Asymmetric Crying Facies

Abstract

Asymmetric crying facies (ACF) refers to a neonate or infant whose face appears symmetric at rest and asymmetric during crying as the mouth is pulled downward on one side while not moving on the other side. It is a minor anomaly found in 1 per 160 live births and is caused by hypoplasia or agenesis of the depressor anguli oris muscle (DAOM) or compression of one of the branches of the facial nerve. Associated major and minor malformations as well as deformations have been described. The risk of associated major anomalies with ACF is 3.5-fold higher compared with the general population. Such anomalies are most common in the cardiovascular system and cervicofacial region. Certain clinical signs may differentiate ACF from true facial paralysis. Physical findings, electromyography, and ultrasonography studies can help differentiate between the two causes of ACF. An approach to the diagnostic evaluation is suggested, both for initial evaluation and for decisions about subsequent treatment of ACF.