Repair of Tessier 7 Cleft Lip DeformityVideo Type: CVideo
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Author: James Phillips
Specialties: Oral Maxillofacial, Otolaryngology, Plastic Surgery
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.
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.
The physical deformity of the Tessier 7 facial cleft, particularly macrostomia. Oral incompetence.
Medical comorbidities precluding the use of general anesthesia.
General plastics surgical instrumentation. Supine positioning with shoulder roll for slight extension at the neck.
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.
Soft tissue infection, unacceptable scar formation, aesthetically unacceptable result and the need for re-operation.
Disclosure of Conflicts
Losee, Joseph E., Kirschner, Richard E. Comprehensive Cleft Care, 2nd Ed. CRC Press, Boca Raton, FL, 2016.