Surgical Management of a Tessier-7 Cleft: A Case Report

Abstract

When the embryonic mandibular and maxillary processes of the first branchial arch fail to fuse because of a failure of mesodermal migration and merging obliterate the embryonic grooves between the maxillary and mandibular processes to form the angle of the mouth at its normal anatomic position, transverse facial clefts (macrostomia), result. Macrostomia can appear on its own or in combination with other abnormalities, such as in this case, accessory pre auricular lobules. It might be bilateral or unilateral, running from the commissure to the tragus. It is frequently partially and only sometimes complete. Males are more likely to be affected. Having a functional, precise, symmetrical, and minimally scarred oral commissure is the aim of macrostomia reconstruction. In this report, the authors presented a case of a 7- months-old girl who had preauricular skin tags on the ipsilateral side along with unilateral macrostomia. The surgical procedure was carried out under general anaesthesia. The extraoral landmarks were marked and skin incisions were made near the mucocutaneous junction of the vermilion border accordingly. All the muscular bundles were re-sutured in their respective anatomic positions after dissection. Patient was extubated uneventfully. At the follow-up appointment, the oral commissures are balanced, the scars are barely noticeable, and the overall harmony of the lip and face shape is superb. For individuals with mild to severe macrostomia, authors advised to use this technique.