42 - Anatomy: The 'Lubendoff Bridge' in the Tessier Craniofacial Cleft Wars

Poster Board Number: 42
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Co-authors:

Pamela Pillay - Senior Lecturer, Clinical Anatomy, University of KwaZulu-natal, Durban; Lelika Lazarus - Professor, University of KwaZulu-natal, Durban; Anil Madaree - Plastic and reconstructive Surgery - University of KwaZulu-natal, Durban

Abstract Body : Introduction

The defects found in Tessier clefts come in various forms in different patients. These variations have to a great extent affected not only documentation of these craniofacial defects but invariably their treatment and communication amongst craniofacial researchers. This variation has led to varying classification schemes with still progress to be made for an understanding of these clefts. This study documented the clinical presentation of these clefts in a South African population using anthropometric measurements to generate a sub-classification that can ease the confusion and reviewed the existing literature on the clefts to compare facial clefts as seen in South Africa with the rest of the world.

Methods

A systematic review of literature was carried out identifying relevant studies from databases with the result being reported using the Preferred Reporting Items for Systematic reviews and Meta-analysis (PRISMA) as well as measurements of the expected defects in each cleft seen in our facility being taken and compared with the unaffected side as reference from CT scans. The emerging pattern of their analysis was then used to generate a sub-classification for these clefts (BREC Ref No: BE 652/17).

Results

It was noted that the association pattern recorded in Tessier cleft number 4 in this study did not conform to its traditional counterpart. The presence or absence of an alveolar cleft, the emerging pattern of comparison of the measurements of the maxilla and the orbits of the cleft side and the non-cleft side as well as absence of the bone were used to arrive at a sub-classification system using (a), (b), (c), (M+ O+), (M- O-) and (0).

Conclusion

Clinical presentation of these clefts, however variable, seem to have a similar presentation worldwide. Additionally, associated clefts do not conform to the original Tessier classification system. The study also recommends a sub-classification for Tessier clefts that will allow physicians anticipate the extent and the form of skeletal defects present before even seeing the patient. This can improve communication amongst surgeons and team members fighting the cleft wars.