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Transverse facial clefts (macrostomia) are rare disorders that result when the embryonic mandibular and maxillary processes of the first branchial arch fail to fuse properly to form the corners of the mouth. Macrostomia may be seen alone or in association with other anomalies. It may be unilateral, extending along a line from the commissure to the tragus. It is usually partial, but rarely complete. Transverse facial clefts are more common in males, and commoner on the left when unilateral. We report on 3 patients with macrostomia managed in our unit. There were 2 girls with a bilateral transverse facial cleft and a boy with a left unilateral transverse facial cleft. All had a 3 layered repair of their clefts with Z-plasty repair of the skin. The longest duration of follow-up was 2 weeks. Strict adherence to the principles of surgical reconstruction is advised in the repair of macrostomia to prevent a poor treatment outcome.