Rotation and Advancement Flap of the Cheek in the Treatment of Rare Craniofacial Clefts

Abstract

The treatment of Tessier no. 3 and no. 4 clefts is controversial, and little is published because of their rarity. Frequently, many surgeries are necessary for correction of these defects, and in some cases, the outcomes are less than the ideal. Aware of that problem, we developed a procedure based on the Van der Meulen rotation and advancement flap of the cheek that may correct the cleft with 1 simple procedure and also respects the aesthetic units of the face. We report 3 patients presenting cleft no. 3 and 1 patient presenting cleft no. 4 and describe the rotation and advancement flap of the cheek technique used in their treatment.

Tessier No. 3 Incomplete Cleft Reconstruction with Alar Transposition and Irregular Z-Plasty

“…Other authors have reported an incidence of 9.5 to 34 per 1000 among all cleft cases [1, 2]. The aetiology of the clefts can be explained through a failure in the fusion of the mesoderm during the embryonic process.…”

“…These techniques mentioned in the literature for the repair of clefts include the Z-plasty [9], local flaps [1, 10], cheek rotation flap including the lower eyelid [11], rotation and advancement flap of the cheek [2], and the tissue expansion [4, 12] methods. …”

“…Longaker et al [10], on the other hand, have used the superiorly based nasolabial flap for the restoration of two Tessier 4 facial clefts and a multiple cleft case. Giglio et al [2] claim that these methods are not ideal for the repair of Tessier 3 facial clefts due to excessive scarring. Toth et al [4] and Menard et al [12] propose tissue expansion for severe cleft reconstructions; still, this technique may not be necessary for the cases where the repair will be performed using local tissue without an expansion.…”

Tessier 3 cleft with bilateral anophthalmia: Case report and surgical treatment

“…In our case, due to the width of the coloboma and the subsequent shortness of the lid, we advanced a Mustardè cheek rotation flap with a temporal extension (Van der Meulen, 1985;Mustardé, 1991;Giglio et al, 2008), which included the lid remnant.…”

“…For reconstruction, we used the cheek rotation flap that included the eyelid remnant that was dissected, advanced, and sutured to the medial palpebral ligament (Mustardé, 1991;Giglio et al, 2008). A transnasal canthopexy was also performed primarily on each side at the time of the cleft closure.…”