Annals of plastic surgery
September 7, 2026 · via Europe PMC
Tessier-3 Clefts: Clinical Features and Staged Reconstruction.
Allam K.
AI summary — for doctors, generated from the abstract only
In a case series of 9 patients with Tessier-3 craniofacial clefts, staged anatomy-driven reconstruction (averaging 3.8 procedures per patient) achieved structural globe preservation in all patients with anatomically formed globes, though amblyopia and preoperative exposure keratopathy were common.
What was studied
A retrospective case series of 9 patients with Tessier-3 clefts (rare craniofacial malformations involving the oro-naso-orbital axis) treated at a tertiary craniofacial center (2015-2024), descriptively analyzing orbital, lacrimal, skeletal, and periocular characteristics, reconstructive sequencing, operative burden, and follow-up outcomes.
Key findings
- Lacrimal drainage anomalies were present in 7 of 9 patients (77.8%), globe malposition in 5 (55.6%), and inferomedial orbital skeletal deficiency in all patients.
- 34 reconstructive procedures were performed across the cohort (mean 3.8 per patient), including 17 secondary procedures (mean 1.9 per patient); lacrimal reconstruction was required in 2 patients (22.2%) for persistent symptomatic obstruction.
- Structural globe preservation was achieved in all 8 patients with anatomically formed globes (the 9th patient had congenital anophthalmia); amblyopia was documented in 5 patients (55.6%) and preoperative exposure keratopathy in 7 (77.8%).
Clinical relevance
This case series may be relevant to craniofacial surgeons managing this rare condition, supporting an individualized, anatomy-driven (rather than strictly age-based) staged reconstructive approach prioritizing early ocular protection, as the authors conclude, though the evidence is purely descriptive from a small cohort.
Who should care
Limitations
Very small case series (9 patients) from a single tertiary center describing a rare condition, without a comparison group or standardized outcome measures, limiting generalizability of the specific operative burden and outcome figures reported.
Staged, anatomy-driven reconstruction of Tessier-3 clefts preserved globe structure in all anatomically formed eyes in this small case series, though amblyopia and exposure keratopathy were common preoperative findings.
This is an AI-generated summary of the published abstract, not a clinical recommendation. It may not reflect the full text or subsequent updates — verify against the original source before acting on it.
Abstract
Background
Tessier-3 clefts are rare craniofacial malformations involving the oro-naso-orbital axis and are frequently associated with orbitolacrimal and inferomedial orbital abnormalities. Published series remain limited, and the relationship between anatomic involvement, reconstructive sequencing, and childhood operative burden remains poorly characterized.
Patients and methods
A retrospective case series included 9 patients with Tessier-3 clefts treated at a tertiary craniofacial center between 2015 and 2024. Clinical records, operative reports, computed tomography imaging, and clinical photographs were reviewed. Orbital, lacrimal, skeletal, and periocular characteristics, reconstructive sequencing, operative burden, and follow-up outcomes were analyzed descriptively. Lacrimal drainage anomalies were present in 7 patients (77.8%), globe malposition in 5 (55.6%), and inferomedial orbital skeletal deficiency in all patients. Reconstruction followed an anatomy-driven rather than strictly age-based strategy, prioritizing early ocular and periocular protection with staged orbital, nasal, and skeletal reconstruction. Thirty-four reconstructive procedures were performed (mean, 3.8 procedures per patient), including 17 secondary procedures (mean, 1.9 per patient). Lacrimal reconstruction was required in 2 patients (22.2%) because of persistent symptomatic obstruction, and 2 patients referred after previous surgery required individualized secondary reconstruction. Structural globe preservation was achieved in all 8 patients with anatomically formed globes; the remaining patient had congenital anophthalmia. Amblyopia was documented in 5 patients (55.6%), and preoperative exposure keratopathy was present in 7 (77.8%).
Conclusions
Tessier-3 clefts demonstrate substantial anatomic and reconstructive heterogeneity requiring individualized, anatomy-driven staged reconstruction. Early ocular protection, selective management of lacrimal dysfunction, and coordinated multidisciplinary care remain central to successful management.
DOI
10.1097/sap.0000000000004889
PMID
42704336
Research metadata (titles, abstracts, authors, publication dates) is sourced from Europe PMC, which aggregates content from PubMed/MEDLINE, PubMed Central, and other providers under the U.S. National Library of Medicine (NLM/NCBI). NLM does not claim copyright on abstracts; the original journal publishers or authors may hold rights to the full articles. AI-generated summaries are derived only from the abstract, never the full text, and are always labeled as AI-generated.
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