Alonso Nivaldo, Freitas Renato da Silva, de Oliveira E Cruz Gilvani Azor, Goldenberg Dov, Dall'Oglio Tolazzi Andre Ricardo
Curitiba and São Paulo, Brazil From the Craniofacial Surgery Unit, Department of Plastic Surgery, São Paulo University; Plastic and Reconstructive Surgery Unit, Federal University of Paraná; and the Assistance Center for Cleft Lip and Palate.
Plast Reconstr Surg. 2008 Nov;122(5):1505-1513. doi: 10.1097/PRS.0b013e318188209c.
: Tessier no. 4 facial cleft is a rare, complex, and challenging craniofacial malformation. The present article aims to describe different clinical features evidenced in 21 cases of this malformation, discussing a 20-year experience with and evolution of its surgical treatment.
: Some demographic data, clinical features, and reconstructive results were evaluated retrospectively. These patients have been evaluated and treated in three specialized Brazilian craniofacial centers. Nineteen were already operated on, with a mean follow-up of 3.5 years (range, 1 to 20 years).
: Sex distribution showed a male prevalence (2:1). The average age of initial treatment was 5.4 years. Four cases were affected on the right side of the face, seven on the left, and 10 bilaterally. Six patients had other rare associated facial clefts, including nos. 5 (three patients), 7, 9, and 10. Cleft upper lip was evidenced in all patients, and maxillary hypoplasia was present in five and maxilla cleft in eight. Lower eyelid coloboma was seen in almost every case (19 patients); 10 of these had medial canthus dystopia. Four patients had amniotic bands in the limbs. Surgical repair was individualized to each patient. Surgical experience gained with these patients allowed the authors to develop some technical modifications, which have improved aesthetic results, camouflaging scars into natural folds and anatomical units, without compromising functional outcomes.
: The great majority of Tessier no. 4 facial clefts can be appropriately treated using local flaps. Classic techniques are extremely useful, but long-term results could be improved if the technical modifications described were adopted.
特西尔4号面部裂隙是一种罕见、复杂且具有挑战性的颅面畸形。本文旨在描述21例该畸形所呈现的不同临床特征，并探讨其手术治疗20年的经验及进展。
回顾性评估了一些人口统计学数据、临床特征及重建结果。这些患者在巴西三个专业颅面中心接受了评估和治疗。19例患者已接受手术，平均随访3.5年（范围1至20年）。
性别分布显示男性居多（2:1）。初始治疗的平均年龄为5.4岁。4例面部右侧受累，7例左侧受累，10例双侧受累。6例患者伴有其他罕见的面部裂隙，包括5号（3例患者）、7号、9号和10号。所有患者均有唇裂，5例有上颌骨发育不全，8例有上颌骨裂隙。几乎每例（19例患者）均可见下睑缺损；其中10例有内眦移位。4例患者四肢有羊膜带。手术修复根据每位患者个体化进行。通过对这些患者的手术经验，作者得以进行一些技术改进，改善了美学效果，将瘢痕隐匿于自然褶皱和解剖单元中，且不影响功能预后。
绝大多数特西尔4号面部裂隙可采用局部皮瓣进行适当治疗。经典技术极为有用，但如果采用所述的技术改进，长期效果可能会得到改善。
