Our Surgical Repair for Macrostomia with Two Novel Small Triangular Flaps Long-term Follow-up and Results

Background: The surgical methods for repairing congenital macrostomia should be carefully selected from both functional and aesthetic points of view. The surgical correction of macrostomia results in normal orbicularis oris function and symmetry of the repaired lip. Herein, we report our novel technique and the results obtained, assessed retrospectively. Methods: Twelve primary cases of macrostomia underwent surgical repair between 1996 and 2013. The age at operation ranged from 3 to 78 months. Our operative procedure uses two small triangular flaps with a superficial layer of orbicularis muscle to preserve the dynamic action of muscle fibers attached to the skin of the triangular flaps, with suturing across the orbicularis muscle bundles. The optimal length of a medial small triangular flap is 1.5-2.0 mm, and the length of a lateral flap is 5-8 mm. Evaluation was based on the degree of symmetry of the lips as a ratio of the affected side to the non-affected side, as well as the scar characteristics. Results: The follow-up period in this retrospective study ranged from 3 to 21 years. The same method was applied to all 12 cases, and the results over several years showed satisfactory outcomes, in the reconstruction of a natural appearance and dynamic function of the oral commissure. Conclusions: Our technique is very useful in the primary operation for macrostomia as the dynamic action of muscle fibers is preserved, if the muscle is not dissected from the skin in the cleft margin that includes the two medial small triangular flaps. The authors have no financial Interest to declare in relation to the content of this article. Presented at The 13th International Congress on Cleft Palate and Related Craniofacial Anomalies in Mahabalipuram, India on February 8-11, 2017. Corresponding author: Keisuke Imai, MD, Department of Plastic & Reconstructive Surgery, Osaka City General Hospital, 2-13-22, Miyakojimahondori, Miyakojima-ku, Osaka, Osaka, Japan. Imai-k@abox3.so-net.ne.jp ©2018American Society of Plastic Surgeons