Tessier 7 Cleft – Its Variation and Application in Reconstruction

Objective: The objective was to evaluate different types of lateral facial clefts and classify them to meet the reconstruction of this very rare cleft lip as a variation challenge in its position and underlying structures. Methods: 3348 Cleft Lip and Palate patients were evaluated for the variation of Tessier 7 cleft deformities. The demographic information and in particular the following data has been extensively recorded: clinical appearance, associated malformations and the type of reconstructive surgical procedure. The Microsoft Excel program was used to analyse the data. Results: The analysis presents with 25 (0.75%) cases of Tessier 7 facial clefts. Associated syndromes occurred in 15 (60.0%) cases: Goldenhar (10), oto-mandibular dysostosis (3), Treacher-Collins (1) and amniotic band syndrome (1). The evaluation of the 25 cases led to a new sub- classification or extension of the Tessier 7 cleft for the cutaneous and muscle involvement; a superior (T7.1), middle (T7.2), inferior (T7.3) and agenetic (T7.4) Tessier 7 cleft. Soft tissue involvement only is indicated as T7.1a or T7.2a, whereas additional bone involvement as T7.1b or T7.2b. Nine cases were surgically reconstructed by means of a single (short cleft, < 1cm) or a double z-approach (long cleft, > 1cm). This reconstruction entailed an intra-oral mucosal lining, partially created with lip mucosa, muscle alignment in the modulus area and a z-approach to the subdermal and dermal components. Conclusions: Tessier 7 clefts or transverse facial clefts were reported in 0.75% of cleft deformities and occurred as a superiorly-rotated, middle-positioned, inferiorly-rotated or agenetic type. The single z- or double z-approach used for the reconstruction or a straight line closure for the superiorly-rotated type is a challenge to the surgeon.