Lower labial vermilion myomucosal flap for commissuroplasty of Tessier 7 transverse facial cleft.

BACKGROUND: Repairing a transverse facial cleft (TFC) while achieving complete closure of the orbicularis oris muscular ring presents a significant surgical challenge. AIMS: This study evaluated the outcomes of commissuroplasty using a lower labial vermilion myomucosal flap (LVMF) for TFC repair. MATERIALS AND METHODS: Twelve patients with TFC were enrolled, including five boys and seven girls (median age: 8.5 months; range: 3-18 months). Among them, four had left-sided TFC, seven had right-sided TFC, and one had bilateral TFC. Eight patients presented with associated developmental anomalies, including accessory auricular appendages, pedunculated masses on the cheek, buccal fistulas, preauricular fistulas, and one case of Goldenhar syndrome. All patients underwent commissuroplasty using a rotating LVMF along with straight-line buccal cutaneous closure. A panel of three surgeons assessed commissural symmetry, scar appearance, and orbicularis oris muscle function. RESULTS: All patients successfully underwent commissuroplasty with LVMF for TFC repair. Thirteen abnormal developmental appendages in eight patients were completely excised. No complications were observed, including hematoma, infection, or wound dehiscence. Commissural symmetry was rated as good in nine cases and satisfactory in three. Scar appearance was evaluated as good in five cases and satisfactory in seven. Orbicularis oris muscle function was good in 11 cases and satisfactory in one. No lateral displacement of the commissure was noted in any patient. CONCLUSION: The use of a LVMF for commissuroplasty, combined with straight-line buccal cutaneous closure, effectively restores the orbicularis oris muscular ring in TFC repair. This technique yields optimal commissural symmetry, aesthetically favorable scars, and satisfactory orbicularis oris muscle function.