D58. Mastering the Art of Symmetry: Myomucosal Advancement Flap Commissuroplasty Outcomes in Patients With Tessier 7 Cleft

PURPOSE: Achieving facial symmetry in Tessier 7 cleft patients, particularly in oral commissure reconstruction, presents significant challenges with variable aesthetic and functional outcomes. Given the rarity of Tessier 7 cleft, data on treatment effectiveness are limited. This study uses facial anthropometrics to evaluate postsurgical symmetry after commissuroplasty over an 18-year period. METHODS: A retrospective review was conducted of patients who underwent commissuroplasty for Tessier 7 cleft from 2005 to 2023. Preoperative and postoperative measurements within six months focused on five areas: Sto-Ch, Ch-Ala, Ch-LC, Ch-Men, and chelion angle deviation (Ang-Dev). Symmetry ratios were calculated, with 1.0 indicating ideal symmetry. Major revisions were defined as repeat surgeries addressing asymmetry or scar issues. RESULTS: Of 25 patients, 6 had bilateral and 19 had unilateral clefts (76% right-sided, 24% left-sided). Mean age at surgery was 13.3 months. Among these, 48% were female, 32% had additional Tessier clefts, and 20% were syndromic. Major revisions were required in 25% of cases. Postoperative measurements showed improved symmetry in four areas, though chelion angulation symmetry did not significantly improve. Mean follow-up for 7 patients was 3.74 years, with stable symmetry ratios over time. CONCLUSION: Oral commissure reconstruction improved symmetry in Sto-Ch, Ch-Ala, Ch-LC, and Ch-Men, but showed limited improvement in chelion angulation. Postoperative symmetry remained stable, underscoring the need for further studies to refine long-term outcomes in Tessier 7 cleft repair.