16.0: Thursday, March 17, 2005

Surgical Management of a Rare Tessier #1 Cleft

Devdas Wali, MD and Mark Urata, MD.

Craniofacial clefts other than cleft lip and palate are rare occurrences. Isolated facial clefts are infrequent and the exact incidence is unknown. There are many reports and small series reviewing a handful of cases, but no definitive data as to the exact incidence. Craniofacial clefts have a wide range of presenting characteristics making classification difficult. Tessier, in 1973, presented a practically oriented classification system which organizes craniofacial clefts based on bony and soft tissue deformity. Since there is tremendous variability in the expression of craniofacial clefts, some patients with the same cleft have solely a microform soft tissue presentation while others present with the complete bony deformity. In this case we discuss a patient with a Tessier #1 cleft which presents as a coloboma of the nasal ala without any bony involvement. Isolated notching of the nasal ala is a rare presentation of a rare craniofacial cleft. This paper reports the evaluation and treatment of this unusual anomaly. The surgical plan consisted of a rotation advancement of the notched ala with augmentation of the soft tissue defect with an ipsilateral auricular composite graft. The details of the operation with pre and post-operative photographs will be presented.