Unilateral macrostomia repair using modified muscle reconstruction: Long-term anthropometric evaluation of static and smile symmetry.

BACKGROUND: Macrostomia, or transverse facial cleft, substantially impairs facial esthetics and oral function. Although various repair techniques have been reported, achieving satisfactory bilateral symmetry, particularly during dynamic expressions such as smiling, continues to be a challenge. Here, we introduce our modified muscle reconstruction technique for unilateral macrostomia repair and evaluate long-term outcomes in static and smile symmetry using anthropometric measurements.

METHODS: A retrospective analysis was conducted on all patients who underwent unilateral macrostomia repair at our institution between December 2008 and December 2019. The key surgical procedure involved anatomical separation of the pars marginalis and pars peripheralis of the orbicularis oris and approximation of the inferior orbicularis oris to superior orbicularis oris and buccinator. Outcomes were assessed at a minimum 5-year follow-up using expert-led visual analog scale (VAS) scoring and objective anthropometric measurements of standardized photographs in three states: repose, closed-mouth smile, and open-mouth smile.

RESULTS: Twelve patients with a median age of 3 months (range: 3-24 months) were included. The mean total VAS score was 3.89, indicating good results in commissure symmetry, residual scar, and scar contracture. Postoperative anthropometric analysis revealed significant improvements in symmetry compared to preoperative measurements (P < 0.001). Furthermore, no statistically significant differences were observed between the affected and unaffected sides at repose and during closed-mouth or open-mouth smile states at long-term follow-up (P > 0.05).

CONCLUSION: Long-term postoperative assessment results indicated that the modified muscle reconstruction technique was associated with favorable static and smile symmetry.