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The Anatomical Subunit Approach to Managing Tessier Numbers 3 and 4 Craniofacial Clefts.

Aaron C Van Slyke1, Jonathan Burge1, Ria Bos2

  • 1Division of Plastic and Maxillofacial Surgery, Department of Surgery, Royal Children's Hospital, Melbourne, Victoria, Australia.

Plastic and Reconstructive Surgery. Global Open
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Summary

This study presents a novel surgical technique for managing rare Tessier clefts 3 and 4, adapting the anatomical subunit approach. The technique offers a structured method for complex facial cleft repair.

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Area of Science:

  • Plastic Surgery
  • Craniofacial Surgery
  • Pediatric Surgery

Background:

  • Atypical facial clefts, such as Tessier clefts 3 and 4, are rare, with limited published surgical management guidelines.
  • The anatomical subunit approach has significantly advanced cleft lip repair techniques.

Purpose of the Study:

  • To outline a novel surgical approach and operative technique for treating Tessier clefts 3 and 4.
  • To adapt the principles of the anatomical subunit approach for these specific facial clefts.

Main Methods:

  • Retrospective review of all Tessier cleft 3 and 4 cases (2019-2021) managed by the senior author.
  • Detailed description of the senior author's surgical technique and treatment principles.

Main Results:

  • Five patients with various presentations of Tessier 3 and 4 clefts (unilateral, bilateral, primary, and secondary) were treated.
  • One case of a lost nasal stent was the only reported surgical complication.

Conclusions:

  • The anatomical subunit approach provides a structured framework for managing complex atypical facial clefts.
  • The presented technique can aid surgeons in treating patients with Tessier 3 and 4 clefts.