Management of Tessier No. 2 Facial Cleft Using Millard Technique with Zig- Zag Ad-vancement Flap: A Case Report

Abstract

Introduction: Craniofacial cleft is a rare congenital disorder that affects facial and skull.         development, with an incidence estimated between 1.4-4.9 per 100,000 births. This condition often results in significant complications such as feeding difficulties, impaired speech, hearing issues, and psychosocial challenges. Among craniofacial clefts, the oblique facial cleft, including Tessier No. 2 cleft, is the rarest and least documented. This cleft is characterized by specific soft and hard tissue deformities resulting from a failure of fusion among facial processes during embryonic development. Case: An 8-month-old female presented with a unilateral cleft of the lips, gums, and palate on the left side, accompanied by a Tessier No. 2 facial cleft. The patient's mother reported no history of teratogenic exposure or family history of clefts. Clinical examination revealed hypoplasia of the middle third of the nasal margin, a flattened lateral nose, a widened nasal bridge, and a deviated nasal septum. The patient was diagnosed with unilateral complete labiognatopalatoschizis accompanied by Tessier No. 2 cleft. Case Management: The patient was prepared for labioplasty under general anesthesia after meeting the "rules of ten" criteria (10 weeks old, 10 pounds, 10 grams/dl hemoglobin). The surgery was performed using the Millard technique with a zig-zag advancement flap to achieve optimal tissue coverage and symmetry. Postoperative care included antibiotics, pain management, and follow-up visits. At the 3-month follow-up, the surgical site showed good healing with no signs of infection or significant complications. Conclusion: Understanding the specific anatomy and pathophysiology of Tessier No. 2 clefts is essential for effective surgical planning and outcomes. The modified Millard technique provides satisfactory aesthetic and functional results, although challenges remain. Comprehensive postoperative management and long-term follow-up are crucial to monitor healing and address any complications. Further research and multidisciplinary.
Keyword: Facial Cleft, Tessier 2, Millard Technique, Zig-zag Advancement Flap