Myoplasty for congenital macrostomia.
OBJECTIVE
To describe the different myoplasty techniques that could be used for limited commissural reconstruction.


METHODS
Twelve cases of congenital macrostomia are reported, with different cleft lengths and termination sites. For each case, an orbicular myoplasty was performed, and in the case of extension to the area of the tragus or tonsillar pillars, a masseteric myoplasty or pharyngoplasty was performed. Functional and aesthetic results were analyzed.


RESULTS
Functional results were excellent, with normal phonation, facial expression, and deglutition in the case of posterior extension. Aesthetic results were good, with only two cases of skin fasciculation during facial movement.


CONCLUSIONS
Myoplasty in macrostomia could be limited to an orbicular reorientation in the case of a short cleft or can include a masseteric myoplasty or pharnygoplasty should the cleft extend further. Analyzing 90 reported cases of congenital macrostomia in the world literature, an important point has emerged. In some cases, the cleft could continue sagittally to the tonsillar pillars or laterally, distal to the anterior border of the masseter, to the region of the tragus. Repair in these cases requires reconstruction of the tonsillar pillars and masseteric repair in addition to orbicular removal. No reports in the world literature have referred to these other myoplasties that could be necessary, even if such pathology is very rare. In addition, no classification of congenital macrostomia was found in the world literature. We therefore propose a surgical classification of macrostomia relative to the nature of myoplasty required.
Gleizal
Arnaud
A
Department of Oral and Maxillofacial Surgery, Universite Claude Bernard Lyon 1, Lyon, France. arnaud.gleizal@chu-lyon.fr
Wan
Derrick C
DC
Kwan
Matthew D
MD
Beziat
Jean-Luc
JL
D002921:Cicatrix / Q000145:classification / Q000209:etiology; D003679:Deglutition / Q000502:physiology; D004954:Esthetics; D005149:Facial Expression; D005152:Facial Muscles / Q000601:surgery*; D005207:Fasciculation / Q000209:etiology; D005260:Female; D006801:Humans; D007223:Infant; D008265:Macrostomia / Q000145:classification / Q000601:surgery*; D008297:Male; D008406:Masseter Muscle / Q000601:surgery; D009055:Mouth / Q000601:surgery; D018485:Muscle Fibers, Skeletal; D010609:Pharyngeal Muscles / Q000601:surgery; D010699:Phonation / Q000502:physiology; D011183:Postoperative Complications; D019651:Plastic Surgery Procedures / Q000379:methods*