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Indian Pediatr 2009;46: 907

Tessier Number 5 Cleft


Ajay Garg and *Sheetal Goyal

Departments of Otorhinolaryngology, and *Obstetrics and Gynaecology, PT BDS PGIMS,
Rohtak, Haryana, India.
E-mail: [email protected]

 

Oblique facial cleft is an extremely rare and disfiguring congenital anomaly of the face manifests in a variety of patterns. Tessier classified craniofacial clefts from 0 to 14, which follow constant lines or axes through the eyebrows or eyelids, the maxilla, the nose and the lip. In these facial clefts, soft tissue and bony skeleton are often not involved to the same degree; the globe can be functional or may be micropthalmic or anopthalmic. The medial canthal tendon is intact but is displaced laterally and inferiorly. The nasolacrimal system is involved as the cleft runs medial to the punctum and through inferior canaliculus.

Fig. 1 Clinical photograph showing cleft extending from right angle of mouth to lower eyelid at its middle and lateral junction.

Among all facial clefts Tessier cleft No. 5 is least frequently found. Morian first drew attention to the infraorbital foramen in distinguishing different categories of facial clefts. In Tessier cleft no 5, the cleft passes lateral to infraorbital foramen (Tessier cleft No. 4 cleft passes medial to foramen). The pyriform aperture is not violated. The American Association of Cleft Palate Rehabilitation classified this anomaly as oro-ocular cleft type II.

 

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