Anatomic approximation approach to correction of transverse facial clefts

Publication date: Available online 12 June 2018
Source:Journal of Plastic, Reconstructive & Aesthetic Surgery
Author(s): Raymond W. Tse, Robert J. Knight, David M Fisher
Transverse clefts of the oral cavity have significant impacts on both form and function. Many methods of repair have been described but there is no consensus on optimal approach. In addition, dissatisfaction with scars, distortion of form, and recurrent deformity have led to complex surgical designs that are difficult to understand and to reproduce. We describe a simple approach to repair that is based upon anatomic approximation of lip components and accurate repair of muscle.Twenty patients have undergone repair by the senior author, who devised the approach, and the corresponding author, who adopted it. Eight (62%) had right-sided clefts, 3(23%) had left-sided clefts, and 2 (15%) had bilateral clefts. One had an associated branchial cleft remnant, 2 had multiple branchial cleft remnants and tragus deformities, 1 had craniofacial microsomia with microtia, and 1 had a contralateral Tessier 1 cleft. Mean age at repair was 23 months. All patients achieved normal oral competence, have favourable scars and commissure form, and have had no recurrent deformity. None have required revision.The described surgical approach is reproducible, easy to understand, and can produce favourable outcomes.