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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Scar on the lower lip becomes more conspicuous over time because of the tension that is created when the mouth is opened. Conficts of interest There are no conflicts of interest. The aim of surgical correction is reconstruction of a functional oral musculature, accurate positioning without contractile scar of the oral commissure, and cheek skin closure with a minimal visible scar.

In this paper, we present a six-year-old girl with unilateral macrostomia with preauricular skin tags and malformation of pinna on nacrostomia side treated with vermillion-square macrosfomia method. The deep layer of orbicularis oris muscle consists of fibers that arise from other facial muscles. Double reversing Z-plasty for correction of transverse facial cleft.

Depair skin flaps for commissure transpose the skin into the corner of mouth and give unnatural appearance.

Macrostomia: A Review of Evolution of Surgical Techniques

The orbicularis oris was dissected and repaired after overlapping the muscle [ Figures 3 and 4 ]. All these methods emphasize the importance of restoration of the integrity of cheek and lip muscle.

Bilateral filter Kaplan—Meier estimator. It is usually partial but rarely complete. Isolated transverse clefts are rare [ 3 ].

The goals of repair have been stated as follows: View at Google Scholar P. To conclude this method is a natural evolution from the earlier methods where the square flap pedicled on lower lip provides a natural shape to commissure avoiding sharp unnatural commissure margins and places scar such that the forces of muscle contraction and scar contracture balance out, thus maintaining the results to be more consistent on long-term followup.


However, the choice of technique should be based on the subclassification of defect in order to disguise the scar in the natural skin lines. Patient was followed up weekly for the first month and thereafter monthly for 2 months Figures 5 a and 5 b. The scar is placed at the upper lip. Straight line closure of orbicularis oris muscle gives pursed lips; to avoid this, Kaplan [ 1314 ] in suggested overlapping myoplasty for muscle closure. Intraoperative photographs with proposed incision markings showing Z plasty limbs and mucosal flaps white triangles.

It may be unilateral, extending along a line from the commissure to the tragus or bilateral. On evaluation, right commissure of the mouth was ill-formed and preauricular ear tags were observed Figure 1.

Case Reports in Dentistry

At 12 months follow-up, there eepair no lateral migration and the aesthetic appearance was satisfactory with good oral competence [ Figures 6 and 7 ]. Two-month postsurgical photographs reveal the symmetry of commissures both at rest and at smiling with minimal scar Figures 3 and 4.

The skin, muscle, and mucosal components of the deformity were separately repaired using a modification of Kaplan’s technique. Advancement of oral commissure in correcting mild macrostomia.

Bilateral macrostomia as an isolated deformity and its repair with a modified technique

Macrostomia is a congenital deformity resulting from failure of fusion of rspair and mandibular process. Keywords Bilateral macrostomia, muscle repair, straight line closure. This is an open access article distributed under the Creative Commons Attribution Licensewhich permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. New surgical technique for macrostomia repair with two triangular flaps.


Skin is closed with small Z-plasty. Various surgical techniques have been proposed for the correction of macrostomia defects.

In conclusion, simple line closure is a technically simple procedure and provides an esthetically pleasing scar without lateral migration or contraction in patients operated on at a young age. New surgical technique for macrostomia repair with two triangular flaps.

Transverse facial clefts are more common in males and more common on the left side when unilateral. Because the corner of the normal mouth is not a repwir but rather a smooth and continuous segment of the vermilion [ 26 ], it is difficult to achieve a natural contour of the corner of the mouth when the scar is located at the angle. Treacher-collins syndrome and mavrostomia microsomia [ 7 ] are frequently associated with macrostomia [ 8 ]. Macrostommia these reference points coincided [Figure 2].

Natural contour of the oral commissure is obtained both at rest and during movement. Simple line closure for macrostomia repair. By using the vermilion square flap pedicled on the lower lip, a scar at the commissural point which may lead to deformity of the oral commissure can be avoided. Ann Plast Surg ; Rpeair age at surgery ranged from 3 to 78 months. At seven weeks of gestation the lips separate from the alveolar areas with the formations of a vestibule and the maxillary and mandibular swellings then merge laterally to form the cheeks.