Tessier Clefts

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also known as
Rare Clefts

Classification Diagram

Common Description

Tessier clefts are rare, occuring in about 1: 150 000 births. They fall into a variety of categories and are manifested in various syndromes but can also be non-syndromic. They are characterised by severe deformities of soft tissue and bony elements of the face.

Medical Description

Clefts are caused by the failure of fusion betwen parts of the face when in utero. They fall into 3 major categories:
1. Clefts through the midline (that is the centre of the face) which cause, among other complications, orbital dystopia (when the eyes are not level).
2. Oro-nasal-ocular clefts, which involve the mouth, nose and the eyes.
3. Lateral clefts which include Treacher Collins Syndrome and craniofacial microsomia and are characterised by gross abnormalities of the lower jaw.


  • Clefting of the hard and soft palate
  • Distortion/clefting of the nose and/or nasal skeleton
  • Distortion of the cranial base
  • Bifid nose
  • Orbital hypertelorism (eyes unusually far apart)
  • Hypoplastic maxilla (unusually small upper jaw)
  • Orbital Dystopia
  • Anophthalmia (small or underdevloped eye ball)
  • Clefting into the orbital floor
  • Facial asymmetry

Our Recommendation

Those who are born with Rare Clefts should be managed from birth to maturity by a full Craniomaxillofacial Team. This is because due to the complex nature of Rare Clefts and the many medical problems that are usually associated with them, not least of which is related to appearance. These can include:
- Breathing difficulties
- Feeding and eating difficulties
- Impairment of speech
- Hearing difficulties
- Eyesight impairment
- Psychological

DDMS Process and Procedure

Professor David has developed a multidisciplinary, from birth to maturity protocol (link to protocol) (which has been used for over 20 years) to produce positive outcomes for patients with this condition.


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Denpasar - Yayasan Senyum
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Launceston General Hospital
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Kota Bharu
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Govt Funded Medicare Cleft Lip and Palate Scheme
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Contact Information

David David Medical Services
226 Melbourne Street
North Adelaide
South Australia, 5006
T (61) 8 8267 1466
F (61) 8 8267 3403