Challenges in nasal reconstruction for facial clefts Tessier 3 bilateral and Tessier 0: a staged surgical approach case report.

IF 2 Q2 DENTISTRY, ORAL SURGERY & MEDICINE
Arif Tri Prasetyo
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Abstract

Background: Craniofacial anomalies, particularly Tessier facial clefts, present significant surgical and functional challenges. Bilateral Tessier 3 and Tessier 0 clefts are extremely rare, often requiring complex reconstructive strategies. These clefts result in severe nasal deformities, including absent nasal septum, hypertelorism, and malpositioned alae nasi, affecting both appearance and function. Due to the lack of standardized approaches in such cases, this report highlights a staged surgical reconstruction aimed at restoring nasal structure and improving facial harmony, with a 12-month follow-up showing stable nasal contour and functional airway restoration.

Case presentation: A 16-year-old female presented with bilateral Tessier 3 and Tessier 0 clefts, exhibiting hypertelorism, a wide nasal dorsum, cranial displacement of the alae nasi, and an absent nasal septum. The patient underwent staged reconstruction. The first stage repositioned the alae nasi and created a functional nasal airway. In the second stage, costal cartilage was used to construct an L-shaped septal extension graft and dorsal onlay graft to restore nasal contour and stability. A subsequent procedure refined the nasal dorsum and approximated the alae nasi. Although orbital box osteotomy was planned to correct hypertelorism, the patient declined further intervention.

Conclusion: This case highlights the effectiveness of a staged reconstructive approach in addressing rare craniofacial anomalies. Twelve-month postoperative follow-up confirmed the stability of nasal contour, functional airway patency, and satisfactory facial symmetry. The decision to forgo orbital box osteotomy emphasizes the role of patient-centered care in craniofacial surgery. This case provides valuable insights for optimizing reconstructive techniques in complex facial clefts.

Tessier 3双侧和Tessier 0面部唇裂鼻重建的挑战:分阶段手术入路病例报告。
背景:颅面畸形,特别是Tessier面部唇裂,给外科手术和功能带来了重大挑战。双侧Tessier 3和Tessier 0唇裂极为罕见,通常需要复杂的重建策略。这些裂口导致严重的鼻部畸形,包括鼻中隔缺失、鼻中隔过远和鼻翼错位,影响外观和功能。由于此类病例缺乏标准化的方法,本报告强调了分阶段的手术重建,旨在恢复鼻结构和改善面部和谐,12个月的随访显示鼻轮廓稳定,气道功能恢复。病例介绍:一名16岁女性,双侧Tessier 3和Tessier 0裂口,表现为远端远视,鼻背宽,鼻翼颅骨移位,鼻中隔缺失。病人接受了分期重建。第一阶段重新定位鼻翼并建立功能性鼻导气管。第二阶段采用肋软骨构建l型鼻中隔延伸移植物和背侧覆盖移植物来恢复鼻轮廓和稳定性。随后的手术细化了鼻背,近似鼻翼。虽然计划进行眶盒截骨术以矫正远视,但患者拒绝进一步干预。结论:本病例强调了分阶段重建方法治疗罕见颅面畸形的有效性。术后随访12个月,鼻轮廓稳定,气道通畅,面部对称性良好。放弃眶盒截骨术的决定强调了以患者为中心的护理在颅面外科手术中的作用。本病例为优化复杂面部裂隙的重建技术提供了有价值的见解。
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来源期刊
Maxillofacial Plastic and Reconstructive Surgery
Maxillofacial Plastic and Reconstructive Surgery DENTISTRY, ORAL SURGERY & MEDICINE-
CiteScore
4.30
自引率
13.00%
发文量
37
审稿时长
13 weeks
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