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      Scoping review of the morphology and anthropometry of Tessier craniofacial clefts numbers 3 and 4

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          Abstract

          Background

          In 2016, WHO reported a death rate of 303,000 newborns before 4 weeks of age due to congenital anomalies. Those that survive congenital anomalies may have long-term disabilities which may have significant impacts on the individual, their families, the healthcare system, and societies. Tessier craniofacial clefts numbers 3 and 4 are congenital anomalies that result in a partial or total defect of craniofacial tissues thereby seriously influencing the patient’s appearance and impair normal functioning. Therefore, understanding these defects is paramount to relieving the burden caused by this disability. The objective of this review was to examine the literature on the understanding of the knowledge of morphology and anthropometry of Tessier craniofacial clefts numbers 3 and 4 so that areas yet to be fully understood by research can be mapped out for future research.

          Methods and analysis

          A scoping review for literature on patients who have Tessier craniofacial clefts numbers 3 and 4 was conducted. Relevant studies from 1976 to the present were identified. The following databases were searched for peer-reviewed literature viz., PubMed, MEDLINE, EBSCOhost, Google Scholar, and the Cochrane library. The study selection was guided by the eligibility criteria. A data table was designed to extract information from the literature. The result of this study was reported using the Preferred Reporting Items for Systematic reviews and Meta-analyses (PRISMA). The quality of the included studies was assessed using the Mixed Method Appraisal Tool (MMAT).

          Result

          Thirty-three studies met the inclusion criteria. The majority of the studies included were conducted in middle-income countries (54.5%) and some in high-income countries (45.5%); none was recorded from low-income countries. The total available sample size from the studies was 120 with a dominant male population of 67 (55.8%) and female 53 (44.2%). The majority (97%) of the studies reported on the knowledge of morphology while 12.1% of the included studies reported on anthropometry. Of the 33 included studies, 32 scored the highest quality (76–100%) from the quality assessment.

          Discussion

          The findings from this review show evidence of the knowledge of morphology and the knowledge of anthropometry of Tessier craniofacial clefts numbers 3 and 4. However, these knowledges have not translated to universally recognized ways of repairing and documenting these clefts due to the sparse amount of studies on Tessier craniofacial clefts numbers 3 and 4.

          Electronic supplementary material

          The online version of this article (10.1186/s13643-019-0951-6) contains supplementary material, which is available to authorized users.

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          Most cited references41

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          The kaleidoscopic world of rare craniofacial clefts: order out of chaos (Tessier classification).

          H Kawamoto (1976)
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            Tessier type 3 oblique facial cleft with a contralateral complete cleft lip and palate.

            Oblique facial clefts are extremely rare congenital deformities with a reported incidence of 0.24% of all facial clefts. This report presents a patient with a right-sided oblique cleft extending through the upper lip, the alar groove and the lower palpebra accompanied by a left-sided complete cleft lip and palate. Hypertylorism and bilateral microphthalmia as well as flexion wrist contractures were also present. Primary straight-line closure of the oblique cleft was undertaken followed by primary closure of the contralateral cleft lip. The treatment modality and 2 year follow-up results are presented.
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              Formatting the surgical management of Tessier cleft types 3 and 4

              Tessier cleft types 3 and 4 are rare entities even among what are considered other rare craniofacial clefts. Very few cases have been reported worldwide, especially in the bilateral form. In the absence of any well-laid guidelines for management of such rare cases, plastic surgeons operate on such cases due to the inherent complexities in technique. To overcome this problem and provide a ground rule for surgical management of such cases, we propose an easier format with a ‘split approach’ of the affected areas. In our proposed formatting, we have divided the affected areas of the cleft into three components: 1. Lid component; 2. Lip component; and 3. Nasomalar component. Any person skilled in the plastic surgical art would appreciate that individual management of the aforesaid demarcated areas is easy as compared to the surgery of the entire craniofacial cleft, that too with the contemporary approach. We have evaluated this formatting technique with a ‘split approach’ in seven cases and found the results more convincing compared to those of classical methods. We invite the surgical fraternity to validate the surgical formatting in their settings and provide us with feedback on the same to consolidate these results.
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                Author and article information

                Contributors
                +278 377 78780 , 216077058@stu.ukzn.ac.za
                soobramoneypa@ukzn.ac.za
                ramsaroopl@ukzn.ac.za
                madaree@ukzn.ac.za
                satyapalk@ukzn.ac.za
                Journal
                Syst Rev
                Syst Rev
                Systematic Reviews
                BioMed Central (London )
                2046-4053
                4 February 2019
                4 February 2019
                2019
                : 8
                : 42
                Affiliations
                [1 ]ISNI 0000 0001 0723 4123, GRID grid.16463.36, Department of Clinical Anatomy, School of Laboratory Medicine and Medical Sciences, , University of KwaZulu-Natal, ; Durban, South Africa
                [2 ]ISNI 0000 0001 0723 4123, GRID grid.16463.36, Department of Plastic and Reconstructive Surgery, , University of KwaZulu-Natal, ; Durban, South Africa
                Author information
                http://orcid.org/0000-0002-8288-4633
                Article
                951
                10.1186/s13643-019-0951-6
                6360760
                30717789
                b6bfd743-4863-4a59-ba84-0a1233fce38a
                © The Author(s). 2019

                Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License ( http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

                History
                : 1 October 2018
                : 14 January 2019
                Funding
                Funded by: College of Health Science, University of KwaZulu Natal
                Award ID: CHS bursary
                Categories
                Research
                Custom metadata
                © The Author(s) 2019

                Public health
                craniofacial clefts,tessier number 3,tessier number 4,morphology,anthropometry
                Public health
                craniofacial clefts, tessier number 3, tessier number 4, morphology, anthropometry

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