Abstract: Alterations in Surgical Method of Tessier Classification Number 7 Cleft (Plastic Surgery 2011 (September 23-27, 2011))

Saturday, September 24, 2011: 9:20 AM

Non-Physical Computer Presentation -- Kiosks on Exhibit Floor

Yong Chan Bae, MD, PhD , Department of Plastic and Reconstructive Surgery, Pusan National University, Pusan, South Korea

Kyung Dong Kang, MD , Department of Plastic and Reconstructive Surgery, Pusan National University, Pusan, South Korea

Su Bong Nam, MD, PhD , Department of Plastic and Reconstructive Surgery, Pusan National University, Pusan, South Korea

Soo Jong Choi, MD, PhD , Department of Plastic and Reconstructive Surgery, Pusan National University, Pusan, South Korea

Kyoung Hoon Kim, MD , Department of Plastic and Reconstructive Surgery, Pusan National University, Pusan, South Korea

Kyeong Ho Song, MD , Department of Plastic and Reconstructive Surgery, Pusan National University, Pusan, South Korea

Presentation PDF file

E-Poster

Purpose

A Tessier classification No.7 cleft, also called a transverse facial cleft or macrostomia, is an uncommon malformation that result from a failure of mesenchymal fusion within the maxillary and mandibular prominences of the 1^st pharyngeal arch. Many operation technique of No.7 cleft repair have been proposed to restore function and improve aesthetic. Fifteen patients underwent repair of a No.7 cleft for 13 years by a modification of the surgical method, and an appraisal of operative outcome is reported herein.

Method

A retrospective review was conducted involving 15 patients with No.7 cleft who underwent surgery between September 1996 and September 2009. The average age at the time of repair was 8 months(range, 2-24 months). The mean follow-up was 49 months(range, 3months to 13years). The change in surgical method included skin closure, attachment of orbicularis oris muscle, and position of repaired commissure; the changes were analysed with a review of medical record and the outcomes of surgery were analysed via photographs. Specifically, the method of skin closure was changed from a Z-plasty to a linear closure, the orbicularis oris muscle overlapped attachment was replaced by a side-to-side approximation with horizontal mattress sutures, and the position of the repaired commissure was changed from 1 mm laterally to 1 mm medially reference to non-cleft side.

Result

A Z-plasty caused additional cutaneous scarring, an overlapped attachment of the orbicularis oris muscle caused a thick oral commissure, and repaired commissure migrated to lateral side, so a 1mm, laterally-positioned commissure caused asymmetry. The altered procedure included a linear skin closure, a side-to-side orbicularis oris muscle approximation, and a 1mm, medially-positioned commissure, which together resulted in good outcomes.

Conclusion

The altered procedure for repair of a no.7 cleft as described herein, yields a short scar, no functional problem with the orbicularis oris muscle, a thin oral commissure, and symmetry of the repaired commissure. A follow-up anthropometric study is in progress

19075 Alterations in Surgical Method of Tessier Classification Number 7 Cleft