Abstract
Facial asymmetry in a crying newborn can be due to a variety of different causes. Neonatal asymmetric crying facies (NACF) is a specific phenotype, which is often underrecognized. It is defined as asymmetry of the mouth and lips with grimacing or smiling, but a symmetric appearance at rest. NACF needs to be differentiated from complete facial palsy in a newborn, which can occur due to traumatic or developmental etiologies. Developmental causes can be present in isolation or may be a part of a recognized syndrome. While asymmetric lower lip depression may be seen in both conditions, complete facial palsy is also associated with upper and mid face deformities. We present a case of NACF and compare it to a case of facial palsy due to perinatal trauma. The purpose of this case series is to clarify some of the confusing nomenclatures and highlight the differences in the physical exam findings, diagnosis, and eventual prognosis of these cases.
Highlights
Neonatal asymmetric crying facies (NACF) represents a specific phenotype, the major symptom of which is the absence or weakness of the downward motion of the lateral side of the mouth with crying [1, 2]
We present a case of NACF and compare it to a case of facial palsy due to perinatal trauma
The first case of facial asymmetry we describe was caused by the absence of depressor anguli oris muscle (DAOM)
Summary
NACF represents a specific phenotype, the major symptom of which is the absence or weakness of the downward motion of the lateral side of the mouth with crying [1, 2] This movement is carried out by a group of four facial muscles, the most important of which is the depressor anguli oris muscle (DAOM). The first case of facial asymmetry we describe was caused by the absence of DAOM We compare this to a case of left-sided facial palsy caused by facial nerve injury secondary to perinatal trauma. The latter is an acquired condition and is known as congenital facial paralysis. A review of the aforementioned cases along with the relevant anatomy of the facial muscles and nerve will help the reader understand the subtle differences between these presentations
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