A facial slit is a crack or a gap in the face, or a malformation of the face. Facial gap is a collective term for all types of loopholes. All structures such as bone, soft tissue, skin etc. May be affected. Facial gap is a very rare congenital anomaly. There are many variations of the type of clefting and classification required to describe and classify all types of clefting. Facial cracks are almost never isolated; most of the time there is overlap with adjacent facial gap.
Video Facial cleft
Cause
The cause of the facial cleft is still unclear.
It is possible that the facial gap is caused by a disturbance in the migration of neural christ cells.
Another theory is that facial cracks are caused by fusion process failure and failure of growth into the mesoderm.
Another theory is that genetics plays a role in the development of facial gaps or that they are caused by amniotic bands.
Maps Facial cleft
Classification
There is a difference in classification of facial cracks. The two most widely used classifications are the Tessier and Van der Meulen classification classifications. Tessier is based on the anatomical position of the gap classification and Van der Meulen is based on embryogenesis.
Tessier Classification
In 1976 Paul Tessier published a classification on the facial gap based on the anatomical position of the cracks. Different types of Tessier gaps are numbered from 0 to 14. These 15 different gaps can be incorporated into 4 groups, by their position: midline slits, paramedian slits, orbital slots, and lateral gaps. Tessier's classification describes a gap in the soft tissue level as well as at the bone level, since it appears that soft-tissue gaps can have slightly different locations on the face than bone cracks.
The centerline
The centerline gap is Tessier number 0 ("median craniofacial dysplasia"), number 14 (frontonasal dysplasia), and number 30 ("lowerline face line cleft", also known as "median mandibular cleft"). This gap divides the two faces vertically through the center line. Tessier number 0 divides the maxilla and the nose, Tessier number 14 coming between the nose and the frontal bone. The number 30 face of tessier face is through the tongue, lower lip and lower jaw. The tongue may be absent, hypoplastic, bifid, or even duplicated. People with this condition are often tongue-bound.
Paramedian clefts
Tessier numbers 1, 2, 12 and 13 are paramedian slits. This gap is very similar to the midline gap, but they are further away from the centerline of the face. Tessier's numbers 1 and 2 both come through the maxilla and nose, where Tessier's number 2 is farther from the lateral line than number 1. Tessier number 12 is at the 2nd border, positioned between the nose and the front bone, while Tessier number 13 is at number 1, also runs between the nose and forehead. Both 12 and 13 run between the midline and the orbit.
Orbit slit
Tessier numbers 3, 4, 5, 9, 10 and 11 are orbital slots. These gaps all have orbital involvement. Tessier numbers 3, 4, and 5 are positioned through the maxilla and orbital floor. Tessier numbers 9, 10 and 11 are positioned between the upper side of the orbit and the forehead or between the upper sides of the orbit and the head temple. Like other clefts, Tessier number 11 is as far as number 3, number 10 is as far away as number 4 and number 9 as far as number 5.
Lateral gap
The lateral gap is a gap that is positioned horizontally on the face. This is Tessier's number 6, 7 and 8. Tessier's number 6 ran from orbit to cheekbone. Tessier number 7 is positioned on the line between the corners of the mouth and ears. The lateral cleft may originate from the corner of the mouth toward the ear, giving the impression that the mouth is larger. There is also the possibility that the gap starts in the ear and runs toward the mouth. Tessier number 8 ran from the outer corner of the eye toward the ear. The combination of Tessier's 6-7-8 figure is seen in Treacher Collins syndrome. Tessier number 7 is more associated with mikomacia and the number 8 more associated with Goldenhar syndrome.
Van der Meulen Classification
Van der Meulen's classification divides the different types of gaps based on where the capture of development occurs in embryogenesis. The main gap may occur in the early stages of facial development (17 mm long embryo). Developmental captures can be divided into four distinct location groups: interna- tional, nasal, nasalmaxil and maxillar. The maxillary location can be subdivided into the median and lateral slits.
Internal dysplasia
Internal dysplasia is caused by a developmental attack before the union of the two nasal passages. This cleft is characterized by median cleft lip, median notch of cupid bow or labial frenulum duplication. In addition to median cleft lip, hypertelorism can be seen in this gap. Also sometimes there is retardation of premaxila.
Nasal dysplasia
Nasal dysplasia or nasoschisis is caused by developmental development of the lateral side of the nose, resulting in cleft in one part of the nose. The nasal septum and cavity may be involved, although this is rare. Nasoschisis is also characterized by hypertelorism.
Nasomaksilaris Dysplasia
Nasomaxilary dysplasia is caused by developmental stops at the lateral side intersections of the nose and upper jaw, resulting in a complete or incomplete gap between the nose and the orbital floor (the nasookular chippy) or between the mouth, nose and orbital floor (oronasal-ocular blockage). Normal lip development.
Maxillary dysplasia
Maxillary dysplasia can manifest itself in two different sites of the maxilla: the medial or lateral portion of the maxilla.
- Median maxillary dysplasia is caused by failure of development of the medial part of the maxillary ossification center. This produces a secondary cleft lip, philtrum and palate. Clefting from the maxilla to the orbital floor has also been reported.
- lateral maxillary dysplasia is caused by a developmental failure of the lateral portion of the maxillary ossification center, which also produces a secondary gap in the lips and palate. Clefting the lateral portion of the lower eyelid is typical for lateral maxillary dysplasia.
Treatment
There is no single strategy for facial clearance, as there are many variations in this gap. The type of operation used depends on which type of gap and structure is involved. There is much discussion about the time of bone reconstruction and soft tissue. The problem with early reconstruction is the recurrence of deformity due to limited intrinsic growth. This requires additional surgery at a later age to ensure all parts of the face are in proportion. The disadvantage of early bone reconstruction is the opportunity to damage tooth germs, located in the upper jaw, just below the orbit. Soft tissue reconstruction can be done at an early age, but only if the used skin flap can be used again during the second operation. Operation times depend on the urgency of the underlying conditions. If the operation needs to function properly, it should be done at an early age. The best aesthetic results are achieved when the incision is positioned in the area that attracts the least attention (they cover the scar). However, if the facial function is not damaged, surgery depends on the psychological factors and facial areas of reconstruction.
Face clearance plans are planned right after diagnosis. This plan covers every necessary operation within the first 18 years of patient's life to fully reconstruct the face. In this plan, differences are made between issues that need to be solved to improve patient health (coloboma) and problems that need to be solved for better cosmetic results (hypertelorism).
Facial cleft treatments can be divided across different facial areas: skull anomalies, orbital and eye anomalies, nasal anomalies, midface anomalies and oral anomalies.
Treatment of skull anomalies
The most common cranial anomaly seen in combination with facial gap is the encephalocele.
Encephalocele
The treatment of encephalocele is based on surgery to correct bone clefts and provide adequate protection from the underlying brain. The question remains if external brain tissue has to be put back into the skull or if it is possible to cut pieces of brain tissue, therefore claiming that the outside of the brain tissue often does not work, with the exception of basal encephalocele, where the pituitary gland can be found in the mouth.
Treatment of orbital anomalies/eyes
The most common orbital/eye disorders seen in children with facial cleft are choloboma and vertical dystopia.
Coloboma
Coloboma that often occurs in the face gap is a cleft in the lower eyelid or top. It should be closed as soon as possible, to prevent eye dryness and loss of vision in a row.
Distopia vertical orbital
Vertical orbital division may occur in the facial opening when the orbital and/or maxillary floor are involved in the gap. Vertical orbital division means that the eye does not lie on the same horizontal line on the face (one eye is lower than the other). This treatment is based on this orbital floor reconstruction, either by closing the boney gap or reconstructing the orbital floor using a bone graft.
Hypertelorism
There are many types of surgery that can be done to treat hypertelorism. 2 options are: osteotomy box and facial bipartition (also referred to as median fasciotomy). The purpose of the box osteotomy is to bring the orbit closer together by removing the bones between orbits, to release the two orbits from the surrounding bone structure and move them both to the center of the face. The purpose of the facial bipartition is not just to bring the orbit closer, but also to create more space in the upper jaw. This can be done by splitting the maxilla and the frontal bone, remove a triangular bone from the forehead and nasal bone and pull both pieces of the forehead together. Hyperorrorism can not only be solved by pulling the forefinger closer, but because of this pull, the space between the two upper parts of the jaw will become wider.
Treatment of nasal anomalies
Nose anomalies found in facial cracks vary. The main purpose of this treatment is to reconstruct the nose to obtain acceptable functional and esthetic results. Some possible treatment options are reconstructing the nose with a forehead flap or reconstructing the nasal dorsum with a bone graft, eg a rib graft. Nasal reconstruction with a forehead flap is based on the repositioning of skin flaps from the forehead to the nose. The possible weakness of this reconstruction is that once you do it at a younger age, you can not extend the flap at a later stage. A second operation is often necessary if surgery is performed at an early age, since the nose has limited growth in the gap area. Improvement of the style (wings of the nose) often requires an inset transplant cartilage, which is usually taken from the ear.
Midface anomaly care
The treatment of the soft tissue portion of the midface anomaly is often a reconstruction of the cheek skin flap. This skinflap can be used for other operations in further, as it can be reappointed and moved again. In the treatment of midface anomalies there is generally more surgery required. Reconstruction of bone tissue from the midface often occurs more slowly than soft tissue reconstruction. The most common method for reconstructing the midface is to use the fracture/incision line described by Renà ©  © Le Fort. When the gap involves the upper jaw, it is possible that the growth disorder will produce a smaller jawbone in all 3 dimensions (height, projection, width).
Oral anomaly treatment
There are several options for oral anomalous care such as Tessier's cleft number 2-3-7. This gap is also seen in various syndromes such as Treacher Collins syndrome and microsomia hemifacial, which makes treatment much more complicated. In this case, oral anomaly treatment is part of the treatment of the syndrome.
Prevention
Since the cause of the facial cleft is still unclear, it is difficult to say what can prevent children from being born with facial cracks. It seems that folic acid contributes to lowering the risk of a child being born with a facial gap.
See also
Related articles
- Ectodacty-ectodermal dysplasia syndrome
- Hands cleft
- Cleft lip and palate
Syndrome
- Treacher Collins Syndrome
- hemifacial microsomia
- Goldenhar Syndrome
References
Source of the article : Wikipedia
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