Facial clefts are splits or gaps in the face, due to tissue and/or bone not fusing together correctly during a baby’s prenatal development. Tessier clefts are severe facial clefts that involve more than just the lip and the upper jaw.

A Tessier cleft can involve the mouth, cheeks, eyes, ears, and forehead and may continue into the hairline. Tessier clefts often include improperly formed teeth, tear ducts, eye orbits, and the base of the skull. Asymmetrical facial features typically result from Tessier clefts, and surgery is critical to allow an affected child to lead a normal life.

Tessier Classification

The Tessier classification system is the most commonly used method for categorizing craniofacial clefts. The Tessier classification system describes soft tissue and skeletal structures relative to each other.

Facial clefts are numbered 0 through 7, and cranial clefts are numbered 8 through 14. The system is devised so that the facial component of the cleft and the cranial component always add up to 14 (e.g., 14:0, 13:1, 4:10). This classification helps to define different types of clefts based on the location and affected area of the face.


Rare facial clefts are typically more severe and fall into three main categories: clefts through the center of the face, clefts involving the mouth, nose and eyes, and lateral clefts associated with significant deformities of the lower jaw.

Symptoms are highly diverse; a child with a mild mid-facial cleft may only have issues with a divided nose (known as a bifid nose) but an otherwise normal appearance. A child with a severe mid-facial cleft may have a double cleft lip, cleft palate, cleft nose and eye differences.

If your child has a rare craniofacial cleft, they may have:

  • Facial asymmetry
  • Differences in the base of the skull
  • Cleft lip and palate
  • An unusually small upper jaw (hypoplastic maxilla)
  • Cleft nose or distortion of the nasal skeleton
  • A bifid nose
  • Wide-set eyes (orbital hypertelorism)
  • Uneven eyes (orbital dystopia)
  • Unusually small eyes
  • A cleft that extends into the base of the eye socket
  • Abnormalities of the eyelids and eyebrows

Children with rare craniofacial clefts will also typically have trouble feeding or breathing.


Prenatal diagnosis of craniofacial clefts can be made by ultrasound examination. Further analysis often involves a CT scan to evaluate the underlying bone and soft tissue defects.


Treatment for most Tessier facial clefts involves a combination of soft tissue and bone repair often followed by corrective jaw surgery or facial bipartition surgery to reposition the face forward and to bring the orbits of the eyes closer together.

Surgeries that involve cutting of the bone can be accompanied by craniofacial distraction osteogenesis, a minimally invasive procedure involving placement of a device that promotes the gradual growth of bone to reshape deformities in the jaw, midface and skull.

Nasoalveolar molding is an option to treat a wide cleft lip and palate.

All of these treatments require a multidisciplinary approach that brings together neurosurgeons, maxillofacial surgeons, plastic surgeons, anesthetists, orthodontists, and otolaryngologists. The North Carolina Cleft and Craniofacial Center houses this expertise in a single location, making it possible to deliver holistic care to your child over the course of his or her treatment.