The Tessier Number 5 Facial Cleft: Surgical Strategies and Outcomes in Six Patients

Abstract

The Tessier no. 5 facial cleft is an extremely rare congenital malformation. Only 26 cases have been described in the English-language literature. The cleft begins in the upper lip just medial to the oral commissure, extending across the cheek as a groove ending at the junction of the middle and lateral thirds of the lower eyelid. The bone involvement usually includes an alveolar cleft in the premolar region, extends across the maxilla lateral to the infraorbital nerve, up to the infraorbital rim and orbital floor. The goals of the surgical procedure include reconstructing the lower eyelid, repositioning the lateral canthus, closure of the labiomaxillary cleft, and restoration of the skeletal continuity (including the orbital floor defect) with bone grafts. We present six patients with the Tessier no. 5 facial cleft who have been treated in our combined centers and discuss the surgical options and difficulties faced in the reconstruction of this rare and challenging craniofacial malformation. To date, we have treated six patients (two with bilateral and four with unilateral clefts). Three of the patients with unilateral clefting had an associated no. 4 cleft and one patient with a bilateral cleft had an associated no. 3 cleft. This paper represents the largest series to date documenting surgery for patients with the Tessier no. 5 facial cleft.

Distribution, side involvement, phenotype and associated anomalies of Korean patients with craniofacial clefts from single university hospitalbased data obtained during 1998–2018

“…In the present study, the most common type was #7 cleft (n = 23, 60.5%, Figure 1), followed by #0 cleft (n = 5, 13.2%, Figure 2) and #14 cleft (n = 4, 10.5%, Figure 2). These findings were similar to those reported by da Silva Freitas et al 36 and Kalantar-Hormozi et al 13 (Table 4). The findings that #3, #5, and #30 clefts were found in only one patient (all n = 1, 2.6%; Figure 2) and #1, #2, #6, #8, #9, #10, #11, #12, #13 were not found (all n = 0, Figure 2) were similar to the results of Mishra and Purwar, 35 who reported that #3 cleft was extremely rare (Table 4), and da Silva Freitas et al, 36 who indicated that #5 cleft was an extremely rare craniofacial cleft (Table 4).…”

Amniotic band syndrome associated with orofacial clefts: a report of two cases

“…In fact, the problem of management was further aggravated by the rural environment in which our hospital is located. Da Silva et al 13 . highlighted the difficulties encountered in the reconstruction of this rare and challenging craniofacial malformation in their own centre, which is more advanced and better equipped.…”

“…Z‐ or W‐plasty are techniques recommended for the closure of commissural clefts, but these geometric techniques may cause additional scarring and are therefore unnecessary in the repair of transverse facial cleft 15 . Linear suturing technique was then the preferred choice in repairing the commissural cleft because of its simplicity while V‐plasty satisfactorily corrected the lower‐lip defect 13,16 .…”

Long-Term Follow-up of a Tessier Number 5 Facial Cleft

“…[1][2][3][4][5][6][7] The number 5 cleft of the Tessier classification system is an extraordinarily rare facial cleft, representing 0.25% of all facial clefts. 8,9 Due to the low incidence and prevalence of this abnormality, there are a limited number of reported cases in the English-language literature, which infrequently include long-term follow-up. We hereby present a long-term follow-up report on managing late deformities associated with this craniofacial malformation 40 years following initial surgical management.…”

“…10 The cheek advancement flap, first described by van der Meulen in 1985, has been advocated because of its efficacy and favorable scarring. 7,8 Other potential regional flaps are the median forehead flap and the nasolabial flap. 7,11 Tissue expansion has been promoted by Menard and colleagues, aiming to recruit adjacent healthy tissues.…”