title: A bilateral tessier number 4 and 5 facial cleft and surgical strategy: a case report.
abstract: BACKGROUND
  Tessier facial cleft is among the rarest facial clefts reported in literatures and there are many issues arguing about its multidisciplinary repairing techniques. Tessier number 4 and 5 are extremely rare facial anomalies. There are few literatures describing these clefts and their surgical modalities. Number 5 Tessier cleft begins medial to oral commissure in the upper lip and extends superiorly as a groove through the cheek and ends at the middle third of lower eyelid. Bonny involvement consists of alveolar ridge, maxillary bone lateral to infra orbital foramen and orbits lower rim and floor. Number 4 Tessier facial cleft begins between cupid bow and oral commissure; skirting the nose and pass through cheek and lateral to lacrimal duct. Bonny involvement consists of alveolar ridge, maxillary bone medial to infra orbital foramen and orbital rim and floor.
  
  
  METHODS
  This paper represents a patient with bilateral number 4 and 5 Tessier cleft lip with unilateral complete cleft palate and surgical approach on her.
  
  
  CONCLUSIONS
  We recommended early repair using autogenously tissues and minimal discarding healthy tissues as possible.
authors.affiliation: Department of Otolaryngology Head and Neck Surgery, Tabriz University of Medical Sciences, Tabriz, Iran.
authors.forename: Shahin
authors.initials: S
authors.lastname: Abdollahifakhim
authors.forename: Nikzad
authors.initials: N
authors.lastname: Shahidi
authors.forename: Gholamreza
authors.initials: G
authors.lastname: Bayazian
keywords: Cleft lip; Facial anomaly; Facial clefts