Surgical Considerations and Refinements for Macrostomia Repair

ABSTRACT

Macrostomia, or lateral facial cleft, is a rare congenital deformity that occurs alone or in combination with other anomalies as a result of a failure of proper fusion of the maxillary and mandibular processes during the fourth week of embryonic life. Although many surgical techniques have been suggested to correct this deformity, the procedures are controversial and no gold standard has yet been established. The purpose of these procedures includes formation of symmetric commissure, restoration of the abnormally positioned orbicularis oris muscles, and an inconspicuous scar. A natural-looking oral commissure is not easily achieved because the commissure is not just a corner but a continuous vermilion web. The purpose of this study is to achieve a more natural-looking commissure using natural anatomical landmarks different from other studies and to divide three anatomical units of the commissure for the proportional surgical repair of congenital macrostomia. Surgical methods include commissuroplasty using mucosal triangular flap, myoplasty of the disarranged orbicularis oris muscle and closure of the cheek cleft with a small Z-plasty. From March, 1999 to Feb, 2003, a total of 12 patients(4 males, 8 females) with congenital macrostomia have been operated. We obtained satisfactory functional and esthetic outcomes in all patients by using these techniques after a long period follow-up. We think the most important aspect of macrostomia repair is a proportional anatomical repair using natural landmarks.