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Source publication
Background:
Transverse facial clefts are Tessier's number 7 facial cleft among numbers 1-15 in Tessier's classification of craniofacial malformations, which varies from a simple widening oral commissure to a complete fissure extending towards the external ear.
Case presentation:
In a patient with a transverse facial cleft, to functionally arrang...
Context in source publication
Citations
... The complex structural relationship between the OOr and buccinator at the modiolus region revealed in the present study would be crucially important for surgical reconstruction of this region for transverse facial clefts [13]. The connection and continuation of muscle fascicles from the buccinator to the OOr revealed in the present study would be a relevant knowledge for Botulinum toxin treatment to the buccinator for facial synkinesis [17]. ...
Purpose
This study aimed to clarify the structural arrangement of the orbicularis oris (OOr), the buccinator, and the other perioral muscles around the modiolus.
Methods
The perioral muscles in seventeen cadavers fixed with formalin were dissected in situ and/or in isolated muscle specimens, and their layers were reconstructed schematically upon pantomographic view of the skeleton to evaluate their actions.
Results
The buccinator was composed of three parts including upper and lower oblique parts in its superficial layer and a middle transverse part in its deep layer. The superior and inferior OOr were composed of an inner marginal part (IM) and an outer labial part (OL) in each. The perioral muscles as a whole were arranged in three layers. The first layer consisted of the depressor anguli oris and the OL of superior OOr connected at the modiolus in a vertical direction. The second layer consisted of the upper and inner oblique part of buccinator and a part of the OL of inferior OOr connected at the modiolus in a horizontal direction. The third layer contained the middle transverse part of buccinator continuous with the IM of both OOr and a part of the OL of inferior OOr without connection to the modiolus.
Conclusions
The different arrangement of the three layers of perioral muscles around the modiolus could serve as a good basis to predict the actions of the individual perioral muscles on the movement of lips in open/close of the oral fissure and widening/narrowing of the lip width.
... It is caused by a lack of ectomesenchyme formation or penetration of the maxillary and mandibular processes during the fourth and fifth weeks of development, resulting in the failure of the maxillary and mandibular processes to fuse at the first pharyngeal arch and a cleft at the commissures of the lips. The deep muscles appear to be split [4,5]. A sulcus at the commissure may be the only finding [6,7]. ...
Tessier no. 7 clefts are characterized by macrostomia, facial muscular diastasis and maxillary and zygomatic bone abnormalities. It is caused by a lack of ectomesenchyme formation or penetration of the maxillary and mandibular processes during the fourth and fifth weeks of development. A case of bilateral transverse facial cleft with an accessory maxilla and an osseous choristoma is presented. The diagnosis of accessory maxilla was based on clinical findings due to the inaccessibility of orthopantomography and computed tomography scan. Orbicularis oris muscle reconstruction, cheiloplasty and excision of accessory maxilla were done. Histopathological examination of the bony lesion showed an osseous choristoma. There were no postoperative complications or local recurrence of the lesion excised. This case report demonstrates the importance of early diagnosis and intervention in maxillofacial congenital anomalies. Cheiloplasty restores function and gives the patient a natural appearance. The excision of accessory bone prevents further complications in the child’s growth.
... It represents only 0.33% to 1% of all facial clefts [1]. Its incidence is 1 case in 60,000 to 300,000 births [6] with a male predominance [7]. The unilateral form is much more common. ...
Transverse facial cleft or congenital macrosomia is a rare facial malformation. It is more common in men than in women. Unilateral form is the most frequent and appears to be associated in most cases with additional facial deformities. Bilateral form is rare and is more often isolated. The cosmetic damage it causes can be source of psychological stress. Sever form can cause oral functional disorders. These consequences justify early repair. We report two cases of isolated bilateral transverse facial cleft in a 6 month old girl and a 5 month old boy. The straight-line technique was used. Mucosal flaps from the lower lip were used to reduce the suture of the labial mucosa to 5 mm from the commissures on the upper lip. The aesthetic and functional outcomes were satisfactory.
... 11,12 Koh et al. performed orbicularis oris muscle convergence and suture reconstruction in seven patients to treat macrostomia. 13 There are other operations, such as those reported in the aforementioned studies, which paid close attention to muscle connection and rearrangement, the recovery of the orbicularis oris ''circle'' surrounding the whole mouth, and the obtainment of an aesthetic effect to some extent. 9,14 Simultaneously, with the development of auxiliary examination and its integration in macrostomia research, the exploration of other issues, such as a flat commissure that lacks a 3D appearance, the lack of perfect symmetry between the affected and healthy sides, dynamic motion, and especially recurrence or aggravation with aging, should be continued. ...
Background: Most of the characteristic facial features of patients with unilateral macrostomia are attributed to the malformation of commissure muscles. This study aimed to evaluate a modified surgical treatment for such patients that focuses on both appearance and symmetry. Methods: Twenty-seven patients with macrostomia underwent surgery using the proposed method. Facial measurements were analyzed preoperatively, 1 week postoperatively, and during a long-term follow-up using statistical software. Results: The overall length ratio of the healthy and affected sides of the vermillion preoperatively, 1 week postoperatively, and during the long-term follow-up was 1:1.61, 1:1.01, and 1:1.00, respectively (all, p > 0.05). The overall angle between the pupil line and the commissure line was 9.90° preoperatively, 2.34° postoperatively, and 3.31° during the long-term follow-up. There was no statistically significant difference in the covering relation of the upper and lower lips between the affected and healthy sides postoperatively (p > 0.05). 3dMD Dynamic Surface Imaging System (3dMD, Atlanta, GA, USA) showed a symmetrical three-dimensional commissure structure during long-term follow-up measurements. Conclusions: The symmetry and appearance of patients with macrostomia commissure significantly improved following this modified surgical method.
... Although there are no clear recommendations on the appropriate timing of lateral cleft lip repair, research findings have suggested that an earlier procedure would be favorable for relieving anxiety among patients and caregivers. Some studies have recommended that lateral cleft lip repairs should be performed on patients 3-4 months of age [14,15]. In this case, as lip adhesion was performed at 2 months of age and cleft lip repair was scheduled at 6 months of age, we planned correction of the lateral cleft lip at 4 months of age. ...
... In this case, as lip adhesion was performed at 2 months of age and cleft lip repair was scheduled at 6 months of age, we planned correction of the lateral cleft lip at 4 months of age. These time points were judged more appropriate since they were consistent with the surgical periods of other studies [14,15]. Although the timing of definitive closure after lip adhesion remains controversial, closure was performed at approximately 6 months of age, similar to that observed in another study [11]. ...
To date, there have been no reports of patients showing a Tessier number 7 cleft with unilateral complete cleft lip and palate. Furthermore, no studies have established the sequence, plan, or timing of surgical methods for treating patients presenting the above anomalies simultaneously. We report a case of a Tessier number 7 cleft with unilateral complete cleft lip and palate. Two months after birth, lip adhesion was performed on the unilateral complete cleft lip and total excision was performed on the skin tag. At 4 months of age, Tessier number 7 cleft was corrected. At 6 months of age, surgery involving two small triangular flaps was performed on the unilateral incomplete cleft lip after performing lip adhesion. At 13 months of age, two-flap palatoplasty with a vomer flap was performed on the complete cleft palate. At 6 years of age, open rhinoplasty was performed on the unilateral cleft lip nose deformity. At 9 years of age, bone grafting was performed for the alveolar cleft. At follow-up appointments up to 13 years of age, there were no major complications. Here, we present this patient, surgical procedures and timelines, and show our results demonstrating good postoperative outcomes.
Objective
To evaluate the long-term outcomes of linear commissuroplasty and linear skin closure with a focus on commissural migration.
Design
Retrospective study.
Patients
Individuals who underwent transverse facial cleft repair at a single institution between 2004 and 2021.
Interventions
The disrupted orbicularis oris muscle was reoriented and sutured. A simple linear commissuroplasty technique was used, and the cheek skin was closed linearly without Z-plasty.
Main outcome measures
The distances from Cupid's bow peak to the oral commissure were measured bilaterally, and the difference between the normal and cleft sides was obtained. Finally, its proportional value as a percentage of the total lip length was calculated from short- and long-term follow-up photographs. Cheek scarring and its effects on melolabial fold breakage were evaluated.
Results
Of the 18 patients who underwent transverse facial cleft repair, 12 were included in this study. The mean follow-up period based on medical photographs was 1773.5 days. The average proportional difference was 4.6%, demonstrating no observable commissural migration. There were no consistent trends in the direction of migration, either on the cleft or normal side. In patients with a transverse cleft crossing the melolabial fold, the folds appeared broken before and after the cleft repair surgery.
Conclusions
No significant long-term commissural migration was observed after transverse facial cleft repair with simple linear commissuroplasty and linear skin closure. Deliberate positioning of the new oral commissure, proper myoplasty, and meticulous skin closure with minimal scar burden can be considered key procedures for successful transverse cleft repair.
