Craniofacial Cleft: A Case of Tessier 10 Cleft With a Novel Method to Repair Large Bilateral Colobomas. (November 2019)

• Record Type: Journal Article
• Authors: Barnett, Joshua M.; Pang, John H. Y.; Herman, Sean; Lee, Jonathan; Stefko, S. Tonya; Losee, Joseph E.; Goldstein, Jesse
• Is Part Of: Cleft palate-craniofacial journal. Volume 56:Number 10(2019)
• Page Start: 1377
• Page End: 1380
• Publication Date: 2019-11
• Subjects: Tessier 10 -- cleft -- coloboma -- rotation flap; Cleft palate -- Periodicals; Skull -- Abnormalities -- Periodicals; Cranial manipulation -- Periodicals; Skull -- Abnormalities -- Surgery -- Periodicals; Face -- Abnormalities -- Surgery -- Periodicals; Fente palatine -- Périodiques; Crâne -- Malformations -- Périodiques; Manipulation crânienne -- Périodiques; Crâne -- Malformations -- Chirurgie -- Périodiques; Face -- Malformations -- Chirurgie -- Périodiques; Cleft palate; Cranial manipulation; Face -- Abnormalities -- Surgery; Skull -- Abnormalities; Skull -- Abnormalities -- Surgery; Cleft Lip; Cleft Palate; Facial Bones -- abnormalities; Skull -- abnormalities; Periodicals; Periodicals; Periodicals; 617.522
• DOI: 10.1177/1055665619853737
• Languages: English
• ISSNs: 1055-6656

Abstract

Objective: To describe a reliable method utilizing large, rotation flaps to reconstruct a number 10 Tessier cleft. Design: This is a descriptive clinical case report. Setting: Pediatric teaching hospital affiliated with a university. Patients, Participants: One participant in this clinical case report. Interventions: Full-thickness excision of the clefted eyelid, brow, and forehead tissue was performed bilaterally to develop medial and lateral eyebrow and forehead flaps. Right: the forehead/brow flap was rotated caudally to reapproximate the eyebrow and an eyelid rotation flap was also used to reapproximate the lid margin. Left: forehead/brow rotation flap allowed realignment of the eyebrow and a series of Z-plasties were used in the eyelid to reapproximate the lid margin and to lengthen the eyelid. Main Outcome Measure(s): Develop and construct a reliable reconstruction with full-eyelid closure and minimal donor site morbidity. Results: Complete eyelid closure bilaterally was achieved intraoperatively, and was maintained at 6-month follow-up with no evidence of ocular pathology. Conclusions: Large, bilateral upper eyelid colobomas require repair to prevent blindness. Although free tarsomarginal grafts and lid-sharing procedures have been described, we demonstrate that large rotation flaps designed along the cleft margin can provide a reliable reconstruction and minimize donor-site morbidity.