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Invited discussion of surgical repair for congenital macrostomia: vermilion square flap method.

Erratum: This Invited Discussion was originally intended to appear with Eguchi T, Asato H, Takushima A, Takato T, Harii K. Surgical repair for congenital macrostomia: vermilion square flap method. Ann Plast Surg 2001;47(6):629–635. However, it was omitted. We regret the error. Eguchi and colleagues presented their experience with a lower lip mucocutaneous vermilion flap combined with a W-plasty in a group of 8 patients with congenital macrostomia. A number of techniques have been described to correct this deformity, each one directed at establishing and maintaining symmetry at the commissure and minimizing cheek scarring. The key to the authors’ good results is their clear understanding of landmarks and abnormal anatomy. The principles of the surgical reconstruction (i.e., accurate positioning of the oral commissure, reconstruction of a functional oral musculature, skin closure with minimal visible scar, and prevention of migration of the commissure secondary to scar contraction) are incorporated into the presented technique. Although one can determine the position of the new commissure based on measurements of the normal half of the lip, the most accurate positioning in our opinion can be determined by careful inspection of the muscle and vermilion at the abnormal commissure. The site of the new commissure is marked at the junction of the normal and abnormal vermilion, where the muscle bundles end and the white line thins (Fig 1). Failure to identify clearly the border of the lower muscle defect may result in an overly lax and long lower lip (one of the more common detractors of many repairs). Fig 1. The site of the new commissure can be identified and marked at the junction of the normal and abnormal vermilion, where the muscle bundles end and the white line thins. The abnormal quality of the vermilion mucosa at the cleft site can be seen easily.