing outcome through the reconstruction of a functioning orbicularis oris muscle ring with minimal scars. We report our experience in the reconstruction of isolated bilateral transverse facial clefts in two patients using Kaplan's technique and a straight-line skin closure. There was a satisfactory preservation of the continuity of the vermillion at the commissure, as well as restoration of both the sphincteric function of the orbicularis oris muscle and size of the oral aperture in the patients.

A newborn with esophageal atresia and a large, asymmetric mouth

Abstract Transverse facial clefts are rare orofacial birth defects with a wide range of severity. This congenital anomaly may be part of a syndrome. Therefore it is important to look for associated anomalies in the presence of a transverse facial cleft. We describe the occurrence of transverse facial cleft associated with esophageal atresia.

Lateral or oblique facial clefts associated with accessory maxillae: Review of the literature and report of a case

IntroductionLateral or oblique facial clefts associated with accessory alveolar processes are very rare congenital anomalies; only a few clinical cases have been reported in published literature. Case report and literature reviewHere, we present a retrospective review of 22 cases of lateral facial clefts and six cases of oblique facial clefts associated with accessory alveolar processes, and a case report of 23-year-old woman from China with bilateral transverse facial clefts and accessory alveolar processes. We present a summary of their clinical features, along with bone and teeth abnormalities. DiscussionWe identified 24 cases from published English literature and four cases from Chinese literature. Accessory alveolar processes in lateral or oblique facial clefts occurred most frequently in the molar region, with pterygoid processes and maxillary tuberosities as the most common site. The maxilla displayed a full complement of deciduous and permanent teeth appropriate to his age. Supernumerary teeth resembled deciduous and permanent molars developed in accessory alveolar processes. There was no cleft in the posterior maxillary alveolus. Some were cases of orbital and mandibular deformation. ConclusionThe maxillary prominence was the main area of the lesion. Accessory alveolar processes may be an isolated pathology in lateral or oblique facial cleft.