Paranasal transposition flap in facial soft tissue reconstruction of facial cleft Tessier type 3 & ADAM complex: A case report

INTRODUCTION: Craniofacial Tessier Cleft type 3 as a common craniofacial cleft with nasolabial region soft tissue defect, forced surgeons to find their ways of reconstructing using localregional flaps to provide defect closure. The cleft may occur in existence with other constriction band syndrome entity such as the ADAM complex. The effort to repair and give back the basic function for daily activity, put surgeons to find ways and one among them are soft tissue reconstruction using most reliable are forehead and melolabial flaps. However, many cases may limit their usages. CASE PRESENTATION: A four-month-old boy presented with ADAM complex syndrome with bilateral facial cleft Tessier 3 was done soft tissue reconstruction to repair the bilateral cleft lips using a combination of the paranasal flap. No early treatment approach such as molding was used. Although the cleft was wide enough, with limitation in flap modality, the wound healing was remarkable with no dehiscence. CLINICAL DISCUSSION: This patient nasal/glabellar flap was not feasible due to glabellar region defect. Some functional and aesthetic limitations of those flaps highlight situations in which the inferior-based interpolated paranasal flap (IPNF) offers an advantageous alternative. CONCLUSION: Thus, an alternative flap from inferiorly based paranasal flap proven to be good flap modalities for alar nasal area. This case report shows the good result of design, lacks, and benefit in using paranasal flap.