John L Spolyar1, Mark Hnatiuk2, Kenneth W Shaheen3, Jennifer K Mertz4, Lawrence F Handler5, Ravinder Jarial6, J Camilo Roldán7. 1. UDM School of Dent, Dept. of Orthodontics, Detroit, MI, USA; Ian Jackson Craniofacial & Cleft Palate Clinic, Wm Beaumont Hospital, Royal Oak, MI, USA; Craniofacial Institute of Michigan, St John Providence Health System, Detroit, MI, USA; Wm Beaumont Hospital, Royal Oak, MI, USA; St John Providence Hospital, Southfield and Novi, MI, USA; Oral Maxillofacial Surgery, Orthodontics at 39611 Garfield Rd - Suite 12, Clinton Twp, MI 48038, USA. Electronic address: spolyarjohn@yahoo.com. 2. Craniofacial Institute of Michigan, St John Providence Health System, Detroit, MI, USA; St John Hospital, Detroit, MI, USA; Providence Hospital, Southfield and Novi, MI, USA; Surgery (Craniofacial), 46325 West 12 Mile Road, Novi, MI 48377, USA. 3. Ian Jackson Craniofacial & Cleft Palate Clinic, Wm Beaumont Hospital, Royal Oak, MI, USA; Wm Beaumont Hospital, Royal Oak, MI, USA; Oakland University William Beaumont School of Medicine, USA; Wayne State University School of Medicine, USA; Surgery (Plastic Reconstructive), 2585 Crooks Rd, Troy, MI 48084, USA. 4. Craniofacial Institute of Michigan, St John Providence Health System, Detroit, MI, USA; St John Providence Hospital, Detroit and Novi, MI, USA; Oral Maxillofacial Surgery, Orthodontics at 18342 Mack Ave, Grosse Pointe Farms, MI 48236, USA. 5. Ian Jackson Craniofacial & Cleft Palate Clinic, Wm Beaumont Hospital, Royal Oak, MI, USA; Oakland University William Beaumont School of Medicine, USA; Surgery (Oculoplastic Skull Base), 2125 Butterfield, Suite 201N, Troy, MI 48084l, USA. 6. RSJ Plastic Surgery, 13005 Southern Blvd., Medical Mall 2, Suite 212, Loxahatchee, FL 33470, USA; Craniofacial Institute of Michigan, St John Providence Park Hospital, Novi, MI, USA. 7. Craniofacial Institute of Michigan, St John Providence Park Hospital, Novi, MI, USA; Division Craniofacial Plastic Surgery, Catholic Children's Hospital Wilhelmstift, Lilinecronstr. 130, 22149 Hamburg, Germany.
Abstract
BACKGROUND: Repair of facial clefts implies wide tissue mobilization with multi-stage surgical treatment. Authors propose pre-surgical orthopedic correction for naso-oro-ocular clefts and a novel surgical option for Tessier No. 3 cleft. METHODS: Two male infants, a Tessier No. 3 cleft (age 7 months) and another Tessier No. 4 (age 3 months), were treated with a modified orthopedic Latham device with additional septo-premaxillary molding and observed to age four years. Tessier No. 3 orthopedic measurements were obtained by image corrected cephalometric analysis. Subsequent repair included tissue expansion on Tessier No. 4 and naso-frontal Rieger flap combined with myocutaneous upper lid flap on Tessier No. 3. RESULTS: Orthopedic movements ranged from 18.5 mm in bi-planar to 33 mm in oblique analyses. Tissue margins became aligned with platform normalization. Tissue expansion on Tessier No. 4 improved distances from ala base-lower lid and subalar base-lip. The naso-frontal flap combined with myocutaneous upper lid flap on Tessier No. 3 had similar achievement, but also sufficiently lengthened ala base-canthal distance. CONCLUSIONS: Repairs were facilitated by pre-surgical orthopedic correction. The naso-frontal flap combined with an upper lid myocutaneous flap seems viable as a single-stage option to lengthen ala base-canthal distance to advance repair achievement in unilateral Tessier No. 3.
BACKGROUND: Repair of facial clefts implies wide tissue mobilization with multi-stage surgical treatment. Authors propose pre-surgical orthopedic correction for naso-oro-ocular clefts and a novel surgical option for Tessier No. 3 cleft. METHODS: Two male infants, a Tessier No. 3 cleft (age 7 months) and another Tessier No. 4 (age 3 months), were treated with a modified orthopedic Latham device with additional septo-premaxillary molding and observed to age four years. Tessier No. 3 orthopedic measurements were obtained by image corrected cephalometric analysis. Subsequent repair included tissue expansion on Tessier No. 4 and naso-frontal Rieger flap combined with myocutaneous upper lid flap on Tessier No. 3. RESULTS: Orthopedic movements ranged from 18.5 mm in bi-planar to 33 mm in oblique analyses. Tissue margins became aligned with platform normalization. Tissue expansion on Tessier No. 4 improved distances from ala base-lower lid and subalar base-lip. The naso-frontal flap combined with myocutaneous upper lid flap on Tessier No. 3 had similar achievement, but also sufficiently lengthened ala base-canthal distance. CONCLUSIONS: Repairs were facilitated by pre-surgical orthopedic correction. The naso-frontal flap combined with an upper lid myocutaneous flap seems viable as a single-stage option to lengthen ala base-canthal distance to advance repair achievement in unilateral Tessier No. 3.