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Journal of the Korean Society of Plastic and Reconstructive Surgeons 2011;38(2):143-147.
Published online March 1, 2011.
Alteration in Surgical Technique of Tessier Classification Number 7 Cleft.
Yong Chan Bae, Kyung Dong Kang, Kyoung Hoon Kim
Department of Plastic and Reconstructive Surgery, School of Medicine, Pusan National University, Busan, Korea. baeyc2@hanmail.net
Abstract
PURPOSE
A Tessier classification number 7 cleft is an uncommon malformation that results from a failure of mesenchymal fusion within the maxillary and mandibular prominences of the 1st pharyngeal arch. Many operative techniques of the number 7 cleft repair have been proposed to restore function and improve aesthetics. Fifteen patients underwent repair of a number 7 cleft over 13 years by a modification of the surgical Technique, and an appraisal of the operative outcome is reported herein. METHODS: A retrospective review was conducted involving 15 patients with number 7 clefts who underwent surgery from 1996 to 2009. The changes in surgical technique included skin closure, attachment of the orbicularis oris muscle, and position of the repaired commissure; the changes were analysed with a review of the medical records and the outcomes of surgery were analysed via photographs. Specifically, the technique of skin closure was changed from the a Z-plasty to a linear closure, the orbicularis oris muscle overlapped attachment was replaced by a side-to-side approximation with horizontal mattress sutures, and the position of the repaired commissure was changed from 1mm laterally to 1mm medially in reference to the non-cleft side.
RESULTS
A Z-plasty caused additional cutaneous scarring, an overlapped attachment of the orbicularis oris muscle caused a thick oral commissure, and the repaired commissure migrated to the lateral side, so a 1mm, laterally-positioned commissure caused asymmetry. The altered procedure included a linear skin closure, a side-to-side orbicularis oris muscle approximation, and a 1mm, medially-positioned commissure, which together resulted in a good outcome.
CONCLUSION
The altered procedure for repair of a number 7 cleft as described herein, yields a short scar, no functional problems with the orbicularis oris muscle, a thin oral commissure, and symmetry of the repaired commissure.
Keywords: Tessier classification number 7 cleft; Transverse cleft; macrostomia; Surgical technique
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A clinical study on the tessier classification No.7 cleft patient.1998 February;25(2)



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