Tessier No. 7 cleft is the most common atypical craniofacial cleft with an incidence of 1:3000-5642 births. This clinical report describes the successful management of a delayed, unusually hypopigmented postoperative facial scar following the surgical closure of a Tessier 7 cleft using the Pfeiffer wave line incision. In the absence of any other associated systemic lesions, the scar was treated as a localized leucoderma. The scar coloration improved dramatically with the chosen line of conservative medical treatment, and a surgical revision was not required. This report highlights the need for continuous follow up despite seemingly good short-term results. The medical management of the hypopigmented scar will aid fellow practitioners who may face similar dilemmas.

The authors present findings and techniques to address hemipalatal discrepancy in patients with Tessier 7 cleft and associated cleft palate during cleft palatoplasty.
The authors report 2 cases of pediatric patients with Tessier 7 facial clefts and associated cleft palate. One patient presents on the broader oculo-auriculo-vertebral spectrum and the other is has isolated Tessier cleft 7. Additionally, a PubMed search was performed using the MeSH terms \"tessier 7,\" \"cleft palate\", \"macrostomia,\" \"tessier 7 AND cleft palate,\" \"macrostomia AND cleft palate,\" AND \"hemipalatal discrepancy.\" All relevant literature was identified and underwent full review for qualitative analysis.
Two patients met criteria for inclusion in this article. The surgical techniques utilized to mitigate the hemipalatal length discrepancy are detailed, and intraoperative photographs are provided. The results of the literature review are also presented. Tessier 7 craniofacial cleft and palatal clefts, when occurring in combination, is noted to result in discrepant hemipalatal length with short maxillary palate length on the affected side as well hypoplasia of the associated speech musculature. The postoperative palatal length after palatoplasty in both patients was longer than the preoperative hypoplastic palatal length.
When occurring in combination, Tessier 7 craniofacial cleft and concomitant palatal cleft results in discrepant hemipalatal length, and deficiency of the bony maxillary palatal shelves, and associated speech musculature and soft tissues. The techniques described in this article may assist in maximizing postoperative palatal length.

BACKGROUND: Bilateral transverse facial cleft is the most common of the rare facial clefts and early presentation is a key element for successful management and prevention of possible complications like poor esthetics, speech and eating difficulties. Though several studies have documented reasons for late presentation, none has highlighted non-referral due to missed diagnosis by healthcare workers as a reason.
METHODS: A nine-year-old girl was brought by her parents to the Primary Oral Health Clinic on account of \"very wide mouth\" noticed at birth. The mother noticed the anomaly few hours after she gave birth to her and immediately pointed the attention of the nurses and birth attendants to it but they dismissed her concern. Subsequently, the mother took the girl to the maternity centre for routine immunization appointments, but none of the healthcare workers she encountered recognized the birth defect. The parents further reported that the girl received jests and abuses from her peers. A diagnosis of Isolated Bilateral Tessier number 7 cleft was made based on clinical examination findings. She was referred to a cleft centre where the repair was successfully carried out at no cost to the patient through the Smile-Train® sponsorship program. Subsequent follow-up visits to the primary healthcare clinic in the sixth and ninth month post-surgery revealed remarkable improvement in both patient\'s and parents\'self-reported psycho-social wellbeing.
CONCLUSIONS: This case report presents a rare presentation of delayed isolated congenital bilateral macrostomia because of healthcare workers failure to diagnose.

BACKGROUND: Several variations on the surgical technique for macrostomia repair have been described in the literature. There has been controversy regarding the preferred method for commissuroplasty and skin closure for optimal functional and aesthetic results. The aim of this study is to present these techniques and the most described methods up to date.Further, five patients operated with a combination of techniques are presented.
METHODS: PRISMA guidelines were followed for literature review.Five consecutive patients with unilateral macrostomia operated during a period of one and a half years at our craniofacial department were included in this study.
RESULTS: 31 studies on macrostomia repair were obtained. The layered closure technique is widely described with several variations on closure of the inner mucosa, orbicularis muscle, commissure and skin. The inner mucosal layer is in most cases sutured with a straight line closure technique. The muscle is most often duplicated and sutured with upper branches overlapping lower branches. The skin is in most cases sutured with either a z- or a w-plasty with variations.The five presented patients all had satisfactory functional and aesthetic results at follow-up.
CONCLUSIONS: Many variations of surgical techniques for macrostomia repair have been presented in the past. We believe that each case of macrostomia needs to be assessed with a tailored surgical plan in order to create the best results. A combination of different techniques with Bütow and Botha\'s and Kaplan\'s technique as a starting point, is believed to give satisfactory functional and aesthetic results.