Tessier 4 cleft of Face

Congenital facial deformity, a type of Tessier cleft. Was operated using an amoeba pattern flap, this post op is 4 yrs after surgery.

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Oh yes, surely her naso lacrimal duct is missing/malformed as well. But you know these patients hardly followup

I would have gone for a melo labial or paramedian forehead flap with ear cartilage to reconstruct the nose. But it would be a two stage procedure. Also the lower lid needs reconstruction. @Nilesh Pagaria definitely lacrimal apparatus is defective. We need to look for bony defects as well, and advise reconstruction. Good case for discussion. It is rare to see such patients.

She has also ectropeon,may be having dribbling of tear.?