Most people have heard of, or seen, a cleft lip. There are much rarer facial clefts, however, where large segments of the soft tissues and bone are involved, leading to missing tissue or bone, or redundant tissue where the two parts of the face didn’t come together as close as they normally should.
These clefts were first described and classified by Paul Tessier, the father of craniofacial surgery, who trained my mentor Dr. Kawamoto (they co-authored the original publication on these clefts). Dr. Tessier pioneered moving the facial bones, including the eye sockets and forehead bone which also houses the brain; he showed that it could be done safely and make patients with severe deformities look normal again.
Now with 3D printers and skull models, we can plan these kinds of surgery in more detail before heading in to the operating room. Dr. Tessier didn’t even have CT scans – just xrays—but he could visualize his plan just from his exam, and improvise in the operating room because of his experience.
There is a nice article and video (above) in the New York Times this week about how the craniofacial surgeon at Boston Children’s Hospital planned a Tessier no. 4 cleft repair for a little girl named Violet using 3D models. It’s so rewarding to be able to help kids look more normal, so that their outsides match their happy, healthy insides!