Tessier 3 and 4 Clefts and Choanal Atresia: An Unusual Association?

Cleft Palate Craniofac J. 2022 Oct;59(10):1228-1232. doi: 10.1177/10556656211042172. Epub 2021 Sep 13.


Introduction: Craniofacial clefts are rare congenital anomalies that might involve both soft tissue and skeletal components. The association of Tessier cleft number 3 and 4 with choanal atresia appears to be unusual and only few clinical cases have been reported in published literature.

Objectives: Report a series of 13 cases of choanal atresia in patients with Tessier numbers 3 or 4 clefts and the literature review on this topic.

Methods: A literature review was undertaken via PUBMED database before April 2020 addressing the association between Tessier numbers 3 or 4 clefts and choanal atresia. Retrospective chart review of patients diagnosed with both comorbidities at a tertiary hospital expertised in craniofacial anomalies.

Results: Literature review yielded 10 studies describing the relationship between choanal atresia and Tessier 3 and 4 facial clefts. We identified 98 patients diagnosed with medial oro-ocular facial clefts (Tessier 3 and 4) and 119 with choanal atresia at our institution over a 20 years time period. Altogether, 13 individuals were diagnosed with both malformations, 3 patients with number 3 cleft, and 10 patients with number 4 cleft. It represents 13.26% of the cases.

Conclusion: This study highlights the features of Tessier 3 and 4 facial clefts associated with choanal atresia. Although the publications regarding this association are very scarce, the authors present the largest series of cases of Tessier number 3 and 4 clefts with choanal atresia showing that association between these conditions could be not so unusual.

Keywords: Choanal atresia; nonsydromic clefting; nose.

Publication types

  • Review

MeSH terms

  • Choanal Atresia*
  • Craniofacial Abnormalities*
  • Face / abnormalities
  • Humans
  • Retrospective Studies