Repair of Tessier 7 Cleft Lip Deformity

The most common of the rare craniofacial clefts, Tessier’s No. 7 cleft is represented by a deficiency of tissue that may span from the oral commissure to the ear. (1)  The repair of the cleft of the lip must include especial attention to restoring continuity of the orbicularis oris muscle as well the vermillion.  This case is presented as an example of the repair of the Tessier 7 cleft lip deformity.

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Transoral Robotic Assisted Radical Tonsillectomy

Contributors: Jeffery Scott Magnuson (University of Central Florida)

1) Purpose: The patient had a history of biopsy proven squamous cell carcinoma of the right palatine tonsil and elected for surgical resection as a primary treatment.

2) Instruments: The DaVinci surgical robot was used with the Maryland dissector and a monopolar cautery on the arms. The FK retractor was used to suspend the patient and gain exposure.

3) Landmarks: The right palatine tonsil is resected along with a cuff of pharyngeal musculature.

4) Procedure: In sequence, the initial incision on the anterior tonsillar pillar, the exposure of the parapharyngeal space, the removal of the specimen, and the final defect are shown.

5) Conflicts of interest: for JSM: Intuitive Surgical: Instructor/Proctor, Honoraria; Lumenis: Consultant, Honoraria; Medrobotics: Member Strategic Advisory Panel, Honoraria.

6) References: Chung, T. K., Rosenthal, E. L., Magnuson, J. S. and Carroll, W. R. (2014), Transoral robotic surgery for oropharyngeal and tongue cancer in the United States. The Laryngoscope.


Ear Tube Removal and T-tube Replacement

Contributors: Gresham T. Richter (University of Arkansas for the Medical Scienc)

1) Purpose: Untreated Eustachian Tube dysfunction can lead to retraction of the tympanic membrane (TM) and, eventually, an atelectatic middle ear. The insertion of a tympanostomy tube attempts to equalize the air pressure of the middle ear with the environment, allowing for the stabilization of the TM. Bobbin style tubes have an average extrusion time of less than a year while T-tubes remain in place longer but risk residual perforation. (1)

2)Instruments: Rigid endoscopes were used to direct and record the procedure with standard video monitoring. Straight cupped forceps were used to debride the external auditory canal. A myringotomy knife was used to make the myringotomy.

3) Landmarks: After debridement of cerumen, the handle of the malleus and the incudostapedial joint are clearly visualized as indicated with titles in the video. Note that the patient’s tympanic membrane shows an incudostapediopexy and deep retraction which is not the typical tympanic membrane position.

4) Procedure: Cerumen is debrided from the EAC. A myringotomy knife is used to enter the middle ear space which is suctioned. A t-tube is placed, and the position is confirmed.

5) Conflict of Interest and Source of Funding The authors have no financial disclosures.

6) References 1. Weigel MT, Parker MY, Goldsmith MM, Postma DS, Pillsbury HC. “A prospective randomized study of four commonly used tympanostomy tubes.” The Laryngoscope. 1989 Mar;99(3):252-6.


Bilateral Cleft Lip Repair

Contributors: Larry Hartzell

Repair of the bilateral cleft lip deformity can be challenging to the cleft and craniofacial surgeon.  The goals of an acceptable repair must include precise continuity of the cupid’s bow, maximizing philtral length, and establishing a mucosa lined sulcus.  We present an example of a repair of the bilateral incomplete lip as described by Millard.


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