Surgical management of a median mandibular facial cleft (Tessier 30)

Introduction: Tessier 30 or median mandibular facial cleft is a rare congenital abnormality and only 69 cases have been reported in the literature, mostly as case reports. It is often associated with ankyloglossia and bifid tongue, but cervical and chest anomalies may also occur. Soft tissue closure should be performed as soon after birth as possible and closure of the bone cleft recommended when the permanent teeth have erupted to avoid damage to the developing tooth buds.

Materials and methods: A case of Tessier 30 is presented. The mother of a 5-year-old daughter consulted the Maxillofacial Unit and complained that her daughter was unable to chew due to movement of the bottom jaw. Surgery on the skin of the lower lip was performed when she was 6 months old by a plastic surgeon. Median mandibular cleft was diagnosed and closure performed with an avascular iliac crest graft. Internal fixation was obtained using 2 bioresorbable plates and screws ( RapidSorb , Synthes ) which were placed to avoid the tooth buds. Additional immobilisation was achieved with jaw splints for children ( Synthes ) and elastics maintained for 4 weeks. Closure of the bone defect resulted and unification of the mobile segments. The plates and the screws were fully resorbed after 12 months.

Conclusion: The bone cleft in Tessier 30 mandibular clefts can safely be closed with bone grafting and bioresorbable plates and screws at an earlier age to improve patient function and comfort without damaging the developing tooth buds.

Conflict of interest: None declared.

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Feb 5, 2018 | Posted by in Oral and Maxillofacial Surgery | Comments Off on Surgical management of a median mandibular facial cleft (Tessier 30)
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