cranio facial clefts 0 to 7. introduction with treatment

1. Presented by:
Dr Waleed Abdullah
PGR, Plastic Surgery
B.V. Hospital , Bahawalpur

2.  Sets of soft and skeletal tissue clefts in Facial and Cranial
regions
 Can present as hypoplasia or hyperplasia
 TESSIER clefts
 Orbits and Eyelids represent the interface of cranium and
Facial structures.
 Above Orbit ………… Cranial Clefts (8 to 14)
 Below Orbit………. Facial Clefts (0 to 7)

3. Abnormal ossifications in or
between the ossification centers
 Preventing the adjacent soft tissue to
develop normally

4.  0 TO 14
 Often occur in combination
 Sum of facial and cranial no. is always 14
 Skeletal numbers are more consistent
than soft tissue numbers

6.  Median ------------- 0 , 14 , 30
 Para median------- 1 - 2 and 12 - 13
 Orbital -------------- 3 - 5 and 9 - 11
 Lateral --------------- 6 - 7 and 8

8.  Midline cleft
 Can be divided into
◦Aplasia /hypoplasia
◦Dysraphia
◦Hyperplasia

9.  Normal to severe midline agenesis
 Mild to severe hypotelorism and CNS anomalies
SOFT TISSUE INVOLVMENT
 False median cleft lip
 Narrowing to absent of columella
 Lack of Nasal tip projection
SKELETAL INVOLVMENT
 Hypoplastic Nasal structures

11.  Failure of fusion of midline structures
◦ True Median cleft lip
◦ Encephalocele
SOFT TISSUE INVOLVMENT
Failure of fusion of paired medial nasal processes
SKELETAL INVOLVMENT
Midline alveolar clefts
Midline primary palatal clefts

13.  Minor duplication of nasal septum TO severe
hypertelorism and nasal duplication
SOFT TISSUE INVOLVMENT
 Widened philtrum
 Bifid nasal tip/ duplication
SKELETAL INVOLVMENT
 Widened maxillary process
 Duplicated nasal spine
 Frontal bossing
 Hypertelorism

17. SOFT TISSUE INVOLVMENT
 MOUTH: cupid bow
 NOSE: soft triangle / alar dome
 EYE: medial to medial canthus
SKELETAL INVOLVMENT
Maxilla : Keel shaped, lateral to nasal spine
NOSE: between nasal bone and frontal process of maxilla
ORBIT: Hypertelorism

18. SOFT TISSUE INVOLVMENT
 MOUTH: Cupid bow peak
 NOSE: Middle 3rd if Alar dome
 EYE: Medial to palpebral fissure
SKELETAL INVOLVMENT
MAXILLA: Nasal sill, primary and Secondary Palate
NOSE: Nasal bone and Frontal rocess of Maxilla
ORBIT: Hypertelorism

20. One of common Tessier cleft
Oro-naso-occular cleft
Common cleft lip
SOFT TISSUE INVOLVMENT
 MOUTH: Philtral column
 NOSE: Lateral Ala
 EYE: Medial canthus to inferior lacrimal punctum

21. SKELETAL INVOLVMENT
 MAXILLA: b/w lateral incisor and canine to lateral piriform
 NOSE: Absent lateral nasal wall and joined with
 ORBIT: Inferio-medial orbit including lacrimal crest

23. Involves mouth and eye but lateral to nose
SOFT TISSUE INVOLVMENT
 MOUTH: lateral to cupid bow but medial to oral
commissure
 ORBIT: medial lower lid, lateral to inferior punctum

25. SKELETAL INVOLVMENT
 MAXIILA: b/w lateral incisor and canine
 NOSE: lateral to piriform aperture
 ORBIT: Inferior orbit b/w inferior orbital foramen
medial to frontal process of maxilla

26. NO. 4 FACIAL CLEFT

27. Least common
SOFT TISSUE INVOLVMENT
 MOUTH: Medial to oral commissure
 NOSE:
 ORBIT: lateral lower lid
SKELETAL INVOLVMENT
MAXILLA: b/w Canine & 1st Pre-molar
NOSE: lateral to piriform aperture
ORBIT: lateral to inferior orbital foramen

29. Associated with mild form of Treacher- Collin syndrome
SOFT TISSUE INVOLVMENT
 MOUTH: Oral commissure
 NOSE:
 ORBIT: lateral to lateral canthus, ectropion,

30. SKELETAL INVOLVMENT
 MAXILLA: Zygomatico-maxillary suture to
pterygomaxillary buttress
 ORBIT: infero-lateral orbit

32.  Commonest Craniofacial Cleft
 Isolated Macrostomia
 Associated with Treacher Collin syndrome
SOFT TISSUE INVOLVMENT
MOUTH: Oral Commissure
EAR: Pre-auricular area , +/- skin tags

34. SKELETAL INVOLVMENT
 MAXIILA: Pterogomaxiilary junction cleft
 ZYGOMA: Dysplastic Zygomatic body , absent arch
 MANDIBLE: Verticle shortened ramus

35. TREATMENT