title: Combination of Tessier clefts 3 and 4: case report of a rare anomaly with 12 years' follow-up.
abstract: Tessier cleft types 3 and 4 are both rare craniofacial anomalies. 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. This type of rare facial cleft poses a major operative challenge. Over a period of years, presurgical alveolar molding with an active appliance was followed by seven operations. A satisfactory esthetic outcome was obtained. A multidisciplinary approach to treatment with a plastic surgeon in charge of the operations and an orthodontist in charge of the cleft deformity is essential.
authors.affiliation: Department of Plastic and Reconstructive Surgery (Dr. Yuhei Yamamoto, MD, PhD, Departmental Chief), Hokkaido University Graduate School of Medicine, Japan.
authors.forename: Taku
authors.initials: T
authors.lastname: Maeda
authors.affiliation: Department of Plastic and Reconstructive Surgery (Dr. Yuhei Yamamoto, MD, PhD, Departmental Chief), Hokkaido University Graduate School of Medicine, Japan. Electronic address: akihiko.oyama@mac.com.
authors.forename: Akihiko
authors.initials: A
authors.lastname: Oyama
authors.affiliation: Department of Plastic and Reconstructive Surgery (Dr. Yuhei Yamamoto, MD, PhD, Departmental Chief), Hokkaido University Graduate School of Medicine, Japan.
authors.forename: Toru
authors.initials: T
authors.lastname: Okamoto
authors.affiliation: Department of Plastic and Reconstructive Surgery (Dr. Yuhei Yamamoto, MD, PhD, Departmental Chief), Hokkaido University Graduate School of Medicine, Japan.
authors.forename: Emi
authors.initials: E
authors.lastname: Funayama
authors.affiliation: Department of Plastic and Reconstructive Surgery (Dr. Yuhei Yamamoto, MD, PhD, Departmental Chief), Hokkaido University Graduate School of Medicine, Japan.
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Furukawa
authors.affiliation: Department of Plastic and Reconstructive Surgery (Dr. Yuhei Yamamoto, MD, PhD, Departmental Chief), Hokkaido University Graduate School of Medicine, Japan.
authors.forename: Toshihiko
authors.initials: T
authors.lastname: Hayashi
authors.affiliation: Department of Plastic and Reconstructive Surgery (Dr. Yuhei Yamamoto, MD, PhD, Departmental Chief), Hokkaido University Graduate School of Medicine, Japan.
authors.forename: Naoki
authors.initials: N
authors.lastname: Murao
authors.affiliation: Department of Orthodontics (Dr. Junichiro Iida, DDS, PhD, Departmental Chief), Division of Oral Functional Science, Hokkaido University Graduate School of Dental Medicine, Japan.
authors.forename: Yoshiaki
authors.initials: Y
authors.lastname: Sato
authors.affiliation: Department of Plastic and Reconstructive Surgery (Dr. Yuhei Yamamoto, MD, PhD, Departmental Chief), Hokkaido University Graduate School of Medicine, Japan.
authors.forename: Yuhei
authors.initials: Y
authors.lastname: Yamamoto
mesh_terms: D000202:Activator Appliances; D000539:Alveolar Process / Q000002:abnormalities; D016025:Bone Transplantation / Q000379:methods; D002971:Cleft Lip / Q000601:surgery; D002972:Cleft Palate / Q000601:surgery; D019465:Craniofacial Abnormalities / Q000601:surgery*; D004955:Esthetics, Dental; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007231:Infant, Newborn; D008437:Maxilla / Q000002:abnormalities; D009666:Nose / Q000002:abnormalities; D009915:Orbit / Q000002:abnormalities; D010158:Palatal Obturators; D019651:Plastic Surgery Procedures / Q000379:methods; D013524:Surgical Flaps / Q000601:surgery; D016896:Treatment Outcome; D015050:Zygoma / Q000002:abnormalities
keywords: Active appliance; Facial cleft; Presurgical alveolar molding; Tessier cleft 3; Tessier cleft 4