Treatment of Midline Cleft of the Mandible-A 2-Stage Approach

Abstract

Midline clefts of the lower lip and mandible are rare congenital anomalies. They may present as complete or incomplete in nature along with associated bifid tongue and ankyloglossia. Some may present with cleft of lower lip, cleft of mandible, fissured tongue, absent hyoid bone, cleft of manubrium sterni, or an extremely rare anomaly known as Tessier cleft no. 30. We present this unique case of midline cleft of the lower lip (incomplete) and mandible (complete) with initial soft-tissue surgery for the lower lip. The hard-tissue surgery for this case is deferred at a later date, and the reasons are discussed.

An Unusual Accessory Mandible and a Submucosal Cleft Palate—A Case Report and Review of the Literature

“…This patient has a median cleft of the lower lip that was classified by Tessier as a type 30 craniofacial cleft (Tessier, 1976). Various forms of median mandibular clefts exist, ranging from minor clefts of the lower lip (Arshad, 1995) to complete clefts of the mandible, with the absence of the hyoid bone, thyroid cartilages, and manubrium (Halli et al, 2011). However, this patient had only a lower lip cleft that did not extend into mandibular bone.…”

Tessier Number 30 Median Mandibular Cleft With Congenital Heart Anomalies in Qena, Egypt

“…Endoscopic examination shows normal larynx and trachea (no hypoplasia or cleft) with right upper tracheal diverticulum and small anterior laryngocele were detected by fiberoptic endoscope examination. Radiologically, a noncontrast 2012Staged repair with rib costochondral graft and mandibular distraction 11 Halli et al, (2011) Lip repaired by modified V-plasty, release of ankyloglossia by Z-plasty, mandibular cleft at later date (bone graft) 12 Freitas et al, (2010) 13 Steven et al, (2007) At 6 months, repair of cleft palate with a Sommerlad style, cleft lip repaired in a straight line with Noordhoff style vermillion flaps. Excision of the dermoid cyst and cartilaginous skin tags.…”

Single Stage Repair of #30 Facial Cleft with Bone Morphogenic Protein

“…Initially, the deformity was treated in 2 stages mirroring the common treatment paradigm of palatal clefts, 3,6,7 with initial correction of the soft tissue followed by bone grafting of the mandibular cleft at a later date. 8 This approach was subsequently described as a single-stage procedure, 9 yet still required 2 surgical sites and the morbidity of bone graft harvest, typically from rib or iliac crest. 3,9…”