Dr.Himika Gupta, G11750
21yr male with repaired cleft palate came with BE watering.BE medial lagophthalmos due to hypoplastic lids.BE absent lower puncta.ROPLAS negative &syringing patent(upper punctum). Vision&ocular WNL.Cleft lip,midface and lower lid repair was planned.Intraop left sided lacrimal sac fistula noted .Fitsulectomy done .Rest of cleft lip and lid repair completed with Weber–Fergusson incision,continued as a lid splitting incision on the lower lid margin,extending laterally as Tenzel flap for lower lid anterior lamella lengthening. Hard palate graft for lower lid posterior lamella lengthening&medial canthal resuspension done.Post op dacryocytography confirmed a patent pathway with lacrimal sac diverticulum. Embryological Tessier Clefts often present with eyelid&complex lacrimal outflow defects.Due to multiple pathologies, the timing and choice of lacrimal surgery while addressing face and eyelid reconstruction are critical for achieving optimal outcomes.
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