Two Cases of Tessier No. 4 Cleft with Anophthalmia

Abstract

Postoperative appearances were acceptable in both cases, because the resulting scars were made along the esthetic facial units. However, the soft tissue deficiency of the lower eyelid was prominent. Furthermore, in the unilateral case, caudal displacement of the palpebral fissure and cephalic deviation of the nasal ala was recognized.

Bilateral Craniofacial Cleft (Tessier Type 4): Case Report and Oculoplastic Reconstruction

“…Our patient, however, presented with multiple anomalies including right renal agenesis, a hypoplastic inferior cerebellum and vermis, and carried a diagnosis of cerebral palsy, epilepsy, and global developmental delay. Few cases in the literature have highlighted the co-occurrence of anomalies, such as central nervous system and renal defects in patients with unilateral or bilateral Tessier type 4 clefts (Tokioka et al, 2005).…”

“…The advantages and shortcomings of various surgical methods have been extensively discussed in the literature. All parties agree that any associated eyelid colobomas resulting in corneal exposure require repair early in the neonatal period to prevent keratopathy and blindness (Sano et al, 1983; Longaker et al, 1997; Coruh and Gunay, 2005; Tokioka et al, 2005; Mishra and Purwar, 2009; Chen et al, 2012). According to Resnick and Kawamoto, the comprehensive surgical treatment of these complex cases includes medial canthopexy and lower eyelid reconstruction, cleft lip repair, bone grafting for orbital bony discontinuity and maxillary deformities, soft tissue reconstruction of cheek defects, tissue expansion of anophthalmic or microphthalmic orbits, and subsequent surgical revisions for bone and soft tissue deformities as needed (Resnick and Kawamoto, 1990; Coruh and Gunay, 2005; Chen et al, 2012).…”

“…The medial canthal tendon is usually intact, but with inferolateral displacement, and the nasolacrimal duct may also be malformed (Portier-Marret et al, 2008). Variable involvement of the globe may result in a functional eye, microphthalmia, or anophthalmia (Tsur et al, 1991; Tokioka et al, 2005). In patients with visual potential, exposure of the globe from frequently associated eyelid colobomas may result in blinding keratopathy.…”

Secondary repair of an oblique facial cleft with an absorbable mesh tray and particulate cancellous bone and marrow

“…Reconstruction of the orbital floor defect involves not only hard tissue reconstruction, but also tissue expansion and soft tissue reconstruction [,]. Tightening of the canthus ligament and adjustment of its length has been reported as necessary to correct malpositioning of the eyeball in oblique facial cleft []. However, as the present case involved a young child, the ligament was preserved in the procedure reported here in light of the effect of surgical invasion in that area on future growth and development and the possibilities of future surgery.…”

Tessier number 4 bilateral orbito-facial cleft: A 26-year follow-up

“…These clefts can be either complete or incomplete and can appear alone or associated with other facial clefts (Anastassov et al, 1993;Darzi and Chowdri, 1993) or anophthalmia (Tokioka et al, 2005). Their frequency is between 1.43 and 4.85 per 100,000 births (Kawamoto, 1976).…”