DOI: http://dx.doi.org/10.18203/2349-3291.ijcp20210130

Facial asymmetry in a newborn

Sheela Madipelli

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.


Keywords


Newborn, Facial asymmetry

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References


Sapin SO, Miller AA, Bass HN. Neonatal asymmetric crying facies: a new look at an old problem. Clinical Pediatrics. 2005;44(2):109-19.

Renault F. Facial electromyography in newborn and young infants with congenital facial weakness. Dev Med Child Neurol. 2001;43:421-27.

Shapiro NL, Cunningham MJ, Pariah R. Congenital unilateral facial paralysis. Pediatrics. 1996;97:261-264.

Parmelee AH. Molding due to intra- uterine posture: facial paralysis proba- bly due to such molding. Am J Dis Child. 1931;42:1155-1159.

Nelson KB, Eng GD. Congenital hypoplasia of the depressor anguli oris muscle: differentiation from congenital facial palsy. The Journal of Pediatrics. 1972;81(1):16-20.

Pasick C, McDonald-Mcginn DM, Simbolon C, Low D, Zackai E, Jackson O. Asymmetric crying facies in the 22q11.2 deletion syndrome: implications for future screening. Clinical Pediatrics. 2013;52(12):1144-148.

Gayler GG. An “epidemic” of congenital facial paresis and heart disease. Pediatrics. 1967;40(4):666-68.

Udagawa A, Arikawa K, Shimizu S. A simple reconstruction for congenital unilateral lower lip palsy. Plast Reconstr Surg. 2007;120(1):238-44.

Isken T, Gunlemez A, Kara B, Izmirli H, Gercek H. Botulinum toxin for the correction of asymmetric crying facies. Aesthet Surg J. 2009;29(6):524-27.