OBJECTIVE: To evaluate the commissural symmetry and commissural migration among patients with unilateral transverse facial cleft.
METHODS: From 2006 to 2009, 31 patients with unilateral transverse facial cleft were repaired with superiorly based vermillion-mucosal flap and orbicularis oris reconstruction. Linear closure and superiorly rotated and inferiorly rotated Z-plasty were randomly chosen for skin closure. An anthropometric method was used immediately after the repair and at the follow-up examination to evaluate the commissural symmetry in both horizontal and vertical directions.
RESULTS: A total of 21 patients was followed-up for 19 months on average. Satisfactory horizontal symmetry was obtained right after surgery; however, the new commissure was generally lower than the unaffected commissure. At the follow-up examination, no significant lateral commissural displacement was observed; however, the commissural droop on the cleft side became more noticeable.
CONCLUSIONS: The anthropometric method used was convenient and reliable for facial symmetry analysis. Rectangular vermillion-mucosal flap and proper muscle reconstruction could prevent the lateral commissural migration caused by skin scar contracture. Both horizontal and vertical symmetry should be considered for macrostomia repair.

We made a descriptive epidemiological study of patients who presented with isolated macrostomia during a mass screening programme and repair of orofacial cleft deformities in Lagos, Nigeria. Detailed histories of environmental, gestational, and hereditary factors that may contribute to the malformation were taken, and physical examinations and specialist consultations to detect associated congenital malformations were made. Three patients had unilateral macrostomia and in 12 it was bilateral and symmetrical. The mean (SD) age was 8 (2) years, range 3 months to 32 years. There were 6 men and 9 women. Two women and one man had unilateral macrostomia; the two women presented with right sided involvement, while the man had left sided involvement. The commonest associated malformation was a low-set ear (n = 7). Other patients had combinations of congenital malformations. The mean (SD) age of the mothers at conception was 24 (1) years, range 18 to 32 years, while those of the fathers during the periods of conception were 35 (1) years, range 26 to 45. No gestational or environmental factors were detected in the history. One mother with unilateral presentation had a child with bilateral deformities.

BACKGROUND: Macrostomia or lateral cleft or commissural cleft or transverse cleft is a rare facial cleft in comparison with standard cleft lip and palate.
METHODS: A retrospective study of 10 cases of congenital macrostomia is realised. For each case a retrospective study with epidemiologic and clinic features was realised.
CONCLUSIONS: From these clinical considerations, a new classification with direct surgical consequences is proposed.

Hemifacial microsomia (HFM), a developmental abnormality involving the first and second branchial arches, is one of the most common craniofacial abnormalities. Although the general presentations of hemifacial microsomia--such as unilateral microtia, macrostomia, and hypoplasia of the mandibular ramus and condyle--are wellknown, the effects on the teeth are not well-documented. This study examined the primary and permanent tooth dimensions of dental casts of 50 hemifacial microsomia patients compared with those of 50 normal control patients matched for sex and dental status. The results showed that the mesiodistal dimensions of the mandibular second primary molar and the mandibular permanent first molar teeth on the affected side in hemifacial microsomia were significantly smaller compared with those of control teeth (p < 0.001). Furthermore, in the maxillary and mandibular first permanent molars and the maxillary and mandibular first and second primary molars, the teeth in the apparently \"normal\" side of hemifacial microsomia were also significantly reduced in the mesiodistal dimensions. Comparison of overall dimensions revealed that all primary and permanent molars in hemifacial microsomia were significantly smaller in the mesiodistal dimensions compared with control teeth. A general gradient effect was observed, with the most posterior tooth in each arch being the most severely affected and no effect being seen in the canines and the incisors. These findings suggest that the dental lamina in hemifacial microsomia is affected, and support the hypothesis that its pathogenesis involves an abnormality of the neural crest. Furthermore, these results also support the concept that hemifacial microsomia is a bilateral rather than a unilateral condition.