Tessier 30 Facial Cleft: A Rare Craniofacial Anomaly

Aim

Surgical correction of median mandibular cleft with ankylossia.

Background

Orofacial developmental abnormalities that involve the upper lip and face are the most common variety. The midline cleft of the mandible is one of the rarest categorized as Tessier #30, which extends along the midline of the mandible, along with ankyloglossia or aglossia. The morphogenesis of craniofacial clefts could be due to the lack of fusion or normal development of the facial processes in the first branchial arch or failure of the mesodermal penetration into the midline.

Case description

This article presents a case of a 3-year-old female child with complete median cleft of the mandible and tongue with ankyloglossia. Single-stage mandibular cleft union with the concept of osteosynthesis and surgical correction of ankyloglossia was performed to restore function and esthetics at the earliest.

Clinical significance

This case signifies the rarity, and as very few cases have been reported worldwide, it is mandatory and worthwhile bringing to light whenever it occurs.

How to cite this article

Palukuri L, JSR, DVN Tessier 30 Facial Cleft: A Rare Craniofacial Anomaly. Int J Clin Pediatr Dent 2023;16(1):177-179.

Tessier 30 Facial Clefts-A Literature Review of 72 Cases (1996-2020), Suggested Treatment Protocol, Outcome Measures, Minimum Dataset for Future Case Reports, and Registries

INTRODUCTION

Tessier 30 facial cleft is a rare anomaly presenting in the soft and hard tissues over the central lower face. Owing to the rarity of cases and difficulty of treatment, there is no universally accepted surgical management strategy. The last comprehensive literature review of Tessier 30 clefts was in 1996. This report aims to update the literature to inform decision-making on treating Tessier 30 cases.

METHODOLOGY

A literature search was performed. PubMed, SCOPUS, and OVID databases were searched. A total of 72 cases in 51 articles were analyzed, looking at demographics, extent of cleft, parent health, family history, procedures, follow-up, existence of other anomalies, and stages of repair.

RESULTS

Surgeons are increasingly choosing to repair Tessier 30 defects in one rather than multiple stages. Of the 72 cases studied, only 31 had documented the completed repair of the cleft. All completed soft tissue only defects were repaired in 1 stage of repair (n = 11). Where both soft tissue and mandible was involved (n = 20), 55% (n = 11) had undergone 1-stage repair to address the Tessier 30 cleft.

DISCUSSION

We argue that a single-stage approach is preferable to multistage. Primary mucogingivoperiosteoplasty should be undertaken in children at the time of management of the soft tissue cleft. The timing of this procedure should be in the latter half of the first year of life, as this is when mandibular symphyseal fusion normally occurs. We have suggested a treatment protocol and we hope that future case reports use our minimum data set.

BMP4/ALK3 deficiency leads to Meckel's cartilage truncation mimicking the mandible Tessier 30 cleft

OBJECTIVE

In chondrogenesis, BMP signaling was inferred to exhibit regional specificity during Meckel's cartilage morphogenesis. This study aimed to explore the differences in BMP signaling activity between different parts of Meckel's cartilage and the impacts of BMP4 or ALK3 deficiency on the development of Meckel's cartilage during embryogenesis.

MATERIALS AND METHODS

The BRE-gal reporter mouse line was utilized to gain an overall picture of canonical BMP signaling activity, as assessed by X-gal staining. Mouse models lacking either Bmp4 or Alk3 in neural crest cells (Wnt1-Cre;Bmp4^fl/fl and Wnt1-Cre;Alk3^fl/fl ) were generated to explore the morphogenesis of Meckel's cartilage and the mandibular symphysis, as assessed by skeletal staining, histology, and immunostaining.

RESULTS

Different parts of Meckel's cartilage exhibited activation of different combinations of BMP signaling pathways. In Wnt1-Cre;Bmp4^fl/fl mutants, Sox9⁺ condensation of the chondrogenic rostral process failed to form, and the V-shaped Runx2⁺ tissue was split in the median mandibular symphysis. The Wnt1-Cre;Bmp4^fl/fl and Wnt1-Cre;Alk3^fl/fl mouse models both exhibited truncated Meckel's cartilage, aberrant mandibular intramembranous bone, and tongue muscle abnormalities.

CONCLUSIONS

The central hard-tissue loss of both mutant mouse models led to a mandibular symphysis cleft, mimicking the typical sign of the median mandible Tessier 30 cleft in humans.

Clinical Correction of Complete Median Cleft of the Mandible and Lower Lip: A 17-Year Follow-Up of a Case Report With Literature Review

The median cleft of the mandible and lower lip is an extremely rare congenital maxillofacial deformity, and the therapeutic options are controversial. To evaluate the clinical characteristics and identify a better choice of treatment modes used among us and others, we reviewed 34 relevant literature and herein describe a 17-year follow-up of a case with a median cleft of the mandible and lower lip. Based on the literature and our case with good functional and aesthetical outcomes, we propose a prospective clinical treatment: Patients of Tessier 30 cleft associated with cleft of the mandible could undergo mandibular repair after puberty in conditions of a good occlusal relationship and normal maxillofacial development, even with mild masticatory dysfunction.