Congenital bilateral macrostomia is a very rare deformity of the mouth, and it is still rarer to see Bilateral macrostomia, muscle repair, straight line closure. Congenital macrostomia is a relatively rare deformity. A number of different methods for its correction have been reported in the past. Here, we report our refined. Congenital macrostomia (transverse facial cleft) is a relatively rare anomaly. Surgical methods used to correct this anomaly include commissuroplasty.

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Keywords Bilateral macrostomia, muscle repair, straight line closure. It is a rare congenital deformity with an incidence of 1 in 60, to 1 inlive births.

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The surgical correction of macrostomia results in normal orbicularis oris function and symmetry of the repaired lip. Charles N Verheyden Annals of plastic surgery Various surgical techniques have been proposed for the correction of macrostomia defects.

Patient was followed up weekly for the first month and macrsotomia monthly for 2 months Figures 5 a and 5 b. The technique of two triangular flaps allows achieving all therapeutic goals, formation of symmetric lips and commissures of the mouth, reconstruction of the orbicularis muscle of mouth to restore labial function, and reconstruction of the commissure of the mouth with a natural looking contour.

Defects might range from mild to severe. Hartsfield and Bixler in their case report in one of reepair twins explained the role of multifactorial inheritance for the etiology [ 5 ]. Incisions were made after infiltration of adrenaline solution in concentration 1 inand the excess tissue is excised.


Repair for Congenital Macrostomia: Vermilion Square Flap Method

Transverse facial cleft is a rare congenital anomaly with only 21 cases reported in the world literature. Indian J Plast Surg ; A lazy W-plasty was designed for closure of the skin of the cleft cheek. Macrostomia is a congenital deformity resulting from failure of fusion of maxillary and mandibular process.

Various techniques were described in the literature for surgical correction. Case Reports in Dentistry. The cleft of macrostomia includes a three layered defects of the skin, muscle and mucosa. Although the former is a more acceptable theory, Gorlin and others claim that post-merging tear is the cause [ 56 ] and it is thought to be part of the manifestation of hemifacial microstomia, the second most common congenital craniofacial anomaly [ 2 ].

Z-plasties were suggested for skin closure to make the scars inconspicuous and to avoid contracture. Congenital Abnormality Search for additional papers on this topic.

It may be unilateral or bilateral, partial or complete extending up to tragus, and isolated or associated with syndromes. At 2-month followup, the oral commissures are symmetric.

Straight line closure for correction of congenital isolated bilateral macrostomia

For commissure, triangular mucosal flaps or triangular skin flaps are used. Preoperative photographs showing the frontal and lateral view of the patient.

Case Report We report a case of year-old boy with a chief complaint of large mouth and drooling of saliva Figure 1. Treacher-collins syndrome and hemifacial microsomia [ 7 ] are frequently associated with macrostomia [ 8 ]. The same method was applied to all 12 cases in the reconstruction of a natural appearance and dynamic function of the oral commissure, and the results over several years showed satisfactory outcomes. Following nasal intubation, the neocommissure was determined by dropping a vertical line from the medial margin of both pupils and marking the well-defined change in color from the normal vermilion to cleft mucosa.


A 6-year-old female patient visited the Department of Pedodontics and Preventive Dentistry with a chief complaint of wide mouth opening and preauricular skin tags since birth Figures 1 a and 1 b.

The goal of macrostomia reconstruction is to achieve functional, symmetrical, and accurate oral commissure with minimal scar. The extent of clefting in the muscle ranges from mild which is confined to the orbicularis oris to the buccinator or even extends backwards to the masseter muscle.

Macrostomia: A Review of Evolution of Surgical Techniques

Surgical technique for the correction of macrostomia should address skin, muscle, and mucosa. Introduction Transverse facial or Tessier No. Double reversing Z-plasty for correction of transverse facial cleft. Transverse facial clefts are more common on right side of face in unilateral cases.

Open Access Case Report. Transverse facial clefts are more common in males and more common on the left side when unilateral. The deep layer of orbicularis oris muscle consists of fibers that arise from other facial muscles.