Commisuroplasty for Macrostomia in Tessier 7 Cleft Using Modified Vermillion Square Flap Technique.

Background: The transverse facial cleft, as described by Tessier, is a rare anomaly that affects both aesthetics and function. Various techniques for commissuroplasty have been discussed in the literature, often with inconsistent results. In this case series, the authors used a modified vermilion square flap technique to achieve satisfactory oral function and aesthetic outcomes.

Methods: Five Tessier 7 cleft patients underwent reconstruction using vermilion square flap technique with W-plasty for the skin closure to help create a less noticeable scar. Evaluation was conducted at least 1 year postoperatively using a patient satisfaction questionnaire and subjective assessment by surgeons and laypeople based on frontal photographs.

Results: Follow-up showed all patients had satisfactory aesthetic outcomes with no commissure contracture. The vermilion square flap produced a natural, rounded commissure, and the skin closure yielded cosmetically pleasing results.

Conclusions: The modified vermilion square flap technique offers excellent results, particularly when orbicularis oris muscle approximation and meticulous skin closure are prioritized.