Advancement of oral commissure in correcting mild macrostomia.

A natural oral commissure is not easily achieved in cases of macrostomia associated with branchial arch syndrome. A technique designed to preserve the existing commissure using a composite flap advanced to the required position is presented. The flap consists of the vermilion at the angle of the mouth and a small amount of adjacent skin together with mucosa and submucous soft tissue. The flap is shifted after excision of medial sections of vermilion of the upper and lower lips. The donor site defect is closed using a Z-plasty or W-plasty. The technique was utilized in 8 patients with satisfactory results. It is especially suitable in patients with mild degrees of cleft and well-preserved contour of the corners.