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Images in Clinical Practice

Indian Pediatrics 2000;37: 1385

Asymmetric Crying Facies


A 2½-month-old boy was admitted with the complaint of fever. He was born at 40 weeks gestation. The mother had un-complicated antenatal and perinatal periods. Family history was non-contributory. On physical examination, he had a vigorous cry and closed his eyes satisfactorily, and extraocular movements were intact. The frontalis, orbicularis oculi, zygomaticus, and mentis muscles functioned adequately, and symmetrical face at rest was recorded (Fig. 1). When he cried, the right corner of the mouth drew right and downward, while the left corner did not move (Fig. 2). Palpable thinning of the left lower lip near its left margin was noted. The patient was diagnosed as an isolated case of asymmetric crying facies because he did not have any other abnormality related to the other systems.

An infant whose face appears symmetrical at rest and whose mouth is pulled downward to one side when crying is said to have an "asymmetric crying facies". The cause of the facial asymmetry in this disorder is congenital absence or hypoplasia of the depressor anguli oris muscle at the corner of the mouth. Asymmetric crying facies may be isolated or it may be associated with various anomalies related to cardiovascular, musculoskeletal, respiratory, gastrointestinal, central nervous system or genitourinary systems.

Hüseyin Çaksen,
Assistant Professor in Pediatrics,
Yüzüncü Yil University Faculty of Medicine,
Van, Turkey
E-Mail: [email protected]

Fig. 1. Photograph of the child
showing symmetrical face at rest.
Fig. 2. On crying, the mouth was pulled down and to the right due to hypoplasia of the depressor anguli oris muscle.

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