Abstract
Median cleft of the lower lip & mandible (Tessier no. 30 facial cleft) is an uncommon condition. This cleft varies in severity, in mildest form it may present as submucosal notching of lower lip & in most severe form it may involve lower lip, tongue, alveolus, mandible, floor of the mouth and neck structures. In our case report, we describe a child patient having median cleft of the lower lip with ankyloglossia, and its treatment.
Highlights
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Tessier no. 30 facial cleft is an uncommon condition.
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Clefts affecting upper lip and maxilla are common but midline cleft involving lower lip and mandible is a rare congenital anomaly.
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Only 75 to 80 cases have been reported in the literature.
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Introduction
Clefts affecting upper lip and maxilla are common congenital entities, but midline cleft involving lower lip and mandible are rare anomalies. This cleft was first described by Couronine in 1819 [ ] and since then very few cases have been reported in literature with different severity. It is also described as Cleft No. 30 in Tessier’s classification of clefts [ ]. This cleft may present with varying degree of severity from isolated midline cleft of the lower lip to the cleft involving lower lip, tongue, alveolus, mandible, floor of the mouth and neck structures [ , ]. We report a case of 6 months old female patient with median cleft of the lower lip & severe ankyloglossia.
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Case report
A 6 months old female child was brought by parents to our cleft unit for correction of her lower lip deformity. On primary examination, median cleft of lower lip with ankyloglossia was diagnosed. The upper lip, nose and palate were normal. There was no known family history of cleft deformities and the pregnancy was uneventful.
On detailed physical examination, the child had median cleft of lower lip extending from vermillion to mentolabial sulcus [ Fig. 1 ]. Intraorally she had significant ankyloglossia. The tip of the tongue was attached to alveolus [ Fig. 2 ]. The palpation of the alveolar margin revealed small crestal notching in the midline but the mandibular surface found to be intact. Radiological examination confirmed absence of any bony cleft [ Fig. 3 ]. Her weight & height were 5.6 kg and 57 cms respectively.
The complete workup was carried out to rule out any other anomalies. She had no other systemic abnormalities and hematological reports were within normal limit.
She was taken for the surgery under general anaesthesia. The ‘‘V″ incision was placed over skin (extra orally) & mucosa (intra orally) along cleft margins. The skin, vermillion & mucosa present in cleft area were excised. The muscle was repaired first followed by closure of skin, vermillion & mucosa intra orally [ Fig. 4 A].
