Repair of Tessier 7 Cleft Lip Deformity

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Author: James Phillips
Published:
Specialties: Oral Maxillofacial, Otolaryngology, Plastic Surgery
Schools:
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Basic Info

The most common of the rare craniofacial clefts, Tessier's No. 7 cleft is represented by a deficiency of tissue that may span from the oral commissure to the ear. (1)  The repair of the cleft of the lip must include especial attention to restoring continuity of the orbicularis oris muscle as well the vermillion.  This case is presented as an example of the repair of the Tessier 7 cleft lip deformity.

DOI #: http://dx.doi.org/10.17797/4h2edlts5zz

Advanced

Procedure

The procedure begins with a design to match the length of the lip to the uninvolved side. Local anesthetic is injected. Initial incisions are carried through the dermal layer, and the redundant soft tissue formed by the cleft is removed. The superior and inferior limbs of the orbicularis oris muscle are identified and approximated with suture. The buccal mucosa is closed. The lateral aspect of the incision is closed. Consideration is made for a z-plasty at the lateral aspect of the incision in order to shorten the length of the incision as well as hide part of it in the nasolabial crease.

Indications

The physical deformity of the Tessier 7 facial cleft, particularly macrostomia. Oral incompetence.

Contraindications

Medical comorbidities precluding the use of general anesthesia.

Instrumentation

Setup

General plastics surgical instrumentation. Supine positioning with shoulder roll for slight extension at the neck.

Preoperative Workup

No imaging or laboratory testing required. Consideration for a hemoglobin/hematocrit.

Anatomy and Landmarks

The highpoints of cupid's bow are identified and used to determine the appropriate length of the lip. The muscle of the orbicularis oris muscle must be identified and re-approximated. A vermillion flap may be designed to inset across the cleft to camouflage it. The nasolabial groove may be utilized to hide a segment of the scar within this natural facial subunit.

Advantages/Disadvantages

Complications/Risks

Soft tissue infection, unacceptable scar formation, aesthetically unacceptable result and the need for re-operation.

Disclosure of Conflicts

none

Acknowledgements

References

Losee, Joseph E., Kirschner, Richard E. Comprehensive Cleft Care, 2nd Ed. CRC Press, Boca Raton, FL, 2016.

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