Congenital macrostomia management in children in a country with limited resources: A case series

The macrostomia is a rare facial deformity characterized by excessively enlarged mouth at the labial commissures. It results from a failure of fusion of the maxillary and mandibular buds of the first branchial arch during the seventh week of embryonic development. Also called lateral or transverse facial cleft, it corresponds to type 7 of the classification of cranio-facial clefts according to Tessier. It can be either unilateral or bilateral, or isolated or syndromic requiring a complete malformative assessment. We report three cases of congenital macrostomia in female infants. Two unilateral cases involving the left side and one bilateral case have been described. The surgical procedure included a commissuroplasty with a suture of the orbicularis muscle to a Z-shaped plasty. The post-operative period was uneventfull. At twelve months of follow up, there was no lateral migration and the aesthetic appearance was acceptable with good oral competence. Several commissuroplasty techniques have been developed with various advantages and disadvantages. Z-commissuroplasty is our preferred technique and seems to offer satisfactory aesthetic and functional results. Macrostomia is an uncommon birth defect. Various surgical procedures have been proposed for its repair. However, the type of the surgical procedure should be based on functional, aesthetic results and the surgeon’s experience. Even in underdeveloped countries, Z-commissuroplasty could be performed with good results. Further research should focus on long-term follow-up, regardless of the type of surgical procedure, with long series. •Congenital macrostomia is an uncommon facial malformation in children.•The choice of the surgical procedure should be based on functional, aesthetic results and the surgeon's experience.•Even in underdeveloped countries, Z-commissuroplasty could be performed with good results.•Further research should focus on long-term follow-up of large series, regardless of the type of surgical procedure.