PMC9831653_01
Preoperative picture of the patient with bilateral commissural cleft.
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The left zygomatic region was more prominent than the right (Fig. 1).
Graphic design of the commissural mucocutaneous flaps.
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Surgery was started from the right site; various points for the design of the commissural mucocutaneous flaps were marked (Fig. 2).
Mucocutaneous flap raised keeping its base in the buccal mucosa.
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Mucocutaneous flap was raised, keeping its base in the buccal mucosa (Fig. 3).
Accessory maxilla removed from the left site with a presence of a distal lesion.
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The cleft on the right site was closed, after that we proceeded to the left, beginning with the removal of the bony lesion in the cheek where a linear incision was made and the bone was dissected and detached posteriorly to the maxilla (Fig. 4).
Z-plasty of both commissural cleft.
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The closure of the left commissural cleft was done following the same principles applied to the right site (Fig. 5).
Facial appearance of the patient's face 1 year after surgery.
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