[Paramedian frontal clefts or superior orbital clefts]

Area of Science:

• Craniofacial surgery
• Pediatric plastic surgery
• Medical genetics

Context:

• Superior orbital frontal clefts are rare craniofacial anomalies classified by Tessier (1976) as types 9, 10, and 11.
• These clefts occur sporadically and affect the area superior to the orbit, with variable involvement of soft tissues and bone.
• The clinical spectrum ranges from minor aesthetic concerns to significant functional impairment, including ocular prognosis.

Purpose:

• To outline the characteristics and classification of superior orbital frontal clefts.
• To emphasize the variability in clinical presentation and potential for dissociation of soft tissue and bone involvement.
• To highlight the importance of computed tomography (CT) scans in diagnosis and the necessity of a tailored, multidisciplinary management approach.

Summary:

• Superior orbital frontal clefts (Tessier types 9, 10, 11) are rare, often sporadic craniofacial clefts.
• Clinical presentation varies widely, impacting soft tissues and bone, with potential effects on eye function.
• Management requires CT imaging and a multidisciplinary strategy, prioritizing emergency eyelid reconstruction if ocular risk exists.

Impact:

• Early and appropriate intervention ensures optimal functional and aesthetic outcomes for affected children.
• A multidisciplinary approach is essential for managing the complex and variable nature of these clefts.
• Timely treatment, particularly for ocular risks, is critical for healthy childhood development and preventing long-term complications.