Surgical management of the Tessier 7 cleft: A review and presentation of 5 cases

INTRODUCTION: Several variations on the surgical technique for macrostomia repair have been described in the literature. There has been controversy regarding the preferred method for commissuroplasty and skin closure for optimal functional and aesthetic results. The aim of this study is to present these techniques and the most described methods up to date. Further, five patients operated with a combination of techniques are presented. MATERIAL AND METHODS: PRISMA guidelines were followed for literature review. Five consecutive patients with unilateral macrostomia operated during a period of one and a half years at our craniofacial department were included in this study. RESULTS: 31 studies on macrostomia repair were obtained. The layered closure technique is widely described with several variations on closure of the inner mucosa, orbicularis muscle, commissure and skin. The inner mucosal layer is in most cases sutured with a straight line closure technique. The muscle is most often duplicated and sutured with upper branches overlapping lower branches. The skin is in most cases sutured with either a z- or a w-plasty with variations. The five presented patients all had satisfactory functional and aesthetic results at follow-up. CONCLUSION: Many variations of surgical techniques for macrostomia repair have been presented in the past. We believe that each case of macrostomia needs to be assessed with a tailored surgical plan in order to create the best results. A combination of different techniques with Bütow and Botha's and Kaplan's technique as a starting point, is believed to give satisfactory functional and aesthetic results.