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Refining macrostomia correction: Case series applying square flap technique and Z/W-plasty skin closure for enhanced aesthetic and functional outcome

INTRODUCTION AND IMPORTANCE: Macrostomia is a congenital deformity found in Tessier no. 7 facial clefts defined as an enlargement of the mouth at the oral commissure. Several techniques are described in literature to achieve optimal functional and aesthetic results, with varying results and surgeon...

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Autores principales: Sundoro, Ali, Hilmanto, Dany, Soedjana, Hardisiswo, Lesmana, Ronny, Septrina, Rani, Hasibuan, Lisa Y., Pramono, Graciella Novian Triana Wahjoe
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Elsevier 2023
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10661592/
https://www.ncbi.nlm.nih.gov/pubmed/37956496
http://dx.doi.org/10.1016/j.ijscr.2023.109023
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author Sundoro, Ali
Hilmanto, Dany
Soedjana, Hardisiswo
Lesmana, Ronny
Septrina, Rani
Hasibuan, Lisa Y.
Pramono, Graciella Novian Triana Wahjoe
author_facet Sundoro, Ali
Hilmanto, Dany
Soedjana, Hardisiswo
Lesmana, Ronny
Septrina, Rani
Hasibuan, Lisa Y.
Pramono, Graciella Novian Triana Wahjoe
author_sort Sundoro, Ali
collection PubMed
description INTRODUCTION AND IMPORTANCE: Macrostomia is a congenital deformity found in Tessier no. 7 facial clefts defined as an enlargement of the mouth at the oral commissure. Several techniques are described in literature to achieve optimal functional and aesthetic results, with varying results and surgeon preferences. In this case series we report surgical repair of macrostomia with a vermillion square flap method for the oral commissure combined with either Z-plasty or W-plasty closure for the skin. CASES PRESENTATION: A retrospective case analysis of 12 patients with macrostomia operated over the past 7 years at our plastic surgery division was performed (by two different operators; 11 cases by A.S. and 1 case by R.S.). Clinical features of the patients were analyzed through photography documentation, and patient description such as age of operation, operation technique, and complications were obtained through patient records. Macrostomia was corrected with a vermillion square flap method for commissure, overlapping muscle closure, along with either Z-plasty or W-plasty closure for the skin. Quality of lip commissure position, symmetry, thickness of vermillion, and scar result were recorded. CLINICAL DISCUSSION: In all twelve patients repaired with the overlapping muscle closure and square flap, the lip commissures were formed with satisfactory shape, position, and thickness with no commissure contracture during the follow up period. The Z-plasty was a simpler method compared to the W-plasty, and resulted in comparable scars. One patient (adult with hemifacial macrostomia and W-plasty skin closure) underwent revision surgery for more accurate symmetry and position of the oral commissure. CONCLUSION: There are many varieties of surgical repair for macrostomia, and each method should be adjusted and combined according to each patient. Overall, macrostomia repair with this technique combination produced satisfactory aesthetic and functional results in all twelve patients. Z-plasty for skin closure after muscle and vermillion closure was a simpler technique and resulted in comparable scars than W-pasty closure in this case series.
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spelling pubmed-106615922023-11-10 Refining macrostomia correction: Case series applying square flap technique and Z/W-plasty skin closure for enhanced aesthetic and functional outcome Sundoro, Ali Hilmanto, Dany Soedjana, Hardisiswo Lesmana, Ronny Septrina, Rani Hasibuan, Lisa Y. Pramono, Graciella Novian Triana Wahjoe Int J Surg Case Rep Case Series INTRODUCTION AND IMPORTANCE: Macrostomia is a congenital deformity found in Tessier no. 7 facial clefts defined as an enlargement of the mouth at the oral commissure. Several techniques are described in literature to achieve optimal functional and aesthetic results, with varying results and surgeon preferences. In this case series we report surgical repair of macrostomia with a vermillion square flap method for the oral commissure combined with either Z-plasty or W-plasty closure for the skin. CASES PRESENTATION: A retrospective case analysis of 12 patients with macrostomia operated over the past 7 years at our plastic surgery division was performed (by two different operators; 11 cases by A.S. and 1 case by R.S.). Clinical features of the patients were analyzed through photography documentation, and patient description such as age of operation, operation technique, and complications were obtained through patient records. Macrostomia was corrected with a vermillion square flap method for commissure, overlapping muscle closure, along with either Z-plasty or W-plasty closure for the skin. Quality of lip commissure position, symmetry, thickness of vermillion, and scar result were recorded. CLINICAL DISCUSSION: In all twelve patients repaired with the overlapping muscle closure and square flap, the lip commissures were formed with satisfactory shape, position, and thickness with no commissure contracture during the follow up period. The Z-plasty was a simpler method compared to the W-plasty, and resulted in comparable scars. One patient (adult with hemifacial macrostomia and W-plasty skin closure) underwent revision surgery for more accurate symmetry and position of the oral commissure. CONCLUSION: There are many varieties of surgical repair for macrostomia, and each method should be adjusted and combined according to each patient. Overall, macrostomia repair with this technique combination produced satisfactory aesthetic and functional results in all twelve patients. Z-plasty for skin closure after muscle and vermillion closure was a simpler technique and resulted in comparable scars than W-pasty closure in this case series. Elsevier 2023-11-10 /pmc/articles/PMC10661592/ /pubmed/37956496 http://dx.doi.org/10.1016/j.ijscr.2023.109023 Text en © 2023 The Author(s) https://creativecommons.org/licenses/by/4.0/This is an open access article under the CC BY license (http://creativecommons.org/licenses/by/4.0/).
spellingShingle Case Series
Sundoro, Ali
Hilmanto, Dany
Soedjana, Hardisiswo
Lesmana, Ronny
Septrina, Rani
Hasibuan, Lisa Y.
Pramono, Graciella Novian Triana Wahjoe
Refining macrostomia correction: Case series applying square flap technique and Z/W-plasty skin closure for enhanced aesthetic and functional outcome
title Refining macrostomia correction: Case series applying square flap technique and Z/W-plasty skin closure for enhanced aesthetic and functional outcome
title_full Refining macrostomia correction: Case series applying square flap technique and Z/W-plasty skin closure for enhanced aesthetic and functional outcome
title_fullStr Refining macrostomia correction: Case series applying square flap technique and Z/W-plasty skin closure for enhanced aesthetic and functional outcome
title_full_unstemmed Refining macrostomia correction: Case series applying square flap technique and Z/W-plasty skin closure for enhanced aesthetic and functional outcome
title_short Refining macrostomia correction: Case series applying square flap technique and Z/W-plasty skin closure for enhanced aesthetic and functional outcome
title_sort refining macrostomia correction: case series applying square flap technique and z/w-plasty skin closure for enhanced aesthetic and functional outcome
topic Case Series
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10661592/
https://www.ncbi.nlm.nih.gov/pubmed/37956496
http://dx.doi.org/10.1016/j.ijscr.2023.109023
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