Congenital macrostomia--transverse facial cleft.

Congenital macrostomia or transverse facial cleft is a rare congenital craniofacial anomaly. It is usually associated with deformities of other structures developed from the first and second branchial arches and is thought to be part of the manifestations of hemifacial microsomia, the second most common congenital craniofacial anomaly. There were several methods to repair this deformity. All the methods emphasize the importance of restoration of the integrity of cheek and lip muscles. The role of vermilion flap and the size and direction of skin Z-plasty remained controversial. A retrospective review on the 16 congenital macrostomia patients repaired in this hospital by 4 different surgeons with 5 different methods was made. The symmetry of lip, commissural shape and scar quality were evaluated among different methods. It was felt that accurate positioning of the oral commissure and reconstruction of a functional oral musculature were quite important to a good result. The skin Z-plasty could lengthen the deficient transverse distance of the cheek tissue and prevent later scar contracture. But a Z-plasty needed careful design and good postoperative care to minimize visible scar. A vermilion flap across the commissure could also prevent the lateral migration of the commissure from a linear scar contracture. The flap also needed careful design to give a better commissural shape.