Macrostomia

What is Macrostomia?

Macrostomia, which literally means “abnormal largeness of the mouth”, occurs in one of every 80,000 births. It accounts for one of every 200 facial clefts and is typically most obvious when a child is laughing or crying, because the missing muscle and tissue become apparent as the face stretches. The most common treatment for this deformity is myoplasty, or plastic surgery of the muscles, and other corrective facial procedures that are most successful if they are performed shortly after birth. Other than aesthetic purposes, a reconstructive surgery for macrostomia is needed so the child can learn to speak correctly and, in more severe cases, be able to eat.

The most common form of this craniofacial cleft is lateral macrostomia, which is when only one side of the mouth and face is affected. Of lateral facial clefts, most occur on the left side of the face. An even more rare form of macrostomia is a bilateral facial cleft, which affects both sides of the mouth and face. This can often make a child appear to be wearing a mask or to have two faces. These cases require corrective surgery as quickly as possible, because children with bilateral macrostomia often have extreme difficulty eating or cannot eat at all.

What to expect during the Macrostomia procedure?

There are several surgical options for correction of macrostomia. Incisions are placed along the borders of the cleft, both inside and outside the mouth. The muscles are then brought into continuity, including the all-important oral sphincter (or, orbicularis oris). The wound is then closed from inside out. Sutures are absorbable and do not require removal. The surgery takes less than 2 hours and can be done on an outpatient basis.

While appearance is of concern for patients with macrostomia, the subsequent speech delays and learning disabilities associated with those delays are the greatest concern for both doctors and parents. Surgery is not guaranteed to correct the issue but, in most cases, it improves macrostomia dramatically. Therefore, corrective surgery conducted at the earliest possible time is the best treatment for these patients and provides their best chance of growing and developing normally.

What to expect during the recovery for the Macrostomia procedure?

Recovery from surgical correction of macrostomia is relatively simple. Patients must avoid contact sports or rough play for a period of at least 3 to 4 weeks. A soft diet is required for up to 6 weeks. Fortunately, complications from macrostomia repair are limited. Typical surgical risks include bleeding, infection, anesthesia complications, and bad scarring. Additionally, there is a anesthesia pre-evaluation may be required in syndromic patients with airway issues or other systemic problems such as cardiac, pulmonary, or endocrinologic defects.