Mastering the Art of Symmetry: Long-Term Outcomes and Management in Patients with Tessier No. 7 Cleft

ObjectiveAchieving facial symmetry in patients with Tessier no. 7 cleft undergoing oral commissure reconstruction remains a challenge, with variable aesthetic and functional outcomes. Due to the rarity of this condition, data on long-term treatment effectiveness is limited. This study evaluates postoperative facial symmetry using facial anthropometric analysis in patients who underwent commissuroplasty over a 19 year period.DesignRetrospective cohort study.SettingSingle-institution craniofacial center.PatientsPatients who underwent commissuroplasty for Tessier no. 7 cleft between 2005 and 2024.InterventionMyomucosal advancement flap commissuroplasty technique.Main Outcome MeasuresFacial symmetry was assessed using 5 2-dimensional measurements: stomion-to-chelion (st_ch), chelion-to-ala (ch_al), chelion-to-exocanthion (ch_ex), chelion-to-pogonion (ch_pg), and commissure angle (co_ang). A symmetry ratio of 1.0 indicated ideal symmetry. Major revisions included secondary surgery for asymmetry or scar revision.ResultsThirty-two patients were included; 24 had unilateral (76% right-sided) and 8 had bilateral clefts. Median age at surgery was 8.1 months; 48% were female. Additional Tessier clefts were present in 25% of patients, and 25% had syndromic diagnoses. Major revisions were required in 28.6% of cases. Symmetry significantly improved in 4 of 5 facial regions, though commissure angle showed no significant change. Symmetry ratios remained stable over a median follow-up of 3.3 years.ConclusionCommissuroplasty improves facial symmetry across most parameters in patients with Tessier no. 7 cleft, with durable long-term outcomes. Limited improvement in commissure angulation highlights the need for continued refinement of surgical techniques.