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

ABSTRACT

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.