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Tessier No. 4 facial cleft: A single institution's 20 year experience
Wm Abouhassan, Wendy Chen, Brian Pan, Christopher Gordon, David Billmire
University of Cincinnati
2013-03-15
Presenter: William Abouhassan
Affidavit:
I certify that the material proposed for presentation in this abstract has not been published in any scientific journal or previously presented at a major meeting. Please make a statement as to how much of the above work represents the original work of the resident.
Director Name: W. John Kitzmiller
Author Category: Resident Plastic Surgery
Presentation Category: Clinical
Abstract Category: Craniomaxillofacial
While the overall estimated incidence of craniofacial clefts has been reported as 1.43 to 4.85 per 100,000 births, the actual incidence of oblique facial clefts is so rare (less than 0.25 percent among all facial clefts) that the actual incidence is unknown. The Tessier number 4 cleft is an extremely rare craniofacial cleft and a complex surgical challenge. The literature is sparse, and long-term follow-up is poor. We present seven patients with a combination of the following diagnoses: Goldenhar and Turner syndromes, microphthalmia with blindness, amniotic banding, gastroschisis, radial club hand, pancraniosynostosis, and choanal atresia. Depending on the patients' needs, a variety of operations were executed for repair of the clefts. Lip closure was obtained through modifications of the Millard rotation/advancement flap or Manchester techniques. Eyelid closure was obtained via lateral canthotomies, cheak rotation/ advancement flaps, medial canthopexies, Z-plasties, or Tripier flaps. Bony clefts were closed with autograft and/or allograft cancellous bone. We discuss the treatment and follow-up of these patients with Tessier No. 4 cleft, and display our institution's outcomes.
