Fourteen-year follow-up of a Tessier number 4 cleft

A 3-month-old girl of Japanese parents presented with a left oblique facial cleft (Tessier number 4 cleft). It extended from the area lateral to the Cupid's bow, through the cheek on the lateral side of the ala nasi, to the medial side of the lacrimal punctum of the lower eyelid. As a result, the left lower eyelid was split, resulting in marked ectropion. There was another cleft present on the medial side of the left upper eyelid. The left ala nasi was normal morphologically but was raised upwards. The cleft extended into the secondary palate. The nasal septum was preserved, and left choanal atresia was present. CT examination revealed hypoplasia of the left maxillary bone and sinus. A total of seven operations was performed during the 14-year follow-up period; the end result was satisfactory. Artificial bone (apatite ceramics) was implanted on the anterior wall of the maxilla, when the child was aged 6 years, and to the orbital floor when she was 13. CT examination (at 13 years) revealed that the artificial bone implanted at age 6 was correctly oriented and had fused to the anterior wall of the maxilla and zygoma. Resorption had been minimal.