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Table 1 Characteristics of articles included

From: Scoping review of the morphology and anthropometry of Tessier craniofacial clefts numbers 3 and 4

Author/date Percentage (male) Percentage (female) Age of population Type of cleft Aim of study Main outcome
Ahmad Muhsin Mohammad Nor, 2016 100%   1 day old FC 4 The aim of this presentation is to report the multidisciplinary sequence of procedures to manage Tessier number 4 facial cleft A multi-disciplinary approach in managing such patient is paramount due to the complexity. Besides the obvious issues, the psychosocial aspect of this matter must also be looked into
Shahin Abdollahi Fakhim et al., 2012   100% 6 months old FC 4 and 5 Was to present a patient with bilateral numbers 4 and 5 Tessier cleft lip with unilateral complete cleft palate and surgical approach on her We recommended early repair using autogenous tissues and as minimal disposal of the healthy tissues as possible
Akoz et al., 1995 100%   4 months old FC 4 To report a case of Tessier no.4 cleft and their surgical approach to repairing it Using a technique of surgery that preserved maximal amount of soft tissue with conjunctival and lower lid reconstruction utilizing a flap from the medial cleft ridge
Allam et al., 2014 70% 30% 6 weeks old to 20 years old FC 3 Considering the rarity of the Tessier number 3 cleft, the objective was to review one of the largest series in the literature describing a single surgeon’s experience in treating this complex facial cleft As these clefts can be variable in presentation, each treatment approach must be individualized to the patient and their needs
Nivaldo Alonso et al., 2008 66.7% 33.3% 1 day old to 25 years old FC 4 The present article aims to describe different clinical features evidenced in 21 cases of this malformation, discussing a 20-year experience with and evolution of its surgical treatment According to our reconstructive experience, the great majority of Tessier no. 4 facial clefts may be appropriately treated using local flaps. Classic techniques are extremely useful and can offer good functional and esthetic outcomes
S. M. Balaji, 2017 100%   18 months old FC 4 This article presents a rare case of an 18-month-old baby with bilateral Tessier no. 4 clefts and its successful rehabilitation Early repair using autogenous tissues and minimal discarding of healthy tissues as much as possible is recommended
F. Bodin et al., 2005   100% 4 months old FC 3, 7, and 11 We report a case of right associated Tessier no. 3, 7, and 11 craniofacial clefts with cardiac malformation The case we report is a unique association of severe hemifacial microsomia and complete oro-naso-ocular cleft. To our knowledge, this association has not been previously reported
Chen et al., 2011 N/A N/A N/A FC 3 and 4 Considering the rarity of the Tessier number 3 cleft, the objective was to review one of the largest series in the literature describing a single surgeon’s experience in treating this complex facial cleft The “midface rotation advancement” concept and technique give rise to esthetically favorable results both in primary and in secondary reconstructions. This technique avoided significant scarring with poor skin color matching and unnatural facial expressions associated with the interdigitating skin flap technique
Atilla Coruh et al., 2003 50% 50% 15 days to 7 years FC 4 This article presents two cases of Tessier no. 4 clefts, one unilateral and the other bilateral, and discusses the problems encountered during their surgical and postoperative managements If the soft tissue deficiency is severe, conventional techniques using flaps or Z-plasties, which are designed to replace the missing tissues, are far from being ideal. Mustarde cheek flaps for lower eyelid reconstruction may be an alternative for extensive facial clefts
Renato da Silva Freitas et al., 2009 43% 57% 1 day old to 30 years old FC 3 The objective was to review the functional outcome and esthetic results of the different techniques applied for each case We have treated 21 patients with Tessier number 3 cleft at 2 craniofacial centers. Eyelid, nose, and upper lip deformities should be treated in sequential stages, positioning the medial canthus, ala, and upper lip, using the contralateral side as the reference
Mohd Ashraf Darzi et al., 1993 66.7% 33.3% 3 months old to 3 years FC 3, 4, 5, and 9 To adequately examine the occurrence of oblique clefts, the medical community must be aware of the problem and new cases should be presented. On the basis of clinical radiologic and surgical examinations, soft tissue and skeletal disruptions of three patients with the most rare craniofacial clefts (Tessier 3, 4, 5, and 9) are presented Kawamoto reported Tessier number 5 cleft to be the least frequently observed oblique facial cleft. Our case three is the third bilateral and overall, the ninth case of Tessier number 5 clefts reported in world literature
E. Gawrych et al., 2010   100% 2 weeks old FC 3 This report presents a patient with a right-sided oblique cleft extending through the upper lip, the alar groove, and the lower palpebra accompanied by a left-sided complete cleft lip and palate. Hypertylorism and bilateral microphthalmia as well as flexion wrist contractures were also present The findings of this report demonstrate the wide variability in the pattern of presentation of oblique facial clefts caused by aberrant tissue bands
Alcir Giglio et al., 2008 25% 75% 5 months to 8 years FC 3 and 4 Considering the rarity of the Tessier number 3 cleft, the objective was to review one of the largest series in the literature describing a single surgeon’s experience in treating this complex facial cleft The rotation and advancement flap of the cheek is a safe technique that may present satisfactory results in the treatment of rare craniofacial nos. 3 and 4 clefts
Ugur Horoz et al., 2016 50% 50% 1 to 12 years old FC 4 The present study presents a new lip-rescue flap technique as an alternative approach for reconstructing Tessier no. 4 facial clefts We applied our lip-rescue flap surgically on 4 patients with Tessier no. 4 facial clefts and found that the design rendered adequate tissue support and provided acceptable functional and esthetic results. Because it achieves more tissue support, we recommend using this lip-rescue flap as a reconstruction method in appropriate patients of Tessier no. 4 facial clefts
Boris Laure et al., 2009 100%   26 years old FC 4 We report a case of a complete bilateral Tessier number 4 cleft and our approach to surgical correction. We analyze the patient’s treatment plan over a 26-year follow-up period These rare facial clefts should be treated with the same surgical management principles as the more common lip and palate clefts
Longaker et al., 1996 33.3% 66.7% 2  to 5 months FC 4 and 1/13, 2/12, 3/11 We present two cases of Tessier no.4 clefts and one case of a multiple clefted (Tessier nos. 1/13, 2/12, 3/11) child with the typical contracted oculo-alar and oculo-oral distances. Reconstruction with a superiorly based nasolabial flap transposed 90 degrees under the eye was performed in all three as a primary procedure The preceding reconstruction approach provided early protection of the eye, better position of the medial canthus, reconstitution of the bony orbit, and immediate improvement in facial appearance
Madaree et al., 1992 100%   6 weeks old FC 3 A method of correction of an incomplete no. 3 facial cleft in an infant is presented. It is compared with previously described repairs, and its advantages are outlined We feel that our inferiorly based transposed paranasal flap is a preferable method of filling the defect above the released alar rim
Maeda et al., 2014   100% 1 day old FC 3 and 4 Here we present the first case of a girl born with a combined anomaly of Tessier clefts 3 and 4 with severe bilateral cleft lip, a displaced premaxilla, and three-dimensional underdevelopment of the hard and soft tissues of the maxilla and zygoma We report an extremely rare case of a combined anomaly of Tessier clefts 3 and 4, which is, to our knowledge, the first case described in the English literature
Mishima et al., 1996 66.7% 33.3% N/A FC 3 and 4 This paper describes three cases of oblique facial cleft, one of which was obviously accompanied by an amnion rupture sequence. Of the other two cases, one was not affected by an amnion rupture sequence, while the other may have been The cause can be adjudged to embryological development. Among our cases, case 3 displayed conditions typical of the amnion rupture sequence, and an amniotic band attached to an encephalocele was also detected
Mishira et al., 2009 28.6% 71.4% 1.5  to 21 years FC 3 and 4 To overcome this problem and provide a ground rule for surgical management of such cases, we propose an easier format with a “split approach” of the affected areas Also, surgeons are often faced with complexities like the ideal age for surgical intervention and methods to ensure minimal scars in these cases. In this article, we have tried to address these issues and have attempted to provide guidelines to manage such cases effectively on the basis of our experience of seven cases of Tessier cleft types 3 and 4 in their unilateral and bilateral forms
Morgan et al., 2016 100%   N/A FC 3 The authors describe a method of correcting incomplete unilateral Tessier 3 cleft based on the principles of anthropometric techniques, based on identifiable landmarks and anthropometric measurements that are compared with contralateral unaffected anatomy or population means and tracked over time to assess impact on growth We present a patient with a good long-term postoperative result based on anthropometric methods to reconstruction. We feel this initial technique along with documentation of subsequent procedures can help provide a more reproducible form of reconstruction of the soft tissues in this rare patient population
Porttier-Marriet et al., 2008   100% 6 months old FC 4 We describe the case of a 9-month-old girl with a complete bilateral facial cleft. On the right cornea protruded a hard lesion, a corneal staphyloma We describe the case of a 9-month-old girl with a complete bilateral facial cleft. On the right cornea protruded a hard lesion, a corneal staphyloma. We described the 3 primary surgical steps used to restore the possibility of satisfactory feeding, to promote language acquisition, and to protect vision in the non-affected eye
Reddy et al., 2014 66.7% 33.3% 2 to 11 years old FC 2 and 3 We present two surgical options to repair such facial clefts. We have been able to demonstrate that nasal dorsum rotation flaps were a viable option for treating the nasal defects of Tessier no. 2 facial clefts. Similarly, FENTF were a viable option to treat the nasal defects of Tessier no. 3 facial clefts.
A. Rintala et al., 1980 36.4% 63.6% 1 day old to 58 years old FC 3, 4, 5, 7, 8, and 9 Explore cases of oblique facial clefts in the center All patients represent different types of clefts, and in most cases, they are associated either with other facial defects or with defects of other developmental fields. There is a slight over representation of females (7:4)
Sari et al., 2003 100%   8 months old FC 4 A patient with a Tessier number 4 cleft is presented, whose bony defect was obliterated with autogenous iliac bone graft chips and soft tissue reconstruction was performed with multiple Z-plasty flaps Postoperative clinical and radiological results demonstrate fine healing and good cosmesis. Although controversy still exists about the treatment of facial clefts with early bone grafts, advantages of performing both bony and soft tissue reconstructions in a single session make this treatment a good alternative with satisfactory clinical and radiological results
Sessena et al., 2011   100% 1 day old FC 3 The authors present a “step-by-step” solution of the malformation pointing out the limitations of the surgical procedures they used and the goals they wanted to obtain The authors report an extremely rare case of a Tessier 3 cleft associated with bilateral anophthalmia, which is, as far as they know, the first one described in the English literature
Spolyar et al., 2015 100%   3 to 7 months FC 3 and 4 Authors propose pre-surgical orthopedic correction for naso-oro-ocular clefts and a novel surgical option for Tessier no. 3 cleft Presurgical assistance facilitates comprehensive repair of the severe facial clefts, even with single-stage primary defect repair during infancy. Lengthening of the ala base-canthal distance is a key achievement, and it can be addressed by performing a frontonasal flap extended with a myocutaneous upper lid flap
Tokioka et al., 2005 50% 50% 1 day old FC 4 In this report, two cases with Tessier no. 4 cleft, which were treated with the cheek advancement flap technique, are presented Our results indicated that by using the cheek advancement flap technique, the soft tissue deficiency of the lower eyelid was not satisfactorily reconstructed. It is suggested that any single flap is not enough for the eyelid reconstruction in such a wide cleft as in our cases. Correction with the other local flaps will be planned in the near future. Tissue expansion or free tissue transfer are good alternatives for soft tissue reconstruction
Uemura et al., 2004 100%   6 years old FC 3 A composite Z-plasty to treat recurrence of cicatricial ectropion of the lower eyelids in Tessier 3 cleft is described Composite Z-plasty is a convenient surgical method suitable for scar contracture of tissues with free margins, such as the eyelid, nostril rim, and auricular helix, from which support tissue and covering skin tissue must be harvested. Composite Z-plasty should be considered in treatment planning for ectropion
Wenbin et al., 2006 100%   1 day old to 2 years old FC 3 Tessier 3 cleft with clinical anophthalmia is one of the rarest craniofacial clefts, and hence little has been published about its management and treatment. This article presents two cases of Tessier 3 cleft with clinical anophthalmia  
Wu et al., 2012   100% 20 months old FC 3 A Uighur girl with severe bilateral Tessier 3 clefts and associated orofacial deformities is described here, and a novel protocol for clefts of this severity and rarity is presented. This study focuses particularly on describing the surgical procedures and techniques The wide facial and palatal clefts were completely closured and the defective nasal ala and the dislocated medial canthi effectively reconstructed. The patient had an acceptable facial appearance with inconspicuous scars and natural facial expression. The outcomes of these operations were functionally and esthetically satisfactory
Xu et al., 2015 100%   1 day old to 6 months old FC 3 In this paper, we report two extremely rare cases of simultaneous Tessier number 3 cleft, contralateral cleft lip, and signs of amniotic band syndrome We report two extremely rare cases of Tessier number 3 cleft with contralateral cleft lip and signs of amniotic band syndrome. From these two cases, we may confirm that amniotic bands are the most probable cause of the Tessier number 3 cleft. Treatment of the Tessier number 3 cleft should be individually designed based on the severity of the deformities
Sigler et al., 2004 100%   6 months old FC 2, 3, and 7 A unique case of a unilateral partial Tessier no. 7 cleft accompanied by nos. 2 and 3 clefts along with a single median lip pit is presented After an extensive review of the literature, we found that unilateral transverse facial cleft along with unilateral CL/P and a median LP to our knowledge has never been describe