Commisuroplasty for Macrostomia in Tessier 7 Cleft Using Modified Vermillion Square Flap Technique.

BACKGROUND

The transverse facial cleft, as described by Tessier, is a rare anomaly that affects both aesthetics and function. Various techniques for commissuroplasty have been discussed in the literature, often with inconsistent results. In this case series, the authors used a modified vermilion square flap technique to achieve satisfactory oral function and aesthetic outcomes.

METHODS

Five Tessier 7 cleft patients underwent reconstruction using vermilion square flap technique with W-plasty for the skin closure to help create a less noticeable scar. Evaluation was conducted at least 1 year postoperatively using a patient satisfaction questionnaire and subjective assessment by surgeons and laypeople based on frontal photographs.

RESULTS

Follow-up showed all patients had satisfactory aesthetic outcomes with no commissure contracture. The vermilion square flap produced a natural, rounded commissure, and the skin closure yielded cosmetically pleasing results.

CONCLUSIONS

The modified vermilion square flap technique offers excellent results, particularly when orbicularis oris muscle approximation and meticulous skin closure are prioritized.