Surgical Repair For Transverse Facial Cleft:Two Flaps With A Superiorly Rotated Single Z-plasty Lateral To The Commissure

Objective:Various techniques have been performed for repairing transverse facial clefts.This study aimed to investigate an optimal method for repairing transverse facial clefts.Methods:Twenty-seven patients from 2014 to 2017 were evaluated.Their mean age at repair was 6.7 months with a follow-up period of 6 months to 3 years.A method using an inferior lip-based triangular mucosa flap and a superior lip-based rectangular vermilion-mucosa flap was designed for transposition.The orbicularis oris was reconstructed by using everting mattress suture.The skin was sutured using linear cutaneous closure with a single superiorly rotated Z-plasty lateral to the commissure.Results : A postoperative symmetrical commissure was obtained owing to complete contraction with the new commissure directed 2 or 3 mm medial to the symmetrical point on the lips individually for the 27 patients.Lateral displacement of the reconstructed commissure was not observed.The patients showed a plump and symmetrical cheek on the cleft side.Twenty-one patients with hemifacial microsomia achieved a prominent improvement compared with their preoperative appearance,although the postoperative cheeks still did not show fullness because of the lesser facial tissue on the cleft side.In the early follow-up period,most patients showed a minimal scar during movement.However,the scar became thinner and symmetrical oral movement was achieved over time.Conclusions:This method obtained a natural oral movement without a conspicuous scar and was reliable and remarkable for the postoperative appearance of commissural symmetry.We conclude that this is an optimal method to repair transverse facial clefts.