Sundoro Ali, Hilmanto Dany, Soedjana Hardisiswo, Lesmana Ronny, Septrina Rani, Hasibuan Lisa Y, Pramono Graciella Novian Triana Wahjoe
Division of Plastic Reconstructive and Aesthetic Surgery, Department of Surgery, Faculty of Medicine Universitas Padjadjaran - Dr. Hasan Sadikin General Hospital, Bandung, Indonesia.
Department of Child Health, Faculty of Medicine, Universitas Padjadjaran - Dr. Hasan Sadikin Hospital, Bandung, Indonesia.
Int J Surg Case Rep. 2023 Dec;113:109023. doi: 10.1016/j.ijscr.2023.109023. Epub 2023 Nov 10.
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.
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.
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.
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.
大口畸形是一种在特谢（Tessier）7号面部裂隙中发现的先天性畸形，定义为口角处口腔开口扩大。文献中描述了多种技术以实现最佳的功能和美学效果，结果各异且因外科医生的偏好有所不同。在本病例系列中，我们报告了采用朱红色方形皮瓣法修复口角大口畸形，并结合Z成形术或W成形术关闭皮肤的手术方法。
对过去7年在我们整形外科接受手术的12例大口畸形患者进行了回顾性病例分析（由两位不同的手术医生进行；A.S.进行了11例，R.S.进行了1例）。通过摄影记录分析患者的临床特征，并通过患者记录获取患者描述，如手术年龄、手术技术和并发症等。采用朱红色方形皮瓣法修复口角，重叠肌肉缝合，同时采用Z成形术或W成形术关闭皮肤来矫正大口畸形。记录口角位置、对称性、朱红色厚度和瘢痕结果的质量。
在所有12例采用重叠肌肉缝合和方形皮瓣修复的患者中，口角在随访期间形成的形状、位置和厚度令人满意，无口角挛缩。与W成形术相比，Z成形术是一种更简单的方法，且瘢痕效果相当。1例患者（患有半侧面部大口畸形且采用W成形术关闭皮肤的成年人）接受了修复手术，以获得更精确的口角对称性和位置。
大口畸形有多种手术修复方法，每种方法应根据每个患者进行调整和组合。总体而言，采用这种技术组合修复大口畸形在所有12例患者中均产生了令人满意的美学和功能效果。在本病例系列中，肌肉和朱红色关闭后采用Z成形术关闭皮肤是一种更简单的技术，且瘢痕效果与W成形术相当。
