Neonatal asymmetric crying facies, described 75 years ago, is a clinical phenotype resembling unilateral partial peripheral facial nerve paralysis, with an incidence of approximately 1 per 160 live births. The cause is either facial nerve compression or faulty facial muscle and/or nerve development. Spontaneous resolution is expected with the former, but not necessarily with the latter etiology. Approximately 10% of the developmental cases have associated major malformations. Mandibular asymmetry and maxillary-mandibular asynclitism (non-parallelism of the gums) are frequently overlooked visual clues to nerve compression. Ultrasound imaging of facial muscles and electrodiagnostic testing may be useful for differential diagnosis and management.
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References
1.
Bonar BE, Owens RW. Bilateral congenital facial paralysis: review of the literature and a classification. Am J Dis Child. 1929;38:1256-1272.
2.
Pape KE, Pickering D. Asymmetric crying facies: an index of other congenital anomalies. J Pediatr. 1972;81:21-30.
3.
Parmelee AH. Molding due to intrauterine posture: facial paralysis probably due to such molding. Am J Dis Child. 1931;42:1155-1159.
4.
Hoefnagel D, Penry J. Partial facial paralysis in young children. N Engl J Med. 1960;262:1126-1128.
5.
Cayler GG. An “epidemic” of congenital facial paresis and heart disease. Pediatrics. 1967;40:666-668.
6.
McHugh HE, Sowden KA, Levitt MN. Facial paralysis and muscle agenesis in the newborn. Arch Otolaryngol. 1969;89:131-143.
7.
Nelson KB, Eng GD. Congenital hypoplasia of the depressor anguli oris muscle: differentiation from congenital facial palsy. J Pediatr. 1972;81:16-20.
8.
Roedel R, Christen HJ, Laskawi R. Aplasia of the depressor anguli oris muscle: a rare cause of congenital lower lip palsy? Neuropediatrics. 1998;29:215-219.
9.
Lahat E, Heyman E, Barkay A, et al.Asymmetric crying facies and associated congenital abnormalities: prospective study and review of the literature. J Child Neurol. 2000;15:808-810.
10.
Perlman M, Reisner SH. Asymmetric crying facies and congenital anomalies. Arch Dis Child. 1973;48:627-629.
11.
Papadatos C, Alexiou D, Nicolopoulos D, et al.Congenital hypoplasia of depressor anguli oris muscle: a genetically determined condition? Arch Dis Child. 1974;49:927-931.
12.
Alexiou D, Manolidis C, Papaevangellou G, et al.Frequency of other malformations in congenital hypoplasia of depressor anguli oris muscle syndrome. Arch Dis Child. 1976;51:891-893.
Miller M, Hall JG. Familial asymmetric crying facies: its occurrence secondary to hypoplasia of the anguli oris depressor muscles. Am J Dis Child. 1979;133:743-746.
15.
Silengo MC, Bell GL, Biagioli M, et al.Asymmetric crying facies with microcephaly and mental retardation: an autosomal dominant syndrome with variable expressivity. Clin Genet. 1986;30:481-484.
16.
Holmich LR, Medgyesi S. Congenital hereditary paresis of ramus marginalis nervus facialis in five generations. Ann Plast Surg. 1994;33:96-99.
17.
Giannotti A, Digilio MC, Marino B, et al.Cayler cardiofacial syndrome and del 22q11.2: part of the CATCH 22 phenotype. Am J Genet. 1994;53:303-304.
18.
Innes AM. Asymmetric crying facies and associated congenital anomalies: the contribution of 22q11.2 microdeletions. J Child Neurol. 2001;16:778.
19.
Stewart HS, Smith JC. Two patients with asymmetric crying facies, normal cardiovascular systems and deletion of chromosome 22q11.2. Clin Dysmorphol. 1997;6:165-169.
20.
Akeakus M, Ozkul Y, Gunes T, et al.Associated anomalies in asymmetric crying facies and 22q11.2 deletion. Genet Counseling. 2003;14:325-330.
21.
Kobayashi T. Congenital unilateral lower lip palsy. Acta Otolaryngol. 1979;88:303-309.
22.
Millen SJ, Baruah JK. Congenital hypoplasia of the depressor anguli oris muscle in the differential diagnosis of facial paralysis. Laryngoscope. 1983;93:1168-1170.
Renault F. Facial electromyography in newborn and young infants with congenital facial weakness. Dev Med Child Neurol. 2001;43:421-427.
25.
Boltshauser E, Martin E, Boesch CH, et al.Magnetic resonance imaging in congenital cranial nerve palsies (Moebius syndrome): preliminary results. Pediatr Radiol. 1988;18:274.
26.
Jemic B, Grobblaar AO, Harrison DH. The abnormal nucleus as a cause of congenital facial palsy. Arch Dis Child. 2000;83:256-258.
27.
Voudris KA, Skardoutsou A, Vagiakou EA. Congenital asymmetric crying facies and agenesis of corpus callosum. Brain Dev. 2003;25:133-136.
28.
Kumari S, Bhargava SK, Choudhury P, et al.Facial palsy in newborn: clinical profile and long-term follow-up. Indian Pediatr. 1980;17:917-922.
29.
Bergman I, May M, Wessel HB, et al.Management of facial palsy caused by birth trauma. Laryngoscope. 1986;94:381-384.
30.
Falco NA, Eriksson E. Facial nerve palsy in the newborn: incidence and outcome. Plast Reconstr Surg. 1990;85:1-4.
31.
Toelle SP, Boltshauser E. Long-term outcome in children with congenital unilateral facial nerve palsy. Neuropediatrics. 2001;32130-32135.
32.
Hepner WR. Some observations on facial paresis in the newborn infant: etiology and incidence. Pediatrics. 1951;8:494-497.
