Tessier 30 Median Mandibular Hard and Soft Tissue Cleft, One-Stage Reconstruction Using a Template-Guided Resorbable “U”-Shaped Plate

Abstract

Midline clefts of the lower lip, tongue, and mandible are a rare type of facial cleft classified as “Tessier 30.” We present the case of a female patient with an isolated Tessier 30 facial cleft affecting the tongue, lower lip, and mandibular symphysis with ankyloglossia. This was reconstructed with a template-guided resorbable “U”-shaped plate at 10 months of age. The procedure was carried out in one stage, which avoided the need for a repeat general anesthetic for the patient. We had a successful outcome with normal dental eruption and we believe such an approach could be considered as a relevant treatment modality for future cases.

Management of Tessier 30-Median Mandibular Cleft: 12-Year Follow-Up—A Case Report

“…Management of the soft tissue element of symmetrical Tessier 30 facial clefts is similar to a standard unilateral cleft lip. [9] But there is no consensus regarding timing and technique for repair of bony defect.…”

“…[4] Sheckter et al (2018) [14] described simultaneous treatment of bone and soft tissue at 4.5 months. He used human recombinant bone morphogenic protein and Walker et al (2019) [9] treated a case of median mandibular cleft at 10 months in single stage. Mandibular fixation has been done using ''U''-shaped resorbable plate without using bone graft and primary gingiva-mucoperiosteoplasty.…”

Tessier 30 Facial Clefts—A Literature Review of 72 Cases (1996-2020), Suggested Treatment Protocol, Outcome Measures, Minimum Dataset for Future Case Reports, and Registries

“…Tessier 30 clefts are a rare, potentially heterogeneous group of facial anomalies that can present a challenge to the cleft & craniofacial surgeon. Concerns relating to airway, feeding, dentition, cosmesis, and number of general anesthetics or procedures exist (Walker et al, 2019a). Timing of surgery is an area where there is little agreement in the literature, but this can be affected by patient presentation and access to safe surgery.…”

“…Tessier 30 facial cleft is a rare anomaly presenting in the soft and hard tissues over the central lower face (Tessier, 1976). Such defects can vary widely in their extent and severity: they can be associated with a midline lower lip cleft, a cleft of the mandibular symphysis, a bifid tongue, ankyloglossia and in some cases can continue to the manubrium sterni and involve the hyoid bone, thyroid cartilage, and strap muscles of the neck (Walker et al, 2019a(Walker et al, , 2019b. These clefts are often associated with dental anomalies, soft tissue skin tags and can be markedly asymmetrical (El-Ashmawi et al, 2019).…”

“…Many recent case reports advocate a multiple stage approach involving soft tissue closure, followed after some time by reconstruction of the mandible (Armstrong and Waterhouse, 1996). However, it is argued that a single-stage approach is preferable (Sherman and Goulian, 1980;Sheckter et al, 2018;Walker et al, 2019a).…”