Bilateral Macrostomia Correction Surgery
What is macrostomia? Macrostomia refers to an unusually wide mouth. Macrostomia is characterized as a physical abnormality that causes clefts to form on the face of affected individuals. These clefts can form on one or both sides of the face. They have an increased rate of occurrence in males. The incidence of macrostomia is about 1 in every 150,000-300,000 live births. Macrostomia usually occurs as one of the symptoms of a more complex disease process such as craniofacial microsomia. Effects of macrostomia in the life of an affected individual This is a condition that affects facial esthetics. It could affect the patient’s psychosocial development if left untreated. Surgical correction is the only solution available for correction of this condition. Selection of the correct surgeon should be done carefully by the patient’s parents. Establishment of facial symmetry should be of paramount importance in this surgery. A face that is asymmetric or with heavy scarring invariably leads to the patient isolating themselves from others. Clefts result from improper development and fusion of the mandibular and maxillary processes. Clefts cause problems with facial muscle development. This would result in impairment of speech function in the patients. Surgical correction of macrostomia deformity would not only result in a dramatic aesthetic improvement in the patient’s face, but would also ensure that the patient’s speech develops normally. Development of normal speech in a patient with macrostomia Although speech language pathology can be considered in certain cases, speech therapy intervention is rarely required as the surgery is performed and macrostomia corrected even before the infant begins to talk. The patient is referred to a speech language pathologist if required by the surgeon during the course of long term follow up of the patient’s condition. This surgery falls under the purview of oral and maxillofacial surgeons as well as board certified plastic surgeons in Western countries. This is a cosmetic procedure as well as a functional surgery. Both cosmetic and functional correction is important as each plays a significant part in the rehabilitation of the patient. Baby girl born with unusually wide mouth This is a 3-month-old baby girl from Jalandhar in Punjab, India. She was born with an unusually wide mouth. This was diagnosed with macrostomia at birth. Her parents were advised to take her to a plastic surgeon. A plastic surgeon who examined her at her hometown felt that surgical correction of her facial deformity would be best addressed by an oral and maxillofacial surgeon who was also a cosmetic surgeon. He therefore referred her to our hospital as our hospital is renowned for macrostomia surgery in India. Our hospital is also a premier center for facial cosmetic surgery in India. All varieties of facial cosmetic surgery procedures are performed routinely in our hospital. Macrostomia correction falls under the category of plastic and reconstructive surgery. Initial presentation at our hospital for consultation and treatment planning Dr SM Balaji, a premier facial cosmetic surgeon in India, examined the patient thoroughly and made the diagnosis of bilateral lateral facial clefts and macrostomia deformity. It was explained to the patient’s parents that surgical correction of macrostomia deformity is ideally performed at the age of 3 months. He decided to correct the patient’s bilateral macrostomia deformity through the vermillion return flap technique. Surgical correction of bilateral macrostomia in the infant Under satisfactory general anesthesia, both corners of the mouth were first marked to ensure that surgical correction of the macrostomia would result in symmetry of the mouth. Care was taken to maintain the integrity and continuity of the muscles of the mouth. The orbicularis oris was reconstructed along with ensuring the natural blending of the mucosa with the skin at the oral commissures. Closure was done in layers to ensure that there was establishment of overall balance between the mouth contour and cheek skin. This was achieved through suturing the tissues in three layers using the mucosa, muscles and finally the skin. Successful outcome of the macrostomia deformity correction surgery Her parents were extremely happy with the results of the surgery. Complete symmetry of the mouth had been achieved as a result of the surgery. Even the minimal scarring would slowly fade away as the baby grew. They expressed their total satisfaction at the results of the surgery before final discharge from the hospital. Surgery Video
Macrostomia, Tongue tie and Ear tags, extra Ear Lobule Correction Surgery
A long drawn search for the best facial cosmetic surgeon for this child This 5-year-old girl from Itarsi was born with a mouth that was very wide on the right side. The medical term for this condition is macrostomia. Her macrostomia and hemifacial microsomia resulted in underdevelopment of her right face. There may be absence of external ear in this condition. Ear tags may be present. The ear tags may contain cartilaginous tissue. If so, they need to be first dissected, repaired and sutured back. This child will need several surgeries later for reconstruction of the lower jaw. Macrostomia correction is first done and the ear tags removal is then done. She needs complete follow up of growth of mandible on the right side. She also had a tongue tie and ear tags with an extra lobe of the right ear. The tongue tie was causing abnormal speech patterns in the child. Her parents had searched far and wide for the best facial deformity surgeon to correct this. Their search had been futile for many years. It was only around six months ago that they met the parents of a similar child. Surgery performed for that child at our hospital had resulted in perfect correction. This led the parents of this little girl straight to our hospital. Treatment plan explained to the parents Dr SM Balaji examined this little girl and ordered diagnostic studies. He explained the proposed surgical plan to her parents. They were in complete agreement with his treatment plan. This was the first stage of surgical correction for this little girl. Tongue tie and macrostomia correction surgery Under general anesthesia, the tongue tie was first addressed. The lingual frenum was then dissected free to enable full extension of the tongue. This would enable normal speech for the child. Attention was next turned to the macrostomia correction. The vermillion border on the right side was first dissected. The excess tissue was then removed. The vermillion border was then sutured to ensure symmetry of the lips. Ear tag and extra ear lobe removal surgery Attention was then directed to the ear tags and extra ear lobe on the right. The ear tags were first dissected free and excised. The extra ear lobe was also addressed in similar fashion with good esthetic results. Suturing of all incisions completed the surgical procedure. The patient’s parents expressed their complete satisfaction with the results before discharge. Surgery Video