Allam Karam A, Lim Alan A, Elsherbiny Ahmed, Kawamoto Henry K
Sohag Cleft-Craniofacial Unit, Plastic Surgery Department, Sohag University, University Street, Sohag 82524, Egypt.
Division of Plastic and Reconstructive Surgery, Department of Surgery, University of California Los Angeles Medical Center, 200 Medical Plaza, Suite 465, Los Angeles, CA 90024, USA.
J Plast Reconstr Aesthet Surg. 2014 Aug;67(8):1055-62. doi: 10.1016/j.bjps.2014.04.020. Epub 2014 May 10.
The Tessier number 3 cleft is one of the most intricate and destructive of all facial clefts, presenting surgeons with a difficult task for reconstruction. We present a series of 10 patients with this rare cleft all treated by a single surgeon over 30 years. All patients with Tessier number 3 clefts treated between 1978 and 2008 by the senior surgeon were reviewed. Demographic data and all associated clinical findings including cranial and extracranial anomalies were recorded. Methods used to reconstruct each patient were also noted. Seven males and three females were identified and age at initial treatment ranged from 12 months to 12 years. Mean follow-up was 6.3 years. Multiple craniofacial anomalies were appreciated including other rare facial clefts, hypertelorbitism, lacrimal obstruction, anophthalmia, choanal atresia, and hemifacial microsomia. Amniotic banding was the most prominent extracranial finding noted in these patients. Tessier number 3 clefts can be associated with multiple other craniofacial anomalies making reconstruction challenging. Soft tissue and bony reconstruction must be considered separately, and a variety of tools may be employed to accomplish each goal. As the presentation can be highly variable, an individualized treatment plan must be made to meet each patient's specific needs.
特西尔3号面裂是所有面部裂隙中最复杂且破坏性最大的一种，给外科医生的重建工作带来了艰巨任务。我们展示了一系列10例患有这种罕见面裂的患者，均由同一位外科医生在30年间进行治疗。回顾了1978年至2008年间由这位资深外科医生治疗的所有特西尔3号面裂患者。记录了人口统计学数据以及所有相关临床发现，包括颅骨和颅外异常情况。还记录了用于每位患者重建的方法。确定有7名男性和3名女性，初始治疗时的年龄范围为12个月至12岁。平均随访时间为6.3年。发现了多种颅面异常，包括其他罕见的面部裂隙、眶距增宽、泪道阻塞、无眼球、后鼻孔闭锁和半侧颜面短小畸形。羊膜带综合征是这些患者中最突出的颅外表现。特西尔3号面裂可能与多种其他颅面异常相关，这使得重建具有挑战性。软组织和骨组织的重建必须分别考虑，并且可能需要采用多种工具来实现每个目标。由于临床表现差异很大，必须制定个性化的治疗方案以满足每位患者的特定需求。
