Transverse Facial Cleft Research Articles

Repair of Transverse Facial Cleft in Hemifacial Microsomia: Long-Term Anthropometric Evaluation of Commissural Symmetry

Cleft of the oral commissure is an uncommon malformation that results from incomplete mesenchymal merging of the mandibular and maxillary prominences of the first pharyngeal arch. Many operative techniques have been proposed to repair this cutaneous and muscular defect. Most authors recommend cutaneous closure by Z-plasty or W-plasty, but these geometric techniques cause additional cutaneous scarring; furthermore, the risk of commissural migration after repair of a transverse facial cleft is poorly documented. Anthropometry was used to evaluate the operative outcome in 13 patients with hemifacial microsomia who underwent repair of a transverse facial cleft by the senior author between 1980 and 2001. The procedure included (1) apposition of the orbicularis oris muscle; (2) linear cutaneous closure; and (3) construction of the commissure using an inferiorly based, rectangular vermilion-mucosal flap. The average age at repair was 11 months, and the mean follow-up was 10.3 years. Comparing the cleft and noncleft sides, the position of the commissure was within 1 mm in all patients, whereas the melolabial fold was asymmetric in six patients. The average length of the scar was 17 mm, and the scar extended lateral to the melolabial fold in all but one patient. No patients were found to have had lateral commissural migration. The authors conclude that Z-plasty or W-plasty is unnecessary in repair of a transverse facial cleft. Closure of the orbicularis oris muscular ring is the critical step in the procedure to provide oral continence and a counterforce to the contraction of the cutaneous scar. There is no lateral creep of the commissure or hypertrophic scarring after straight-line cutaneous closure.

Mandibular Distraction for Amniotic Band Syndrome in the Neonate

Prior reports have advocated the use of distraction osteogenesis (DO) in the management of neonates with mandibular hypoplasia to avoid early tracheostomy and its associated morbidity. Our center recently reported on the successful use of DO in a neonate with muscular dystrophy, a condition which affects the bone as well as the adjacent skeletal muscle. Herein, we describe the use of neonatal DO for mandibular hypoplasia in the setting of amniotic band sequence (ABS). The child had significant soft tissue contracture in the region of the cheek, associated with bilateral transverse facial clefts. This report highlights the successful utilization of DO for the treatment of mandibular hypoplasia and airway compromise in a patient with ABS.

Macrostomie congénitale bilatérale

Congenital macrostomia, a transverse facial cleft, is a rare deformity of the mouth, which can occur alone or in association with other deformities. We report a case of congenital bilateral macrostomia. We discuss the difficulties of plastic surgery in this pathology. Congenital macrostomia in a one-year-old girl compromised feeding. The patient presented an isolated bilateral transverse facial cleft. Surgery associated a suture of the orbicularis oris muscle and a cutaneous W plasty. At twelve months, follow-up has been uneventful. Congenital macrostomia is most commonly associated with others anomalies. Many procedures are described regarding surgical correction of macrostomia. Reconstruction of the integrity of the oral sphincter associated with W plasty usually gives the best results.

Bilateral transverse facial cleft as an isolated deformity: Case report

Transverse facial clefts are rare deformities, these mostly occur as part of syndromes such as facial dysostosis and branchial arch syndrome. This is a report of a case of isolated, asyndromic bilateral facial cleft seen at a semi-urban specialist hospital. Congenital facial defects remain sources of mental and social stress to the families. Infanticide, perhaps a thing of the past in the developed world may still be practiced in cases of congenital deformities in the developing countries, hence the need for early involvement of social workers and clinical psychologist in management.

Isolated Bilateral Macrostomia: Case Series and Review of Literature

Macrostomia is a rare congenital anomaly of the face, especially the isolated type. This report aims to document our experience inmanaging this rare pathology. All consecutive cases of children managed for isolated bilateral macrostomia at the Jos UniversityTeachingHospitalwere retrospectively reviewed. Five patients, aged between 10 weeks and 30 months were managed. They were all females and presentedwith bilateral symmetrical transverse lateral facial cleft (macrostomia). There were no associated anomalies, and no family history of facial clefts or any other congenital anomaly. All the patients had repair of the defect under a general anaesthesiawith satisfactory outcome. Macrostomia can present as an isolated entity. The final outcome of the repair depends on the technique of repair, function of the orbicularis oris muscle and the quality of scar. Keywords : Macrostomia; Facial cleft;Neocommissure. African Journal of Paediatric Surgery Vol. 4 (1) 2007: pp. 41-45

The Influence of Craniofacial Growth in a Case of Transverse Facial Cleft

This report presents the case of a female patient bearing a right-side transverse facial cleft. She has received interdisciplinary treatment since birth. At regular intervals, dental casts were made, and profile and full-face photographs, lateral and postero-anterior cephalograms were taken during the course of orthodontic treatment and maxillofacial surgery. We evaluated her diagnostic records with the intent of documenting the effects of growth and therapy on the skeletal structures of the facial cranium and on occlusion, and to show the influence on facial esthetics. Her facial morphology and occlusion were manifest at birth and in the primary dentition. The maxilla and mandible deviated from the midsagittal plane toward the cleft side, with the mandible considerably more affected, revealing a markedly posterior position. The lateral skeletal deviation of both jaws increased slightly during growth, yet the midline deviation of the dental arches and malocclusion clearly worsened. The increasing deviation was not obvious in full-face photographs. Especially in the primary and mixed dentition, the mandible shifted to the anterior, which was visible in both the lateral cephalograms and profile photographs. On the whole, however, no noteworthy alteration in the character of the craniofacial morphology occurred by the time growth was complete, despite functional jaw-orthopedic and maxillofacial surgical treatment consisting of two distraction osteogenesis procedures.

Newborn With Transverse Facial Cleft Associated With Polyhydramnios

We describe here the case of a female newborn baby with a bilateral complete transverse facial cleft. Obstetrical ultrasound had revealed an increased amount of amniotic fluid from 28 weeks' gestation without fetal hydrops or congenital anomalies. A 1900-g baby girl born at 36 weeks' gestation presented with bilateral wide facial clefts with macrostomia, microphthalmia, nose, and auricular deformities. Her breathing was dependent on life support, which was discontinued 2 hours after birth. An autopsy revealed no congenital malformations in vital organs but the absence of the olfactory nerves. Polyhydramnios and respiratory arrest after birth were presumed to be due to central disintegration of swallowing and breathing, in this case with brain anomaly.

Surgical repair for congenital macrostomia: vermilion square flap method.

Congenital macrostomia (transverse facial cleft) is a relatively rare anomaly. Surgical methods used to correct this anomaly include commissuroplasty, muscle-plasty of the orbicularis oris, and closure of the cleft cheek. The authors report a new vermilion square flap surgical technique that combines a lower lip mucocutaneous vermilion border flap with a lazy W-plasty to ensure a natural commissure and cheek skin closure. This technique was used in 8 patients with satisfactory results.

A Left Transverse Facial Cleft with a Median Cleft of the Lower Jaw

Abstract Objective: A 13-day-old girl with a left transverse facial cleft and a median defect of the lower jaw is reported in detail. Left macrostomia was repaired using a W-plasty technique, and preauricular appendages were excised. The median defect of the mandible demonstrated by computed tomography scan on the first examination had disappeared at 1 year of age. Conclusion: Congenital clefts of the mandible can fuse at a later stage; thus, it is necessary to wait to treat the mandibular defect until the infant is slightly older.

唇顎口蓋裂を伴った第１，第２し弓症候群の１例

We report a case of first and second branchial arch syndrome with complete cleft lip and palate. A Japanese newborn baby was referred to our clinic for the treatment of the cleft lip and palate and a transverse facial cleft. Cheiloplasty was performed under general anesthesia at the age of 4 months. Plastic surgery of the transverse facial cleft was performed under general anesthesia at the age of 9 months. The patient has atrial septal defect with malformation of the auricles and the right thumb, which should be treated at another department. At our clinic, palatoplasty with a pushback method will be performed in near future, and comprehensive speech therapy will be required.

New Surgical Procedure for Transverse Facial Cleft

New Surgical Procedure for Transverse Facial Cleft

片側性横顔裂の６例

We report six cases of unilateral transverse facial cleft. Five patients were male and one was female. One case was diagnosed as solitary macrostomia, and other cases had accessory ears. Among latter cases, one also suffered from microtia and was diagnosed as the first and second branchial syndrome. Another case was diagnosed as Goldenhar syndrome because of the presence of epibulbar dermoid. The other cases were diagnosed as the first branchial syndrome.

Bilateral transverse facial clefts and accessory maxillae—variant or separate entity?

We report an extremely rare case of bilateral transverse facial clefts and accessory maxillae with severe mandibular hypoplasia in a 7-year-old Chinese boy. The transverse facial clefts had been repaired in infancy. The accessory maxillae were excised via a combined temporal and oral approach. Functional orthodontic appliance therapy was not feasible due to restricted protrusive movements of the mandible. Bimaxillary osteotomies were performed one year later due to failure mandibular catch-up growth to occur. The pathogenesis of the accessory maxillae in the presence of lateral facial clefting is postulated to be compensatory mesenchymal growth from the temporal region, and a case is made for this condition to be considered as a possible syndrome rather than a variant of the transverse facial cleft.

New classification of mandible on transverse facial cleft

New classification of mandible on transverse facial cleft

Focal dermal hypoplasia syndrome with incomplete transverse facial cleft and tumour of the lips

A case of Goltz's syndrome complicated with both incomplete transverse facial cleft and characteristic tumour of the upper and lower lips is presented. Tumour excision and repair of defect were successfully performed.

横顔裂（巨口症）を伴ったＣａｔ ｃｒｙ ｓｙｎｄｒｏｍｅの１例

We experienced a case of cat cry syndrome with transverse facial cleft. We reported this case with sound analysis and some considerations.The patient was a two-month-old boy. The chief complaint was a cleft from the left angular to the cheek. His face was distinctive and had a left side transverse facial cleft, micrognathia, microencephaly, saddle nose, malformation of the external ear and ocular hypertelorism were observed. His crying resembled kitten mewing, therefore we assumed this syndrome. We examinated his chromosomes and definitely diagnosed the cat cry syndrome. We analysed his crying and determined that the sound resembled kitten mewing. He had a plastic operation of transverse facial cleft under general anesthesia at his seventh month.

Goldenhar's Syndrome (A Case Report)

SummaryGoldenhar's syndrome or occulo-auriculo-vertebral dysplasia is characterized by the presence of abnormalities of the first and second branchial arches accompanied by apibulbar dermoids or lipodermoids and vertebral anomaties. Other associated congenital anomaties may be frequently present. A case of Goldenhar's syndrome with macrostomia, transverse facial cleft and telepes calcaneovalgus deformity is being presented.

横顔裂の５例

We have seen 5 cases of transverse facial cleft among 107 fresh cases of cheilognathopalatoshisis in the past 11 years. All of these 5 cases were unilateral and found in one maleand four females. Three cases were on the left side and two cases were on the right.Combined malformations of accessory ears, dextroposition of the heart, stricture of the pulmonary artery, absence of spleen, deaf-mutism were seen in one case. Accessory ears were observed in three other cases. In addition, dermoid on the eyeball and accessory papilla were noted. There were no additional malformations noted in the remaining case.There are many types of amlformations present in combination with transverse facial cleft. However, it is very difficult to determine whether these malformations share a common etiology with transverse facial cleft or if there is merely overlapping phenomenon.

A bilateral total cleft of lip and hard and soft palate and transverse cleft face with an atypical paramedian defect of the lower lip and lower jaw on the right side: A case report of a new syndrome?

A three-month-old male baby who has a complete bilateral cleft of the lip and hard and soft palate, and a right unilateral transverse facial cleft, with an atypical paramedian defect of the lower lip and jaw is reported in detail. As these associated malformations are very rare, it may represent a new dysmorphic syndrome.

Bilateral complete transverse facial cleft

A rare case of bilateral complete transverse cleft in an otherwise normal newborn male baby is presented. The operative management and the technique of repair adopted by the author are described. The result proves that the technique of operation by mucosal flaps as described here gives a good cosmetic appearance.