A Rare Case of Bilateral Tessier no. 7 Clefts With Maxillary Duplication

Objectives: Tessier clefts are very rare congenital deformities. The no. 7 cleft is a lateral facial cleft consisting of macrostomia, lateral facial muscular diastasis, bony and dental abnormalities of the maxilla. Macrostomia affects both aesthetics and function, requiring surgical correction to achieve symmetrical lips and restore orbicularis oris muscle function. We report an extremely rare case of bilateral Tessier’s 7 cleft along with maxillary duplication. The surgical rehabilitation of the case is also discussed.
Methods: Case report
Results:
An 11-month-old boy presented with bilateral Tessier no. 7 clefts, revealing distinct characteristics upon examination. Externally, he exhibited asymmetric macrostomia, with the cleft being notably wider on the left side, while the rest of his facial structures appeared normal. On intraoral inspection, there was a noticeable bony outgrowth with a single tooth on the left posterior maxilla, alongside a fibroma on the inner right cheek mucosa. Interestingly, no alveolar cleft was identified. Surgical reconstruction was performed under general anesthesia, involving the excision of the cleft tissue, a straight line closure of the mucosa, the raising of a vermilion flap from upper to lower lip, and meticulous dissection and overlapping of the orbicularis muscle bundles. Skin closure was executed using a z-plasty technique on the right side and a straightforward linear closure on the left side.
Conclusions: Macrostomia disrupts facial anatomy, leading to saliva and food leakage and potentially affecting occlusal alignment and mandibular development. Therefore, early surgical intervention in infancy is essential for effective treatment. Later follow-up is crucial to assess dental growth and overall progress.