title: Ophthalmic considerations in the management of Tessier cleft 5/9.
abstract: OBJECTIVE
  To describe a patient with Tessier cleft number 5 and 9 and review the literature on the ocular impairment and management of this extremely rare anomaly.
  
  
  METHODS
  Interventional case report and literature review.
  
  
  RESULTS
  The literature review showed that the present patient is the second case with clefts 5/9. The ophthalmic consequences of this rare association are virtually unreported. Our case demonstrates that the presence of cleft number 9 adds a cicatricial component on the upper eyelid that severely impairs the dynamics of this lid. The corneal status of the patient was successfully managed with simultaneous upper eyelid lengthening and facial reconstruction.
  
  
  CONCLUSIONS
  In order to avoid corneal perforation, simultaneous upper and lower eyelid reconstruction is mandatory in cases of cleft 5/9. The affected patients should be continuously followed in order to prevent amblyopia.
authors: Craniofacial Unit, Department of Ophthalmology, Otorhinolaryngology and Head and Neck Surgery, School of Medicine of Ribeirão Preto, University of São Paulo, São Paulo, Brazil.
authors: Filipe J
authors: FJ
authors: Pereira
authors: Gherusa H
authors: GH
authors: Milbratz
authors: Antonio A V
authors: AA
authors: Cruz
authors: João J A
authors: JJ
authors: Vasconcelos
mesh_terms: D000015:Abnormalities, Multiple / Q000601:surgery*; D019465:Craniofacial Abnormalities / Q000601:surgery*; D005124:Eye Abnormalities / Q000601:surgery*; D005143:Eyelids / Q000002:abnormalities; D005145:Face / Q000002:abnormalities; D005260:Female; D006801:Humans; D007231:Infant, Newborn; D013508:Ophthalmologic Surgical Procedures; D009915:Orbit / Q000002:abnormalities; D019651:Plastic Surgery Procedures