In principle, reconstruction in macrostomia requires symmetry and accurate positioning of the newly reconstructed commissure. The proper position of the new commissure can be determined by several methods. In the determination of the new commissure of bilateral cases, generally the average length of the lips or the distance from anatomical landmarks other than the lips, such as the pupils or tragi, has been used. A new approach was reported by Tse et al in 2018: the anatomic approximation approach. Macrostomia repair refers to anatomical landmarks in the lips to determine the new commissure. The authors performed surgery using this anatomic approximation approach for bilateral macrostomia and achieved the good results. Address correspondence and reprint requests to Kazuki Ueno, MD, Department of Plastic and Reconstructive Surgery, Wakayama Medical University, 811-1 Kimiidera, Wakayama, Wakayama 641-8509, Japan; E-mail: kueno@wakayama-med.ac.jp Received 1 October, 2020 Accepted 20 October, 2020 Ethical approval: Approved. The authors report no conflicts of interest. Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal's Website (www.jcraniofacialsurgery.com). © 2020 by Mutaz B. Habal, MD.
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