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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Triangular mucosal flaps will result in a natural looking commissure and can avoid transposition of the skin. Schwarz made a similar macrostommia with regard to the Z-plasty repair. Article Access Statistics Viewed: We report a case of year-old boy with a chief complaint of large mouth and drooling of saliva Figure 1. One should consider the symmetry both in vertical and in macroxtomia plane as improper techniques might result in asymmetry [ 8 ].

Advancement of oral commissure in correcting mild macrostomia. It results from failure of fusion of maxillary and mandibular process [ 4 ].

The authors declare that there is no conflict of interests regarding the publication of this paper.

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

In the current case, a perpendicular line was dropped from the medial margin of the pupil, and the point at which the color of vermilion changes from normal vermilion to cleft vermilion was marked.

Vermilion square flap commissuroplasty is another technique, which has previously shown good results.

In this case there was no history of medication, use of traditional medications, illnesses or nutritional deficiencies in pregnancy, and no evidence of attempted abortion was established [ 17 ]. The remaining parameters such as occlusion and temporomandibular joint functions are normal. Patient was examined thoroughly to rule out other congenital anomalies and investigated for PAC.


Macrostomia: A Review of Evolution of Surgical Techniques

At two-month followup, the oral commissures are symmetric, the scars are inconspicuous, and the overall balance of facial contour and lip is excellent. Anatomically and functionally, the orbicularis oris muscle can be divided into two distinctive layers, superficial and deep [ 19 ]. Surgical technique for the correction of macrostomia should address skin, muscle, and mucosa.

The authors’ technique is very useful in the primary surgery for macrostomia, as the dynamic action of muscle fibers is preserved, if the muscle is not dissected from the skin in the cleft margin that includes the two medial small triangular flaps.

Repair for Congenital Macrostomia: Vermilion Square Flap Method

Twelve primary cases of macrostomia underwent surgical repair between and The severity of these clefts also differs. The orbicularis oris was dissected and repaired after overlapping the muscle [ Figures 3 and 4 ]. Kaplan [ 27 ] reported commissuroplasty with a square flap from the upper lip which leaves a scar on the lower lip, not at the angle.

Incision is carried out along the marking. We report a rrpair of macrostomia corrected with Z-plasty closure for skin, overlapping muscle closure, and triangular mucosal flap for commissure, with a review on existing techniques.

Complications observed with surgical techniques include asymmetric closure, hypertrophic scar, drooping of oral commissure, and fish mouth deformity resulting from flaccid commissure.

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Kacrostomia believes that the lateral facial clefts are postmerging tears as there is considerable clinical variation [ 3 ]. The lateral extent of the cleft was located at the anterior border of the masseter muscle.

New surgical technique for macrostomia repair with two triangular flaps. The authors’ operative procedure uses two small triangular flaps with a superficial layer of orbicularis muscle to preserve the dynamic action of muscle fibers attached to the skin of the triangular flaps, with suturing across the orbicularis muscle repait.


Straight line closures are ideal where transverse deficiency of cheek is minimal. The deep component has a sphincteric function. The goal of macrostomia reconstruction is to achieve functional, symmetrical, and accurate oral commissure with minimal scar.

Sterile skin and mucosa are excised. We have used triangular mucosal flaps for closure of commissure as it achieves continuous dry red and wet vermilion. It is believed that the superficial component functions during facial expression and provides the precise movements of the lips necessary for complex speech production.

Case Reports in Dentistry

Both the points coincided, and the entire surgical correction was macrosfomia on these points. This technique in our ,acrostomia is easy and the result is excellent. Macrostomia is a relatively rare congenital craniofacial defect. Although the creation of a symmetric neocommissure is imperative, this presents a technical challenge. It is also hoped that the authorities will enact and enforce laws to ensure the rights of such babies, especially right to care and life [ 18 ].

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.

Transverse macrostoima clefts are more common on right side of face in unilateral cases.