Lateral facial cleft is relatively rare congenital malformation, which is known as macrostomia. Tessier’s No. 7 facial cleft is also another rare form, which varies from a simple widening oral commissure to a complete fissure extending toward the external ear. Especially for this lateral facial cleft repair, several operation techniques can be used. But there are no standardized or recommended approach methods up to date. The purpose of this article is to review of surgical approaches for the lateral facial cleft including the facial cleft number 7 of Tessier’s classifications. During last several years, authors have experienced 15 cases of lateral facial cleft in Vietnam, Jordan, India and Ghana. And we used direct closure with straight line or W plasty, Pfeifer wavy incision, multiple Z plasty flap, geometrical designed flap and so on. The appropriate incision design for lateral facial cleft could be suggested with several consideration factors, such as unilateral or bilateral, combined with other facial defect, skin color, commissure contour and other functional disturbances. The lip commissure with only one linear scar can be achieved after determining the lost commissure location like the opposite normal commissure as a guide in the unilateral facial cleft patient. And the new commissure site can be determined by deciding the transition line between the color of the lip mucosa and that of the deeper buccal mucosa in the bilateral facial cleft cases. For the better understanding of lateral facial cleft management as a routine esthetic and functional reconstructive procedure, the various surgical approaches were reviewed and summarized in this article.