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

Area of Science:

• Plastic Surgery
• Craniofacial Surgery
• Reconstructive Surgery

Background:

• Transverse facial clefts (Tessier 7) are rare congenital anomalies impacting facial aesthetics and function.
• Existing commissuroplasty techniques yield inconsistent outcomes.
• A modified vermilion square flap technique was investigated for improved reconstruction.

Purpose of the Study:

• To evaluate the efficacy of a modified vermilion square flap technique in reconstructing transverse facial clefts.
• To assess both functional and aesthetic outcomes following the surgical procedure.

Main Methods:

• Five patients with Tessier 7 clefts underwent reconstruction using a modified vermilion square flap.
• W-plasty was employed for skin closure to minimize scar visibility.
• Postoperative evaluation included patient satisfaction questionnaires and subjective assessments by surgeons and laypeople based on photographs at least 1 year after surgery.

Main Results:

• All patients reported satisfactory aesthetic results.
• No instances of commissure contracture were observed postoperatively.
• The vermilion square flap technique resulted in a natural, rounded oral commissure with cosmetically pleasing skin closure.

Conclusions:

• The modified vermilion square flap technique provides excellent results for transverse facial cleft reconstruction.
• Prioritizing orbicularis oris muscle approximation and meticulous skin closure enhances outcomes.