To evaluate the long-term outcomes of linear commissuroplasty and linear skin closure with a focus on commissural migration.
Retrospective study.
Individuals who underwent transverse facial cleft repair at a single institution between 2004 and 2021.
The disrupted orbicularis oris muscle was reoriented and sutured. A simple linear commissuroplasty technique was used, and the cheek skin was closed linearly without Z-plasty.
The distances from Cupid\'s bow peak to the oral commissure were measured bilaterally, and the difference between the normal and cleft sides was obtained. Finally, its proportional value as a percentage of the total lip length was calculated from short- and long-term follow-up photographs. Cheek scarring and its effects on melolabial fold breakage were evaluated.
Of the 18 patients who underwent transverse facial cleft repair, 12 were included in this study. The mean follow-up period based on medical photographs was 1773.5 days. The average proportional difference was 4.6%, demonstrating no observable commissural migration. There were no consistent trends in the direction of migration, either on the cleft or normal side. In patients with a transverse cleft crossing the melolabial fold, the folds appeared broken before and after the cleft repair surgery.
No significant long-term commissural migration was observed after transverse facial cleft repair with simple linear commissuroplasty and linear skin closure. Deliberate positioning of the new oral commissure, proper myoplasty, and meticulous skin closure with minimal scar burden can be considered key procedures for successful transverse cleft repair.

Tessier cleft 7 are rare craniofacial clefts. Live-birth incidence varies from 1/80,000 to 1/300,000, with the incidence of 1 in 120 craniofacial clefts among Asians. Its clinical presentation varies widely in severity, thus, complicating diagnosis and contributing to the lack of consensus regarding its surgical management. The aim of this study is to describe clinical findings, types of Tessier cleft 7 soft tissue repair, and its outcomes in Kuala Lumpur Hospital.
This retrospective study reviewed records of children operated from January 2001 to July 2019. Data regarding concurrent congenital anomalies, complications, type of surgery, etc., were collected from outpatient records, operative notes, and clinical photographs.
Twenty-eight children were treated, and 33 clefts (5 bilateral) were repaired. The male-to-female ratio was 1.3:1 (16 males and 12 females). Twenty-three patients had unilateral clefts (82.14%), with 14 right (60.86%) and 8 left (34.78%). Bilateral clefts were less common (17.86%). Twenty-three patients (82.14%) were Malay, 3 (10.71%) Chinese, 1 (3.57%) Indian, and 1 (3.57%) Cambodian. Eleven medical records were untraceable (discontinued due to duration of inactivity). There were 10 straight-line repairs, 5 Z-plasties, and 1 W-plasty performed; 3 cases did not detail the type of repair. One child required scar revision, and 1 had hypertrophic scarring requiring corticosteroid injection-no disturbances in speech or oral incompetency while eating were reported. Duration of follow-up ranged from 3 to 14 years.
Our center has a higher rate of Tessier cleft 7 attendance. Straight-line cutaneous repairs combined with inferior vermilion mucosal flap can be used with low rates of complication and revision surgery.

Extensive resections of advanced stage oral cavity cancers can sometimes lead to significant through and through buccal defects with compromise of the oral commissure/lips. Post free flap reconstruction, such patients often require a secondary delayed commissuroplasty to assist with improved oral function and quality of life. In current literature, limited methods exist for free flap commissuroplasty with some key limitations, particularly their negative impact on buccal sulcus or oral vestibule. Our technique of the triangular cheek flap commissuroplasty allows the surgeon to reconstruct a neo-commissure without compromising the oral vestibular depth or decreasing mouth opening. Through this pictorial essay we describe a detailed surgical technique for secondary reconstruction of the oral commissure.

Congenital macrostomia is a rare congenital deformity that consists of an enlargement of the commissure of the mouth. The malformation may be unilateral or bilateral and has a polymorphic presentation. Various surgical techniques have been described to correct macrostomia, with only a few cases illustrating the expected results. The surgical repair must consider both esthetic as well as functional impacts for the patient. We here propose a technical note to refine and provide additional information for good achievement of \"Double Reversing Z-Plasty\" for correction of macrostomia. Our case series also reports good long-term functional and esthetic results obtained with this technique, especially in case of a minor cleft.

暂无摘要。

BACKGROUND: Macrostomia or lateral cleft lip is a rare congenital deformity. In this article we describe a surgical technique of macrostomia repair developed. The objective of this article is to assess the results of our surgical technique and to validate a method for macrostomia surgical result evaluation.
METHODS: We included retrospectively patients with unilateral and bilateral macrostomia, operated from 1995 to 2014 in our department. First part of the study was a satisfaction questionnaire completed by patients. The second part was subjective evaluation of frontal photography (closed mouth, wide open and smiling) by surgeons and lay people with a questionnaire. Both group completed a second questionnaire within one to six months.
RESULTS: Eighteen patients answered the questionnaire. The satisfaction for all patients were considered as very good for 38.9% (n = 7) of patients and good for 44.4% (n = 8). 21 patients were photographed, 5 isolated macrostomia, 13 macrostomia with minor facial asymmetry and 3 with a major asymmetry. Surgeons evaluated the result as very good for isolated macrostomia and good for syndromic macrostomia. Layperson evaluated the result as good in isolated macrostomia and macrostomia with minor facial asymmetry and average with major facial asymmetry. P < 0.0001. The evolution of the results between medical and non-medical assessors in our two questionnaires, were non-significant.
CONCLUSIONS: In this study, we propose a new methodology to assess commissuroplasty surgical results, with a 3 type of evaluator: patients, surgeons and laypeople. We present a simple surgical technique, that allows good results in syndromic and isolated macrostomia.

OBJECTIVE: We aimed to evaluate the therapeutic effectiveness of commissuroplasty in mitral valve repair for rheumatic mitral valve disease. For this purpose, we summarise our experience with this technique and analyse the mid-term postoperative outcomes.
METHODS: We retrospectively evaluated the records of patients with rheumatic valve disease who underwent mitral valve repair between January 2011 and January 2018 at our centre. Detailed follow-up data were collected. A Kaplan-Meier survival curve for survival free from reoperation and valve failure was constructed. Multivariate Cox regression analyses were performed to identify predictors of relevant end points (death, reoperation, and valve failure).
RESULTS: A total of 362 patients underwent rheumatic mitral valve repair during the study period. Mitral valve stenosis was the primary pathological feature. Almost all surgeries were accomplished via commissuroplasty. The mean duration of follow-up was 25.57 ± 19.91 months. Twenty-two (22) endpoint events were noted during follow-up. The 2- and 7-year rates of survival free from reoperation and valve failure were 93.9%±1.4% and 91.5%±2.0%, respectively. Multivariate Cox regression analysis revealed that left atrial anteroposterior diameter >60 mm (hazard ratio, 5.2; p < 0.001) was an independent predictor of all endpoints.
CONCLUSIONS: Most Chinese patients with rheumatic valve disease were treated effectively via commissuroplasty combined with other surgical procedures, and the mid-term postoperative outcomes were satisfactory.

Mitral valve (MV) repair is the procedure of choice to correct mitral regurgitation caused by degenerative MV disease, due to its well-documented superiority over MV replacement. Repair of the MV is feasible in more than 95% of such patients and restores valve function and preserve ventricular function. Surgeons choose from a wide variety of mitral repair techniques, with the ultimate procedure based upon the pathology and the particular surgeon\'s personal preference. As a result, there is considerable controversy concerning choice of repair techniques and prostheses (ie, annuloplasty device). This targeted review of available data concerning repair of the degenerative valve will inform surgeon decision-making in MV repair.

The normal commissure is not a simple joint of the upper and lower lip, but a triangular mucosal area. To reconstruct a symmetrical oral commissure in patients with a unilateral transverse facial cleft, we designed composite vermilion flaps, including triangular flaps. We retrospectively studied 17 patients with unilateral transverse facial clefts from 2013-2016. Three-dimensional images were obtained with a 3-dimensional photogrammetry system at the 1-year follow-up, and we used an anthropometric method to evaluate the postoperative symmetry of the commissure. No obvious deformity was found during the follow-up examination, and comparison of the cleft and non-cleft sides by the paired samples t test showed that in all cases both horizontally and vertically symmetrical commissures had been achieved.

Commissurorraphy is a surgical procedure designed to move the lip commissure rostrally. This procedure may be helpful as a unilateral procedure in cases of unilateral mandibulectomy to support tongue function and improve esthetics. Bilateral commissurorraphy is utilized in cases of radical bilateral mandibulectomy and as a salvage procedure for support of bilateral mandibular fractures in cases where rigid surgical fixation is not feasible. Dehiscence is the most likely complication of commissurorraphy. Tension can be reduced at the rostral extent of the incision by utilizing mattress sutures, intravenous fluid tubing, and/or buttons to prevent tearing through sutures.