The Presentation Patterns of Tessier 7 Clefts.

Given its rarity, there are few large-number studies regarding Tessier 7 clefts. A review and classification of 81 Tessier 7 patients who presented to our craniofacial center was performed. The most common Tessier 7 clefts were middle positioned, followed by agenetic, superiorly rotated, and inferiorly rotated clefts, respectively. A total of 77/81 patients had simple macrostomia and 4/81 patients had macrostomia with muscle diastasis. The most common associated anomalies were craniofacial microsomia, skin tags, and ear anomalies occurring in 80%, 71%, and 37% of patients, respectively. In this cohort, the most common subsequent procedures performed in our center were orthognathic surgery (15), fat grafting (11), and facial contouring (7). This information can assist clinicians in patient assessment, family counseling, and refining surgical planning. In this work, we compared our results to other centers by performing a meta-analysis and found we had a higher rate of left-sided clefts, craniofacial microsomia, and simple macrostomia. Our rates of bilaterality and gender distribution were similar to that of other centers. A review of 766 Tessier 7 presentations across 34 recent studies demonstrated unilateral clefts in 84.3% and bilateral clefts in 15.7% overall. Up to 62% of black African patients had bilateral Tessier 7 presentations. There was also increased rates of associated craniofacial microsomia in ethnically Chinese population groups. Overall review of 766 patients demonstrated more right-sided clefts than left, and a slight female preponderance.