Tessier number 7 facial cleft

Tessier number 7 facial cleft, also known as temporo-zygomatic facial cleft or lateral facial cleft, is a rare congenital craniofacial malformation classified within the Tessier cleft classification system. This cleft extends laterally from the oral commissure (corner of the mouth) toward the ear, following the line between the cheek and the ear along the path of the zygomatico-temporal region. It is sometimes referred to as macrostomia (lateral enlargement of the mouth) when the soft tissue component predominates. The condition primarily affects the facial soft tissues and underlying bony structures, including the maxilla and zygoma. Clinically, patients present with widening of the oral commissure (macrostomia), lateral soft tissue deficiency or clefting of the cheek, preauricular skin tags, and variable involvement of the mandible and external ear. The Tessier 7 cleft is the most common of the rare lateral facial clefts and is frequently associated with hemifacial microsomia (oculo-auriculo-vertebral spectrum or Goldenhar syndrome), in which there is underdevelopment of structures derived from the first and second branchial arches on one or both sides of the face. The severity of Tessier number 7 cleft varies widely, ranging from a minor soft tissue notch at the oral commissure to a complete cleft extending through the cheek to the preauricular region with significant bony involvement. Associated features may include microtia (underdeveloped ear), mandibular hypoplasia, facial nerve weakness, and hearing loss. Some patients may have vertebral anomalies or epibulbar dermoids when the condition occurs as part of the oculo-auriculo-vertebral spectrum. Treatment is primarily surgical and is tailored to the severity of the cleft. Commissuroplasty (surgical repair of the oral commissure) is typically performed in infancy or early childhood to restore a symmetric mouth opening and improve feeding and facial appearance. More complex cases may require staged reconstructive procedures including bone grafting, soft tissue reconstruction, mandibular distraction osteogenesis, and ear reconstruction. A multidisciplinary team approach involving craniofacial surgeons, orthodontists, speech therapists, audiologists, and other specialists is essential for optimal outcomes.

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