Many affected individuals were found in Lagos, an industrial area of Nigeria, where water supplies are known to be contaminated by improper disposal of industrial and domestic waste. Complete lateral facial cleft
The facial cleft runs from the corner of the mouth towards the bottom of the ear. The outside of the ear on the affected side of the face appears as normal and a region of soft tissue connects the cleft to the right lateral posterior hard palate. Internally there is no soft palate. Simple macrostomia
This version of macrostomia is less severe because it does not affect the facial muscles and is not associated with any soft tissue or bone deformities. A small cleft(s) extends from the mouth and can be repaired surgically. Diastasis of the facial musculature
Clefts in this variant are slightly more severe than the ones seen in simple macrostomia. It also does not have bone deformities, but it does include minor soft tissue deformities. The defining feature is muscle diastasis which is separation of the masseter. This phenotype can also be partially corrected with surgery. Isolated facial musculature diastasis
The facial cleft in this case results in a more severe muscle separation even though there is not a true open cleft. Bones in the region remain unaffected and the phenotype appears as an indentation of the cheek rather than an open cleft. The external ear in this phenotype can also be deformed. Mechanism
Likely due to the complexity of macrostomia, many theories have been provided over time in an attempt to define its origin.
Solar purpura (also known as "Actinic purpura," and "Senile purpura") is a skin condition characterized by large, sharply outlined, 1- to 5-cm, dark purplish-red ecchymoses appearing on the dorsa of the forearms and less often the hands. : 825 The condition is most common in elderly people of European descent. It is caused by sun-induced damage to the connective tissue of the skin.No treatment is necessary. The lesions typically fade over a period of up to three weeks. See also
List of cutaneous conditions

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