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Repair of Tessier no. 3 and no. 4 craniofacial clefts with facial unit and muscle repositioning by midface rotation advancement without Z-plasties.

Abstract：

BACKGROUND:The accepted surgical correction of Tessier no. 3 and no. 4 craniofacial clefts is the use of interdigitating skin flaps along the line of the facial cleft, which frequently results in unsightly facial scars, poor skin color match, and an unnatural facial expression. The authors report their technique of midface rotation-advancement concept to repair these craniofacial clefts. METHODS:Fourteen patients who had undergone Tessier no. 3 and no. 4 cleft repair over a 35-year period (1976 to 2010) at the craniofacial center in Chang Gung Memorial Hospital were retrospectively reviewed. Five patients (group 1) were operated on using Z-plasty principles. Nine (group 2) were operated on using the rotation-advancement technique; six of them had Tessier no. 3 clefts and three had Tessier no. 4 clefts. Seven of those nine patients were primary cases; the other two had secondary or tertiary revisions. Patient photographs were reviewed to assess outcomes. RESULTS:Group 1 had a less overall satisfactory result in terms of scar quality, color matching, or natural facial expression. Overall, a much improved appearance with a higher satisfaction rate was demonstrated in group 2. Patients in group 2 who were surgically treated with the midface rotation advancement technique, though their medial canthus and alar base might not have been well repositioned, still had much better results. CONCLUSIONS:Midface rotation advancement avoided significant scarring with poor skin color matching and unnatural facial expressions. This technique is applicable to either the primary repair or secondary revision of Tessier no. 3 and no. 4 craniofacial clefts. CLINICAL QUESTION/LEVEL OF EVIDENCE:Therapeutic, III.

journal_name

Plast Reconstr Surg

journal_title

Plastic and reconstructive surgery

authors

Chen PK,Chang FC,Chan FC,Chen YR,Noordhoff MS

doi

10.1097/PRS.0b013e31824ec310

subject

Has Abstract

pub_date

2012-06-01 00:00:00

pages

1337-1344

issue

eissn

0032-1052

issn

1529-4242

pii

00006534-201206000-00020

journal_volume

129

pub_type

杂志文章

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Repair of Tessier no. 3 and no. 4 craniofacial clefts with facial unit and muscle repositioning by midface rotation advancement without Z-plasties.