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Published on: May 23, 2020
Combined Multi-Axis Tessier Clefts: Surgical Management and Early Functional Outcomes From a Tertiary Center
Karam Allam1, Shenouda Gameel1, Sherif Bakri1
1Department of Plastic Surgery, Faculty of Medicine, Sohag University, Sohag, Egypt.
Summary
Patients with multiple craniofacial clefts require complex, staged reconstructive surgery. Early outcomes are acceptable, but ongoing multidisciplinary care is crucial for managing residual deformities and functional sequelae.
Area of Science:
- Craniofacial Surgery
- Pediatric Plastic Surgery
- Congenital Anomalies
Background:
- Rare craniofacial clefts present significant reconstructive challenges.
- Multiple independent craniofacial cleft axes are exceptionally rare.
- Limited data exists on their anatomical patterns and reconstructive outcomes.
Purpose of the Study:
- To characterize anatomical patterns of combined craniofacial clefts.
- To evaluate the reconstructive burden and early functional outcomes.
- To describe management strategies for these rare anomalies.
Main Methods:
- Retrospective review of patients with combined craniofacial clefts (≥2 independent axes).
- Data collected from a tertiary craniofacial center (2015-2024).
- Analysis of surgical stages, anatomical involvement, and early functional outcomes.
Main Results:
- Thirteen patients met inclusion criteria; 77% underwent staged reconstruction (mean 3.1 stages).
- Orbital (9/13) and palatal (6/13) involvement were common; skeletal reconstruction needed in 3/13.
- Early functional outcomes were acceptable; some revision cases had residual deformities/speech issues. Minor complications included wound infection (3) and scarring (4).
Conclusions:
- Combined multi-axis craniofacial clefts are rare, surgically demanding congenital anomalies.
- Function-prioritized, staged reconstruction is essential.
- Continued multidisciplinary follow-up throughout growth is critical.
