Macrostomia, also called a transverse or lateral facial cleft, is a relatively rare malformation. Although many surgical procedures have been introduced, and no gold standard has yet been established. Moreover, most papers published in Korea were based on the results of the research conducted on the very limited number of patients, and for this reason its findings do not offer sufficient clinical reliability. We devised a modified commissuroplasty as follows: First, new commissure was placed 1 or 2mm inside when compared with the opposite side so that the commissure may not look longer than usual because of the scar on the side. Second, z-plasty of about 5mm was performed on the nasolabial fold to prevent the displacement of the new commissure on its lower part and avoid a continuation of a scar with the medial flap placed upward. We treated 32 cases of macrostomia from August 1, 1998 to July 1, 2002. We obtained relatively satisfactory clinical results by using this modified commissuroplasty. Based on our experience, we intend to present a clinical analysis and an operation technique of our own derived from the classic commissuroplasty, so that we may contribute to the diagnosis and treatment of the patients in the future.
Cicatrix ; Diagnosis ; Humans ; Korea ; Macrostomia* ; Nasolabial Fold

Congenital macrostomia is a result of defective union between the mandibular and maxillary processes and it is a rare deformity seen in every 100 to 300 facial clefts. Ohnizuka1`classified macrostomia into two groups as congenital and posttraumatic. We experienced two cases of acquired macrostomia due to NOMA sequelae(58/F:Lt & 51/F:Rt) and one case of congenital macrostomia (3 months/M:Rt). Many plastic surgeons have developed surgical procedures for repair of this congenital macrostomia. Among them, McCarthy6,11 described the classic commissuroplasty. We could repaired 1 case of congenital macrostomia and two cases of acquired macrostomia due to NOMA sequelae using modified technique of McCarthy,s classic commissuroplasty. McCarthy described new oral commissure 2-3mm laterally for prevention of postoperative contraction, orbicularis oris muscle transposition to restore labial function and a z- plasty cutaneous closure. But some author raise an objection to new oral commissure 2-3mm laterally, and they made new oral commissure at same distance of opposite side normal commissure. And so, we designed the new oral commissure moved 1mm laterally comparing to original commissuroplasty in a congenital case for the prevention of displacement. In cases of acquired macrostomia due to NOMA sequelae, we reconstructed new oral commissure like congenital case, moved 1mm laterally. Orbicularis oris muscle transposition could not be possible because of destruction of muscle, adhesion and atrophy. And so we dissected muscle and just sutured side by side. Acquired macrostomia following NOMA sequelae manifsted facial deformity variably, and reconstruction of the facial deformity is difficult by using simple approach. Other variable reconstructive procedures were needed with commissuroplasty as like Washio flap, rotation advancement flap, bone graft and free radial forarm flap, etc. Postoperative results were relatively good. We propose that macrostomia due to NOMA sequelae must add to Ohnizuka classification of acquired macrostomia.
Atrophy ; Classification ; Congenital Abnormalities ; Macrostomia* ; Noma ; Transplants

Craniofacial clefts are rare among facial anomalies with an incidence of 1.5 to 5 per 100,000 births, and 1 per 100 cases of cleft lip and palate. The Tessier No. 7 clefts are unusual lesions that result from failure of the embryonic mandibular and maxillary processes to properly fuse and form the corners of the mouth. We experienced a case of Tessier No. 7 craniofacial cleft in a 1 day-old female patient who presented with a macrostomia and auricular malformation. The diagnosis was established by clinical and radiographic findings. A brief review of literature was made.
Cleft Lip ; Diagnosis ; Female ; Humans ; Incidence ; Macrostomia ; Mouth ; Palate ; Parturition

Macrostomia, or lateral facial cleft, is a rare congenital deformity that occurs alone or in combination with other anomalies as a result of a failure of proper fusion of the maxillary and mandibular processes during the fourth week of embryonic life. Although many surgical techniques have been suggested to correct this deformity, the procedures are controversial and no gold standard has yet been established. The purpose of these procedures includes formation of symmetric commissure, restoration of the abnormally positioned orbicularis oris muscles, and an inconspicuous scar. A natural-looking oral commissure is not easily achieved because the commissure is not just a corner but a continuous vermilion web. The purpose of this study is to achieve a more natural-looking commissure using natural anatomical landmarks different from other studies and to divide three anatomical units of the commissure for the proportional surgical repair of congenital macrostomia. Surgical methods include commissuroplasty using mucosal triangular flap, myoplasty of the disarranged orbicularis oris muscle and closure of the cheek cleft with a small Z-plasty. From March, 1999 to Feb, 2003, a total of 12 patients(4 males, 8 females) with congenital macrostomia have been operated. We obtained satisfactory functional and esthetic outcomes in all patients by using these techniques after a long period follow-up. We think the most important aspect of macrostomia repair is a proportional anatomical repair using natural landmarks.
Cheek ; Cicatrix ; Congenital Abnormalities ; Follow-Up Studies ; Humans ; Macrostomia* ; Male ; Muscles

The goals of the reduction mammoplasty are to reduce the volume of the breast, to create aesthetic shape that is stable over time, to maintain blood supply and innervation to the nipple-areolar complex, and to make fine limited scars. There are 3 rationales in our reduction mammoplasty. To reduce the scar, we perform the periareolar incision. To make effective reduction of the breast volume, and to preserve blood supply and innervation to the nipple-areolar complex, we use a central or an inferior pedicle technique. To prevent areolar widening, we use a purse-string suture. We performed the periareolar reduction mammoplasty to 36 breasts in 18 patients from Jul. 1998 to Jun. 2000. The mean follow up period was 8 months. The mean age was 41 and mean resection amount was 420 gm per breast. Most patients satisfied with their fine periareolar scars, adequate size of breasts and the innervation of the nipple-areolar complex. We applied this procedure to all kinds of macrostomia. The greatest advantage of the periareolar reduction mammoplasty is the inconspicuous limited scar. Other advantages over conventional technique include preservation of sensitivity to the nipple-areolar complex and shorter operative time. As disadvantages, 10 breasts(28%) showed areolar widening. In 8 of 10 breasts with areolar widening, purse-string suture was not applied in the skin flap margin of the outer circle and reoperation was executed to reduce the areolar size by excision of the widened areola. The application of the purse-string suture was carried out in 6 breasts. Two breasts with purse-string suture showed areolar widening possibly due to loosening of the purse-string suture knot. There were persistent periareolar wrinkles in 4 breasts and poor sensitivity to the nipple-areolar complex in 6 breasts in which more than 500 gm of breast tissue per breast was resected. Periareolar reduction mammoplasty is optimal for patients who require reduction of lesser than 500 grams per breast. In the severe macromastia with or without ptosis, inverted T-incision is preferable to the periareolar incision, and periareolar incision can be modified by adding wedge resection of the outer excess skin flap inferiorly which results in a periareolar and vertical scar below the nipple-areolar complex.
Breast ; Cicatrix ; Female ; Follow-Up Studies ; Humans ; Macrostomia ; Mammaplasty* ; Operative Time ; Reoperation ; Skin ; Sutures

PURPOSE: A Tessier classification number 7 cleft is an uncommon malformation that results from a failure of mesenchymal fusion within the maxillary and mandibular prominences of the 1st pharyngeal arch. Many operative techniques of the number 7 cleft repair have been proposed to restore function and improve aesthetics. Fifteen patients underwent repair of a number 7 cleft over 13 years by a modification of the surgical Technique, and an appraisal of the operative outcome is reported herein. METHODS: A retrospective review was conducted involving 15 patients with number 7 clefts who underwent surgery from 1996 to 2009. The changes in surgical technique included skin closure, attachment of the orbicularis oris muscle, and position of the repaired commissure; the changes were analysed with a review of the medical records and the outcomes of surgery were analysed via photographs. Specifically, the technique of skin closure was changed from the a Z-plasty to a linear closure, the orbicularis oris muscle overlapped attachment was replaced by a side-to-side approximation with horizontal mattress sutures, and the position of the repaired commissure was changed from 1mm laterally to 1mm medially in reference to the non-cleft side. RESULTS: A Z-plasty caused additional cutaneous scarring, an overlapped attachment of the orbicularis oris muscle caused a thick oral commissure, and the repaired commissure migrated to the lateral side, so a 1mm, laterally-positioned commissure caused asymmetry. The altered procedure included a linear skin closure, a side-to-side orbicularis oris muscle approximation, and a 1mm, medially-positioned commissure, which together resulted in a good outcome. CONCLUSION: The altered procedure for repair of a number 7 cleft as described herein, yields a short scar, no functional problems with the orbicularis oris muscle, a thin oral commissure, and symmetry of the repaired commissure.
Branchial Region ; Cicatrix ; Esthetics ; Humans ; Macrostomia ; Medical Records ; Muscles ; Retrospective Studies ; Skin ; Sutures

Macrostomia is a relatively rare malformation. There have been many surgical methods for the correction of macrostomia. The old method, a simple straight line closure , did not include reconstruction of the orbicularis oris muscle. Postoperatively, a depressed scar and severe contraction on the cheek were found, especially with animation. As a result, many authors have known that reconstruction of the orbicularis oris muscle was very important to avoid a depressed scar for the correction of macrostomia. The tendency toward lateral displacement of the reconstructed commissure has been attributed to linear scar contraction, and Z-plasty is advocated to prevent this deformity. However, we found that the Z-plasty scar may be conspicuous when the patient smiles. So we performed reconstruction of the orbicularis oris muscle to avoid a depressed scar, and straight line closure to avoid a conspicuous scar. In order to prevent linear scar contracture due to straight line closure, we overcorrected the new commissure. We treated 6 cases of macrostomia form May 1, 1996 to April 30, 1999 using straight line closure and reconstruction of the orbicularis oris muscle. Periods of follow-up were from 12 months to 35 months, with an average of 20,2 months. Every patient was analyzed clinically by ordinary scale method and anthropometrically by the ratio of abnormal distances to normal distances between cheilion and crista philtri. In 3 clinical assessments : symmetry of the commissure was excellent: degree of the scar at rest was good: and degree of depression with animation was excellent. The anthropometrical ratio was 1:1.05. Despite the fact that the linear scars were perpendicular to the minimal skin tension lines, the scars were inconspicuous. The muscle repair provided reconstruction to the modiolus and gave a natural appearance to the commissure, however it did not seem to provide sufficient bulkiness around the commissure. The straight line skin closure and repair of the orbicularis oris muscle provide effective functional and aesthetic reconstruction.
Cheek ; Cicatrix ; Congenital Abnormalities ; Contracture ; Depression ; Follow-Up Studies ; Humans ; Macrostomia* ; Skin

Facial clefts are uncommon congenital deformities in comparison to the clefts of the lip and palate. the clinical expression of the craniofacial clefts is highly variable. the face can be marred by a faint expression of the cleft or be disfigured by a full representation of the defect. the extent of the soft tissue and skeletal components is also variable, and they are seldom affected to an equal degree. Generally, discription of the clefts are based on the bony malformation, since the skeletal landmarks tend to be more constant. I report six cases of rare craniofacial clefts that I recently experienced. the soft tissue repair was accomplished with local flaps from cheek, eyelid and nose. Additional vertical length was obtained from the lower Z-plasty flaps in the sutures. the coloboma was corrected with local flaps and a cartilage graft, the depression of cheek with a dermofat graft, and the macrostomia with the repositioning of orbicularls oris muscle and a Z-plasty. the results were cosmetically acceptable.
Cartilage ; Cheek ; Coloboma ; Congenital Abnormalities ; Depression ; Eyelids ; Lip ; Macrostomia ; Nose ; Palate ; Sutures ; Transplants

The squamous cell carcinoma is the most common cancer of lower lip. Although various treatment methods have been introduced, surgical resection and reconstruction is considered to be the most important medical remedy. We surveyed 11 patients who received the surgery for squamous cell carcinoma on lower lip from January 1992 to December 1997. The survey included the size and location of tumor mass, the presence of lymph node metastasis for a preoperative evaluation, the aesthetic and the performance of lower lip after the operation, the recurrence rate, the complication and the mortality rate. In resectioning tunmor mass, the surgery has to completely remove the mass and meanwhile has to minimize the loss of normal tissues. Also in reconstruction of lower lip, it has to resemble, aesthetically and functionally, the normal lower lip as well. To achieve such s, the pre-excisional frozen biopsy was performed to determine the surgical margins and various reconstructive methods were tried according to the location and size of the defect remained in the lower lip. In the most of clinical cases, appropriate vermillion and nasolabial sulcus were fashioned and they functioned normally in both speech and mastication. As for complications, each case of drooling and macrostomia were reported, There was no mortality from lower lip carcinoma and its recurrence. Due to determination of the safe surgical margin by pre-excisional frozen biopsy and reconstruction by appropriate procedure according to the location and the size of defect, the survey indicates minimized postoperative complications, no recurrence and no mortality as well as aesthetically and functionally adequate lower lip
Biopsy ; Carcinoma, Squamous Cell* ; Humans ; Lip* ; Lymph Nodes ; Macrostomia ; Mastication ; Mortality ; Neoplasm Metastasis ; Postoperative Complications ; Recurrence ; Sialorrhea

A female infant (4 months-old) with Goldenhar syndrome was scheduled for cheiloplasty to treat a transverse facial cleft and congenital macrostomia. There was no past history of difficulty during feeding or airway obstruction. Following induction of anesthesia using an inhalational anesthetic technique, conventional oro-tracheal intubation was possible. However, following extubation of the endotracheal tube she developed an upper airway obstruction. Her lungs could not be ventilated using a facial mask and oxygen saturation was decreased. A #1 laryngeal mask airway (LMA) was inserted immediately, which allowed us to ventilate her lungs and restore the oxygen saturation. Here we describe the use of a LMA for emergency airway management in an infant.
Airway Management ; Airway Obstruction ; Anesthesia ; Emergencies ; Female ; Goldenhar Syndrome ; Humans ; Infant ; Intubation ; Laryngeal Masks ; Lung ; Macrostomia ; Masks ; Oxygen