Tissue expansion in the reconstruction of Tessier craniofacial clefts: A series of 17 patients

Tessier craniofacial clefts are among the most surgically challenging examp les of craniofacial dysmorphology. These clefts are characterized by hypopl asia of soft-tissue and skeletal elements throughout the three-dimensional extent of the cleft. Whereas bone grafting and craniofacial osteotomies hav e been successful toward correcting the underlying skeletal abnormalities, the ultimate success of these reconstructions has been limited by the defic iency of skin and soft tissue. This deficiency demands reconstruction ideal ly with tissue of like texture, consistency, and, especially in the face, c olor. Craniofacial tissue expansion was used toward reconstructing these fa cial clefts with like-quality tissue, allowing for tension-free reconstruct ion after osteotomy and bone grafting. Seventeen patients with Tessier cran iofacial clefts underwent preoperative craniofacial soft-tissue expansion i n the surgical management of their clefts. Tissue expansion was used in the primary correction of facial clefts in eight patients, with nine patients undergoing expansion before secondary surgery. In this series, tissue expan sion has evolved as an important clement in overcoming the skin and soft ti ssue deficiency associated with these clefts, allowing for tension-free clo sure and improved aesthetic results in these surgically challenging patient s.