ホームベース型赤唇弁と波線縫合を用いた巨口症手術の1例

Repair for Congenital Macrostomia: Home Plate-shaped Myomucosal Flap and Wavy Line Closure

はじめに

　巨口症は上顎突起と下顎突起の癒合障害により生じるとされ，発生率は2万～4万人に1人と比較的まれな疾患である 1）。巨口症では複数の術式が報告されているが，発症頻度が少ない疾患であり推奨されている単一の術式はない。一般的に，巨口症の治療目標は口輪筋の再建による機能回復と，整容的改善である。これまで著者らは，口角部の自然な筋の形態を再建できるという利点から口輪筋を含む矩形赤唇弁を用いた術式 2）を行っていた。しかしこの術式において，時に口角が正常より分厚い症例（図1）を経験した。今回これを修正する目的で，矩形赤唇弁に三角形粘膜を付加しホームベース型とする工夫を行い，良好な結果を得たため，皮膚縫合法の工夫とともに報告する。

　Macrostomia is a rare facial malformation with a reported incidence of approx. 1 in 20,000 births to 1 in 40,000 live births. Many techniques for macrostomia repair have been reported, and no single technique is clearly superior to the others. We report a new surgical technique for macrostomia repair that combines a myomucosal vermilion flap that is shaped like the home plate in baseball, together with a wavy line closure to ensure a natural commissure and cheek skin closure. A 2-year-old girl was referred to our department of plastic surgery for the treatment of her accessory auricle. At that time, she was diagnosed with left macrostomia. We designed a home plate-shaped myomucosal vermilion flap (the white skin roll and vermilion are square-shaped, and the mucosal lip is in the shape of a triangle) at the upper lip, and we reconstructed the smooth corner of the mouth. We avoided a corner scar. The top of the triangular mucosal flap was attracted internal to avoid a bulky appearance. The cheek cleft was closed with a wavy line. The patientʼs postoperative course was uneventful; the appearance of the angle of her mouth is natural, and there is no contracture at rest or during movement.