Combined Multi-Axis Tessier Clefts: Surgical Management and Early Functional Outcomes From a Tertiary Center

BackgroundRare craniofacial clefts are among the most complex anomalies encountered in reconstructive surgery. Although isolated Tessier clefts are well described, patients with multiple independent craniofacial cleft axes remain exceptionally rare, and their anatomical patterns, staged reconstructive burden, and early functional outcomes remain incompletely characterized.Patients and MethodsA retrospective review was conducted of patients with combined craniofacial clefts treated at a tertiary craniofacial center between 2015 and 2024. Combined clefts were defined as 2 or more independent craniofacial cleft axes according to the Tessier classification.ResultsThirteen patients met inclusion criteria. Ten (77%) underwent staged reconstruction at our institution, with a mean of 3.1 operative stages per treated patient. Orbital involvement was present in nine patients and palatal clefts in 6. Skeletal reconstruction was required in three patients. Early functional outcomes were generally acceptable during follow-up, although residual deformities and speech-related sequelae persisted in some referred revision cases. Minor wound infection occurred in three patients, and hypertrophic or widened scarring in 4.ConclusionsCombined multi-axis craniofacial clefts represent a rare and surgically demanding subset of congenital anomalies requiring function-prioritized staged reconstruction and continued multidisciplinary follow-up throughout growth.