Repair of Transverse Facial Cleft in Hemifacial Microsomia: Long-Term Anthropometric Evaluation of Commissural Symmetry

Abstract

The authors conclude that Z-plasty or W-plasty is unnecessary in repair of a transverse facial cleft. Closure of the orbicularis oris muscular ring is the critical step in the procedure to provide oral continence and a counterforce to the contraction of the cutaneous scar. There is no lateral creep of the commissure or hypertrophic scarring after straight-line cutaneous closure.

Commissural Symmetry in Unilateral Transverse Facial Cleft Patients: An Anthropometric Study

“…In their anthropometric study, 13 patients repaired with linear skin closure were followed up for an average of 10 years, and no significant commissural migration was observed. 24 In our study, neither the middle notch of the Cupid's bow-cheilion distances nor HCSR suggested significant lateral commissural displacement, regardless of how the skin was closed. Our results have further supported the opinion that competent muscle apposition could counteract skin scar contraction and prevent postoperative commissural lateral displacement.…”

“…Linear cutaneous closure results in a minimal scar; however, some investigators have been concerned that the contracture of the straight line scar might lead to lateral displacement of the commissure. [9][10][11][12]24,30 Various Z-plasty, W-plasty, and double Z-plasty techniques have been introduced to break the straight line scar; however, these techniques could generate an extra scar. 4,5,13,14,17,21,23 Some have suggested hiding the central limb of the Z-plasty in the melolabial groove.…”

“…9,14,[16][17][18][19][20][21][22] Although a few cases of lateral commissural migration have been reported, 10,23 objective analyses are limited in the published studies. 24 Using an anthropometric method, the commissural symmetry and commissural migration among patients with unilateral transverse facial cleft was objectively evaluated in both horizontal and vertical directions.…”

Bilateral macrostomia as a sole entity

“…On the other hand, the disadvantage of straight-line closure is scar contracture leading to migration of the commissure [15]. However, no lateral deviation of the commissure after straight-line cutaneous closure was noted by Rogers [16], and he concluded that Z-or W-plasty is unnecessary in the repair of macrostomia.…”

Lateral facial cleft associated with accessory mandible having teeth, absent parotid gland and peripheral facial weakness

“…It can be associated with the first and second branchial arches syndromes (Franco et al, 2007;Rogers and Mulliken, 2007). Transverse facial cleft is seen in every 100e300 facial clefts (Franco et al, 2007;Chen et al, 2009;Kajikawa et al, 2010;Bütow and Botha, 2010).…”