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KMID : 0602919960020010096
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Journal of the Korean Society of Aesthetic Plastic Surgery
1996 Volume.2 No. 1 p.96 ~ p.103
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Problems after Classic Commissuroplasty in Congenital Macrostomia
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Abstract
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Congenital macrostomia is reported as lateral facial cleft or a transverse facial cleft, has received little attention in the literature. Congenital macrostomia is characterized by a spectrum from a simple widening of the oral commissure to a
full
thickness defect of the cheek.
McCarthy described the classic commissuroplasty as follow. (1) To account for anticipated wound contraction, the new oral commissure was moved 2 to 3mm laterally. (2) the divided orbicularis oris muscle should be secured after transposing each
other.
(3) A z-plasty cutaneous closure should be done.
We have repaired 6 cases of congenital macrostomia with the classic commissuroplasty proposed by McCarthy and found that the reconstructed oral commissure was tend to be displaced laterally and inferiorly.
So, we devised a modified commissuroplasty to prevent this problem as follows.
(1) The new commissure is positioned at the same as the opposite side. (2) The skeletonized muscle bundles are freed from zygomaticus, risorius and depressor anguli oris muscle and the bundles should be fixed at the higher position after
transposition.
(3) The commissure is reconstructed with vermilion commissure flap from upper lip and cutaneous coverage is done by z plasty.
Longterm follow up of one case of congenital macrostomia after this modified commissuroplasty reveals that the new commissure is not displaced with symmetry.
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