Lateral facial cleft

Lateral facial cleft, also known as transverse facial cleft or macrostomia, is a rare congenital craniofacial malformation resulting from failure of fusion of the maxillary and mandibular prominences (the first branchial arch derivatives) during embryonic development. This condition corresponds to Tessier cleft number 7 in the Tessier classification system of craniofacial clefts. It presents at birth as a widening of the oral commissure (corner of the mouth) extending laterally toward the ear, which may be unilateral or bilateral. The severity ranges from a minor widening of the mouth (incomplete form) to a cleft extending to the tragus of the ear (complete form). The condition primarily affects the facial soft tissues, including the skin, subcutaneous tissue, and orbicularis oris muscle, and in more severe cases may involve the underlying bony structures of the maxilla and mandible. Key clinical features include macrostomia (abnormally wide mouth), disruption of the oral commissure, and potential involvement of the parotid duct and facial nerve branches. Associated anomalies may include preauricular skin tags, accessory tragus, mandibular hypoplasia, and ear malformations. Lateral facial cleft can occur as an isolated anomaly or as part of broader syndromic conditions such as hemifacial microsomia (oculo-auriculo-vertebral spectrum) or Treacher Collins syndrome. Treatment is primarily surgical, with the goal of reconstructing the oral commissure to restore normal facial appearance and function, including proper oral competence for feeding and speech. Surgical repair typically involves commissuroplasty, which includes careful reconstruction of the orbicularis oris muscle to create a functional and aesthetically acceptable oral commissure. The timing of surgery is generally in infancy or early childhood. A multidisciplinary approach involving craniofacial surgeons, speech therapists, and orthodontists may be necessary, particularly when the cleft is part of a syndromic presentation.

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