Transverse facial cleft (macrostomia) repair: modification of a traditional technique

2019 
Abstract Objective Outcomes from surgical repair of transverse facial cleft (macrostomia) may not be very satisfactory when conventional methods are used to position the oral commissure to be repaired. To improve patient outcomes, we developed a modified oral commissure positioning and reconstruction method for transverse facial cleft repair. Method In the modified positioning method, the oral commissure at the abnormal side was positioned precisely and reconstructed by a combination of two conventional methods, the distance measurement method and the anatomical charateristics method. The function of orbicularis oris muscle was preserved. Postoperative surgical scar score and oral commissure symmetry score were determined and compared between patients and healthy controls. The scores ranged from one to five with one representing the best and five indicating the worst results. Results Nine patients aged 4 to 31 months (7 girls) underwent the modified transverse facial cleft repair surgery. All the patients had unilateral transverse facial cleft with or without microsomia and/or complete cleft lip. The patients were followed up for one to five years. Although patients’ average surgical scar scores (close-mouth: 1.8±0.8, range: 1.0-2.8; open-mouth: 1.8±0.9, range 1.0-3.6) remained significantly higher (P Conclusions The modified procedure appears to lead to promising long-term benefit on restoring oral commissure symmetry.
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