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. 2025 Jun 30.
doi: 10.1097/SCS.0000000000011572. Online ahead of print.

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

Kristaninta Bangun  1   2 , Reinhart Jonathan  1   2 , Vika Tania  1   2 , Jessica Halim  1   2 , Clara Menna  1
Affiliations

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

Kristaninta Bangun et al. J Craniofac Surg. .

Abstract

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.

Keywords: Commisuroplasty; Tessier 7; facial cleft; macrostomia.

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Conflict of interest statement

The authors report no conflicts of interest.

References

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    1. Franco D, Franco T, Freitas RdS, et al. Commissuroplasty for macrostomia. J Craniofac Surg 2007;18:691–694
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