CHAPTER 26 CRANIOFACIAL CLEFTS AND HYPERTELORBITISM
TESSIER CLASSIFICATION
The Tessier classification for rare craniofacial clefts links clinical observations with underlying skeletal deformities seen with preoperative 3D computed tomography (CT} scan imaging and confirmed during surgery. o In the Tessier classification, clefts are numbered from 0 to 14 (Figure 26.2}. o The eyelids and orbits are designated as the horizontal axis of this functional system dividing the face into upper and lower hemispheres. o The orbit separates the facial clefts (0 through 7; going from medial to lateral) from the cranial clefts (8 through 14; going from lateral to medial). o In many cases, the facial clefts extend into the cranium in predictable lines to form combination cranial and facial clefts, including 0 and 14, 1 and 13, 2 and 12, 3 and 11, 4 and 10, 5 and 9, and 6 and 8.
o …show more content…
The skeletal landmarks tend to be more constant and reliable than the soft tissue landmarks.
DEFINING FEATURES OF CRANIOFACIAL CLEFTS
Number 0 cleft
The number 0 Tessier craniofacial clefts are unique in that there may be deficient, normal, or excess tissue.
Median craniofacial hypoplasia (deficiency of midline structures):
Clinically, it may be important to distinguish among patients with poor brain differentiation (alobar holoprosencephaly) who may die in infancy from those with a better prognosis (lobar brain).
Soft tissue deficiencies with Tessier 0 clefts include the upper lip and nose. Agenesis or hypoplasia may result in a false median cleft lip and absence of philtral
TESSIER CLASSIFICATION
The Tessier classification for rare craniofacial clefts links clinical observations with underlying skeletal deformities seen with preoperative 3D computed tomography (CT} scan imaging and confirmed during surgery. o In the Tessier classification, clefts are numbered from 0 to 14 (Figure 26.2}. o The eyelids and orbits are designated as the horizontal axis of this functional system dividing the face into upper and lower hemispheres. o The orbit separates the facial clefts (0 through 7; going from medial to lateral) from the cranial clefts (8 through 14; going from lateral to medial). o In many cases, the facial clefts extend into the cranium in predictable lines to form combination cranial and facial clefts, including 0 and 14, 1 and 13, 2 and 12, 3 and 11, 4 and 10, 5 and 9, and 6 and 8.
o …show more content…
The skeletal landmarks tend to be more constant and reliable than the soft tissue landmarks.
DEFINING FEATURES OF CRANIOFACIAL CLEFTS
Number 0 cleft
The number 0 Tessier craniofacial clefts are unique in that there may be deficient, normal, or excess tissue.
Median craniofacial hypoplasia (deficiency of midline structures):
Clinically, it may be important to distinguish among patients with poor brain differentiation (alobar holoprosencephaly) who may die in infancy from those with a better prognosis (lobar brain).
Soft tissue deficiencies with Tessier 0 clefts include the upper lip and nose. Agenesis or hypoplasia may result in a false median cleft lip and absence of philtral