Surgical repair of transverse facial cleft: Oblique vermilion–mucosa incision☆

Summary 

Various surgical techniques have been reported for the repair of the transverse facial cleft using a straight-line closure, Z- or W-plasty, local flaps, etc. However, several problems remain such as deviation, distortion and scars in the commissure and cheek. To resolve these problems, we studied the anatomy of the commissure again and devised the most reasonable method for repair of the transverse facial cleft.

In our new method, oblique vermilion and mucosa incision lines, 45° to the vermilion–cutaneous junction, were designed. After mucosal closure, the orbicularis muscle was reconstructed by cross-overlap joining the upper muscular bundle over the lower muscular bundle at an angle of 90°. The skin was sutured using horizontal straight-line closure with a small Z-plasty lateral to the nasolabial fold.

We performed the new method on seven macrostomias. The patient cohort consisted of four girls and three boys, and their ages ranged from 4 months to 3 years. Symmetrical commissure and natural oral movement was obtained in the past five cases. The scar around the commissure and cheek was inconspicuous in all cases.

The new method used the oblique vermilion–mucosa incision and straight-line closure, the cross-overlap joining of the muscular bundles at an angle of 90°, and the horizontal straight-line skin closure with a small Z-plasty lateral to the nasolabial fold. This method, which is anatomically reasonable, can construct a symmetrical and natural commissure without conspicuous scars.

Keywords: Commissuroplasty, Macrostomia, Transverse facial cleft, Tessier type 7 cleft, Oblique vermilion–mucosa incision