Summary
Background
Median and paramedian craniofacial clefts are associated with hypertelorism, anterior
encephalocele, positional abnormalities of the maxilla, and nasal deformity. Cleft
lip and palate, eyelid coloboma, and widow's peak are frequently present.
Methods
The authors collected data from 30 patients (mean age, 5.8 years; range, 4 months
to 18 years) operated between 1986 and 2017 with median or paramedian craniofacial
clefts of differing degrees of severity. Malformations of the different anatomic units
and their surgical treatment were assessed, as well as complication rates.
Results
All patients presented nasal malformations and either telecanthus (n = 16) or hypertelorism
(n = 14). Most patients (n = 23) had anterior encephalocele. All patients underwent
nasal corrections, and most of them had medial canthopexy (n = 24). Excision of encephalocele
was associated with fronto-orbital remodeling. Medialization of the orbits was performed
in 11 patients, mainly by box shift (n = 9). Patients from outside Switzerland (n = 23)
were operated at an older age than those in the native patient group. Because of staged
reconstruction, 13 patients had more than one operation. Surgical complications included
three infections and one expander exposition. One patient had bone resorption of a
frontal bone flap. Nasal correction needed more than one procedure in 5 patients,
and medial canthopexy had to be repeated in 7 patients. Esthetic results were satisfactory,
permitting social integration.
Conclusion
Median and paramedian craniofacial clefts need adapted and carefully planned corrections
respecting the growth of anatomic units. The quality of the medial canthal and nasal
reconstruction is to a large extent responsible for the overall result.
Keywords
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Article info
Publication history
Published online: January 09, 2019
Accepted:
January 6,
2019
Received:
July 25,
2018
Footnotes
☆Parts of this article have been presented at the following meetings: 1. 10th European Craniofacial Congress, Gothenburg, Sweden, 24–27 June 2015. 2. Annual Congress of the Société Française de Chirurgie Plastique, Reconstructrice et Esthétique, Paris, France, 19–21 November 2015.3. European Society of Craniofacial Surgery: Biennial Congress, Birmingham, UK, 23–24 November 2016. 4. The Joint American Society of Craniofacial Surgeons-American Society of Pediatric Neurosurgeons Symposium, Hawaii, USA, 23–25 January 2017. 5. European Plastic Surgery Research Council. Hamburg, Germany, 23-25 August 2018.
Identification
Copyright
© 2019 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by Elsevier Ltd. All rights reserved.
