What Is Macrostomia and How Is It Treated?

Written by Medicover Team and Medically Reviewed by Dr Ganisetty L V S Durga Parasuram , Pediatric Surgeon

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1. Causes 2. Find a Doctor 3. Diagnosis 4. Treatment 5. FAQs

Macrostomia is a congenital facial abnormality in which the corners of the mouth extend farther toward the cheeks than usual. It is also known as a transverse facial cleft and may occur alone or together with other craniofacial abnormalities or genetic syndromes.

It develops during fetal facial development.
The mouth opening is wider than usual because of incomplete fusion of facial tissues.
It may affect one or both sides of the mouth.
It can interfere with feeding, speech, lip closure, and oral hygiene.
The severity can range from a small widening of the mouth corner to a more extensive facial cleft.

What Are the Types of Macrostomia?

Macrostomia can vary in severity and may occur as an isolated facial abnormality or as part of a broader craniofacial condition.

Unilateral macrostomia: The abnormal widening affects one side of the mouth.
Bilateral macrostomia: Both corners of the mouth are affected.
Isolated macrostomia: The condition occurs without other major congenital abnormalities.
Syndromic macrostomia: Macrostomia occurs along with other congenital abnormalities as part of a genetic or craniofacial syndrome.

What Are the Symptoms of Macrostomia?

The main feature of macrostomia is an unusually wide mouth opening. Associated symptoms depend on the severity of the facial cleft and whether other structures are affected.

Widened mouth opening
Difficulty closing the mouth completely
Difficulty feeding or drinking
Drooling or saliva leakage from the mouth corner
Speech or articulation difficulties
Facial asymmetry
Difficulty maintaining oral hygiene
Dental or jaw abnormalities when associated facial structures are affected

What Causes Macrostomia?

Macrostomia develops because of abnormal fusion of the facial processes during early embryonic development. The exact reason why this developmental abnormality occurs is not always known.

Abnormal development or fusion of facial tissues during fetal development
Developmental abnormalities involving the first and second pharyngeal arches
Genetic or chromosomal abnormalities in some syndromic cases
Associated craniofacial developmental disorders
Rarely, macrostomia may occur as part of a broader congenital syndrome

Macrostomia is generally a congenital developmental condition and is not caused by fetal macrosomia, maternal obesity, prolonged labor, or the use of forceps or vacuum delivery.

When Should You See a Doctor for Macrostomia?

A newborn or child with an unusually wide mouth opening, feeding difficulty, or facial asymmetry should be evaluated by a healthcare professional. A pediatric surgeon, plastic surgeon, craniofacial specialist, or pediatrician can assess the condition and determine whether additional specialists are needed.

Noticeable widening of one or both corners of the mouth
Difficulty feeding or drinking
Persistent drooling or poor lip closure
Speech or articulation difficulties as the child develops
Facial asymmetry or other facial abnormalities
Associated ear, jaw, dental, or facial abnormalities

Seek prompt medical attention if:

Feeding difficulties are causing inadequate nutrition or dehydration
There are significant swallowing or breathing difficulties
Other major congenital abnormalities are present

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How Is Macrostomia Diagnosed?

Macrostomia is usually diagnosed through a physical examination of the face and mouth. The healthcare professional evaluates the size and location of the mouth opening and checks for associated abnormalities.

Clinical examination: Assessment of the mouth, lips, facial symmetry, jaw, and surrounding structures.
Medical and family history: Evaluation for congenital abnormalities or genetic conditions in the child or family.
Imaging studies: Ultrasound, CT, or MRI may be recommended when deeper facial, jaw, or soft-tissue abnormalities need to be assessed.
Genetic testing: May be considered when macrostomia occurs with other features suggestive of a genetic syndrome.
Multidisciplinary evaluation: Pediatric, craniofacial, plastic surgery, dental, and speech specialists may participate when necessary.

What Are the Treatment Options for Macrostomia?

Treatment depends on the size of the facial cleft, whether one or both sides are affected, associated abnormalities, and the child's functional needs. The primary treatment for significant congenital macrostomia is surgical repair.

Commissuroplasty: Surgical reconstruction of the corner of the mouth to reduce the abnormal opening and restore lip continuity.
Reconstructive surgery: May be required to improve facial symmetry and restore the function of the lips and surrounding muscles.
Speech therapy: May help children with persistent speech or articulation difficulties.
Feeding support: Specialized feeding techniques or nutritional support may be needed when feeding is difficult.
Dental and orthodontic care: Regular dental evaluation can help identify and manage associated dental or jaw abnormalities.
Management of associated conditions: Other congenital or genetic abnormalities are treated according to the child's individual needs.

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What Are the Risk Factors for Macrostomia?

Because macrostomia is a rare developmental abnormality, specific risk factors are not well established. Some cases occur as part of genetic or craniofacial syndromes, while others occur without an identifiable cause.

Presence of a craniofacial developmental disorder
Certain genetic or chromosomal abnormalities
Family history of specific congenital or genetic syndromes
Other congenital facial abnormalities

What Is the Recovery and Long-Term Management for Macrostomia?

Recovery after surgical repair generally focuses on proper wound healing, restoration of lip function, facial symmetry, and normal oral function. Long-term care depends on the severity of the condition and the presence of associated abnormalities.

Follow postoperative instructions to support proper healing.
Attend follow-up appointments with the treating surgical team.
Monitor facial symmetry and lip movement as the child grows.
Use speech or feeding therapy when recommended.
Maintain regular dental and orthodontic evaluations.
Monitor for associated craniofacial or developmental problems.

Frequently Asked Questions

1. What are the common signs of macrostomia?

Common signs include a widened mouth opening, extended corners of the mouth, facial asymmetry, and difficulty closing the lips. It is usually present from birth.

2. What are the recommended do's and don'ts for managing macrostomia?

Do: Follow a specialist's advice and maintain proper oral and facial care. Don't: Attempt to correct the condition without medical guidance or delay evaluation if feeding or speech problems occur.

3. What complications can macrostomia cause?

Macrostomia may cause difficulty with feeding, swallowing, speech, lip closure, drooling, dental problems, and facial asymmetry. Psychological or social concerns may also occur because of facial appearance.

4. How is macrostomia treated?

Treatment usually involves surgical repair to reconstruct the corner of the mouth and improve facial symmetry. Speech or feeding therapy may be recommended when needed.

5. Can macrostomia return after treatment?

Macrostomia usually does not recur after successful surgical repair. However, follow-up may be needed to monitor healing, facial growth, scar formation, and functional outcomes.