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

Abstract

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.

Osseous choristoma: Report of a case on the palate and a literature review

“…Several studies have been conducted to unravel the etiology of osseous choristomas. Previous research suggested a congenital basis for these lesions 25,30 . The tongue is formed by the fusion of two parts: the anterior two‐thirds of the tongue is derived from the first branchial arch, while the posterior third is from the third branchial arch.…”

“…In this case, the lesion was accompanied by Tessier no.7 or transverse facial cleft. 25 Moreover, osseous choristoma tends to appear more in females and the mean age of the female patients was relatively lower than males.…”

“…Previous research suggested a congenital basis for these lesions. 25 , 30 The tongue is formed by the fusion of two parts: the anterior two‐thirds of the tongue is derived from the first branchial arch, while the posterior third is from the third branchial arch. These branchial arches also give rise to normal osseous structures such as the hyoid bone, malleus, incus, and styloid process, through a process called endochondral ossification.…”