Anatomical Classification of Tessier Craniofacial Clefts Numbers 3 and 4

Abstract

Background: Craniofacial clefts are rare occurrences with an incidence of about 1.43 to 4.85 per 100,000 live births. Understanding the skeletal deformity in these clefts is basic to any reconstructive surgery of the face. This study documented the skeletal defects present in Tessier numbers 3 and 4 using anthropometric measurements to generate a subclassification which will aim to improve the means of communication between surgeons managing this anomaly. Methods: Seven computed tomography scans of patients who had been treated for Tessier 3 and 4 clefts between 2003 and 2017 were analyzed. Measurements of the expected defects in each cleft was taken and compared with unaffected side as the reference. Emerging patterns of their analysis was then used to generate a subclassification for these clefts. The reliability and validity of the measurements were ensured by allowing the data to be examined by both an intra- and interobserver. Results: The presence or absence of an alveolar cleft, the emerging patterns of comparison of the measurements of the maxilla and the orbits of the cleft side and the noncleft side as well as absence of the bone were used to arrive at a subclassification system using (a), (b), (c), (M+ O+), (M− O−), and (0). Conclusion: The study recommends a subclassification for Tessier clefts numbers 3 and 4 that will allow physicians anticipate the extent and the form of skeletal defects present before even seeing the patient. This can improve the communication among surgeons and team members regarding Tessier craniofacial clefts.

Tessier cranio-facial clefts presenting to a tertiary eye care center in Northern India: Ophthalmic features and a review of management

“…In cases of numbers 3 and 4, the ophthalmic features include infero-medial lower eyelid coloboma, lacrimal drainage anomalies, and a symblepharon originating in the infero-medial aspect with surface keratinization, microphthalmos, anophthalmos, microcornea, lenticular coloboma, and irido-fundal coloboma. [ 10 11 12 ]…”

Atypical facial clefts: Tessier number 3 and 4 clefts

“…Though there are clear differences in heights around the medial and lateral margins of these clefts that impact repair, knowledge of the anthropometrics has been lacking in the literature [1]. Omodan et al [5] have proposed a subclassification of Tessier number 3 and 4 clefts based on imaging measurements, with the goal of characterizing the extent of skeletal defects. They identified patterns from anthropometric measurements of seven computed tomography (CT) scans from patients with diverse presentations of Tessier number 3 and 4 clefts.…”

“…Though there are clear differences in heights around the medial and lateral margins of these clefts that impact repair, knowledge of the anthropometrics has been lacking in the literature [1]. Omodan et al [5] have proposed a subclassification of Tessier…”

“…Tessier number 3 clefts (also known as 'oral-nasalocular clefts' or 'nasomaxillary dysplasia' [2]) cross the lip in the region of the philtral column or where a unilateral cleft lip occurs, but continue superiorly in varying degrees to involve the alar base, cheek, medial canthus, and the lower eyelid with disruption of the nasolacrimal apparatus. The associated alveolar cleft emerges between the lateral incisor and canine, involving the frontal process of the maxilla with the possibility of direct communication with the orbit, maxillary sinus, and/or nose [3][4][5][6].…”

Clinical characterization of anophthalmic and microphthalmic cavities in individuals with craniofacial anomalies

“…There are 15 fissures: those below the orbit are numbered 0-8, and those above the orbit 9-14. 21 The clefts that have a special involvement with the ocular, eyelid, and orbital regions are among the rarest and are clefts 3, 4, and 5…”