Lateral Or Transverse Cleft
Lateral facial cleft - The ULTIMATE Clinical pearls To achieve the ultimate result various aspects have to be considered. Ignoring one or more of these aspects will lead to suboptimal aesthetic and functional results. 1. Lateral or transverse facial clefts are rare. Their prevalence is 0.8% among all clefts. In 55.9% they might be associated with syndromes, such as Goldenhar, oto-mandibular dysostosis or Treacher-Collins syndrome. 2. Lateral facial clefts may present unilaterally on the left or right side or even bilaterally. Four different types can be identified: i) superior lateral (T7.1), ii) middle lateral (T7.2), iii) inferior lateral, also known as ‘fish mouth type’ (T7.3), and iv) aplastic type (T7.4) with partial agenesis of skin, mucosa and muscles. 3. Macrostomia represents a lateral facial variation in that the total cleft area presents with normal dry and wet lip red mucosa lining and manifests in any of the four above-mentioned variations (T7.1 – T7.2). A lateral cleft without normal lip red mucosa is not considered to be a macrostomia. 4. Repair involves: 1) straight line mucosal closure; 2) rotational commissural closure, preventing both future scar formation in the new commissure and cheilitis; 3) modiolus muscle repair and 4) straight line cutaneous closure in T7.1, or otherwise a rotated cutaneous Z-plasty. Straight line closure in T7.2 – T7.4 types may lead to fish mouth appearance.
Book: Cleft Ultimate Treatment -- Oro-facial and Cranio-maxillo-facial Deformities (Second Edition) Authors: Dr. Kurt Butow and Dr. Roger Z...