Transverse Tessier Number 7 Facial Cleft

Transverse Tessier number 7 facial cleft is a birth defect where the corner of the mouth is split and stretched sideways toward the ear, so the mouth looks wider than normal on one side or on both sides. Doctors call this a rare “lateral facial cleft,” and it sits at position number 7 in the Tessier craniofacial cleft system. In this cleft, the problem can involve only skin and the lip, or it can also involve the facial muscles and the bones of the upper jaw (maxilla) and cheek bone (zygomatic bone). The child may have macrostomia (very wide mouth), gaps in the cheek muscles, and missing or under-developed cheek bones or jaw parts.

Transverse Tessier number 7 facial cleft (also called transverse facial cleft, lateral facial cleft or congenital macrostomia) is a rare birth defect where the corner of the mouth is abnormally wide and the cleft can extend toward the ear. It corresponds to Tessier cleft number 7, the most lateral cleft in the Tessier craniofacial classification. This cleft involves the soft tissues at the mouth corner, facial muscles used for smiling and sometimes the bones of the upper and lower jaw, leading to problems with feeding, speech, drooling and facial symmetry.

During early pregnancy, the upper jaw (maxillary process) and lower jaw (mandibular process) normally fuse around the seventh week of gestation. In Tessier 7 cleft, this fusion fails or breaks down, leaving a gap that forms the abnormally wide mouth opening. The condition may occur by itself or together with other syndromes such as hemifacial microsomia or Treacher Collins syndrome, where there are wider problems of facial bone under-development and ear anomalies.

Tessier 7 clefts are very rare, with estimates around 1 in 80,000 live births, and can be one-sided or affect both sides of the face. Babies may have trouble latching to the breast or bottle, may choke easily because the cheeks and lips do not close well, and may later develop speech and dental problems if not treated early. The main treatment is planned surgery in early childhood, supported by long-term therapies such as feeding, speech and dental care.

Transverse Tessier number 7 facial cleft develops very early in pregnancy when the small facial parts that should join together on the side of the mouth do not fuse properly. These parts come from the first and second branchial (pharyngeal) arches in the embryo. When fusion fails, a cleft forms at the corner of the mouth and can run toward the ear.

This cleft is very rare. Studies suggest it happens in about 1 in 60,000 to 1 in 300,000 live births and makes up a small percentage of all facial clefts.

Other names

Doctors and researchers use several other names for transverse Tessier number 7 facial cleft. It is often called “lateral facial cleft” because it runs across the side of the face, and “transverse facial cleft” because the split goes sideways.

Another very common name is “congenital macrostomia,” which simply means “big mouth present at birth.” Some articles also say “lateral lip cleft” or “commissural facial cleft,” because the cleft starts at the oral commissure, which is the corner of the mouth.

You may also see the terms “Tessier number 7 cleft,” “Tessier 7 cleft,” or “temporo-zygomatic cleft.” These names remind doctors that the cleft often affects the cheek bone (zygomatic bone), the area in front of the ear (temporal area), and the side of the upper jaw.

Anatomy and embryology

To understand this cleft, it helps to know how the face forms. The embryo has several small facial processes: the maxillary (upper jaw) process and the mandibular (lower jaw) process must grow and join at the side of the mouth. If this joining (fusion) does not happen, a gap stays at the corner of the mouth.

In the fourth to seventh week of pregnancy, cells called ectomesenchyme move into these facial processes and build bone, muscles, and skin. If these cells do not grow or move correctly, the maxillary and mandibular processes may fail to meet. This can lead to a cleft running from the mouth toward the ear.

The same early structures also form the external ear, middle ear, and some facial muscles. That is why a Tessier 7 cleft can be linked with ear deformities, small or missing parts of the jaw, and muscle gaps in the cheek, all on the same side of the face.

Types

Doctors describe several types or patterns of this cleft. These types help to plan treatment and to talk clearly about the problem.

1. Unilateral type – The cleft is on only one side of the mouth. This is the most common pattern. One corner of the mouth is pulled outward toward the ear, while the other side looks normal.
2. Bilateral type – The cleft is on both sides of the mouth. The child has a very wide “stretched” mouth that may give a “clown-like” appearance. Bilateral cases are very rare but are reported in the medical literature.
3. Incomplete (mild) type – Only the skin and the corner of the mouth are involved. The cleft may look like a small notch or short line at the lip corner. The deeper muscles and bones are normal or nearly normal.
4. Complete (severe) type – The cleft runs from the mouth toward the ear and may pass through skin, fat, muscle, and sometimes bone. The cheek can look open, and the corner of the mouth can be very far from the midline.
5. Soft-tissue-only type – Here, there is a split in the lip and cheek skin and in the facial muscles, but the bones are normal or nearly normal. The main problems are appearance, weak lip seal, and drooling.
6. Osteocutaneous (bone-and-skin) type – In this type there are clear defects in the maxilla and cheek bone. The zygomatic arch may be missing or very small, and the upper jaw on that side can be short or malformed.
7. Isolated type – The cleft is the only major abnormality. The baby does not have a full syndrome. Apart from the cleft and local bone changes, the rest of the body is normal.
8. Syndromic type – The cleft occurs together with other features as part of a syndrome, such as craniofacial microsomia or Treacher-Collins-like patterns, with ear deformities and jaw under-development.

Causes

For many children, doctors cannot find one single clear cause. Most experts think this cleft is “multifactorial,” which means it comes from a mix of genetic and environmental factors that affect early facial development.

1. Failure of fusion of maxillary and mandibular processes – The main cause is poor fusion of the upper-jaw and lower-jaw facial processes at the first pharyngeal arch. When these parts do not join, a lasting gap appears at the mouth corner.

2. Problems with ectomesenchyme formation – The cells that should fill the facial processes (ectomesenchyme) may not form or move properly. This lack of tissue can stop the normal joining of the side of the mouth.

3. Disturbed mesoderm migration – Some authors suggest that disturbed migration of mesoderm cells in the first branchial arch can lead to a lateral facial cleft, because there is not enough tissue to fuse the edges.

4. Vascular disruption (stapedial artery interruption) – Damage or interruption of small early arteries, such as the stapedial artery, has been proposed as a cause. Reduced blood flow can injure growing tissues and lead to a cleft.

5. Post-zygotic mutations – After fertilization, new (post-zygotic) genetic changes in facial tissues may disturb local development. Some reports describe lateral clefts as part of multifactorial or post-zygotic changes.

6. Association with craniofacial microsomia – This cleft is often seen with craniofacial microsomia, where one side of the face is under-developed, suggesting shared developmental pathways and possible common genetic factors.

7. Association with other craniofacial clefts – Some children have combined Tessier 3, 4, and 7 clefts, which shows that wide disturbances in facial patterning can cause several clefts at once.

8. Association with ear and temporal-bone anomalies – Frequent ear and temporal-bone defects in Tessier 7 clefts suggest that shared early arch defects may contribute to both the cleft and hearing problems.

9. Association with syndromes that affect first and second arches – Conditions such as oculo-auriculo-vertebral spectrum (including Goldenhar-type features) involve first and second arch structures and can include or resemble Tessier 7-type clefts.

10. Family clustering in some craniofacial disorders – While most Tessier 7 clefts are sporadic, some craniofacial conditions with similar arch problems show family clustering, suggesting that inherited genes can raise risk.

11. Maternal illnesses in early pregnancy – Serious illness, high fever, or poorly controlled conditions such as diabetes in the mother can disturb embryo development and are known risk factors for other orofacial clefts; similar effects are suspected for lateral clefts, though data are limited.

12. Low folate and poor nutrition – Lack of folic acid and poor general nutrition in early pregnancy are known risks for neural tube and other clefts. Some case reports mention bad diet and missing supplements in mothers of babies with lateral clefts, although proof is not strong.

13. Exposure to harmful medicines or chemicals – Teratogenic (harmful to the unborn baby) drugs and toxins are known to cause other facial and cranial defects. Experts think similar exposures could also contribute to transverse facial clefts, even though specific drug links are not firmly proven.

14. Maternal smoking and alcohol use – Smoking and alcohol in pregnancy raise the risk of common clefts like cleft lip and palate. Some authors suggest these exposures may also increase the risk of rare craniofacial clefts, including Tessier 7, through general effects on blood flow and tissue growth.

15. Intra-uterine vascular problems – Problems with placental blood flow or small clots can reduce oxygen to specific areas of the embryo. This “vascular disruption” idea is often used to explain craniofacial microsomia and may also play a role in lateral facial clefts.

16. Mechanical forces on the face (rare) – Severe constraints in the womb, such as oligohydramnios (very low fluid) or uterine bands, are known to cause some facial deformities. They could, in theory, worsen a mild cleft or change its shape.

17. Accessory maxilla and abnormal bone growth – In some patients, an “extra” piece of maxilla bone develops together with the cleft. This suggests that early mis-patterning of bone growth can directly contribute to the defect.

18. Random developmental error – Sometimes, even when there is no clear family history or risk factor, developmental processes go wrong “by chance” during a critical time window. Many cases of Tessier 7 cleft likely fall in this group.

19. Combination of genes and environment – Most authors think the real cause is a combined effect: slightly risky genes plus modest environmental stresses, which together cross a threshold and lead to the cleft.

20. Unknown factors – Despite detailed study, the exact cause often remains unknown. Researchers continue to report new cases and imaging findings to better understand this rare condition.

Symptoms and clinical features

1. Very wide mouth (macrostomia) – The most obvious sign is that the mouth opening is larger than normal, usually on one side, so the child looks like they have an “extra” smile line stretching toward the ear.

2. Visible cleft at the mouth corner – There is a split or notch at the corner of the mouth. In severe cases this split looks like a full cleft running across the cheek.

3. Drooling and poor lip seal – Because the lips cannot close tightly, saliva may run from the mouth, and the child may drool a lot, especially while eating or when tired.

4. Feeding difficulties in babies – Newborns may struggle to suck and latch on properly, so feeding can be slow or tiring. Some need special bottles or early surgery to help them feed well.

5. Speech problems later in childhood – As the child grows, weak lip movement and poor mouth closure can make it hard to form some sounds clearly, especially those that need strong lip action such as “p,” “b,” or “m.”

6. Cheek muscle weakness or gap – There may be a groove or ridge running from the mouth toward the ear because the cheek muscles are split or missing, which reduces strength when the child smiles or blows.

7. Ear deformities – The outer ear can be small, low-set, or misshapen, and there may be extra skin tags in front of the ear on the same side as the cleft.

8. Hearing problems – Because the ear canal or middle ear bones may be abnormal, some children have conductive hearing loss and need early hearing tests and follow-up.

9. Jaw and bite problems – The upper jaw and cheek bone on the affected side can be short or under-developed. This can lead to crooked teeth, bite misalignment, and difficulty chewing on that side.

10. Facial asymmetry – The two sides of the face may not match. One side may be smaller, flatter, or have a different shape of cheek, jaw, or ear, which becomes more obvious as the child grows.

11. Associated cleft lip or palate – Some children have a typical cleft lip or palate together with the lateral cleft, which can add to feeding, speech, and ear infection problems.

12. Dental problems – Teeth near the cleft area may be missing, extra, or wrongly placed. Rarely, an accessory maxilla with extra teeth can be present behind the normal upper jaw.

13. Breathing and airway issues (in severe cases) – If the jaw is very small or there are other facial anomalies, the child can have airway problems, especially during sleep or illness, and may snore or breathe noisily.

14. Eye and eyelid differences (in syndromic cases) – In some syndromes that include a Tessier 7-like cleft, the eyelids or eye position can also be affected, leading to dryness, irritation, or vision problems.

15. Psychosocial and emotional impact – Facial differences can lead to teasing, low self-confidence, and social anxiety as the child grows. Support from family, counseling, and early reconstruction can help reduce this burden.

Diagnostic tests

Diagnosis of a transverse Tessier number 7 facial cleft is mainly clinical, based on how the baby’s face looks and functions. However, doctors use several tests to check muscles, bones, ears, teeth, and overall health, and to plan surgery safely.

Physical examination

1. Full newborn and infant physical exam – Right after birth, the doctor examines the whole baby, looking at the face, mouth, body, limbs, heart, lungs, and abdomen. This helps detect the cleft, check for other malformations, and see if the baby might have a larger syndrome.

2. Focused facial and oral cavity inspection – The doctor looks closely at the lips, cheeks, gums, palate, and tongue. They note how far the cleft extends, whether muscles are missing, and if there are other clefts in the lip or palate. This careful look guides the choice of surgical repair.

3. Ear and hearing-related physical exam – The ears are checked for shape, size, and position, and the ear canal is examined with a light (otoscope). The doctor looks for microtia (small ear), missing canal, or skin tags that often occur with Tessier 7 clefts.

4. Neurological and cranial nerve exam – The doctor tests facial nerve function by asking the child (when old enough) to smile, close the eyes, and puff the cheeks. They also screen other cranial nerves to look for associated brain or nerve problems.

Manual and functional tests

5. Mouth opening and closing test – The clinician gently asks the child to open and close the mouth as wide as possible. They may measure the distance between upper and lower teeth to see if jaw movement is limited or unbalanced between sides.

6. Lip seal and blowing test – Older children may be asked to close their lips tightly, blow out air, or hold water in the mouth. If air or water leaks from the cleft area, it shows poor lip seal and weak cheek support that may need surgical correction or therapy.

7. Facial expression and muscle strength test – The doctor observes how well the child can smile, frown, and raise the eyebrows. Differences between the two sides of the face can point to muscle absence, mis-attachment, or facial nerve weakness.

8. Feeding and swallowing observation test – A speech or feeding therapist may watch the baby drink from a bottle or breast, or an older child eat solid foods. They look for choking, prolonged feeding time, or food leaking from the side of the mouth.

Lab and pathological tests

9. Routine blood tests (CBC, coagulation, biochemistry) – Before surgery, doctors order blood tests to check hemoglobin, platelets, clotting, kidney function, and electrolytes. This helps make sure the child can safely have anesthesia and surgery to repair the cleft.

10. Infection screening if needed – If the baby has recurrent infections, pneumonia, or poor weight gain, blood tests and cultures may be done to rule out underlying infection or immune problems that could affect healing.

11. Genetic testing for craniofacial syndromes – When there are multiple anomalies (such as ear defects, vertebral problems, or eye findings), doctors may order gene panels or exome testing to look for known craniofacial genes linked to first and second arch syndromes.

12. Chromosomal microarray or karyotype – A chromosomal study can detect deletions, duplications, or rearrangements that might explain a syndromic form of the cleft, guide prognosis, and help with family counseling.

Electrodiagnostic tests

13. Facial nerve conduction study and EMG – In children with suspected facial nerve weakness, doctors may record the electrical activity of the facial nerve and muscles. This helps show whether the nerve is present and how well it works, which can influence surgical planning.

14. Brainstem auditory evoked response (BAER) – This test measures electrical signals from the hearing nerve and brainstem after a sound. It is very useful in babies and young children with ear anomalies, because it does not require active cooperation and can detect hearing loss early.

15. Otoacoustic emission (OAE) test – A small probe in the ear canal plays sounds and records echoes from the inner ear. Abnormal results suggest hearing problems and prompt more full hearing tests and imaging.

Imaging tests

16. Prenatal ultrasound (2D and 3D) – In some pregnancies, detailed ultrasound can show a wide mouth or missing mouth corner as early as the second trimester. This allows early counseling of the parents, planning delivery in a specialist center, and preparing for feeding support and surgery.

17. Postnatal skull and jaw X-rays – Simple X-rays can show gross bone defects, missing parts of the jaw, or abnormal tooth buds. They are often used as first-line imaging in some centers and before more detailed scans.

18. CT scan of face and temporal bone – CT (computed tomography) uses X-rays to make detailed images of facial bones, cheek bones, jaw, and ear structures. It helps identify absent or duplicated parts of the maxilla and zygoma and guides complex reconstruction.

19. 3D cone-beam CT of jaws and teeth – In older children, cone-beam CT provides three-dimensional views of the jaws and teeth with lower radiation than conventional CT. It helps orthodontists and surgeons plan correction of dental and bite problems.

20. MRI of face and temporal bone – MRI (magnetic resonance imaging) shows soft tissues, muscles, and nerves in good detail, and is useful when doctors need to study facial muscles, salivary glands, brain structures, or the internal ear without using radiation. It complements CT in the full assessment of children with Tessier 7 clefts.

Non-Pharmacological Treatments (Therapies and Other Approaches)

1. Early feeding support and positioning
Special feeding techniques help babies with a transverse Tessier 7 facial cleft get enough milk safely. Nurses and lactation specialists show parents how to position the baby so milk flows toward the intact part of the mouth and how to use paced feeding to reduce choking and aspiration. This improves growth before surgery and reduces chest infections from milk going toward the lungs.

2. Specialized feeding bottles and nipples
Soft, squeezable bottles with specially shaped nipples can compensate for weak lip closure and poor suction. Caregivers can gently squeeze the bottle to assist milk flow, while the nipple shape helps seal the widened mouth corner. This non-drug approach is crucial in the first months of life to maintain nutrition and prepare the child for reconstructive surgery.

3. Speech and language therapy
After surgery, many children need speech therapy to learn correct lip, tongue and jaw movements. The therapist uses simple games, mirror work and sound practice to improve articulation of sounds like “p,” “b” and “m,” which depend on a well-sealed mouth corner. Therapy also supports language development and confidence in school and social settings.

4. Orofacial myofunctional therapy
Orofacial myofunctional therapy focuses on exercises for facial muscles around the lips, cheeks and jaw. The therapist teaches the child to close the lips, improve cheek tone, and coordinate swallowing. This can reduce drooling, improve chewing and support a more balanced smile, working together with the surgical repair.

5. Early dental and orthodontic monitoring
Children with Tessier 7 clefts often have dental crowding, malocclusion or missing teeth on the affected side. Early visits to a pediatric dentist and orthodontist help detect problems in tooth eruption and jaw growth. Preventive treatments, protective coatings and timed orthodontic interventions reduce the risk of cavities and long-term bite problems.

6. Physiotherapy for associated facial asymmetry
If the cleft is part of hemifacial microsomia, one side of the face, neck and jaw can be under-developed. Physiotherapists prescribe gentle stretching and posture exercises to improve neck range of motion and encourage symmetrical head position. This helps the child develop a more balanced posture and may support better jaw growth over time.

7. Occupational therapy for feeding and self-care
Occupational therapists help children practice self-feeding, tooth-brushing and other daily skills adapted to their facial anatomy. They may suggest utensils with special shapes, small spoons and strategies to keep food from leaking out of the wider mouth corner. This builds independence and reduces frustration for the child and family.

8. Psychosocial and family counseling
Visible facial differences can affect self-esteem, peer relationships and family stress. Psychologists and social workers counsel parents about coping strategies, support groups and how to talk about the condition with siblings and teachers. For older children, individual therapy can address teasing, anxiety and body image concerns.

9. Multidisciplinary craniofacial team care
The best care usually comes from a craniofacial team including plastic surgeons, oral and maxillofacial surgeons, pediatricians, ENT specialists, dentists, speech therapists and psychologists. Regular team visits ensure that feeding, breathing, hearing, dental development and emotional health are all reviewed in a coordinated way over many years.

10. Hearing assessment and early intervention
Because Tessier 7 clefts may be associated with ear malformations or middle-ear problems, early hearing tests are important. If hearing loss is found, hearing aids or other supports are provided to protect language development. Audiologists monitor hearing regularly because good hearing is essential for speech therapy to succeed.

11. Nasogastric or gastrostomy feeding (when needed)
In very severe cases with poor feeding and repeated aspiration, temporary tube feeding may be used. A soft tube through the nose or a small stomach tube lets the child get enough calories while the mouth and face are being prepared for surgery. This is usually a short-term support until oral feeding improves.

12. Scar management and massage after surgery
After cleft repair, gentle scar massage and moisturizing help keep the scar soft and flexible. Some teams use silicone gel sheets or pressure garments to reduce thick or raised scars. Good scar care helps the new mouth corner look more natural and move better when the child smiles or talks.

13. Sun protection for facial scars
New scars are very sensitive to sunlight and can become dark or uneven in color. Parents are advised to use hats and broad-spectrum sunscreen on the healed scar when the child is outdoors. This simple measure helps the scar blend better with the surrounding skin over time.

14. Breathing and airway monitoring
In some children with associated jaw or tongue anomalies, airway obstruction can occur, especially when sleeping. Non-pharmacological approaches such as positioning the child, using prone or side-lying sleep positions, or later positive airway pressure devices may be needed. Continuous monitoring helps detect problems early and guide further treatment.

15. Nutritional counseling
Dietitians tailor meal plans that are soft, high in calories and rich in protein, vitamins and minerals to support growth and wound healing. They also advise how to divide meals into smaller, more frequent portions to match the child’s chewing and swallowing abilities. Good nutrition makes surgery safer and recovery faster.

16. Parental education and home exercise programs
Parents are taught simple daily exercises for lip closure, cheek puffing and jaw movement and how to encourage clear speech at home. Written instructions and videos make it easier to continue therapy between clinic visits. Parent involvement strongly improves long-term functional outcomes.

17. School-based support and accommodations
Teachers can help by allowing extra time for oral tasks, understanding speech differences and supporting social inclusion. Sometimes the child may need seating near the teacher or speech therapist visits at school. Early coordination with the school helps prevent bullying and supports learning.

18. Psychological preparation for surgery
Age-appropriate explanations, play with dolls or picture books and pre-operative tours of the hospital help reduce fear. Child-life specialists can teach relaxation breathing or distraction techniques for blood tests and IV placement. A calmer child usually has smoother anesthesia induction and recovery.

19. Long-term follow-up into adolescence
Facial growth continues into the teenage years, and small asymmetries can become more visible. Regular reviews allow the team to plan secondary procedures, orthodontics or additional therapies only if truly needed. Continuous follow-up supports stable functional and cosmetic results.

20. Participation in patient support groups
Families often benefit from connecting with others facing similar craniofacial conditions. Support groups and online communities provide emotional support, practical tips and hope by sharing before-and-after stories of surgery and rehabilitation. This social connection can greatly reduce feelings of isolation.

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Drug Treatments (Medicines Used Around Tessier 7 Cleft Care)

Important: Medicines do not “cure” a transverse Tessier 7 facial cleft. They are used for surgery, pain control, infection prevention and related problems. All doses must be chosen by the child’s doctors based on age, weight and health.

Below, example drugs are described using information from FDA-approved labels on accessdata.fda.gov.

1. Amoxicillin (oral)
Amoxicillin is a penicillin-type antibiotic often used to treat skin, respiratory and ear infections, which can complicate facial cleft care or surgery. Typical pediatric doses are weight-based and given two or three times daily, as described in FDA labels for AMOXIL. It works by blocking bacterial cell-wall synthesis and is generally well tolerated; common side effects include diarrhea, rash and, rarely, allergic reactions.

2. Amoxicillin–clavulanate
This combination adds clavulanate, a β-lactamase inhibitor, to extend coverage against resistant bacteria. It can be used for more complex skin and soft-tissue infections of the face or ear regions in children with Tessier 7 clefts. Doses are calculated by the amoxicillin component and divided two or three times daily; side effects include gastrointestinal upset and risk of liver enzyme elevation.

3. Cefazolin (intravenous peri-operative antibiotic)
Cefazolin is a first-generation cephalosporin commonly used as a single pre-operative dose (sometimes repeated) to prevent surgical site infection in clean-contaminated facial surgeries. It inhibits bacterial cell-wall synthesis. Dosing is weight-based, usually given just before incision; side effects include allergic reactions, diarrhea and, rarely, kidney effects.

4. Acetaminophen (paracetamol, oral or IV)
Acetaminophen is a first-line pain and fever medicine after cleft repair. According to FDA labeling for acetaminophen injection, typical doses in adolescents ≥50 kg are 1,000 mg every 6 hours (maximum 4,000 mg/day), with lower weight-based doses in smaller children. It works centrally to reduce pain and fever; overdose can cause serious liver damage.

5. Ibuprofen (oral NSAID)
Ibuprofen is a non-steroidal anti-inflammatory drug used for mild to moderate postoperative pain and fever. FDA labels for ibuprofen suspension describe weight-based dosing every 6–8 hours, up to a daily maximum based on age. It blocks prostaglandin synthesis and can cause stomach upset, kidney strain or, rarely, bleeding or allergic reactions, so doctors balance benefits and risks carefully in each child.

6. Opioid analgesics (for severe postoperative pain)
Short-acting opioids such as morphine or hydromorphone may be used in the hospital immediately after major facial surgery if pain is not controlled with acetaminophen and ibuprofen. They act on opioid receptors in the brain and spinal cord to reduce pain perception but can cause drowsiness, constipation, nausea and respiratory depression, so close monitoring and short-term use are essential.

7. Ondansetron (IV or oral anti-nausea medicine)
Ondansetron is a 5-HT3 receptor blocker used to prevent nausea and vomiting after anesthesia and opioid use. FDA labels for ZOFRAN injection recommend weight-based IV dosing before or just after surgery, with possible repeat doses. Side effects may include headache, constipation and, rarely, heart rhythm changes, so dosing follows strict guidelines.

8. Propofol (IV anesthetic)
Propofol is a short-acting IV anesthetic widely used to induce and maintain general anesthesia during cleft repair surgery. It enhances GABA activity in the brain, causing rapid sleep and quick wake-up once infusion stops. FDA labeling for DIPRIVAN describes titrated weight-based dosing; side effects include low blood pressure, breathing suppression and, rarely, allergic reactions or propofol infusion syndrome with prolonged high doses.

9. Local anesthetics (e.g., lidocaine with epinephrine)
Local anesthetics are injected around the cleft area to numb the tissues and reduce postoperative pain. Lidocaine blocks sodium channels in nerve membranes, stopping pain signals. Adding low-dose epinephrine prolongs the effect and reduces bleeding during surgery. Side effects can include temporary numbness, rare allergic reactions or toxicity if injected in excessive doses or into a blood vessel.

10. Topical antibiotic ointments
After surgery, surgeons may prescribe topical antibiotic ointment on the incision line to reduce superficial bacterial colonization. These ointments act locally by inhibiting bacterial growth at the wound surface. Side effects are usually mild, such as local irritation or contact dermatitis; systemic absorption is minimal when used correctly.

11. Topical corticosteroid creams (short-term scar management)
In selected cases of thick, raised scars, short courses of topical corticosteroids may be used under close supervision to reduce inflammation and scar thickness. They work by down-regulating inflammatory pathways and collagen deposition. Prolonged use can thin the skin and change pigmentation, so they are used cautiously and for limited periods.

12. Intralesional steroid injections for hypertrophic scars
If scars around the mouth remain thick and firm, small amounts of steroid may be injected directly into the scar. This reduces collagen overgrowth and improves scar softness and appearance. Side effects include temporary discomfort, skin thinning, small depressions or lightening of skin color at the injection site.

13. Saline nasal and oral rinses
Although not drugs in the classic sense, isotonic saline sprays and rinses keep mucosal surfaces moist and help remove crusts and secretions after surgery. They work by mechanical cleansing and gentle re-hydration. Side effects are minimal, usually only mild stinging if the solution is not properly prepared.

14. Antibiotic ear drops (if ear anomalies and infections)
Children with ear malformations may have recurrent otitis media or external ear infections. Topical antibiotic drops are used to treat local infection and protect hearing. They act directly on bacteria in the ear canal; side effects include local irritation or, rarely, allergic reactions, and they must be used under ENT guidance to avoid damage to the eardrum.

15. Nasal decongestants (short-term peri-operative use)
Short courses of nasal decongestant drops or sprays may be used to reduce nasal swelling and improve breathing when safe and appropriate. They constrict blood vessels in the nasal mucosa, decreasing congestion. Overuse can cause rebound congestion, so doctors limit duration and frequency strictly.

16. Systemic corticosteroids (peri-operative swelling control)
In some surgical protocols, low-dose systemic steroids may be given briefly around the time of surgery to reduce swelling and nausea. They work by suppressing inflammatory pathways. Because steroids can affect immunity, blood sugar and wound healing, they are used for the shortest effective duration.

17. Antibiotic mouthwashes
Chlorhexidine-containing mouthwashes or swabs may be used post-operatively in older children to lower the bacterial load in the mouth and protect the incision at the new commissure. They act on bacterial cell membranes. Possible side effects include temporary taste change and staining of teeth with prolonged use.

18. Lubricating eye drops or ointments
If facial nerve function or eyelid closure is affected in associated syndromes, lubricating eye drops and ointments protect the cornea from drying. They provide a protective film over the eye surface. Side effects are usually mild, such as temporary blurred vision after ointment use.

19. Stool softeners when opioids are used
Because opioid painkillers can cause constipation, stool softeners or mild laxatives are sometimes prescribed during the short period of opioid use. They act by increasing stool water or stimulating bowel movements. This helps avoid painful straining that could stress fresh facial sutures.

20. Vitamin D and iron supplements when deficient
If blood tests show deficiencies, simple vitamin D or iron supplements may be prescribed. They support bone growth, immune function and energy. Doses are individualized based on age and lab values; side effects can include stomach upset or constipation, so dosing and monitoring are guided by the child’s doctor.

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Dietary Molecular Supplements

1. Vitamin C (ascorbic acid)
Vitamin C supports collagen formation and wound healing. In children with poor dietary intake, supplements may be used before and after surgery to support good scar formation. Typical pediatric doses are modest and weight-based; too much can cause diarrhea or stomach cramps, so the dose is chosen by the clinician.

2. Zinc
Zinc is important for immune function and wound repair. In children with documented deficiency or poor nutrition, zinc supplements may improve appetite and healing after facial surgery. Excessive zinc can lead to nausea and interfere with copper balance, so laboratory monitoring is recommended.

3. Vitamin A
Vitamin A supports epithelial and immune health, but high doses in pregnancy are linked to craniofacial malformations. In children after birth, carefully dosed vitamin A may help mucosal healing in deficiency states, but overdosing is toxic, so any supplement must strictly follow pediatric guidelines.

4. B-complex vitamins (including folate)
B-vitamins support cell division, nervous system health and energy metabolism. Folate is important in early facial development; after birth, B-complex supplements may be used when diet is poor or lab tests show deficiency. Side effects are rare at recommended doses; very high doses should be avoided without medical indication.

5. Iron
Iron is vital for red blood cell production and oxygen delivery, which supports healing and growth. If a child with Tessier 7 cleft is anemic from poor intake or other causes, iron supplements are prescribed with doses based on weight. Side effects include dark stools and constipation; overdoses are dangerous, so storage safety is essential.

6. Vitamin D
Vitamin D helps calcium absorption, bone mineralization and immune regulation. Many children have low vitamin D levels; a supplement can support jaw and facial bone growth, especially when sun exposure is limited. Doses reflect age and lab values; too much vitamin D can raise blood calcium and damage kidneys.

7. Calcium
Calcium works with vitamin D to support bone health. Children with poor dairy intake or special diets may benefit from calcium supplements to support overall skeletal growth, including the jaws. Side effects can include constipation or, rarely, kidney stones if doses are very high.

8. Omega-3 fatty acids (fish oil)
Omega-3s have mild anti-inflammatory effects and may support cardiovascular and brain health. When used as a supplement, doses are adjusted for age; side effects include fishy after-taste and, at high doses, slightly increased bleeding tendency, so surgeons often stop them before operations.

9. High-energy oral nutrition formulas
When growth is poor, high-calorie, protein-rich oral formulas can be used between meals. They provide balanced macros plus vitamins and minerals to support catch-up growth and wound healing. Side effects are usually minor, like temporary bloating or changes in stool pattern.

10. Probiotics (selected strains)
Probiotic supplements may help maintain healthy gut flora when children need repeated courses of antibiotics, potentially reducing antibiotic-associated diarrhea. Only well-studied strains and doses appropriate for children should be used. In otherwise healthy children, side effects are minimal; in immunocompromised patients, use is more cautious.

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Immune-Boosting and Regenerative / Stem-Cell-Related Drugs

These agents are not standard treatments for Tessier 7 clefts themselves but may be used for associated conditions or are being explored in broader regenerative medicine research.

1. Filgrastim (G-CSF)
Filgrastim is a granulocyte colony-stimulating factor that increases white blood cell counts in patients with severe neutropenia. It is not a routine drug for Tessier 7 clefts, but in children with associated bone-marrow problems, it can reduce infection risk before or after surgery. Side effects include bone pain and transient spleen enlargement.

2. Erythropoiesis-stimulating agents (ESAs)
In specific hematologic disorders with anemia, ESAs can stimulate red blood cell production and reduce transfusion needs, indirectly supporting tissue oxygenation and healing. They are used under specialist supervision, with careful monitoring for hypertension and thrombosis. They are not used solely for facial clefts but may be relevant when complex syndromes coexist.

3. Platelet-rich plasma (PRP – procedure-based)
PRP involves concentrating the patient’s own platelets and growth factors and applying them to surgical wounds. Early studies in craniofacial surgery suggest possible improvements in soft-tissue and bone healing, but evidence is still evolving. Risks include local pain and rare infection; since it uses the patient’s own blood, allergy risk is low.

4. Bone graft substitutes with growth factors
During secondary jaw or zygoma reconstruction, surgeons may use bone grafts or synthetic materials combined with growth factors such as BMPs (bone morphogenetic proteins) in selected indications. These agents promote bone formation but can cause local swelling and ectopic bone, so they are reserved for carefully chosen cases.

5. Experimental mesenchymal stem cell therapies
Research in craniofacial defects is exploring mesenchymal stem cells to enhance bone and soft-tissue regeneration. These approaches remain largely experimental, usually in clinical trials or animal studies, and are not standard of care for Tessier 7 clefts at present. Potential risks include immune reactions and uncontrolled tissue growth, so they must be studied under strict protocols.

6. Topical or injectable growth-factor-based wound products
Some advanced wound-care products contain recombinant growth factors or bioengineered matrices designed to speed healing in complex wounds. In craniofacial surgery, their use is selective and based on individual wound risk. Side effects may include local irritation or allergy; cost is often high, and evidence is still growing.

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Surgical Management Options

1. Primary transverse facial cleft repair (commissuroplasty)
The main surgery closes the cleft and creates a new, symmetric mouth corner (oral commissure). Surgeons design flaps of skin and muscle that are rearranged so the orbicularis oris muscle forms a functional ring around the mouth, and the skin closure follows natural lines. The goal is to improve feeding, speech and a natural smile.

2. Z-plasty or triangular flap techniques at the commissure
To avoid a straight, obvious scar and to maintain natural lip contour, surgeons often use Z-plasty or small triangular flaps at the new commissure. These techniques break up the scar line, reduce contracture and help the mouth corner move more naturally when the child smiles or speaks.

3. Muscle reconstruction (orbicularis oris and modiolus repair)
In Tessier 7 clefts, the muscle fibers at the mouth corner are disrupted. Surgeons carefully identify and reattach these muscles to recreate the modiolus (the muscular hub at the corner of the mouth). Proper muscle repair is crucial for good lip seal, drooling control and symmetrical smiling.

4. Secondary revision surgery for asymmetry or scar problems
As the child grows, small differences in lip length, scar tightness or mouth width can appear more obvious. Secondary revision surgery may adjust scar position, refine the commissure or correct asymmetries. These procedures are typically less extensive than the primary repair but can improve both function and appearance.

5. Orthognathic and skeletal reconstruction in complex cases
When Tessier 7 cleft is associated with significant jaw or cheekbone under-development (hemifacial microsomia), additional bone surgery may be needed in adolescence. Procedures can include mandibular distraction, bone grafting or osteotomies to realign the jaws and cheeks. These surgeries aim to achieve a balanced bite, improved airway and more symmetric facial skeleton.

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Prevention Strategies

Because Tessier 7 facial clefts are rare and often sporadic, they cannot always be prevented. However, general measures that reduce the risk of many congenital anomalies may also help:

1. Take folic acid before and during early pregnancy as recommended by healthcare providers to support proper facial development.

2. Avoid high-dose vitamin A or retinoid medicines in pregnancy unless absolutely necessary and prescribed, because they are linked to craniofacial defects.

3. Avoid alcohol, tobacco and recreational drugs in pregnancy, which may increase the risk of multiple birth defects.

4. Control maternal diabetes and chronic diseases with medical guidance before conception and during pregnancy.

5. Attend regular antenatal visits so problems can be detected early and medicines reviewed for safety.

6. Avoid unapproved herbal or over-the-counter products during pregnancy, especially in the first trimester.

7. Reduce exposure to known teratogens such as certain industrial chemicals or radiation, by following workplace safety rules.

8. Maintain a balanced, nutrient-rich diet with enough protein, iron and vitamins as recommended.

9. Seek genetic counseling if there is a family history of craniofacial anomalies or syndromes.

10. Follow medical advice about spacing pregnancies and overall maternal health, which supports better outcomes for future babies.

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When to See a Doctor

Parents should seek medical care urgently if a newborn has an unusually wide mouth opening, visible facial cleft toward the ear, difficulty feeding, choking, noisy breathing or poor weight gain. Early evaluation by a pediatrician and referral to a craniofacial team allows safe feeding strategies and planning of surgery.

Later in childhood, parents should see the doctor or surgeon if there is persistent drooling, speech problems, recurrent ear infections or teasing at school due to facial appearance. Any redness, swelling, discharge or opening along the old surgical scar also needs prompt review, because it may indicate infection or scar breakdown that requires treatment.

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What to Eat and What to Avoid

1. Prefer soft, easy-to-chew foods such as mashed potatoes, yogurt, soft rice, soups and well-cooked vegetables, especially soon after surgery.

2. Choose high-protein options like eggs, lentils, fish, chicken and dairy to support wound healing and growth.

3. Offer small, frequent meals to reduce fatigue while chewing and to maintain calorie intake.

4. Encourage slow eating and careful swallowing, with sips of water between bites to prevent choking.

5. Avoid very hard or crunchy foods (nuts, hard candies, chips) that can irritate or damage the surgical site.

6. Avoid very spicy, acidic or very hot foods early after surgery, as they can sting the incision and discourage eating.

7. Limit sugary snacks and drinks to reduce the risk of dental caries, which are already more likely with altered oral anatomy.

8. Use straws only if the surgeon approves, because suction can sometimes stress facial repairs.

9. Maintain good hydration with water, milk or oral nutrition formulas, especially if the child has low appetite.

10. Follow any special diet instructions from the surgical and nutrition team for the immediate post-operative period.

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Frequently Asked Questions (FAQs)

1. Is transverse Tessier 7 facial cleft life-threatening?
On its own, Tessier 7 cleft usually is not life-threatening, but it can cause serious feeding and breathing problems in newborns if not managed properly. Early assessment by specialists helps prevent complications and supports safe growth until surgery is done.

2. When is the best age for surgery?
Many centers perform primary repair in late infancy or early childhood, often between 3 and 12 months, when the child is big enough for safe anesthesia and before speech development progresses too far. Exact timing depends on feeding, associated anomalies and the team’s protocol.

3. Will my child need more than one surgery?
Most children need one main repair of the cleft. However, some will later need smaller revision surgeries or additional bone operations if there are associated jaw or cheekbone problems. The craniofacial team monitors growth and decides if further surgery is really necessary.

4. Will my child be able to speak normally?
With good surgical repair and early speech therapy, many children develop near-normal speech. Some may have mild articulation differences that improve with practice and therapy. Ongoing support from speech therapists and teachers is very helpful.

5. Can my baby breastfeed?
Some babies with a mild cleft can breastfeed with special positioning and help from lactation specialists; others may need expressed milk in special bottles. The goal is always to provide breast milk when possible, because it supports immunity and growth.

6. Is Tessier 7 cleft genetic?
Most cases appear sporadic, but some may be linked with genetic syndromes like hemifacial microsomia or Treacher Collins syndrome. A clinical geneticist can assess family history, examine the child and advise whether genetic testing or counseling is recommended.

7. Can prenatal ultrasound detect this cleft?
Detailed mid-trimester ultrasound or fetal MRI can sometimes detect wide lateral facial clefts, especially in severe or syndromic cases. However, small or isolated macrostomia can be missed. If an anomaly is suspected, the pregnancy is usually followed by a specialist fetal medicine team.

8. Will my child look “normal” after surgery?
Modern surgical techniques can create a very natural-appearing mouth corner and significantly improve symmetry. Small differences may remain, especially on close inspection, but many children are not easily recognized as having had a facial cleft once scars mature.

9. Does the cleft affect brain development?
Tessier 7 cleft itself primarily affects facial soft tissue and bones, not the brain. However, when it occurs with broader craniofacial syndromes, there may be additional structural or functional issues. Pediatricians and neurologists evaluate development and learning and arrange support if needed.

10. Can the cleft come back after repair?
Once the cleft is surgically closed, it does not “reopen” by itself, but scars can stretch or become tight as the child grows. That is why long-term follow-up is important—minor revisions can be done if function or appearance is affected later.

11. Are there long-term problems with teeth?
Yes, dental crowding, missing teeth or bite problems on the affected side are common. Regular care by a pediatric dentist and orthodontist helps manage these issues with cleaning, fillings, braces and, occasionally, tooth extractions or prosthetic replacements.

12. Will my child be able to play sports and live normally?
Most children with a successfully repaired Tessier 7 cleft can eat, speak, attend school, play sports and pursue normal careers. Some may need extra support for self-confidence or speech, but with family and professional help, they can lead full, active lives.

13. Do vaccines or routine childhood illnesses worsen the condition?
Routine vaccines are safe and recommended; they do not worsen the cleft. Common childhood illnesses can still occur but are managed as usual, with extra care if breathing or feeding is temporarily harder. Keeping vaccines up to date helps protect vulnerable children from serious infections.

14. Can adults with unrepaired Tessier 7 cleft still benefit from surgery?
Yes. While early surgery is ideal, adults with untreated or sub-optimally treated clefts can still benefit from modern reconstructive techniques. Goals include improving oral seal, speech, chewing and facial symmetry. Recovery may take longer, and realistic expectations are important.

15. Where can families find more information and support?
Families can ask their craniofacial team for reputable patient information websites, national cleft support organizations and local parent groups. These resources provide educational materials, emotional support and practical advice about surgery, school issues and growing up with a facial difference.

Disclaimer: Each person’s journey is unique, treatment plan, life style, food habit, hormonal condition, immune system, chronic disease condition, geological location, weather and previous medical  history is also unique. So always seek the best advice from a qualified medical professional or health care provider before trying any treatments to ensure to find out the best plan for you. This guide is for general information and educational purposes only. Regular check-ups and awareness can help to manage and prevent complications associated with these diseases conditions. If you or someone are suffering from this disease condition bookmark this website or share with someone who might find it useful! Boost your knowledge and stay ahead in your health journey. We always try to ensure that the content is regularly updated to reflect the latest medical research and treatment options. Thank you for giving your valuable time to read the article.

The article is written by Team RxHarun and reviewed by the Rx Editorial Board Members

Last Updated: February 25, 2025.