Surgical Management of Lateral Facial Clefts — a Modified W-plasty Technique

Objective: Lateral facial clefts are rare congenital anomalies of the head and neck and form a distinct anatomic entity as per the Tessier classification of soft- and hard-tissue clefts. This report discusses the pathogenesis and management of lateral facial clefts (macrostomia) and clarifies the use of a simple, modified W-plasty done with a fish-mouth modification near the commissure to ensure a natural closure of the commissure. It also includes an overview of the incidence, embryology, and clinical features of lateral facial clefts.Patients and Methods: Four patients who reported with lateral facial clefts to the hospital were enrolled in the study. The patients presented with unilateral lateral facial clefts (n = 2), bilateral facial clefts (n = 1), or a combination of unilateral lateral facial cleft and an underlying Tessier bony cleft (n = 1). A simple, modified W-plasty with a fish-mouth modification near the commissure was chosen for the correction of the clefts in these patients.Result: The 4 cases of lateral facial clefts were managed successfully. Long-term follow-up showed satisfactory healing response, minimally discernible scars, good aesthetics, and stable results in all 4 patients.Conclusion: The modified W-plasty technique eliminates the need for complex flaps for the reconstruction of the commissure and uses the incision line to form the natural commissural crease. This eliminates the force of scar contracture over linear scars and helps preserve the reconstructed symmetry of the oral commissure. All patients showed good competence of the oral aperture and acceptable scars with minimal scar contractures over long-term follow-up.