Tessier No. 3 Facial Cleft: Surgical and Orthopaedic Treatment A Literature Review
Journal Title: Biomedical Journal of Scientific & Technical Research (BJSTR) - Year 2018, Vol 9, Issue 4
Abstract
Tessier No. 3 is one of three types of oblique facial clefts according to Tessier's classification. This serious and rare congenital anomaly requires many specialized reconstructive operations and long-term postoperative treatment, the necessity for which is emphasised in this article. Based on a review of the literature, the paper discusses techniques of ortho-surgical treatment of Tessier type 3 facial cleft.Craniofacial clefts constitute a broad spectrum of malformations which have a large variety offorms. They occur at a frequency of1 to 5 per 100,000 live births [1]. One such extremely rare developmental defect is an oblique face cleft, which represents 0.24% of all craniofacial clefts [2]. Currently, the most widely used classification of cleft defects in the facial part of the skull is that proposed by Tessier in 1976 [3]. Oblique facial clefts are described as Tessier types 3, 4 and 5; the naso-ocular cleft Tessier 3, is located the most mesialy. It involves such a craniofacial structure as the vermilion border of the upper lip and the nasal wing. It results in the lack of an oral vestibule in this area. Then, the cleft fissure passes through the side wall of the nose up to the medial angle of the eye, medially in relation to the lower lacrimal point. In addition, this type of cleft is accompanied by a slit in the lower eyelid, a downward dislocation of the medial angle of the eye, microphthalmia, hypertelorism, improperly formed nasopharyngeal tract, a cleft of the medial orbital wall, as well as a cleft of the hard palate and the maxillary alveolar process [4-6].Most often, the first surgical intervention of Tessier type 3 cleft is performed in infancy and consist of a correction of the lower eyelid, preventing the development of keratitis [5,6]. This procedure involves lifting the lower eyelid to the level corresponding to the medial angle of the eye, an effect which is obtained by making an incision along the lower eyelid and cheek [6]. The second stage of surgical treatment involves surgery of the lipo-nasal component of the cleft. In infancy, surgery for the primary closure of the cleft lip is performed [7]. Due to the shortage of soft tissues within the oral vestibule and nasal wings, the cleft closure can be performed by means of the turn-in flap technique using cheek tissue [6]. Alternatively, if the fissure is very wide, the complete cleft closure is preceded by orthopaedic treatment with a passive acrylic plate implemented soon after birth. The orthopaedic treatment aimed at directing the development of the jawbone to the desired position and reducing the width of the cleft made it possible to perform surgery within the soft tissues [5].
Authors and Affiliations
Nadia Przygocka, Magdalena Kotatuch, Artur Matthews Brzozowski, Teresa Matthews Brzozowska
Keywords
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- EP ID EP591809
- DOI 10.26717/BJSTR.2018.09.001849
- Views 130
- Downloads 0
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