Repair of tessier No. 3 and No. 4 craniofacial clefts with facial unit and muscle repositioning by midface rotation advancement without Z-plasties

Philip Kuo Ting Chen, Frank Chun Shin Chang, Fuan Chiang Chan, Yu Ray Chen, M. Samuel Noordhoff

Research output: Contribution to journalReview article

11 Citations (Scopus)

Abstract

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.

Original languageEnglish
Pages (from-to)1337-1344
Number of pages8
JournalPlastic and Reconstructive Surgery
Volume129
Issue number6
DOIs
Publication statusPublished - Jun 1 2012
Externally publishedYes

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Facial Muscles
Facial Expression
Skin Pigmentation
Cicatrix
Lacrimal Apparatus
Color
Skin

ASJC Scopus subject areas

  • Surgery

Cite this

Repair of tessier No. 3 and No. 4 craniofacial clefts with facial unit and muscle repositioning by midface rotation advancement without Z-plasties. / Chen, Philip Kuo Ting; Chang, Frank Chun Shin; Chan, Fuan Chiang; Chen, Yu Ray; Noordhoff, M. Samuel.

In: Plastic and Reconstructive Surgery, Vol. 129, No. 6, 01.06.2012, p. 1337-1344.

Research output: Contribution to journalReview article

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abstract = "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.",
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N2 - 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.

AB - 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.

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