Tessier number 6 facial cleft

Tessier number 6 facial cleft is an extremely rare congenital craniofacial malformation classified within the Tessier cleft system, which categorizes rare facial clefts based on their anatomical position relative to the orbit. The Tessier number 6 cleft extends from the medial aspect of the lower eyelid (near the inner canthus) downward through the cheek toward the oral commissure region, running between the Tessier number 5 and number 7 clefts. It involves both soft tissue and potentially the underlying bony structures, specifically affecting the area between the maxillary bone (zygomatic process of the maxilla) and the zygoma. Clinically, this cleft may present as a groove or fissure in the cheek, coloboma of the lower eyelid, disruption of the lateral nasal and cheek soft tissues, and incomplete formation of the zygomatic-maxillary junction. Affected individuals may exhibit asymmetry of the midface, soft tissue deficiency along the cleft line, lower eyelid abnormalities including coloboma, and potential exposure of the orbit. The cleft can vary in severity from a subtle soft tissue notch to a complete cleft involving both skin and bone. Associated dental anomalies and orbital dystopia may also be present depending on the extent of the malformation. As with other rare Tessier clefts, the condition is apparent at birth. Treatment is primarily surgical and requires a multidisciplinary craniofacial team. Surgical reconstruction aims to restore facial symmetry, close the cleft defect, reconstruct the lower eyelid and cheek soft tissues, and address any underlying bony deficiencies. Multiple staged surgeries may be necessary throughout childhood. Supportive care may include ophthalmologic monitoring, dental and orthodontic management, and speech therapy if oral function is affected. There is no known medical or pharmacological treatment for the structural defect itself.

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