Tessier No. 3 Incomplete Cleft Reconstruction with Alar Transposition and Irregular Z-Plasty

Facial clefts are extremely rare congenital deformities and there are only a few technique reports for surgical reconstruction of clefts in the literature. In this article, we report a Tessier no. 3 incomplete cleft reconstruction with alar transposition and irregular Z-plasty in a 2-year old female patient. Facial clefts are rare clinical entities observed with an incidence varying between 1.43 and 4.85 per 100,000 births. Other authors have reported an incidence of 9.5 to 34 per 1000 among all cleft cases [1, 2]. The aetiology of the clefts can be explained through a failure in the fusion of the mesoderm during the embryonic process. Still, it is difficult to explain the lateral oro-ocular, some types of nasoocular, and medial oro-ocular clefts with this theory. Some investigators claim that the existence of amniotic bands plays a role in the formation of these clefts [3–5]. In 1976, Tessier classified the clefts between 0 and 14 based on the central facial landmarks [6]. The Tessier 3 facial cleft, also called a naso-ocular or a nasomaxillary cleft, results from the disruption of the lateral nasal and maxillary processes. However, in Fearon’s surgical classification, this cleft may also be called the orbital cleft because of the orbital involvement [7]. This cleft extends in a direction between the philtrum of the lip and the medial canthus of the eye, involving the nasal ala [3]. In a 2-year-old female patient consulted at our clinic due to facial deformity, a Tessier 3 facial incomplete cleft has been detected. The child born as the first child to unrelated healthy parents (mother 23 years, father 29 years of age) through normal vaginal delivery was 51？cm and 3270？gr at birth. In the patient’s history, there was no exposure to teratogens or any information pointing towards a genetic syndrome in the families of either parent. For the repair of the deformity in the patient, alar transposition flap (for nasomalar component) and irregular Z-plasty (for lid component) have been planned in an asymmetrical manner considering the nasomalar and the lid components separately as suggested by Mishra and Purwar [8] (Figure 1). Figure 1: (a) Oblique view of the case at 10-month old. (b) Preoperative frontal view of the case at 2-year old. (c) The dotted parts indicate the incision made for the alar transposition and the area of the flap inset. The straight lines show the incisions for the irregular Z-plasty. (d) Intraoperative photograph after alar transposition flap and irregular Z-plasty. (e)-(f) At 3-month followup. The techniques used for the repair of