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Case Report Plastic and Aesthetic Research

Straight line closure for correction of

congenital isolated bilateral macrostomia

Narendra S. Mashalkar, Naren Shetty

Department of Plastic Surgery and Burns, St. John’s Medical College, Koramangala, Bengaluru 560034, Karnataka, India.
Address for correspondence: Dr. Narendra S. Mashalkar, Department of Plastic Surgery and Burns, St. John’s Medical College, Koramangala,
Bengaluru 560034, Karnataka, India. E-mail: plasticnaren2005@yahoo.co.in

ABSTRACT
Congenital bilateral macrostomia is a very rare deformity of the mouth, and it is still rarer to see cases
of isolated bilateral macrostomia. Although the creation of a symmetric neocommissure is imperative,
this presents a technical challenge. A review of the literature for surgical solutions revealed various
techniques, but no cases in which a bilateral straight line repair was described and adopted. This report
presents the case of a 3-month-old boy with isolated bilateral macrostomia for whom straight line
closure was performed on both sides. At 1 year follow-up, the oral commissures are symmetric with
aesthetically pleasing scars and no lateral migration.
Key words:
Bilateral macrostomia, muscle repair, straight line closure

INTRODUCTION The lateral extent of the cleft was located at the
Transverse facial cleft is a rare congenital anomaly anterior border of the masseter muscle. After a thorough
with only 21 cases reported in the world literature. [1‑3] evaluation to rule out any associated anomalies, the child
Many procedures have been developed for correction was scheduled for surgical correction.
of this malformation, including the vermilion square Following nasal intubation, the neocommissure was
[4]
flap technique described by Eguchi et al., the Z‑plasty determined by dropping a vertical line from the medial
[5]
technique described by Longacre et al., the two margin of both pupils and marking the well‑defined change
[6]
triangular flaps method described by Ono and Tateshita, [7] in color from the normal vermilion to cleft mucosa.
and another correction presented by Schwarz and Sharma
et al. All techniques described highlight the importance Both these reference points coincided [Figure 2].
[8]
and challenge of achieving a properly positioned The orbicularis oris was dissected and repaired
symmetrical neocommissure. In this report, the straight after overlapping the muscle [Figures 3 and 4]. The
line repair of isolated bilateral congenital macrostomia is postoperative period was uneventful [Figure 5]. At
presented for the first time. The father of the child involved 12 months follow‑up, there was no lateral migration and
in this article agreed to publish the child’s pictures and the aesthetic appearance was satisfactory with good oral
signed the consent form. competence [Figures 6 and 7].

CASE REPORT DISCUSSION
A 3‑month‑old male child presented to us for definitive
correction of congenital bilateral macrostomia [Figure 1]. The cleft of macrostomia includes a three layered defects
of the skin, muscle and mucosa. Discontinuity in the
[9]
[9]
Access this article online muscle results in an incompetent oral sphincter. The
Quick Response Code: goals of surgery for macrostomia include symmetric
Website: placement of the neocommissure, restoration of oral
www.parjournal.net
competence by repair of the orbicularis oris muscle, and
closure of the buccal mucosa to achieve a normal contour
[9]
DOI: and prevent lateral migration of the commissure.
10.4103/2347-9264.153210 The point of the new commissure must be determined
accurately to achieve the above goals. In the current

Plast Aesthet Res || Vol 2 || Issue 2 || Mar 13, 2015 95