title: Tessier No. 3 and No. 4 clefts: Sequential treatment in infancy by pre-surgical orthopedic skeletal contraction, comprehensive reconstruction, and novel surgical lengthening of the ala base-canthal distance.
abstract: BACKGROUND
  Repair of facial clefts implies wide tissue mobilization with multi-stage surgical treatment. Authors propose pre-surgical orthopedic correction for naso-oro-ocular clefts and a novel surgical option for Tessier No. 3 cleft.
  
  
  METHODS
  Two male infants, a Tessier No. 3 cleft (age 7 months) and another Tessier No. 4 (age 3 months), were treated with a modified orthopedic Latham device with additional septo-premaxillary molding and observed to age four years. Tessier No. 3 orthopedic measurements were obtained by image corrected cephalometric analysis. Subsequent repair included tissue expansion on Tessier No. 4 and naso-frontal Rieger flap combined with myocutaneous upper lid flap on Tessier No. 3.
  
  
  RESULTS
  Orthopedic movements ranged from 18.5 mm in bi-planar to 33 mm in oblique analyses. Tissue margins became aligned with platform normalization. Tissue expansion on Tessier No. 4 improved distances from ala base-lower lid and subalar base-lip. The naso-frontal flap combined with myocutaneous upper lid flap on Tessier No. 3 had similar achievement, but also sufficiently lengthened ala base-canthal distance.
  
  
  CONCLUSIONS
  Repairs were facilitated by pre-surgical orthopedic correction. The naso-frontal flap combined with an upper lid myocutaneous flap seems viable as a single-stage option to lengthen ala base-canthal distance to advance repair achievement in unilateral Tessier No. 3.
authors.affiliation: UDM School of Dent, Dept. of Orthodontics, Detroit, MI, USA; Ian Jackson Craniofacial & Cleft Palate Clinic, Wm Beaumont Hospital, Royal Oak, MI, USA; Craniofacial Institute of Michigan, St John Providence Health System, Detroit, MI, USA; Wm Beaumont Hospital, Royal Oak, MI, USA; St John Providence Hospital, Southfield and Novi, MI, USA; Oral Maxillofacial Surgery, Orthodontics at 39611 Garfield Rd - Suite 12, Clinton Twp, MI 48038, USA. Electronic address: spolyarjohn@yahoo.com.
authors.forename: John L
authors.initials: JL
authors.lastname: Spolyar
authors.affiliation: Craniofacial Institute of Michigan, St John Providence Health System, Detroit, MI, USA; St John Hospital, Detroit, MI, USA; Providence Hospital, Southfield and Novi, MI, USA; Surgery (Craniofacial), 46325 West 12 Mile Road, Novi, MI 48377, USA.
authors.forename: Mark
authors.initials: M
authors.lastname: Hnatiuk
authors.affiliation: Ian Jackson Craniofacial & Cleft Palate Clinic, Wm Beaumont Hospital, Royal Oak, MI, USA; Wm Beaumont Hospital, Royal Oak, MI, USA; Oakland University William Beaumont School of Medicine, USA; Wayne State University School of Medicine, USA; Surgery (Plastic Reconstructive), 2585 Crooks Rd, Troy, MI 48084, USA.
authors.forename: Kenneth W
authors.initials: KW
authors.lastname: Shaheen
authors.affiliation: Craniofacial Institute of Michigan, St John Providence Health System, Detroit, MI, USA; St John Providence Hospital, Detroit and Novi, MI, USA; Oral Maxillofacial Surgery, Orthodontics at 18342 Mack Ave, Grosse Pointe Farms, MI 48236, USA.
authors.forename: Jennifer K
authors.initials: JK
authors.lastname: Mertz
authors.affiliation: Ian Jackson Craniofacial & Cleft Palate Clinic, Wm Beaumont Hospital, Royal Oak, MI, USA; Oakland University William Beaumont School of Medicine, USA; Surgery (Oculoplastic Skull Base), 2125 Butterfield, Suite 201N, Troy, MI 48084l, USA.
authors.forename: Lawrence F
authors.initials: LF
authors.lastname: Handler
authors.affiliation: RSJ Plastic Surgery, 13005 Southern Blvd., Medical Mall 2, Suite 212, Loxahatchee, FL 33470, USA; Craniofacial Institute of Michigan, St John Providence Park Hospital, Novi, MI, USA.
authors.forename: Ravinder
authors.initials: R
authors.lastname: Jarial
authors.affiliation: Craniofacial Institute of Michigan, St John Providence Park Hospital, Novi, MI, USA; Division Craniofacial Plastic Surgery, Catholic Children's Hospital Wilhelmstift, Lilinecronstr. 130, 22149 Hamburg, Germany.
authors.forename: J Camilo
authors.initials: JC
authors.lastname: Roldán
mesh_terms: D002971:Cleft Lip / Q000601:surgery*; D005145:Face / Q000601:surgery*; D006801:Humans; D007223:Infant; D008297:Male; D019651:Plastic Surgery Procedures / Q000379:methods*; D013524:Surgical Flaps / Q000601:surgery*
keywords: Cleft nose; Facial cleft; Naso-oro-ocular cleft; Pre-surgical orthopedic correction; Rare cleft; Tessier cleft