da Silva Freitas Renato, Alonso Nivaldo, Busato Luciano, Ueda Wellington Keity, Hota Thiago, Medeiros Simone Helena, Kunz Regiane Tiemi
Section of Plastic and Reconstructive Surgery, Federal University of Paraná, Curitiba, Paraná.
J Craniofac Surg. 2010 Mar;21(2):390-5. doi: 10.1097/SCS.0b013e3181cfa6b1.
Number 3 cleft or oral-nasal-ocular cleft is a well-known entity that was described by Morian over a century ago. This malformation is a paranasal-medial orbitomaxillary cleft running across the lacrimal segment of the lower eyelid and over the lacrimal groove. The Tessier number 3 naso-ocular cleft represents one of the most difficult and challenging malformations to correct for the reconstructive surgeon. We have conducted a retrospective analysis of our series consisting of 21 cases.
The objective was to review the functional outcome and aesthetic results of the different techniques applied for each case.
From 1997 to 2007, 21 patients with a Tessier number 3 cleft were treated in our craniofacial units. The clinical findings, tomographic studies, and surgical procedures were reviewed and analyzed. We have discussed our protocol of the treatment.
We have treated facial malformation in 2 craniofacial centers. Fourteen patients were evaluated in the first year of their life, with an average age at presentation of 3 years. Twelve patients were female, and 9 were male; 6 patients had amniotic bands in limbs, 5 patients had an association with Tessier number 11 cleft, 3 patients with number 9 cleft, and 1 with number 7 cleft. Related to cleft lip, 10 patients had bilateral cleft lip, and 8 patients had unilateral cleft lip. Three patients did not have any involvement of the upper lip. The alar base was deviated upward in 19 patients, 11 cases had severe anatomic alteration with the lateral border of the ala above the medial canthus, and 8 cases had a mild dislocation. Nine cases of lacrimal duct obstruction and 8 cases of lacrimal duct extrophy were identified. Twelve patients had a lower eyelid coloboma of varying grades, and there were 2 cases of microblepharia. Aiming the soft tissue reconstruction, eyelid, nose, and upper lip were evaluated regarding their position, absence of tissue, and position of medial canthus and ala. Twelve of our patients underwent correction in the same moment, their medial canthus rotated upward and the ala downward, using the contralateral side as the reference. The lip was treated using a Millard-like technique. Neo-conjunctivorhinostomy was performed in the same moment in 2 patients or later in 1 case. Four patients had plagiocephaly due to the cranial involvement, and they were submitted to cranioplasty. Three had neurosurgical approach and advancement of the frontal bandeau. One adult patient received an acrylic plate to reshape the frontal area.
Tessier number 3 cleft is one of the most difficult and challenging malformations to correct for the reconstructive surgeon. Besides the difficulties of its treatment, patients with Tessier number 3 cleft may achieve good results when the team has good skills.
3号腭裂或口鼻眼裂是一个知名的病症，一个多世纪前由莫里安首次描述。这种畸形是一种鼻旁-内侧眶上颌裂，穿过下眼睑的泪段并越过泪沟。泰西埃3号鼻眼裂是重建外科医生最难矫正且最具挑战性的畸形之一。我们对21例病例进行了回顾性分析。
目的是回顾针对每个病例应用的不同技术的功能结果和美学效果。
1997年至2007年，我们颅面外科治疗了21例泰西埃3号腭裂患者。对临床发现、断层扫描研究和手术过程进行了回顾和分析。我们讨论了治疗方案。
我们在两个颅面中心治疗面部畸形。14例患者在出生后第一年接受评估，就诊时平均年龄为3岁。12例为女性，9例为男性；6例患者四肢有羊膜带，5例与泰西埃11号腭裂相关，3例与9号腭裂相关，1例与7号腭裂相关。与唇裂相关的情况，10例患者为双侧唇裂，8例为单侧唇裂。3例患者上唇未受累。19例患者鼻翼基部向上偏移，11例有严重解剖改变，鼻翼外侧缘高于内眦，8例有轻度移位。发现9例泪道阻塞和8例泪道外翻。12例患者有不同程度的下眼睑缺损，2例有睑裂狭小。针对软组织重建，评估了眼睑、鼻子和上唇的位置、组织缺失情况以及内眦和鼻翼的位置。我们的12例患者同时进行矫正，以内眦向上、鼻翼向下旋转，以对侧为参照。采用类似米勒德技术治疗唇部。2例患者同时或1例患者稍后进行了新结膜鼻造口术。4例患者因颅骨受累出现斜头畸形，接受了颅骨成形术。3例采用神经外科方法并推进额带。1例成年患者接受了丙烯酸板以重塑额部区域。
泰西埃3号腭裂是重建外科医生最难矫正且最具挑战性的畸形之一。除了治疗困难外，当团队技术娴熟时，泰西埃3号腭裂患者可能会取得良好效果。
