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Surgical Approach to Hemipalatal Discrepancy in Tessier 7 Reconstruction: Review of Literature and Case Series
Aditi M Kanth1, Max Krevalin1, Oluwaseun A Adetayo2
1Division of Plastic Surgery, 138334Albany Medical Center, Albany, NY, USA.
Insights
This study details techniques for managing hemipalatal discrepancy in patients with Tessier 7 cleft and cleft palate. Surgical methods improved palatal length in pediatric cases, aiding speech development.
Area of Science:
- Craniofacial surgery
- Pediatric plastic surgery
- Cleft lip and palate research
Background:
- Tessier 7 clefts, when combined with cleft palate, cause hemipalatal discrepancy.
- This discrepancy involves short maxillary palate length and hypoplastic speech musculature.
- Existing literature lacks comprehensive management strategies for this specific combined condition.
Purpose of the Study:
- To present surgical techniques for addressing hemipalatal discrepancy in Tessier 7 cleft and cleft palate patients.
- To evaluate the effectiveness of these techniques in improving palatal length.
- To contribute to the understanding of managing complex craniofacial anomalies.
Main Methods:
- Case report of two pediatric patients with Tessier 7 cleft and associated cleft palate.
- Detailed description of surgical techniques used during cleft palatoplasty.
- PubMed literature search using relevant MeSH terms for qualitative analysis.
Main Results:
- Surgical intervention successfully increased postoperative palatal length compared to preoperative measurements.
- The study identified a consistent pattern of hemipalatal length discrepancy and hypoplasia in combined Tessier 7 and cleft palate cases.
- Literature review confirmed the challenges associated with managing this combined condition.
Conclusions:
- Combined Tessier 7 cleft and cleft palate leads to significant hemipalatal length discrepancy and tissue deficiency.
- The described surgical techniques show promise in maximizing postoperative palatal length.
- Further research and refined techniques are crucial for optimizing outcomes in these complex cases.
Objective:
The authors present findings and techniques to address hemipalatal discrepancy in patients with Tessier 7 cleft and associated cleft palate during cleft palatoplasty.
Design:
The authors report 2 cases of pediatric patients with Tessier 7 facial clefts and associated cleft palate. One patient presents on the broader oculo-auriculo-vertebral spectrum and the other is has isolated Tessier cleft 7. Additionally, a PubMed search was performed using the MeSH terms "tessier 7," "cleft palate", "macrostomia," "tessier 7 AND cleft palate," "macrostomia AND cleft palate," AND "hemipalatal discrepancy." All relevant literature was identified and underwent full review for qualitative analysis.
Results:
Two patients met criteria for inclusion in this article. The surgical techniques utilized to mitigate the hemipalatal length discrepancy are detailed, and intraoperative photographs are provided. The results of the literature review are also presented. Tessier 7 craniofacial cleft and palatal clefts, when occurring in combination, is noted to result in discrepant hemipalatal length with short maxillary palate length on the affected side as well hypoplasia of the associated speech musculature. The postoperative palatal length after palatoplasty in both patients was longer than the preoperative hypoplastic palatal length.
Conclusions:
When occurring in combination, Tessier 7 craniofacial cleft and concomitant palatal cleft results in discrepant hemipalatal length, and deficiency of the bony maxillary palatal shelves, and associated speech musculature and soft tissues. The techniques described in this article may assist in maximizing postoperative palatal length.
