The Postoperative Laterality of the Oral Commissure in Lateral Facial Cleft

ABSTRACT

Lateral facial cleft is a very rare craniofacial malformation involving various degree of skeletal and soft tissue hypoplasia. For the reconstruction of the oral commissure, McCarthy and Fuleihan(1986) measured the distance between the unaffected philtral column and commissure and that distance is marked on the affected side of the upper lip. And it is moved 2 to 3mm lateral to allow for future wound contraction. The purpose of this study is to analyze the postoperative shift of the oral commissure in the lateral facial cleft. We have reconstructed lateral facial cleft and divided them into two groups. In group A, the distance between the commissure and philtral column is marked on the unaffected side and transferred to the affected side. And the transferred point was moved 2 to 3 mm in the lateral direction. In group B, the transferred point to the affected side was exactly the same distance between the commissure and philtral column on the unaffected side. This study involved 19 patients aged from 2 months to 3 years (mean age of 20.8 months) with lateral facial cleft who underwent the commissuroplasty from June 1997 to August 2002. Group A and group B involved 10 and 9 lateral facial clefts, respectively. By using the caliper, each patient's postoperative upper lip width was measured on both the unaffected side and the affected side by one panel. Follow-up was available in 12 patients. In group A, oral commissural point was lateralized by 2.57mm on average, and the mean follow-up period was 3 years and 2 months. In group B, oral commissural point was lateralized by 0.82mm on average, and mean follow-up period was 1 year and 10 months. In all patients, oral commissural points were displaced laterally. In conclusion, we have noticed the reconstructed oral commissural point was lateralized. And we propose that the point which is selected as the site of the reconstructed commissure should be moved more in the medial direction.