CRANIOFACIAL CLEFTS

Craniofacial clefts are major clefts affecting the face, the cranium, or both. They occur without any pattern of heredity. They are much rarer than simple cleft lip/palate, although their true incidence is difficult to calculate since the milder forms are likely to go unrecognized.

The severity of craniofacial clefts varies considerably, ranging from a barely perceptible notch on the lip or on the nose or a scar-like structure on the cheek, to a dramatic separation of all layers of facial structures.

Craniofacial clefts occur along certain axes of the face designated by numbers for purposes of classification and record keeping. The point of reference is the orbit and the numbers follow a counter clockwise pattern, so that the smaller numbers have a southbound direction and affect the facial structures, while the larger ones have a northbound course and affect the cranial structures. Combinations of clefts are not infrequent and when they do coexist the clinical picture becomes correspondingly more dramatic.

Figures showing the direction of facial clefts as designed by Dr. Paul Tessier

The areas of the face affected depend on the particular cleft. For example cleft #0 causes a widening of the middle of the nose, whereas clefts #1 and 2 affect the side of the nose. Cleft #3 separates the side of the nose from the cheek and may be associated with absence of the eye on that side. Cleft #4 may also be associated with absence of the eye is located a little more to the side. Cleft #5 is rare and affects the upper jaw and lip. Clefts #6,7 and 8 affect the area of the zygomatic -cheek bone- and cause deformities of the side of the face and corner of the mouth as well as of the lower eyelid. Clefts #11-14 affect the forehead and may even cause bulging of the brain through a defect in the forehead.

Cleft #2, Cleft #3, Cleft #4, Cleft #7 bilateral

Complex surgical procedures along the guidelines of Craniofacial Surgery are planned and carried out by a multitude of specialists. Treatment generally starts in infancy and may extend into adolescence. Careful planning will reduce the number of necessary operations and will assure the best possible results.