Facial asymmetry in a newborn

Abstract

Facial asymmetry especially Neonatal asymmetric crying facies (NACF) is not an uncommon diagnosis. Many cases are undiagnosed or underreported. Early determination of the etiology is important for better cosmetic outcome. Newborn infant presents at birth with asymmetry of the right side of the face every time he cried. Infant's face is symmetric when he is calm and not crying. Infant is born at full term by elective cesarean section. Pregnancy was uncomplicated and the infant had normal APGARS.  No forceps, vacuum or other instruments were used to facilitate the delivery. No family history of similar asymmetry of face, cardiac defects or neurological problems. Infant is both breastfeeding and bottle feeding with normal sucking and no drooling. On examination, vitals are within normal limits. Infant has asymmetry of the lower face when crying with no asymmetry of the upper face. He had no lagophthalmos and nasolabial folds were intact. Infant had no asymmetry of the face when he was not crying or quiet. A harsh systolic murmur is noted at the left lower sternal border. Infant has good peripheral pulses, good perfusion and no cyanosis. Infant is moving all extremities and has no neurological deficits. Rest of the physical examination is within normal limits. NACF is not uncommon and the actual incidence may be higher, as milder cases are either undiagnosed or underreported. A thorough birth history and careful physical exam are important as well as looking for associated anomalies like cardiac defects. Early determination of etiology is important as cosmetic outcome is better in the nerve compression group than the muscle hypoplasia group.