Document Detail


Repair of Tessier no. 3 and no. 4 craniofacial clefts with facial unit and muscle repositioning by midface rotation advancement without Z-plasties.
MedLine Citation:
PMID:  22327890     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: The accepted surgical correction of Tessier no. 3 and no. 4 craniofacial clefts is the use of interdigitating skin flaps along the line of the facial cleft, which frequently results in unsightly facial scars, poor skin color match, and an unnatural facial expression. The authors report their technique of midface rotation-advancement concept to repair these craniofacial clefts.
METHODS: Fourteen patients who had undergone Tessier no. 3 and no. 4 cleft repair over a 35-year period (1976 to 2010) at the craniofacial center in Chang Gung Memorial Hospital were retrospectively reviewed. Five patients (group 1) were operated on using Z-plasty principles. Nine (group 2) were operated on using the rotation-advancement technique; six of them had Tessier no. 3 clefts and three had Tessier no. 4 clefts. Seven of those nine patients were primary cases; the other two had secondary or tertiary revisions. Patient photographs were reviewed to assess outcomes.
RESULTS: Group 1 had a less overall satisfactory result in terms of scar quality, color matching, or natural facial expression. Overall, a much improved appearance with a higher satisfaction rate was demonstrated in group 2. Patients in group 2 who were surgically treated with the midface rotation advancement technique, though their medial canthus and alar base might not have been well repositioned, still had much better results.
CONCLUSIONS: Midface rotation advancement avoided significant scarring with poor skin color matching and unnatural facial expressions. This technique is applicable to either the primary repair or secondary revision of Tessier no. 3 and no. 4 craniofacial clefts.
CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, III.
Authors:
Philip Kuo-Ting Chen; Frank Chun-Shin Chang; Fuan-Chiang Chan; Yu-Ray Chen; M Samuel Noordhoff
Publication Detail:
Type:  Case Reports; Journal Article    
Journal Detail:
Title:  Plastic and reconstructive surgery     Volume:  129     ISSN:  1529-4242     ISO Abbreviation:  Plast. Reconstr. Surg.     Publication Date:  2012 Jun 
Date Detail:
Created Date:  2012-05-30     Completed Date:  2012-08-07     Revised Date:  2012-09-10    
Medline Journal Info:
Nlm Unique ID:  1306050     Medline TA:  Plast Reconstr Surg     Country:  United States    
Other Details:
Languages:  eng     Pagination:  1337-44     Citation Subset:  AIM; IM    
Affiliation:
Craniofacial Research Center, Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital, Taoyuan, Taiwan. philip@adm.cgmh.org.tw
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MeSH Terms
Descriptor/Qualifier:
Craniofacial Abnormalities / surgery*
Face / surgery*
Facial Expression
Female
Follow-Up Studies
Humans
Infant
Male
Retrospective Studies
Tissue Expansion / methods*
Comments/Corrections
Comment In:
Plast Reconstr Surg. 2012 Jun;129(6):1345-6   [PMID:  22634649 ]

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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