Classification of facial clefts and fissures that take the orbital cavity as anatomical starting point. It is unrelated to the embryology or the cause of the defect, which could be genetic, ischemic or an amniotic band in some cases. There are 15 numbered clefts from 0 to 14 and 30 (figure)
Some slots are the cause of defects:
- 0 and 14: hypertelorism
- 3 (orbitomaxillary) internal: microphthalmia, abnormalities of the nasolacrimal tract
- 4 (orbitomaxillary) median: defect of the floor of the orbit and the orbital rim
- 5 (orbitomaxillary) external: microphthalmia and abnormalities of the middle third of the lower eyelid
- 6 (intermaxillo-zygomatic), , 7, 8 : Treacher-Collins syndrome
- 7 (temporo-zygomatic): hemifacial microsomia
- 8 (fronto-zygomatic): Goldenhar syndrome
- 9 (orbital injection): microphthalmia, abnormalities of the superoexternal angle of the orbit
- 10: iris and upper eyelid coloboma, ablepharia
- 11: hypertelorism, coloboma of the inner third of the palpebra
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on the left: bone clefts; on the right: soft tissue clefts.
Different identified clefts:
♦ cranial clefts, present at and above the orbital roof, numbered 8 to 14.
♦ facial clefts, present at and below the orbital floor, numbered 0 to 7, plus cleft 30.
There are also orofacial clefts involving the oral cavity and comprising :
♦ atypical orofacial clefts (some median or oblique clefts: Tessier 0, 30, 3, 4, 5, 7),
♦ typical orofacial clefts (paramedian clefts of the lip and/or palate: Tessier 1 and 2).
A cardiac malformation is present in some cases: VSD, ASD, double outlet right ventricle, tetralogy of Fallot.
Anesthetic implications:
echocardiography; risk of difficult intubation but especially difficulties with facial mask ventilation: it may be useful to fill bone defects with wet compresses or a transparent occlusive dressing, or to use some malleable material (e.g., as for dental impressions). Eye protection against pressure and corneal erosions; laryngeal mask successfully used to ventilate and provide guidance for intubation with a fiberscope
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Updated: February 2024