Maxillary augmentation, nasal notch correction and alar web correction surgery

A brief introduction to Tessier’s facial cleft and their management

Tessier’s facial clefts are of 14 types. They can extend from the hairline above the forehead to the mandible. These malformations can be debilitating for the patient and distressing for the family. It requires extensive surgical correction to rehabilitate these patients. Tessier’s facial clefts can also include malformations of the brain.

A patient with Tessier’s facial cleft presents to our hospital

This young man was born with Tessier’s facial cleft. He has already undergone innumerable surgeries elsewhere in the past. A doctor in his hometown referred him to our hospital for further management. Dr SM Balaji, facial reconstruction specialist, examined the patient and ordered radiographic studies. The patient needed maxillary augmentation, nasal notch correction and right alar web correction. He explained that rib grafts were mandatory for this surgery. The patient and his parents consented to the surgery.

Surgical correction of labial and infraorbital defect with rib grafts

Under general anesthesia, rib grafts were first harvested from the patient. A Valsalva maneuver demonstrated a patent thoracic cavity. The incision was then closed in layers with sutures. Attention was next directed to the patient’s labial defect. There was heavy scarring of the buccal vestibular mucosa from the previous surgeries. Incisions were made in the vestibular region. A costochondral graft was then shaped and placed in the anterior maxillary region. Rib grafts were then used to augment the remaining maxillary defects. The grafts were then fixed with screws. Sutures were then used to close the incisions.

Attention was next turned to correction of the nostrils. Notching on the left nostril was then corrected followed by right alar web correction. The incisions were then closed with sutures.

The patient recovered without event from general anesthesia. The patient and his parents expressed their complete satisfaction at the results.

Surgery Video