19075 Alterations in Surgical Method of Tessier Classification Number 7 Cleft

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
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 1st 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