Tessier provided an anatomical classification of rare craniofacial clefts. In his paper, the number 7 cleft is characterised by macrostomia, diastasis of muscles in the lateral face, and abnormalities of the bony maxilla and zygoma. A growing patient series prompted review of this condition and its soft tissue and bony features. A retrospective case-note review of Australian Craniofacial Unit patients treated over 25 years elucidated 15 cases. Treacher-Collins syndrome and hemifacial microsomia cases were excluded. Clinical photography and CT imaging of this group were examined. The prominent features of the Tessier number 7 cleft group included macrostomia, soft tissue ridging from muscular diastasis, and variable bony abnormality of the maxilla. The bony changes included standard clefting (55%), maxillary duplication (39%) and intermaxillary fusion (6%). Recognition of the bony abnormality prompted amendments to the management plan to address cases of maxillary duplication.
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