Surgical management of facial, craniofacial, and laterofacial clefts involving the lips, the jaws, and the palate

Craniofacial dysraphia, orbito-maxillary and lateral facial clefts are rarecongenital malformations compared to the cleft lip and palate. Theoccurrence of lateral facial clefts is reported in 0.7 up to 5.4 out of 1000cases of cleft lip and palate. The anatomical classification describedby Tessier is commonly used for further differentiation. Among these 15malformations, clefts no. 0, 1, 2, 3, 4, 5, and 7 are often associated withclefts of the lip, the alveolar process and the palate. The combination of acleft lip and palate on the one hand and the gradual evidence of associatedsymptoms of the central and the lateral face on the other can be regarded asa severe dysmorphic disorder in terms of aesthetic as well as functionalaspects. In these cases an extensive surgical management is required. Theaesthetic and functional correction of facial clefts poses a specialsurgical challenge. The extent of the defects involving the soft tissues andthe bony structures is often underestimated. We present the clinicalfeatures and therapeutic concepts in 11 patients with median and paramediancraniofacial clefts, unilateral and bilateral oculofacial clefts and obliquefacial clefts treated in our surgical center between 01/1993 and 04/2001.The general and special surgical principles in the treatment of thesecomplex clefts are described. The basic condition for the normalization ofthe facial growth is an extensive mobilisation with consecutive anatomicalreconstruction of the perioral, perinasal, and infraorbital facial muscles.It often takes a second or third surgical intervention for the bony cleftsto be closed. We present casuistics of four exemplary patients withdifferent complex facial clefts (Tessier 0, 3, 4, and 7) includingphotographs with preoperative, intraoperative and later follow-upfeatures. Keywords: lateral facial cleft, cleft lip and palate, Tessier classification, surgical treatment