Mastering the Art of Symmetry: Long-Term Outcomes and Management in Patients with Tessier No. 7 Cleft

Authors

Valeria Mejia, Division of Plastic and Maxillofacial Surgery, Children's Hospital Los Angeles, Los Angeles, CA, USA.
Raina K. Patel, Division of Plastic and Maxillofacial Surgery, Children's Hospital Los Angeles, Los Angeles, CA, USA.
Erin Wolfe, Division of Plastic and Maxillofacial Surgery, Children's Hospital Los Angeles, Los Angeles, CA, USA.
Melanie Bakovic, Division of Plastic and Maxillofacial Surgery, Children's Hospital Los Angeles, Los Angeles, CA, USA.
Asli Pekcan, Division of Plastic and Maxillofacial Surgery, Children's Hospital Los Angeles, Los Angeles, CA, USA.
Sophia Garnica, Division of Plastic and Maxillofacial Surgery, Children's Hospital Los Angeles, Los Angeles, CA, USA.
Alyssa Valenti, Division of Plastic and Maxillofacial Surgery, Children's Hospital Los Angeles, Los Angeles, CA, USA.
William P. Magee, Division of Plastic and Maxillofacial Surgery, Children's Hospital Los Angeles, Los Angeles, CA, USA.
Mark M. Urata, Division of Plastic and Maxillofacial Surgery, Children's Hospital Los Angeles, Los Angeles, CA, USA.
Jeffrey A. Hammoudeh, Division of Plastic and Maxillofacial Surgery, Children's Hospital Los Angeles, Los Angeles, CA, USA.

Document Type

Journal Article

Publication Date

10-3-2025

Journal

The Cleft palate-craniofacial journal : official publication of the American Cleft Palate-Craniofacial Association

DOI

10.1177/10556656251380547

Keywords

craniofacial growth; craniofacial surgery; facial cleft; facial esthetics; tessier cleft

Abstract

ObjectiveAchieving facial symmetry in patients with Tessier no. 7 cleft undergoing oral commissure reconstruction remains a challenge, with variable aesthetic and functional outcomes. Due to the rarity of this condition, data on long-term treatment effectiveness is limited. This study evaluates postoperative facial symmetry using facial anthropometric analysis in patients who underwent commissuroplasty over a 19 year period.DesignRetrospective cohort study.SettingSingle-institution craniofacial center.PatientsPatients who underwent commissuroplasty for Tessier no. 7 cleft between 2005 and 2024.InterventionMyomucosal advancement flap commissuroplasty technique.Main Outcome MeasuresFacial symmetry was assessed using 5 2-dimensional measurements: stomion-to-chelion (st_ch), chelion-to-ala (ch_al), chelion-to-exocanthion (ch_ex), chelion-to-pogonion (ch_pg), and commissure angle (co_ang). A symmetry ratio of 1.0 indicated ideal symmetry. Major revisions included secondary surgery for asymmetry or scar revision.ResultsThirty-two patients were included; 24 had unilateral (76% right-sided) and 8 had bilateral clefts. Median age at surgery was 8.1 months; 48% were female. Additional Tessier clefts were present in 25% of patients, and 25% had syndromic diagnoses. Major revisions were required in 28.6% of cases. Symmetry significantly improved in 4 of 5 facial regions, though commissure angle showed no significant change. Symmetry ratios remained stable over a median follow-up of 3.3 years.ConclusionCommissuroplasty improves facial symmetry across most parameters in patients with Tessier no. 7 cleft, with durable long-term outcomes. Limited improvement in commissure angulation highlights the need for continued refinement of surgical techniques.

APA Citation

Mejia, Valeria; Patel, Raina K.; Wolfe, Erin; Bakovic, Melanie; Pekcan, Asli; Garnica, Sophia; Valenti, Alyssa; Magee, William P.; Urata, Mark M.; and Hammoudeh, Jeffrey A., "Mastering the Art of Symmetry: Long-Term Outcomes and Management in Patients with Tessier No. 7 Cleft" (2025). GW Authored Works. Paper 8319.
https://hsrc.himmelfarb.gwu.edu/gwhpubs/8319

Department

School of Medicine and Health Sciences Student Works