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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

Chen, Philip Kuo-Ting M.D.; Chang, Frank Chun-Shin M.D.; Chan, Fuan-Chiang M.D.; Chen, Yu-Ray M.D.; Noordhoff, M. Samuel M.D.

Plastic and Reconstructive Surgery: June 2012 - Volume 129 - Issue 6 - p 1337–1344
doi: 10.1097/PRS.0b013e31824ec310
Pediatric/Craniofacial: Original Articles

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.


Linkou and Taoyuan, Taiwan

From the Craniofacial Research Center, Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital, and Department of Chemical and Materials Engineering, College of Engineering, Chang Gung University.

Received for publication August 6, 2011; accepted December 14, 2011.

Disclosure: The authors have no commercial associations or conflicts of interest to report.

Philip Kuo-Ting Chen, M.D.; Craniofacial Center, Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital, 5, Fu-Hsin Street, Kwei-Shan, Taoyuan, Taiwan,

©2012American Society of Plastic Surgeons