15018752330
15018752330
发表时间：2015-12-09 浏览次数：943次
Introduction
Transverse facial cleft is a rare congenital anomaly with only 21 cases reported in the world literature. [1],[2],[3] Many procedures have been developed for correction of this malformation, [4] including the vermilion square flap technique described by Eguchi et al., [5] the Z-plasty technique described by Longacre et al., [6] the two triangular flaps method described by Ono and Tateshita, [7] and another correction presented by Schwarz and Sharma et al. [8] All techniques described highlight the importance and challenge of achieving a properly positioned symmetrical neocommissure. In this report, the straight line repair of isolated bilateral congenital macrostomia is presented for the first time.
Discussion
The cleft of macrostomia includes a three layered defects of the skin, muscle and mucosa. [9] Discontinuity in the muscle results in an incompetent oral sphincter. [9]
The goals of surgery for macrostomia include symmetric placement of the
neocommissure, restoration of oral competence by repair of the
orbicularis oris muscle, and closure of the buccal mucosa to achieve a
normal contour and prevent lateral migration of the commissure. [9]
The point of the new commissure must be determined accurately to
achieve the above goals. 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. Both the points coincided, and the entire surgical correction
was centered on these points. The stump of the superior orbicularis oris
was closed in a double-breasted fashion to the inferior orbicularis
stump under adequate tension with reference to the overlying commissure.
This maneuver is of vital importance in creating competence, shape and
contour at the commissure. [9]
Vermilion square flap commissuroplasty is another technique, which has previously shown good results. [8] The Z-plasty technique has fallen out of favor as the scar is more visible, particularly when smiling. [3] Yoshimura et al.[10]
performed a study in which he compared five children with a Z-plasty
repair and seven with a simple line repair, and found that Z-plasty
gives a less aesthetic result. Schwarz made a similar observation with
regard to the Z-plasty repair. [10] Younger patients are also at high risk of lateral migration of the commissure with advancing age with this technique. [4]
In
conclusion, simple line closure is a technically simple procedure and
provides an esthetically pleasing scar without lateral migration or
contraction in patients operated on at a young age.
References
1.Makhija LK, Jha MK, Bhattacharya S, Rai A, Dey AB, Saha A. Transverse facial cleft: a series of 17 cases. Indian J Plast Surg 2011;44:439-43.
2.Gleizal A, Wan DC, Picard A, Lavis JF, Vazquez MP, Beziat JL. Bilateral macrostomia as an isolated pathology. Cleft Palate Craniofac J 2007;44:58-61.
3.Mahtar M, Benjelloun A, Chekkoury Idrissi A. Bilateral congenital macrostomia. Rev Stomatol Chir Maxillofac 2007;108:55-7.
4.Torkut A, Coskunfirat OK. Double reversing Z-plasty for correction of transverse facial cleft. Plast Reconstr Surg 1997;99:885-7.
5.Eguchi T, Asato PH, Takushima A, Takato T, Harii PK. Surgical repair for congenital macrostomia: vermilion square flap method. Ann Plast Surg 2001;47:629-35.
6.Longacre JJ, deStefano GA, Hommstrand KE. The surgical management of first and second brachial arch syndromes. Plast Reconstr Surg 1963;31:507-20.
7.Ono I, Tateshita T. New surgical technique for macrostomia repair with two triangular flaps. Plast Reconstr Surg 2000;105:688-94.
8.Schwarz R, Sharma D. Straight line closure of congenital macrostomia. Indian J Plast Surg 2004;37:121-3.
9.Chang HH, Tang YB, Hsu WM, Chen MT, Hsieh MH. Vermilion square flap for correction of bilateral macrostomia-A case report. J Plast Surg Assoc ROC 2008;17:399-404.
10.Yoshimura Y, Nakajima T, Nakanishi Y. Simple line closure for macrostomia repair. Br J Plast Surg 1992;45:604-5.