الفهرس 
EmbryologyOnly 14 pages are availabe for public view
 |  | from | 159 |  |  |
| | | from | 159 | | |
Abstract
Congenital craniofacial clefts are abnormal disfigurements of the face and cranium with deficiencies, excesses, or even a normal (but separated) amount of tissue occurring along linear regions. Of all congenital facial anomalies, craniofacial clefts are among the most disfiguring. They may be seen in a variety of patterns and varying degrees of severity. Although at frst glance they appear to defy definable.(Paul Tessier.,1976) The exact incidence of rare craniofacial clefts is unknown. However, they have been estimated at 1.4 to 4.9 per 100,000 live births. Comparing rare craniofacial clefts to common clefts, their incidence seems to approximate 9.5 to 34 per 1000. (Henry Kwamoto et al., 1990)
In the largest series reported , Ortiz Monsaterio (1987) reviewed 6500 clefts
treated over 20-year period ,the vast majority of these patients only had the
common cleft lip & palate deformity only 2.2 % (146 patients )had nasal clefts
corresponding to types 0,1,2,3 of Tessier classification (Kris B. Shewmake et
al.,1992).
Several theories have been proposed to explain the etiology of facial clefts
the most widely accepted theory at this time is the mesodermal penetration theory
which states that clefts occur along potential lines of fusion as lack of mesodermal
penetration. Without this reinforcement epithelial breakdown and separation
occur. (Henry Kwamoto et al., 1990)
Patterns of nasal clefts is very variable ranging from simple notch or
asymmetry of alar margin to complex complete craniofacial cleft involving the lip ,
nose , eyelid, brow , forehead and underlying bones.
Over the years several classifications have been created to describe the rare
craniofacial clefts. They include: American Association of Cleft Palate
Rehabilitation Classification by Harkins et al. in 1962, Karfik Classification
in1966, Van Der Meulen and Associates Classification in1983, Median Tissue
Deficiency Classification by De Myer in 1964, and Median Excess Tissue
Classification by De Myer in 1967. The most widely accepted classification of
craniofacial clefts is Tessier classification which is proposed by Paul Tessier at
1976. This classification based on specific axes (0-14) along the face and the
cranium . The orbit divides the cranial clefts (9-14) from facial clefts (0-7) and
facial clefts have cranial extensions. Tessier clefts involving the nose are types 0,
1, 2, 3 with their cranial counterparts. (Paul Tessier., 1976)
Because of its rarity there is no standardized methods of correction of
congenital nasal clefts have yet established. and management is tailored for each
case using the basic principles of management. Principles of management include
Precise clinical and radiographic diagnosis one must first know the normal
anatomy and the sense of proper facial proportions and landmarks. (Kawamoto
HK et al., 1990)
Each component of the nose, skin, mucous lining and support (both bony
and cartilaginous) must be evaluated in a qualititative and quantitative manner.
Staged reconstruction of patient with complex craniofacial clefts frequently
requires multiple staged reconstructive procedures. Replace like with like for
example bone defects repaired with bone grafts (calvarial, rib, ilia.etc). Free
cartilage grafts or chondromucosal flaps are used to repair cartilage defects
according to size. Adequate nasal lining is also essential to achieve functional and
predictable aesthetic units also optimal lining will help vascularity of reconstructed
area for small area local mucosal flap can be used for larger defects
mucopericondreal grafts can be used. (Renato da Silva et al., 2010)