Tissue Expansion in the Reconstruction of Tessier Craniofacial Clefts: A Series of 17 Patients

Abstract

Tessier craniofacial clefts are among the most surgically challenging examples of craniofacial dysmorphology. These clefts are characterized by hypoplasia of soft-tissue and skeletal elements throughout the three-dimensional extent of the cleft. Whereas bone grafting and craniofacial osteotomies have been successful toward correcting the underlying skeletal abnormalities, the ultimate success of these reconstructions has been limited by the deficiency of skin and soft tissue. This deficiency demands reconstruction ideally with tissue of like texture, consistency, and, especially in the face, color. Craniofacial tissue expansion was used toward reconstructing these facial clefts with like-quality tissue, allowing for tension-free reconstruction after osteotomy and bone grafting. Seventeen patients with Tessier craniofacial clefts underwent preoperative craniofacial soft-tissue expansion in the surgical management of their clefts. Tissue expansion was used in the primary correction of facial clefts in eight patients, with nine patients undergoing expansion before secondary surgery. In this series, tissue expansion has evolved as an important element in overcoming the skin and soft-tissue deficiency associated with these clefts, allowing for tension-free closure and improved aesthetic results in these surgically challenging patients.

Anthropometrically-Based Surgical Technique for Tessier 3 Cleft Reconstruction

“…General surgical options, including multiple local flaps with or without tissue expansion, for complex Tessier 3 clefts in combination with a multitude of other craniofacial anomalies are usually presented as case reports or small series. [6][7][8][9][10][11][12][13] While most report some degree of long-term follow-up, there is often little description of secondary procedures and no standardized discussion of topographic landmarks or reproducible measurements to develop a standardized approach to management. A reconstructive algorithm based on soft tissue and bony involvement has been proposed.…”

Malar Reconstruction Using Y-V Advancement Flaps after Tissue Expansion in Treacher Collins Syndrome

“…4 Menard et al 5 reported tissue expansion in the reconstruction of a series of Tessier craniofacial clefts: primary correction of facial clefts and preparation for bone grafting or osteotomy. They concluded that long-term bone graft viability demanded coverage with tissue of adequate vascularity and that tissue expansion was effective in tension-free reconstruction for osteotomy and bone grafting.…”

Two Cases of Tessier No. 4 Cleft with Anophthalmia

“…Correction with the other local flaps will be planned in the near future. Tissue expansion or free tissue transfer are good alternatives for soft tissue recon- struction (Toth et al, 1990;Longaker and Siebert, 1996;Menard et al, 1999). Caudal displacement of the palpebral fissure and cephalic rotation of the ala was noted in case 1.…”