Introduction:

• The Tessier No. 7 cleft, or transverse facial cleft, is a rare congenital anomaly involving the oral commissure. 

• Restoring facial symmetry in these patients is particularly challenging. 

• Commissuroplasty outcomes vary significantly, and standardized data on optimal reconstructive techniques remain limited due to the rarity of the condition. 

• Facial anthropometric analysis may provide a reproducible way to assess symmetry after surgery.

Objective:

To evaluate postoperative facial symmetry following myomucosal advancement flap commissuroplasty in patients with Tessier 7 cleft, using standardized anthropometric measurements over an 19-year period.

Methods:

• Retrospective review at a tertiary children’s hospital in Design: Retrospective review (2005–2024)

• Population: patients <18 yo. undergoing commissuroplasty for Tessier 7 cleft

• Surgical procedure as in Figure 1.

• Anthropometric Measurements performed with ImageJ

• (Pre/Postoperative photographs in repose position

• Sto-Ch, -Ala, Ch-LC, Ch-Men, Chelion angle deviation (Ang-Dev) as seen in Figure 2.

Results:

• Median Age at Surgery:8.1 months (IQR: 4.5–12.7)

• Median Follow-up Duration:3.3 years (IQR: 0.2–8.6)

• Major Revisions:28% (n=9) of patients required repeat commissuroplasty for scar excision (n=5) or asymmetry (n=4).

Improved Postoperative Symmetry:

Significant improvement in 4 of 5 regions: Sto-Ch,Ch-Ala,

Ch-LC, Ch-Men (Table 1). No significant improvement in

chelion angle deviation

Symmetry Over Time:

In 7 patients with long-term follow-up (mean 3.74 ± 6.5

years), symmetry ratios remained stable postoperatively at

1-year and 5-year follow-up.

Conclusions:

• Myomucosal advancement flap commissuroplasty is a reliable technique for restoring oral commissure symmetry in Tessier No. 7 clefts.

• Patients maintained stable, improved symmetry over both short- and long-term follow-up.

• Revisions were infrequent, with no recurrence of deformity or major complications observed.