Surgical correction of unilateral macrostomia with modified square vermilion flap / 中华整形外科杂志

Objective@#To evaluate the outcome of unilateral macrostomia repairment, using modified square vermilion flap for commissuroplasty and straight-line suture for buccal defect repair.@*Methods@#Forty-six patients (29 male, 17 female) with unilateral macrostomia underwent surgical interventions. All cases underwent the same surgical procedures: the commissuroplasty using modified square vermilion flap, cross-over lapping suture to reconstruct orbicularis oris muscle, and straight-line suture to repair buccal defect. Patients had the surgeries at the age of 3 months to 19 years (median age of 6.6 months). The static and dynamic facial appearance were recorded both preoperatively and postoperatively. The appearance of ipsilateral oral commissure, the symmetry of bilateral commissures, the appearance of transferred square vermilion flap, and the recovery of the buccal scar were observed.All patients were followed for more than 6 months (ranging from 6 months to 3 years, with an average of 11.5 months).@*Results@#All 46 patients healed well at stage I. The commissures of 42 cases were basically symmetrical in both horizontal and vertical directions.Forty patients had symmetrical mouth when smiling and mouth opening. The vermilion flap was transferred to the lower lip in 45 cases. Their scars were smooth, and almost invisible. However, 18 patients had different local mucosal protrusion. All the buccal wound showed straight lines, without distorting or deforming the nasofacial grooves, when smiling or mouth opening. The buccal scar of 43 cases is smooth and not obvious.@*Conclusions@#The modified square vermilion flap can effectively reconstruct commissure caused by macrostomia. A small local mucosal protrusion is very common at the site of transferred vermilion flap, which might need secondary surgical correction. The buccal wound can be closed by the straight-line suture method, without obvious scar left, and avoid asymmetrical commissures and distorted nasolabial grooves. The fine muscle reconstruction and stratified sutures are important for a good surgical outcome.

Correction of microstomia by bilateral commissuroplasty using "over and out" buccal mucosa flaps: report of a case

A Case of Three Triangular Flaps as a Secondary Operative Procedure after Reconstruction of the Lower Lip by Estlander's Method

Estlander's method was popular for lower lip reconstruction after wide excision of malignant tumor of lower lip. This operative method is safe, easy and has good result, but it is necessary to perform a secondary commissuroplasty because of round and small commissure. Several methods have been suggested for secondary commissuroplasty. We have performed commissuroplasty with three triangular flaps according to Ichiro's report.5 This method uses two opposing triangular mucosal flaps in the vermilion area and one small triangular skin flap on the commissure. We can obtain satisfactory results in terms of aesthetic and functional consideration. Thus, we report the usefulness of three triangular flaps as a secondary commissuroplasty after reconstruction of the lip by Estlander's method.

Surgical Correction of the Macrostomia

Macrostomia, also called a transverse or lateral facial cleft, is a relatively rare malformation. Although many surgical procedures have been introduced, and no gold standard has yet been established. Moreover, most papers published in Korea were based on the results of the research conducted on the very limited number of patients, and for this reason its findings do not offer sufficient clinical reliability. We devised a modified commissuroplasty as follows: First, new commissure was placed 1 or 2mm inside when compared with the opposite side so that the commissure may not look longer than usual because of the scar on the side. Second, z-plasty of about 5mm was performed on the nasolabial fold to prevent the displacement of the new commissure on its lower part and avoid a continuation of a scar with the medial flap placed upward. We treated 32 cases of macrostomia from August 1, 1998 to July 1, 2002. We obtained relatively satisfactory clinical results by using this modified commissuroplasty. Based on our experience, we intend to present a clinical analysis and an operation technique of our own derived from the classic commissuroplasty, so that we may contribute to the diagnosis and treatment of the patients in the future.

Surgical Correction of Macrostomia

Congenital macrostomia is a result of defective union between the mandibular and maxillary processes and it is a rare deformity seen in every 100 to 300 facial clefts. Ohnizuka1`classified macrostomia into two groups as congenital and posttraumatic. We experienced two cases of acquired macrostomia due to NOMA sequelae(58/F:Lt & 51/F:Rt) and one case of congenital macrostomia (3 months/M:Rt). Many plastic surgeons have developed surgical procedures for repair of this congenital macrostomia. Among them, McCarthy6,11 described the classic commissuroplasty. We could repaired 1 case of congenital macrostomia and two cases of acquired macrostomia due to NOMA sequelae using modified technique of McCarthy,s classic commissuroplasty. McCarthy described new oral commissure 2-3mm laterally for prevention of postoperative contraction, orbicularis oris muscle transposition to restore labial function and a z- plasty cutaneous closure. But some author raise an objection to new oral commissure 2-3mm laterally, and they made new oral commissure at same distance of opposite side normal commissure. And so, we designed the new oral commissure moved 1mm laterally comparing to original commissuroplasty in a congenital case for the prevention of displacement. In cases of acquired macrostomia due to NOMA sequelae, we reconstructed new oral commissure like congenital case, moved 1mm laterally. Orbicularis oris muscle transposition could not be possible because of destruction of muscle, adhesion and atrophy. And so we dissected muscle and just sutured side by side. Acquired macrostomia following NOMA sequelae manifsted facial deformity variably, and reconstruction of the facial deformity is difficult by using simple approach. Other variable reconstructive procedures were needed with commissuroplasty as like Washio flap, rotation advancement flap, bone graft and free radial forarm flap, etc. Postoperative results were relatively good. We propose that macrostomia due to NOMA sequelae must add to Ohnizuka classification of acquired macrostomia.