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.